HomeMy WebLinkAbout1998-1103 CANDIDATE C&ECertificate of Limited Contributions and Expenditures
Please type or print legibly in black ink. p,
Candidate or Political Committee Name: f~)~ Committee ID Number:
Treasurer's Name (if~J-fferent th~n ~and~date): ' Telephone Number:
Election: I ~rimm), 19 [~General 19 ~c~ [--I Other
1, ~ (name of candidate or treasurer), hereby certify I expect neither
the aggregate contributions received nor the aggregate expenditur, es made by or on behalf of my candidacy or committee for this
election to exceed $500.
~,ignature of c~da~ Sr treasurer ~ Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the first pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contributions or total expenditures for the election exceed $500, detailed contribution and expenditure
reports must be filed. The firsUdetailed report must be filed for the accounting period in which the committee exceeds $500 in
either contributions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline dates for filing a Certificate of Limited Contributions and Expenditures or detailed contribution and expenditure
reports MUST lie strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
FOR OFFICE USE ONLY
Summary Statement of ContributionS and Expenditures
Please type or print legibly in black ink. Page 2 of 2
Candidate or Political Committee Name: Committee ID Number:
[~riginal [] Primary 19 [] General 19 ~,,~ [] Other
[] Amendment [] 1st Pre-election [] 2nd Pre-election ~O-ost-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) + --
26. Loan Payments (Exempt)
(line I 8) +
27. Forgiven Loans
(Total loans forgiven during this accounting period) +
2g. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27) =
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures
(line 34 Of prevlous report)
31. Total Personal Expenditures
(Accounting Period Total from p(~' 3A,) +
32. PERSONAL EXPEND,tORE SUBTOTAL
(lines 30 + 31) =
33. Total Personal Expenditure Reimbursements
(Total expenditures on PC 3 wi~h purpose code R) ~ 2.,/3
34. OUTSTANDING PERSONAL EXPENDITURES
(line 32 minus line 33) = -
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
35. Ending Cash Balance
(line 20)
36. Accounts Receivable
(Accounting Period Total from PC 5) +
37. SUBTOTAL
(lines 35 * 36) =
38. Total Outstanding Loans
(line 29)
39. Outstanding Personal Expenditures
(line 34)
40. Accounts Payable
(Accounting Period Total from PC 6) +
41. SUBTOTAL
(lines 38 + 39 + 40) =
42. BALANCE/DEFICIT
(line 37 minus line 41: indicate 4- or - balance) =
I, ~ ~ ~/X/' t/"~/~J5 ~) )~v/ (name of candidate or U'easurer), hereby certify that the above
statement and the attached supporting reports are true and correct.
Signature of candidate or treasurer Date signed
· .,.,~s Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page I of 2
Candidate or Political Committee Name:
Address (street or route, city, state, zip code):
Treasurer's Name: Telephone Number (da)):
CommiRee ID Number: Commi~ee Type, Measure Number or Office:
~Original ~ Prim~ 19 ~ Ge.,ral 19 q ~ ~ Other
~ Amendment ~ 1st Pre-election ~ 2nd Pre-election ~Post-election ~ September Supplemental
~-xoT~s ~og ~ms ~U~T~V~ TOT~S
~CCOUS~ ~mOO FOg ~mS ~ON
O08T8IBUTION$ - -
1. Cash Con~ibutions
(Accouming Period To~l from PC 2) +
2. Lo~s Received ~on-~xempt)
(Accounting Peri~ To~ from PC
~. Total C~h Con~ibufions
4.
(Accounting Period Total eom PC 2) + +
5. TOTAL CONTRIBUTIONS
~PENDITURES
6. Cash Expenditures -' :.
(Accounting Period To~l from PC 3) '
7. Lo~ Paymen~on-Exemp0
(Accounting Perio~ Total from PC 3) +
g. Total C~h Expenditures
9. In-Kind
(Accounting Peri~ Total from PC 2) + +
I0. TOTAL EXPENDITURES
CASH BALANCE
I I. Begi~ing C~h Bal~ce
(Ending C~h Bal~c¢ from previous report) 2 Z E' ~ / FOR OFFICE USE ONLY
IZ Total Con~ibutions
13. O~er Receipts.
(Accounting Period Total from PC 4A) +
14. Lo~s Received (Exempt)
(Accounting Period To~al from PC 4A) +
16. To~l Exp~ndi~r¢~
17. Other Disbu~ements
(Accoumin$ Period Total from PC 4B) +
1S. Lo~ Payments (Exemp0
(Accounting P~i~ Total from PC 4B) +
20. ENDING CASH BALANCE
' Cash Contr, bufions, Loans Received and In-Kind
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Page __ of__
Election: [] Primary 19 [] General 19~ [] Other
Report: [] 1st Pre-election [] 2nd Pre-election ~]~Post-election [] September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE t: Contributor Type CODE 2: Contribution Type
B Business Entity CA Cash
C Political Committee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organization
O Other
P Political Party Committee
Amount of /n-K/ed Purpose
line # Name and Address of Cont#butor
Con~bu#on (see manual for suggested purpose codes)
Occupational ln~rma~on, Con~fbu#ng Cont~butor
Date Rece/ved Comm/#ee's ID~, or Descsp#on if Code lis '0" Aggregate Cede 1 Code 2
4. $
Page Totals (Add all mounts with the same Accounting Period Totals (Complete only for last page
See contribution type. Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1.)
