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Election Info: Michael Balocca
of Ashland zcorder'sOffice ,ra Christensen, City Recorder .) 488-5307(phone) City Hall 20 E. Main St. Ashland, Oregon 97520 (541) 488-5311 (fax) December 26, 2002 Committee to Elect Michael Balocca 1233 Orchid Street Ashland, OR 97520 I have examined your Post-election contribution and expenditure report for the General Election of November 5, 2002 and found the following' Your committee report is sufficient. If you have any questions regarding this examination letter, please feel free to contact my office. Sincerely, City Recorder/Treasurer PC Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. Page 1 of 2 Candidate(.l~d.}/~ [~ ~'~ ~/'}°r Political Committee '~Name (use~~p.~.full nam. e): ~/~.['~']~'fJ,.~,t~.l~'"'! O~~ Mailing Address a~ it mp~ar~ on gt~tement of Orgonization (street, route or box.number, ~ity_, stat~ zip code): Treasurer's/Nam. e: Telepholle Number (day): Committee ID Number: J Commit~e Twe, Measure Number or Office: I ~JfOriginal ['-] Primary 20 /~General 20 O 2~ ~[~ Oth'~r " [--] Amendment I--] 1st Pre-election ' [~] 2nd Pre-elec~nn ZPost-election [--] September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions ~0~ 0 3 ~ ~} ~' (Accounting Period Total from PC 2) ~ _ 2. Loans Received (Non-Exempt) + (Accounting Period Total from PC 2) ~ + 3. Total Cash Contributions = ~ ~2)~-', ¢._~ = ~qS, (lines 1+ 2) 4. In-Kind + t/~ + (Accounting Period Total from PC 2)~ 5. TOTAL CONTRIBUTIONS (lines 3 + 4) =...- 0 ~. O 3 = .~gqb'~ /3 EXPENDITURES 6. Cash Expenditures (Accounting Period Total from PC 3) ~ ~'-, & 3 ~gqSE /3 7. Loan Payments (Non-Exempt) + + (Accounting Period Total from PC 3) 8. Total Cash Expenditures (lines 6 + 7) = ~ I~ '~'~- , b 5' = ~gqS 9. In-Kind + ----- + (Accounting Period Total from PC 2) 10' TOTAL EXPENDITURES(lines 8 + 9) = ~)~_.fl~)"-, 03 = ~,~~ q,.~ CASH BALANCE 11. Beginning Cash Balance (Ending Cash Balance from previous report)~ FOR OFFICE USE ONLY 12. Total Contributions(line 5) ~"O~-- O 3J 13. Other Receipts + ~ (Accounting Period Total from PC 4A) 14. Loans Received (Exempt) + (Accounting Period Total from PC 4A) 15. CONTRIBUTION SUBTOTAL = l~)O~ (linesll+12+13+14) ' - ..... .- : -.-. ...... ~ ...... · . 16. Total Expenditures (linel0) ~O~' · ~ g ' .'"'. :' ." '' 17. Other Disbursements + .--- (Accounting Period Total from PC 4B) · 18. Loan Payments (Exempt) + (Accounting Period Total from PC 4B) 19. EXPENDITURE SUBTOTAL = . ~, (lines 16 + 17 + 18) 20. ENDING CASH BALANCE = ~ (line 15 minus line 19) Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. Candidate or Political Committee Name: f'~_ I Committee ID Number: I ,J~ Original ~] Primary 20__ ,l~['General 20Oo~, I~l Other ~] Amendment [--] 1st Pre-election [--] 2nd Pre-election .~ Post-election LOAN SUMMARY 21. Beginning Outstanding 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 + 22 + 23) 25. Loan Payments (Non-Exempt) (line 7) 26. Loan Payments (Exempt) (line 18) 27. 28. 29. 30. 31. 32. 33. 34. 35. Forgiven Loans (Total loans forgiven during this accounting period) LOAN PAYMENT SUBTOTAL (lines 25 + 26 +27) TOTAL OUTSTANDING LOANS (line 24 minus line 28) PERSONAL EXPENDITURE SUMMARY Beginning Outstanding Personal Expenditures (line 36 of previous report) Personal Expenditures (Accounting Period Total from PC 3A) PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) Personal Expenditure Reimbursements (Total expenditures on PC 3 with purpose code R) Forgiven Personal Expenditures (Total personal expenditures forgiven this acctg, period) REIMBURSEMENT SUBTOTAL (lines 33 + 34) 36. OUTSTANDING PERSONAL EXPENDITURES PC Rev. 12/0 Page 2 of 2 [-] September Supplemental (line 32 minus line 35) = FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37. Ending Cash Balance (line 20) 38. Accounts Receivable (Accounting Period Total from PC 5) 39. SUBTOTAL (lines 37 + 38) 40. Total Outstanding Loans (line 29) 41. Outstanding Personal Expenditures (line 36) 42. Accounts Payable (Accounting Period Total from PC 6) 43. SUBTOTAL (lines 40 + 41 + 42) 44. BALANCE/DEFICIT (line 39 minus line 43' indicate + or - balance) I+ = statement and the a---~acVhed supporting rep'orts are true and correct. Signature of c~(J-[trea'-'-surer FOR OFFICE USE ONLY (name of candidate or treasurer), hereby certify that the above PC 2 Cash Contributions, Loans Received and In-Kind Candidate or Political Committee Name: Committee liD Number: C~.A-~~.