Instructions Cash (CA) $ ~[C/. ~ ~ Cash (CA) $ ~{ Y' 7 7
OR Back and ~t~ on Summa~ statement, Column A, Line I
in Campaign
Finance In-Kind (IK) $ In-Kind (IK) $
Loans Received (La) $ Loans Received (La) $
Cash Expenditures and Loan Payments
Please type or print legibly in black ink.
Candidate or Political Committee Name:
Election: [] Prim~ 19~
Repom ~ I st ~e-election
[] General 19
[] 2nd Pre-election
Committee ID Number: I Page __ of __
[] Other
~-Post=election
[] September Supplemental
PURPOSE CODES (see back of form for instructions and code definitions)
A Agent
B Broadcast Advertising (Radio, TV)
C Cash Contributions
F Fundraising Event Expenses
G General Operational Expenses (describe
if over $50)
I Interest Payment
L Literar~e, Brochures, Printing
M Management Services
N Newspaper and Periodical Advertising
O Other Advertising (yard signs, buttons, etc.)
P Postage
R Reimbursement
S Surveys and Polls ..
T Travel Expenses (describe if over $50)
W Wagns, Salarie~, Benefits _
Date Check # Payee's Name Pu~ose
(as it appears on invoice, receipt or check)
EXPENDITURE TYPES
CA Cash
LP Loan Payment
Amount of
'Expenditure
sZ '
$ /z
s ?24?
$
$
$
$
$
$
See
Instructions
on Back and
in Campaign
Finance
Manual
Page Totals (Add all expenditures with the same
expenditure type.)
Cash (CA) $ g 3 .
Loan Payment CLP) $ ~ ~'/'~)
Accounting Period Totals
transfer these amounts to the Summa~
last page and
:, PC 1.)
Cash (CA) $
Enter mt Summa~ Statement. Column A. Linc 6
Loan Payment (LP) $
Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page I of 2
Candidate or Political Committee Name:
Committee to Suooort Cate Ha~zell
Address (street or route, ciD', state, zip code):
P.O. Box 465, Ashland, OR 9~520
Treasurer's Name: Telephone Number (da>'):
Martin H. Levine, CPA 541/482-7801
Comminee [D Number: Committee Type, Measure Number or Office:
n/a Principal Campaign Committee
k--;"'~Original [] Primary 19 ~'"lGenera119 98 r~other Post-election Sunolementa]
[] Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
A-TOTALS FOR THIS B-CuMuLATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS -- · -
I. Cash Contributions
(Accounting Period Total from PC 2) + 0.00 + 3 t 579. S 0
2. Loans Received (Non-Exempt) +
(Accounting Period Total from PC 2) + 0 · 00 0 · 00
3. Total Cash Contributions
(lines 1+ 2) -- 0.00 = 3r579.50
4. In-Kind
(Accounting Period To~al from PC 2) + 0.00 + 0 · 00
5. TOTAL CONTRIBUTIONS
(lines 3 "- 4) = 0.00 = 3,579.50
EXPENDITURES
6. Cash Expenditures
(Accounting Period Total from PC 3) + 98.95 + 3 r 579.50 ' '
7. Loan Payments (Non-Exempt)
(Accounting Period Total from PC 3) + 0.00 + 0 · 00
8. TotaICash Expenditures
(lines 6 + 7) - 98.95 = 3,579.50
9. In-Kind
(Account ng Period Total from PC 2) + 0 · 00 + 0 · 00
10. TOTAL EXPENDITURES ' '
(lines 8 + 9) = 98.95 = 3,579.50
CASH BALANCE
1 I. Beginning Cash Balance · '
FOR OFFICE USE ONLY
(Ending C~h Balance from previous ~cport) ' 9 8.9 5
12. Total Contributions
(line 5)
13. Other Receipts,
(Accounting Period Total from PC 4A) + 0 · 00
14. Loans Received(Exempt)
(Accoumiog Period Total from PC 4A) + 0 · 00
15. CONTRiBUTION SUBTOTAL
(linesll.~12+13+14) = ",~, 98.95
16. Total Expenditures
· 98.95
(line 10)
17. Other Disbursements
+ 0.00
(Accoundn~ Period Total from PC 4B)
I g. Loan Payments (Exempt)
(Accounting Period Total from PC 4B) + 0 * 00
19. EXPENDITURE FOTAL .'
(lines 16 ~ 17 + l$) = 98.95
DEC 1 1 1995a
20. ENDING CASH BALANCE = none
(line 15 minus line 19)
Summary Statement of Contributions and Expenditures
Please t~pe or print legibly in black ink. Page 2 of 2
Candidate or Political Commi~ee Name: Committee ID Number:
Committee to Suo~ort Cate Hartzell p/a
['~Origina[ [--[Primary 19 ~'~Genera119 98 [~Other Post-election Sunnlementa]
[] Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans FOR OFFICE USE ONLY
(Total Outstanding Loans from previous report) none
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL .,
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) + --
26. Loan Payments (Exempt)
(line 18) + ' ·
27. Forgiven Loans
(Total loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27) =
29. TOTAL OUTSTANDING LOANS
(linc 24 minus line 28) = none
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures
(line 34 of previous report) 77,1 0
31. Total Personal Expenditures
(Accounting Period Total from PC 3A) + 2 1 ·
32. PERSONAL EXPENDITURE SUBTOTAL
(lines 30 + 3 I) = 9 8.9 5
33. Total Personal Expenditure Reimbursements
(Total expenditures on PC 3 with purpose code R) 9 8.9 5
34. OUTSTANDLNG PERSONAL EXPENDITURES
(line 32 minus line 33) = none
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
35. End[ag Cash Balance
(linc 20) none
36. Accounts Receivable
(Accounting Period Total from PC 5) +
37, SUBTOTAL
(lines 35 + 36) =
38. Total Outstanding Loans
(line 29)
39. Oumumding Personal Expenditures
(line 34)
40. Accounts Payable
(Accounting Period Total from PC 6) +
41. SUBTOTAL
(lines 38 + 39 + 40) =
42. BALANCE/DEFICIT ~*C~ DEC 1 1 1998
(line 37 minus line 41: indicate + or - balance) = none
I, ~art~ 1~ Fi' _ T,~xr~ r ~,. f, on m,,-~= ~,,,-~,- (name of candidate or treasurer), hereby certify that the above
stalest }ne a~ ~l the attached f apl~orting r~:,~orts ~re true a~a correct.
Signature of candidate or treasurer ! Date signed
PC3
Cash Expenditures and LOan Payments
Please type or print legibly in black ink.
Candidate or Political Committee Name: I Commit'tee ID Number:
Committee to Suppor~ Cate Hartzell [ n/a Page 1 0£ 1
Election: E~ Primm-y 19 l~,General 19 9~
Report: [] I st Pre-election [] 2nd Pre-election
[~]Other p~e-election Suoolementa
[] Post-election [] September SupplemenlaI
PUPPOSE CODES (see back of form for instructions and code definitions)
EXPENDITURE TYPES
A Agent M
B Broadcast Advertising (Radio, TV) N
C Cash Contributions O
F Fundraising Event Expenses P
G General Operational Expenses (describe. R
if over $50) S
I Interest Payment T
L Literam.re, Brochures, Printing W Wages, S_.a!a.rie~, Benefits
Oate
12/10/98
12/10/98
Management Services CA Cash
Newspaper and Periodical Advertising LP Loan Payment
Other Advertising (yard sig~s, bu~ons, etc.)
Postage
Reimbursement
Surveys and Polls .,
Travel Expenses (describe if over S50)
Check #
1016
1017
Payee's Name
(as it appea~ on invoice, receipt or check)
VOID
Cate Hartzell
10.
Page Totals (Add all expenditures with the sa.me
expenditure type.)
Purpose
R
Amount o!
~;oenditure
$
$ 98.95
$
$
$
See
Instructions
on Back and
in Campaigo
Finance
Manual
Cash(CA) $ 98.95
Loan Payment (LP) $ 0.0 0
Accounting Period Totals (Complete only for lint page and
transfer these amounts to the Summary Statement, PC 1.)
Cash(CA) $ qB.qB
Loan Payment (LP) $ 0.0 0
Personal Expenditures For Reimbursement
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Committee to SuDnort Cate Hartzell n/a Page 1 of 1
Ejection: [] Pr[mary [9 ~ General 1999 [] Other Post-election Supplemental
Report: [] 1st Pre-election [--~ ind Pre-eLection [] Post-election [] September Supplemental
PURPOSE CODES (see back of form for instructions and code definitions)
A Agent M Management Services
B Broadcast Advertising (Radio, TV) N Newspaper and Periodical Advertising
C Cash Contributions 0 Other Advertising (yard signs, buttons, etc.)
F Fundraising Event Expenses P Postage
G General Operational Expenses (describe if over S50) S Surveys and Polls
Interest Payment T Travel Expenses (describe if over $50)
L Literature, Brochures, Printing _ W. Wages, Salaries, Benefi~
I.~e # Date Payee's Name Purpose Amount of
Expenditure
1, 12/10/98 Cate Hartzell P $ 21.85
2. $
3, $
5, $
6. ' $
7, $
9. $
10. $
Page Total Accounting Period Total (Comp ere only for last page ~nd
~nst'er this amount to the Summary Statement, PC 1 .) ~"
See Personal Expendk'ures $ 21 . R5
Instructions Personal Expenditures $ 21 . R5 LL
on Back and ~,er da S~mm,~. S~,~.~ Un¢ 3!
in Campaign
Finance .
Manual
Certificate of Limited Contributions and Expenditures
Please type or print legibly in black ink.
Candidate or Political Committee Name: Commitlee ID Number:
Treasurer's Name (if different than candidate): Telephone Number:
Address (street or route, city, state, zip code):
Election: ] [] Primary 19 [] General 19 ~ ~ [] Other
1, ~ ~ (name of candidate or treasurar), bereby certify I expect neither
the aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy or committee for this
election to exceed $500.