~ J-D ~I~C.~ ~ ~~ ~~~ Page Election: ~ Prima~ 20 ~Genera1200~ ~ Other Repom ~ 1 st Pre-election ~ 2nd Pre-election ~Post-election September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1' Contributor Type ~ntribution Type B Business EntiW ~~ ~ ~sh C Political ~o~ittee (includes business and ~~~~ ~~O ~[~ ~dgner Obligation F Candidates I~ediate Family (includes can~)~ IK ~I~ind I Individual ~)~ ~ ~ ~ ~~Received L Labor Organization ~%~ 7 ~:'~ ' ~ O Other ~ ~ ~ P Political Pa~ Co~ittee Am In-Kind Purpose Line ~ Name and Address of Contributor~ , ~ontribution (see manual for,suggested purpose codes) Occupational Information, Contributing Contributor Date Received Commi~ee's I~, or Description if Code 1 is "0" Aggregate Code 1I Code 2 2. $ , 3. $ $ 4. $ 5. $ $ , Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and See contribution t~e. Do not include aggregates.) transfer these amounts to the Su~aw Statement, PC 1 .) Instructions on Back and Cash (CA) $ ~S, ~3 Cash (CA) $ in Campaign Enter on Sugary Statement, Colum A, kine 1 Finance in_Kind (IK) $ ~ in_Kind (IK) $ Ma~a[ Enter on Summy Statement, Column A, Lines 4 and 9 Loans Received (LR) $ ~ Loans Received (LR) $ PC 2 Enter on Su~:~ Statement, Colum A, Line 2 , Cash Contributions, Loans Received and In-Kind Please type or print legibly in black ink. List only one entry per line. ACCOUNTING PERIOD TOTALS - Complete this box only on the last page of the section. Add Cash totals from all pages of form PC 2 and enter the amount on the Cash line in the Accounting Period Totals box. Add In-Kind totals from all pages of form PC 2 and enter the amount on the In-Kind line in the Accounting Period Totals box. Add Loans Received totals from all pages of form PC 2 and enter the amount on the Loans Received line in the Accounting Period Totals box. Transfer these totals to the lines indicated on the Summary Statement of Contributions and Expenditures (PC 1). AMOUNT OF CONTRIBUTION - Amount of contribution received on this date. CODE 1: CONTRIBUTOR TYPE - S~elect thE; appropriate contributor type from the list provided on the form. Designate only one contributor type for each entry. If comte O (Other) is used, a description of the contributor must be provided in the Occupational Information box. Code 1 should notbe completed when reporting "miscel'laneous contributions $50 and under." CODE 2: CONTRIBUTION TYPE - Select the appropriate contribution type from the list provided on the form. Designate only one contribution type for each entry. CONTRIBUTING COMMIT'rEE!S~ID# - If the contribution is from a state political committee, list the six digit ID# assigned to the contributing committee by the ~ecretary of State. CONTRIBUTOR AGGREGA'FfF: - Total amount of contributions received from one contributor during all the accounting periods for one election (i.e., first pre-election, second pre-election, post-election and supplemental accounting periods). Aggregate includes cash contributions, loans received (except exempt loans), cosigner obligations (except candidate's spouse), in-kind contributions and accounts receivable pledges DATE RECEIVED - The date the contribution or loan was received in the candidate or political committee's physical custody or the date the candidate or committee first had knowledge of the in-kind contribution. Date must include the month, day and year. Do not use the date of the check un, less the check is dated and received the sarne day. A range of dates may be used for "miscellaneous contributions $50 and under"' and other limited circumstances. See pages 56 and 57 of the Campaign Finance Manual. IN-KIND PURPOSE - If the contribution type is IK, provide a description of the in-kind contribution or use the s'bggested purpose codes listed in the Campaign Finance Manual on pages 73 and 74. NAME AND ADDRESS OF CONTRIBUTOR .