Signature of candidate or treasurer Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the flint pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contribtuions or total expendituras for the election exceed $500, detailed contribution and expenditure
reports must be filed. The first detailed report must be filed for the accounting period in which the committee exceeds $500 in
either conffibutions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline dates for filing a Certificate of Limited Contributions and Expenditures or detailed contribution and expenditure
reports MUST BE slrictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
FOR OFFICE USE ONLY : :
PC7
Rev.,, 7 Certificate of Limited Contributions and Expenditures
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Treasurer's Name (if diffe~rent than ca~'didate): Telephl>ne Number:
Address (street or rout~, city, state, zip code):
office:
[ [] Primary 19. [~Genera119~ [] Other
Election:
I, /~t~t'%c ~e~ ~r~* ~'(~'~ (name of candidate or treasurer), hereby certify, expect rleither
the aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy or committee for this
election to exceed $500.
Signature of candidate or treasurer Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the first pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contributions or total expenditures for the election exceed $500, detailed contribution and expenditure
reports must be filed. The first detailed report must be filed for the accounting period in which the committee exceeds $500 in
either contributions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline dates for filing a Certificate of Limited Contributions and Expenditures or detailed contribution and expenditure
reports MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
FOR OFFICE USE ONLY ~ .
-%.
-%
Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page 1 of 2
C_t~l~idate or Political Committee Name:
Address (street or route, ci~', state, zip code):
Comm nee ID Number:
Comminee Type, Measure Number or Office:
[] Original
[~mendment
[] Primary 19
[] 1st Pre-election
Telephone Number (da>'):
[] General 19 [] Other
[] 2nd Pre-election ~Post-election
A-TOTALS FOR THIS
ACCOUNTING PERIOD
[] September Supplemental
B-CUMULATIVE TOTALS
FOR THIS ELECTION
CONTRIBUTIONS - -
Cash Contributions
(Accounting Period Total from PC 2)
Loans Received (Non-Exempt)
(Accounting Period Total from PC 2)
Total Cash Contributions
(lines 1+ 2)
In-Kind
(Accounting Period Total from PC 2)
TOTAL CONTRIBUTIONS
(lines 3 + 4)
EXPENDITURES
Cash Expenditures
(Accounting Period Total from PC 3)
Loan Payments .(Non-Exempt)
(Accouming Period Total from PC 3)
Total Cash Expenditures
dines 6 + 7)
In-Kind
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES
(lines 8 + 9)
CASH BALANCE
I I. Beginning Cash Balance
(Ending C~h Balance from previous report)
12. TotalContributions .
+ I 'b 9 ?, ?
13. Other Receipts.
+
(Accounting Period Total from PC 4A)
14. Loans Received (Exempt)
(Accounting Period Total from PC 4A) +
15. CONTRIBUTION SUBTOTAL
(lines l l -~ 12 + 13 + 14'}
16. Total Expenditures
(line 10)
17. Other Disbursements
(Accounting Period Total from PC 4B)
ilS. Loan Payments (Exempt)
t: (Accounting Period Total from PC 4B) +
19. EXPENDITURE TOTAL
(lines 16- 17+ 18)
20. ENDING CASH BALANCE
(linc 15 minus line 19)
FOR OFFICE USE ONLY
REC'D DEC 1 0 1998
Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page 2 of 2
~Cy.~ndid~e o~litic~ Committee Name: Committee ID Number:
[] Original [] Primary 19__ [] General 19 ~ V [] Other
[~Amendment [] 1st Pre-election [] 2nd Pre-election [~Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous rcport) FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) + --
26. Loan Payments (Exempt)
(linc 18) +
27. Forgiven Loans
(Total loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27) =
29. TOTAL OUTSTANDING LOANS
(line 24 minus linc 28) =
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures
(line 34 of previous report)
31. Total Personal Expenditures +
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUBTOTAL
33. Total Personal Expenditure Reimbursements
(Total expenditures on PC 3 with purpose code R) '~/
34. OUTSTANDING PERSONAL EXPENDITURES
(line 32 minus line 33) ' = ~ '
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
35. Ending Cash Balance
(line 20)
36. Accounts Receivable
(Accounting Period Total from PC 5) +
37. SUBTOTAL
(lines 35 ~- 36) =
38. Total Outstanding Loans
(line 29)
39. Outstanding Personal Expenditures
(line 34) +
40. Accounts Payable
(Accounting Period Total from PC 6) +
41. SUBTOTAL
(lines 38 + 39 + 40) =
42. BALANCE/DEFICIT ~ RECq) DEC 1 0 1998
(line 37 minus line 41: indicate + or - balance) =
s~ment and the attac~.he~ supporting reports are O'ue and correct.
Signature of candidate or n'easurer D'at~' ~ig~ed
Cash Expenditures and Loan Payments
Please type or print legibly in black ink.
Candidate,or Pofitical Clommittee Name: Committee ID Number:
Election: [] Primat7 19.._~ I~ General 19.__~ - [] Other
Report: [] I st Pre-electro' 'n [] 2nd Pre-electro' tn ' [~Post-election
PURPOSE CODES (see back of form for instructions and code definitions)x
Agent
Broadcast Advertising (Radio, TV)
Cash ConUibutions
Fundraising Event Expenses
General Operational Expenses (describe
if over $50)
Interest Payment
Literature, Brochures, Printing
[] September Supplemental
M Management Services
N Newspaper and Periodical Advertising
O Other Advertising (yard signs, buttons, etc.)
P Postage
R Rehnbursement
S Surveys and Polls .,
T Travel Expenses (describe if over $50)
W Wages, Salarie~, Benefits _
EXPENDITURE TYPES
CA Cash
LP Loan Payment
Date Check # Payee's Name
(as it appears on invoice, receipt or check)
Puq~ose
Amount of
Expenditure
$
$
$
Sec
Instructions
on Back and
in Campaign
Finance
Manual
Pate Totals (Add all expenditures with the same
expenditure type.)
Cash (CA)
Loan Payment (LP)
Accounting Period Totals (Complete only for last page and
transfer these amounts to the Summary Statement, PC 1.)
Cash(CA) $ / ~ ~' ~, ~ ~--
Enter on SummaQt Statemeat. Column A. Line 6
Loan Payment (LP) $
Enter on Summary StatcmcnL Column A. lane 7
I C1) DEC 1 0 1998
,.. Cash Contributions, Loans Received and In-Kind
Please type or print legibly in black ink.
rC~.rLdidate[or Roliti/;al Committee Name: Commi~ee ID Number:
Election: ~Prima~19.~ ~Generall9 ~ ~ ~Other ' '
Repom ~ l sl Pre-election ~ 2nd ~e-elecfion ~ost-elecdon ~ September Supplememal
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE i: Contributor Type CODE 2: Contribution Type
B Business Enti~ CA Cash
C Political Commiuee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organi~lion
O Other
P Political Pa~ Comminee
Amounl of In.Kind Purpose
Line ~ N~me ~nd Address of Contributor Conlribulion (see m~nud for sugges/ed purpose ~des)
O~up~Jiond ln/orm~tion, Conldbu~ing Conlnbulor Code ~ Code 2
O~le ~e~/ved Corem/flee ~ ID.~ or Desk, lion if Code I i~ '0" Ag~reg~le
-
Page Torah (Add all amount* with the same Accounting Period Torah (Complete only for I~t page and
See con~ibution b,pe. Do not include aggregates.) troffer these mount~ Io the SummaU S~Icmcnt, PC 1.)
In~truction~
C sh(CA) s
ia Campaign
Finance In-Kind (IK) S In-Kind (IK)
Loans Received
.c.?, Cash Contributions, Loans Received and In-Kind
Please type or print legibly in black ink.
Candidate or.Political Committee Name: Committee ID Number:
Election: [] Primary 19__ [] General 19 ~ 7 [] Other
Report: [] I st Pre-election [] 2nd Pre-election ~Post-election [] September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE 1: Contributor Type CODE 2: Contribution Type
B Business Entity CA Cash
C Political Committee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Recei~,ed-
L Labor Organization -
0 Other
P Political Party Committee .
'' Amount of In-Kind Purpoge
line # Name and Address of Contributor
ContnI)ution (see manua_l for su~gested pulpose codes)
Occupational Information, Contributing Conlnbulor code'i Code 2
Date Received Commi#ee's log, or Description if Code 1 is '0' Aggregate
$
2.
$
$
$
Page Totals (Add all amounts with the same Accounting Period Totals (Comple~ for last page and
See contribution Wpe. Do not include aggregates.) tr~sfer these amounts to the Summa~e~,?C 1.)
Instructions Cash (CA) $ ~ ] ~ C,~) ~ Cash (CA)
in C~mpaign
Finance In-Kind (IK) $ In-Kind (IK)
Loans Received (LR) $ Loans Received (LR) $
Personal Expenditures For Reimbursement
Please type or print legibly in black ink.
Candidate or Political Committee Name:
Election: [] Primary 19
Report: [] Ist Pre-election
CommiUee ID Number:
[] General 19
[] 2nd Pre-election
[] Other
~Post-election
PURPOSE CODES (see back of form for instructions and code definitions)
' Page [ of..
[] September Supplemental
A Agent
B Broadcast Advertising (Radio, TV)
C Cash Contributions
F Fundraising Event Expenses
G General Operational Expenses (describe if over $50)
Interest Payment
L Literature, Brochures, Printing
Date Payee's Name Purpose
M Management Services
N Newspaper and PeriodicalAdvettising
O Ofiaer Advertising (yard signs~ buttons, etc.)
P Postage
S Surveys and Polls
.,
T Travel Expenses (describe if over $50)
W Wages, Salaries, Benefits
See
Instructions
on Back and
in Campaign
Finance
Manual
Amount of
Expenditure
Page Total
Personal Expenditures
Accounting Period Total (Comp~,~,~p,y P g
~sfer ~is ~ount to ~e Summ~ ~temen~ PC 1.)
Personal Expenditures $ ~ ~- ~ ~
Summary Statement of Contributions and Expenditures
[ Plets¢ type or print legibly in black ink.
~litlcal Committee Name:
¢ iT
Address (s~raet or route, city, state, zip code):
Treasurer's Name:
F/ I£
committee I~ ~um~r:
. .a Original
~Ameodment
Page t of 2
If--I Primary 19
[] Ist Pre-election
CONTRIBUTIONS
I. Cash Cona'ibutions
(Accounting Period Total from PC 2)
2. Loan~ Received (Non. Exempt)
(Accounting Period Total from PC 2)
3. Total Cash Con~ibutions
(lines I+ 2)
4. In-Kind
(Accounting Period Total from PC 2)
5. TOTAI. CONTRIBUTIONS
{lines 3 + 4)
EXPENDITURES
6. Cash Expenditures
(Accounting Period ToM from PC 3)
?.