- Name and complete address for contributor, including residence or mailing address, city, state and zip code. OCCUPATIONAL INFORMATION - If the contributor is an individual, provide the occupation of the contributor or the name and address of the contributor's employer, or documentation showing that you requested the information within seven days of receipt of the contribution. "Self-employed," "business owner," "public employee," "education employee," or listing only a title (e.g., president, chief executive officer or administrator) are not acceptable unless the nature of the business or employment is indicated (e.g., clothing manufacturer president, CEO timber industry or medical office administrator). PAGE TOTALS - Add all code CA contributions and enter the amount on the Cash line in the Page Totals box. Add all code IK contributions and enter the amount on the In-Kind line in the Page Totals [)ox. Add all code LR contributions and enter the amount on the Loans Received line in the Page Totals box. Code Definitions Code 1: Contributor Type B Business Entity: Includes for-profit and professional corporations, cooperatiw;s, partnerships, lirrdted liability companies, etc. C Political Committee: Committees filed in the State of Oregon or any other jurisdiction, including principal campaign committees and political committees established by business entities and labor organizations. F Candidate's Immediate Family: Includes the candidate, the candidate's spouse and any child, parent, grandparent, brother, half-brother, sister or half-sister of the candidate and the spouses of such persons. I Individual: Includes a sole proprietorship or living trust. L Labor Organization O Other: Includes clubs, associations, nonprofit corporations, tribal organizations, etc. If this code is used, a description of the contributor must be provided in the Occupational Information box. P Political Party Committee: A committee established by a major or minor political party in Oregon. Code 2: Contribution Type CA Cash: Any legal instrument redeemable as currency, transmitted via physical or electronic means. CO Cosigner Obligation: The amount of the loan for which that person agreed to be liable in a written agreement, unless the endorser or guarantor is the candidate's spouse. This amount must be considered as part of the cosigner's individual contribution aggregate until the loan has been repaid or forgiven. IK In-Kind: A thing or service, other than money, having monetary value. The value of this contribution is based on the fair market value of the product or service. This amount is considered both a contribution and expenditure for the committee and must be reported on line 4 and line 9 of the Summary Statement of Contributions and Expenditures (PC 1). All in-kind contributions must be itemized, regardless of the amount. LR Loan Received: Each endorser or guarantor of a non-exempt loan is considered to have contributed that portion of the total amount of the loan for which that person agreed to be liable in a written agreement, unless the endorser or guarantor is the candidate's spouse. Note: A loan from a financial institution may be exempt and, if so, is reported on form PC 4A. However, any cosigner of that loan must be reported on form PC 2, unless the cosigner is the candidate's spouse. Pc 3 Cash Expenditures and Loan Payments Candidate or Political Committee Name: Committee ID Number: C~~I'//'J~ ~'~ ~i(~>~.~F /~l~-///~-~J &,t[~ Page Election:0 ~' ~ Prima~ 20~ ~eneral 20~ ~ ~ Other Repo~: ~ 1st Pre-election ~ 2nd Pre-election ~ost-election ~ September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) E~~ TYPES A Agent N Newspaper and Other Periodical A~e~~a~ B Broadcast Adve.ising (Radio, TV) O Other Adve.ising (yard signs,~~~~~n C Cash Contributions P Postage ~ F Fundraising Event Expenses R Reimbursement ~ G General Operational Expenses (describe S Su~eys and Polls ~ if over $50) T Travel Expenses (describe ifove~l~ I Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~ices Z Preparation and Production of