8.
Committee Type, Measure Number or Office:
: [] General 19 ~ ~.~/Other
[] 2nd Pre-election I~ Post-election
A-TOTAt. S FOR THIS
ACCOUNTING PF. RIOD
Loan Payments (Non-Exempt)
(Accounting Period Total from PC
To~ Cash Expenditures
(lines 6 + 7)
9. In-Kind
(Accounting Period Total from PC 2)
10. TOTAl. EXPENDITURES
(lines 8 + 9)
CASH BALANCE
1 I. Beginning Cash Balance
(Ending C~h Balance from previous report)
12. Total Contributions
(linc $)
13. Other Receipts
(Accounting Period Total from PC 4A)
14. Loans Received (Exempt)
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL
(lines I I + 12 + 13 + 14)
16. Total Expenditures
(line 10)
17. Other Disburscmcnta
(Accounting Period Total from PC 4B)
18. Loan Payments (Exempt)
(Accounting Period Total from PC 4B)
19. EXPENDITURE TOTAL
(lines 16+ 17+ 18)
20, ENDING CASH BALANCE
(line I$ minus linc 19)
Number (day):
[] September Supplemental
~-CUMUE.ATIVE TOTALS
FOR THIS ELECTION
FOR OFFICE USE ONLY
,-, Summary Statement of Contributions and Expenditures
Please ~pe or print legibly in black ink. I Committee ID Number: Page
Candidate or Political Committee Name:
"Original 1 [] Primary 19 [] General 19 I~J.~.~hher
~j~mendment I [] Ist Pre-election [] 2nd Pre-election M Post-election
LOAN SUMMARY
21. Beginning Outatanding Loans
(Total Outstanding Loans from previous report)
22. Loans Received (Non-Exempt)
(line 2)
23. Loans Received (Exempt)
(line 14)
24. LOANS RECEIVED SUBTOTAl.
(lines 21 4. 22 '+ 23)
25. ~men ts (Non- Ex erupt).
~.6. ~lTayments (E. xemp0
(line 18)
~7. Forgiven Loans
(Total loans forgiven during Ihis accounting period)
28. LOAN PAYMENT SUBTOTAL
(lin~s 25 + 26 + 27)
!9. TOTAl. OUTSTANDING LOANS
{line 24 minus line
0. Ending C~sh Balance
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD ,._,,~
.1. Accounts Receivable
(Accounting Period Total from PC 5)
2. SUBTOTAL
(lines 30 + 31)
3. Total Outstanding Loans
(ling 29)
4. Accounts Payable
(Accounling Period Total from PC 6)
~. SUBTOTAL
(lines 33 + 34)
5. BALANCE/DEFICIT
(line 32 minus lin~ 35: indicate + or- balance)
~naturc of ~ ;:. ~a.-t
[] September Supplemental
~/~FFOR OFFICE USE ONLY
(name of candidate or treasurer), hereby certify that the above
DEC 0 8 1998
Date signed
Cash Expenditures and Loan Payments
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Election: ~ Prima~ I~ ~ General 1~ ~h~r
Report: ~ I st Pre-election ~ 2nd Pre-election ~ Post-election ~ September Supplements,
PU~OSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPKff~
/
A Agent M Management Se~ices CA Cash
B Broadcast Advenising(~dio,~) N Newspaper and Periodical Advertising LP Loan Payment
C C~hContributions O Other Advertising(yard signs, burtons,
F FundraisingEvent Expenses etc.)
G GeneraIOperational Expenses (describe P Postage
ifover $50) S Su~eysand Polls
Interest Payment T Travel Expenses (describe if over $50)
L Literature, Brochures, Printing W Wages, Ssi=les, Benefits
Payee ~ Name Exp. ~nt of
Line ~ Dale Cfle~ · ~se
/~ f f (a$ it ap~am ~ ~, ~e&t or ~) r~ ~iture to
~yu~ v~vI ~1 ~/~ ~v /1~,$'~.
Page Totals (Add all expenditures with th~ a~¢ Accounting Period Totals (Complet~
See , expenditure ~pc.) transfer these amounts to thc Summa~ Statement, ~C I.)
,nslruciions C~h(CA) $~ Cash(~) S ~;~ ~ '
in Campaign ~~ .~ ~ e
Finance Loan Payment (LP)~ Loan Payment (LP) ~b- /
~[~ ~ Summ~ Statement. Col~n A, ~ne 7
Manual
Cash Contributions, Loans Received and In-Kind
Please type or print legibly in black ink. /
Candidate or Political Committee Name: Committee ID Number:
c/fy Page /
Election: ~ Prima~ 19 ~ g~neral 19 ~ Other
~ost-election
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE 1: Contributor Type CODE 2: Contribution Type
B Business Entity CA Cash
C Political Commitlee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organization
O Other
P Political Party Committee
Amount of /n.K/nd
~e # Name and Address o! Contributor Cont#but~n (see manual for suggested pu~oose ~ndss)
O~upa~n~/ Infonna/~n, Con~n'but/ng Cont#butor
Date Receive~ Committee's ID/l,, or De$cript/on i/Code 1L~ '0' Aggregate Cnde I Code 2
S ZOo'
Page Torah (Add all ~oun~ wiffi ~e same Accounting Period Totals (Complete only for IMf page
See con~ibution ~pe. Do not include aggregates.) ~sfer these ~ounts to the Summ~ Statement, PC 1 .)
in Campaign
Finance In-Kind (IR) $ ~ ~ ~ In-Kind (IR) $ ~ ~, ~
Loans Received (LR) $ Loans Received (LR) $
50 Third Street
P.O. Box 66
Ashland, Oregon 97520
My ref.: election98
Your ref.:
08 December 1998, 1032-L
J. DAVID FINE
Attorney at Law
-- Area Code 541 --
Telephone: 488-1458
Cellular: 840-4804
Fax: 488-1923
Home study tel, & fax: 482-4978
(800) 848-1458
E-Mail: OREGON LAW~BIGFOOT.COM
http://www.ashlandweb.com/oregonlaw
Mrs. Barbara Christensen
Ashland City Recorder
City Hall, 20 East Main Street
Ashland, Oregon 97520
Dear Barbara:
Attached please find an Amended Post-election Financial Report. The figures thereon
have been changed to reflect the numbers you asked for.
Yours tr3_ ly,
J. David Fine
H :\city99\christensen.041.wpd
PC7
Certificate of Limited Contributions and Expenditures
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Treasurer's Name (if different than candidate): Telephone Number:
Address (street or route, city, state, zip code):
Office:
Election: I [] Primary 19 [] General 19 a[~:~ [] Other
I, "~--~'~_'~-X" ~, .'"~ I~.k~ ~,~ ~..n:'~- (name of candidate or treasurer), hereby certify I expect neither
the aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy or committee for this
election to exceed $500.
Signature of candidate or treasurer ~ate signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the first pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contributions or total expenditures for thc election exceed $500, detailed contribution and expenditure
reports must be filed. The first detailed report must be filed for the accounting period in which the committee exceeds $500 in
either contributions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline dates for filing a Certificate of Limited Contributions and Expenditures or detailed contribution and expenditure
reports MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page 2 of 2
C a n d i d a~/c~_.lit ~j~ 7n e e/~ar~: g,4~ ~/,..~/~3 CommitXee ID Number:
[] Original [] Primary 19__ [] General 19 [] Other
[] Amendment [] 1st Pre-election [] 2nd Pre-election ,~Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) O FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
/
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) + --
26. Loan Payments (Exempt)
(line 18) +
27. Forgiven Loans
(Total loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27} =
29. TOTAL OUTSTANDING LOANS
(line 24 minus linc 28) =
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures
(line 34 of previous report)
31. Total Personal Expenditures
(Accounting Period Total from PC 3A) +
/
32. PERSONAL EXPENDITURE SUBTOTAL
(lines 30 + 31) =
33. Total Personal Expenditure Reimbursements
(Total expenditures on PC 3 with purpose code R)
34. OUTSTANDING PERSONAL EXPENDITURES
(line 32 minus line 33) =
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
35. Ending Cash Balance
(line 20)
36. Accounts Receivable
(Accounting Period Total from'PC 5) +
37. SUBTOTAL
(lines 35 + 36) =
38. Total Outstanding Loans
(line 29)
39. Outstanding Personal Expenditures
(line 34) +
40. Accounts Payable
(Accounting Period Total from PC 6) +
41. SUBTOTAL
(lines38+3,+40) =to ltECl)DEC 3 1998 ,
42. BALANCE/DEFICIT
(line 37 minus line 41: indicate + or - balance) =
', ~/'//~ /~.~'//g) (name of candidate or treasurer), hereby certify tha~ the above
statement and the attached supporting reports are n-ue and correct.
Date sig,'ned /
Signature of cad,ate or u-easurer
Summary Statement of Contributions and Expenditures
Please ~'pe or print legibly in black ink. Page I of 2
Candidi,%e or Political Committee Name:
Address (s~eet or route, cJ~, state, zip code):
Telephone Number (day):
Treasurer's Name:
,q,,/-,e,,: ,4,,,,q/e./,:
Committee ID Number: Committee Type, Measure Number or Office:
Origina[ [] Primary 19 [] General 19 [] Other
Amendment [] 1st Pre-election [] 2nd Pre-election ~Post-election [] September Supplemental
A-TOTALS FOR THIS B~UMULATWE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS -
Cash Contributions
(Accounting Period Total from PC 2)
Total Cash Contributions
(lines 1+ 2)
2. Loans Received (Non-Exempt)
(Accounting Period Total from PC 2) +
4. In-Kind
(Accounting Period Total from PC 2)
TOTAL CONTRIBUTIONS
(lines 3 + 4)
EXPENDITURES
Cash Expenditures
(Accounting Period Total from PC 3)
Loan Payments (Non-Exempt)
(Accounting Period Total from PC 3)
8. TotaICash Expendivares
(lines 6 + 7)
9. in-Kind
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES
(lines 8 + 9)
.5'aZ. O3
+
CASH BALANCE
I I. Beginning Cash Balance
(Ending Cash Balance from previous report)
12. Total Contributions
(line 5) + ~'/5".
13. Other Receipts.
(Accounting Period Total from PC 4A) +
14. Loans Received(Exempt)
(Accounting Period Total from PC 4A) +
15. CONTRIBUTION SUBTOTAL
16. Total Expenditures
17. Other Disbursements
(Accounting Period Total from PC 4B) +
lg. Lo~ Paymen~ (Exempt)
(Accounting Period Tot~ from PC 4B) +
19. EXPEND[~ tOTAL
20. ENDING CASH BALANCE
(line 15 minus line 19)
= O
FOR OFFICE USE ONLY
DEC 998,
Cash Expenditures and Loan Payments
Please type or print legibly in black ink.
Candidate or Political Committee Name:
Election: [] Primary 19.~
Report: [] I st Pre-election
[] General 19 [] Other
[] 2nd Pre-election [~Post-election [] September Supplemental
PURPOSE CODES (see buck of form for instructions and code definitions)
Agent
Broadcast Advertising (Radio, TV)
Cash Conuibutions
Fundraising Event Expenses
General Operational Expenses (describe
if over $50)
Interest Payment
Literature, Brochures, Printing
M
N
O
P
R
S
T
W Wages, S_alatie~, Benefits
Management Services
Newspaper and Periodical Advertising
Other Advertising (yard signs, buttons, etc.)
postage
Reimbursement
Surveys and Polls .,
Travel Expenses (describe if over $50)
EXPENDITURE TYPES
CA Cash
LP Loan Payment
Date Check #
(as i~ appears on invoee, recei~ or checl~
Amount of
Expenditure
See ¸
Instructions
on Back and
in Campaign
Finance
Manual
Page Totals (Add all expenditures with the same
Cashexpenditure type.)(CA)
Loan Payment (LP) $
Accounting Period Totals (Complete only for last page and ~
transfer these amounts to.the Summa~ Statement+ PC 1.)
Loan Payment (LP) $
Cash Contributions, Loans Received and In-Kind
Please ~pe or print legibly in black ink.
Candidat~ or Political Committee Name: Commi~ee ID Number:
Election: [] Primary 19 [] General 19 [] Other
Report: [] 1st Pre-election [] 2nd Pre-election ~Post-eleetion [-1 September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE 1: Contributor Type CODE 2: Contribution Type
B Business Entity CA Cash
C political Committee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organization
O Other
P Political Party Committee
Amount of In-tO'nd Purpose
L/ne # Name and Addmss of Coatn'~utot Con~'bution (see manual [or stogested puCa~e codes)
Date Received Occupat/onal InFotmaties, Cantnbutinff Conlnbutar
Committee's II~, or DascripEo~, if Coffe ! is '0' ~t~ate Code I[ Code 2
P~ge Totals (Add all amounts wi~h the same Accounting Period Totals (Complcte only for last page and
See cunUibutinn type. Do not include aggregates.) transfcr these amoums to the Summary Statemcm, PC I.)
lnstructiom Cash(CA) $ / ~f~. O0 Cash(CA) $
ia Campaign
Finance In-Kind (IK) $ F~=. O~ In-Kind (IK) $
]~nunl F. atu on Summa~ Stamnm, Column A, Um 4 ntd 9
Loans Received (LR) $ ~ ! Loans Received (LR) $ ~)
hey..,97 Certificate of Limited Contributions and Expenditures
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Treasurer's Name (if differant than candidate): Telephone Number:
Address (street or route, city, state, zip code):
I [] Primary 19 [] General 19 ~n~" [] Other
Election:
1, ~'/,~,~,,'lZ, t"~._~ (name of candidate or treasurer), hereby certify I expect neither
the aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy or committee for this
election to exceed $500.
Signature of candidate or treasurer Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the th-st pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contributions or total expenditures for the election exceed $500, detailed contribution and expenditure
reports must be filed. The first detailed report must be filed for the accounting period in which the committee exceeds $500 in
either contributions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline datas for filing a Certificate of Limited Contributinns and Expandituras or detailed contribution and expenditure
reports MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
FaR OFFICE U~SE ONLY
3t.lL 1.. ? 1998
PC7
· Certificate of Limited Contributions and Expenditures
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number:
Treasurer's Name (if different than candidate): Telephone Number:
Address (street or route, city, state, zip code):
Office:
Election: ] [] Primary 19 [~"General 19 [] Other
1, ~ '~YXY~O, 50 ~ e ~, (name of candidate or treasurer), hereby certify I expect neither
the aggregate cJontributions received nor the aggregate expenditures made by or on behalf of my candidacy or committee for this
election to exceed $500.
Signa~4r~ of candidate or ~asurer Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total or more than $500 nor spend a total or more than $500
for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this certificate
when they originally file their Statement of Organization or during the first pre-election reporting period. A committee may not
file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form can not be used by chief petitioners of an initiative, referendum or recall petition.
· When either the total contributions or total expenditures for the election exceed $500, detailed contribution and expenditure
reports must be filed. The first detailed report must be filed for the accounting period in which the committee exceeds $500 in
either contributions or expenditures and must reflect all contributions and expenditures to date. Refer to the Campaign Finance
Manual for further information.
· Deadline dates for filing a Certificate of Limited Contributions and Expenditures or detailed contribution and expenditure
reports MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to impose a civil penalty
against a candidate or treasurer for filing a late or insufficient detailed contribution and expenditure report or Certificate of
Limited Contributions and Expenditures.
FOR OFFICE ~ ONLY /~,., .
%