Adv~~ Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to ~P 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ 10. Page Totals (Add all expenditures with the same Accounting Period Totals (Complete .only for last page and See expenditure t~e.) transfer these amounts to the Su~aw Statement, PC 1 .) Instructions on Back and Cash(CA) $ ~0~' &5' Cash(CA) * in Campaign Enter on Su~a~ Statement, Colum A, Line 6 Finance Loan Payment (LP) $ ' - Loan Payment (LP) $ ' ' ' Manual Enter on Su~a~ Statement, Colum A, Line 7 PC 3 Cash Expenditures and Loan Payments Please type or print legibly in black ink. List only one entry per line. ACCOUNTING PERIOD 'TOTALS - Complete this box only on the last page of the section. Add Cash totals from all pages of form PC 3 and enter the amount on the Cash line in the Accounting Period 'Totals box. Add Loan Payment totals from all pages of form PC 3 and enter the amount on the Loan Payment line in the Accounting Period Totals box. Transfer these totals to the lines indicated on the Summary Statement of Contributions and Expenditures (PC 1). AMOUNT OF EXPENDITURE - Amount of check, cash transaction or credit card charge. CHECK # - The number of the check. For cash transactions, write "cash" in the check number box. If the expenditure was charged on a committee credit card, enter "credit card." DATE - The date the expenditure or loan payment was made. Date must include the month, day and year. A range of dates may be used for reporting bank clharges. EXPENDITURE TYPE - Select the appropriate expenditure type from the list provided on the form. Designate only one expenditure type for each entry. PAGE TOTALS - Add all code CA expenditures and enter the amount on the Cash line in the Page Totals box. Add all code LP expenditures and enter the amount on the Loan Payment line in the Page Totals box. PAID TO ACCOUNTS PAYABLE- Check this box if the expenditure is a payment of a previously reported account payable. PAYEE'S NAME - The name of the vendor or individual to whom payment was made. If the payee is a state political committee also list the six digit ID# assigned to the committee by the Secretary of State. PURPOSE - Use the purpose codes from the list provided below (note exceptions) or write in the purpose of the expenditure. If one or more of the following purpose codes are used to describe an expenditure, no other description is generally needed. A Agent: A payee who is an individual or firm, such as an advertising agency or a public relations firm, authorized by a committee to make expenditures for broadcast or newspaper advertising or for payment of petition circulators and makes such expenditures. If an expenditure is made for the committee by an agent, you must file a Report of Expenditures Made by an Agent (PC 9) or submit a copy of an invoice from the agent detailing the agent's expenditures. The invoice must contain the same information required on form PC 9. B Broadcast Advertising: Expenditures for the purchase of radio and television advertising. This is a sufficient purpose only if payment is made dir,gctly to a specific radio or TV station. If payment is made to ;~n agent solely for preparation or production of advertising, use code Z. If payment is made to an agent for purchase of advertising, use code A. C Cash Contributions: Contributions made to other committees or organizations. F Fundraising Event Expenses: Expenditures associated with holding a fundraiser, including payments to restaurants, hotels, caterers, other food and refreshment vendors, entertainers and speakers. Use code L for expenditures associated with printed matter produced in connection with fundraising events. G General Operational Expenses: General campaign operating expenses, including filing fees, bank service charges, purchase or rental of office equipment and furniture for the campaign and office supplies. If a general operational expenditure is more than $50, describe the type of expenses (e.g., office supplies, furniture, etc.) Interest Payment: Payment to a financial institution or other lender for the interest on a loan to the campaign. L Literature, Brochures, Printing: Expenditures made for the preparation and production of campaign literature and printed solicitations, including expenditures for mailing lists, design, photography, copy, layout, printing and reproduction. Use code P for expenditures associated with literature mailing costs. M Management Services: Includes fees and commissions paid to campaign management companies and contract consultants. The exceptions when using one of the above purpose codes are: N Newspaper and Other Periodical Advertising: Expenditures for the purchase of advertising in newspapers, periodicals and other publications. This is a sufficient purpose only if payment is made to a specific publication. If payment is made to an agent solely for preparation or production of advertising, use code 7. If payment is made to an agent for purchase of advertising, use code A. O Other Advertising: Expenditures associated with the production and purchase of advertising on billboards, yard signs and campaign paraphernalia such as buttons, bumper stickers, T-shirts, etc. P Postage: Expenditures for stamps, postage, United Parcel Service, Federal Express and direct mail services. Use code L for design and other production costs associated with producing campaign literature. R Reimbursement: An expenditure reimbursing the candidate or treasurer for personal expenditures (including credit card charges) made on behalf of the committee. The personal expenditures made by the candidate or treasurer must be itemized on form PC 3A during the accounting period in which they are made. S Surveys and Polls: Expenditures associated with polls, reports on election trends, voter surveys, telemarketing, telephone banks, etc. T Travel Expenses: Expenditures associated with travel. If a travel expenditure is more than $50, describe the type of expenses (e.g., lodging, airfare, meals, gas, mileage, etc.) U Utilities: Expenditures for telephone, internet access, electricity, etc. W Wages, Salaries, Benefits: Expenditures associated with hiring campaign employees (including wages, employment taxes, insurance, etc.) Z Preparation and Production of Advertising: Payments associated with the preparation or production of broadcast, newspaper or other periodical advertising. If payment is made to an agent for purchase of advertising, use code A. 1. If an in-kind expenditure is made on behalf of another committee, the purpose description must include the purpose of the expenditure, state that it is an in-kind contribution and name the recipient candidate or committee. 2. If an expenditure is an independent expenditure on behalf of a candidate, measure or political committee, the purpose description must include the purpose of the expenditure, state that it is an independent expenditure, name the candidate, measure or political committee and indicate support or opposition. PC 6 Accounts Payable .~. 12/01 Candidate or Political Committee Name: Committee ID Number: C(5;[~.~)~.~r~ /Lo~(p___~~[.&ff(~! r~.~l~~ Page ?~ of ~ Election: ti O~ Prima~ 20~_ ~General 20 O~ ~ Other ~ Repo~: ~ l st Pre-election ' ~ 2nd Pre-election ~~ ~ September Supplemental PURPOSE CODES (see back for instructions and code defin~~~ A Agent ~~~--~~ewsp~~d Other Periodical Adve~isihg Adve~ising (Radio, TV) ~¢~ O Q~;~[~e~ng (yard signs, buttons, etc.) B Broadcast C Cash Contributions ~X~ IIX ~Pd~ge ~ ~. . ~ ~Cv , ~ F Fundrms~ng Event Expenses ~~ ~t3' ~- S~~ Po~ G General Operational Expenses (describe if over ~ ~~.~e] E~describe if over $50) I Interest Payment ~ '¢~~~ L Literature, Brochures, Printing ~ ~ages~alafies, Benefits M Management Se~ices ~ Z Pr~aration and Production of Adve~ising Note: Accounts Payable must include all amounts not paid by the end of the accounting period. See back of fo~ for instructions. Amount of Line ~ Date Payee's Name Purpose Account Payable 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ ~0. $ Page Total (Add all accounts payable on this Accounting Period Total (Complete only for last page and See fo~.) transfer these amounts to the Su~a~ Statement, PC 1 .) Instructions on Back and Accounts Payable $ ~O ~' ~5 Accounts Payable $ ~O S7. &g in Campaign Enter on Su~a~ Statement, Col~ A, Line 42 Finance Manual PC 6 Accounts Payable Please type or print legibly in black ink. List only one entry per line. ACCOUNTING PERIOD TOTAL - Complete this box only on the last page of the section. Add all page totals for accounts payable from all pages of form PC 6 and enter the amount in the Accounting Period Total box. Transfer this total to line 42 on the Summary Statement of Contributions and Expenditures (PC 1). AMOUNT OF ACCOUNT PAYABLE - The,amount owed for the goods or services at the end of the accounting period. You must continue to report any amount owing until t~he entire amount has been paid in full or forgiven. Use an estimated amount if the invoice has not been received. DATE - The date the obligation is first incurred, even if an invoice is not received until a later date. Generally, the obligation is incurred when the order for goods or services is placed. PAGE TOTAL - Add all accounts pay:able and enter the amount in the Page Total box. PAYEE'S NAME - The name of the ~endor or individual to whom payment is owed. If the account payable is to reimburse for expenditures made on behalf of the committee you must supply the name of the vendor or individual to whom the actual expenditure was made. PURPOSE - Use the purpose codes from the list provided below (note ...exceptions) or write in the purpose of the account payable. If one or more of the following purpose codes are used to describe an a~ccounts payable entry, no other description is generally needed. Agent: A payee who is an individual or firm, such as an advertising agency or a public relations firm, authorized by a committee to make expenditures for broadcast or newspaper advertising or for payment of petition circulators and makes such expenditures. If an expenditure is made for the committee by an agent, you must file a Report of Expenditures Made by an Agent (PC 9) or submit a copy of an invoice from the agent detailing the agent's expenditures. The invoice must contain the same information required on form PC 9. B Broadcast Advertising: Expenditures for the purchase of radio and television advertising. This is a sufficient purpose only if payment is made directly to a specific radio or TV station. If payment is made to an agent solely for preparation or production of advertising, use code Z. If payment is made to an agent for purchase of advertising, use code A. C Cash Contributions: Contributions made to other committees or organizations. F Fundraising Event Expenses: Expenditures associated with holding a fundraiser, including payments to restaurants, hotels, caterers, other food and refreshment vendors, entertainers and speakers. Use code L for expenditures associated with printed matter produced in connection with fundraising events. G General Operational Expenses: General campaign operating expenses, including filing fees, bank service charges, purchase or rental of office equipment and furniture for the campaign and office supplies. If a general operational expenditure is more than $50, describe the type of expenses (e.g., office supplies, furniture, etc.) I Interest Payment: Payment to a financial institution or other lender for the interest on a loan to the campaign. L Literature, Brochures, Printing: Expenditures made for the preparation and production of campaign literature and printed solicitations, including expenditures for mailing lists, design, photography, copy, layout, printing and reproduction. Use code P for expenditures associated with literature mailing costs. The exceptions when using one of the above purpose codes are: M Management Services: Includes fees and commissions paid to campaign management companies and contract consultants. N Newspaper and Other Periodical Advertising: Expenditures for the purchase of advertising in newspapers, periodicals and other publications. This is a sufficient purpose only if payment is made to a specific publication. If payment is made to an agent solely for preparation or production of advertising, use code Z. If payment is made to an agent for purchase of advertising, use code A. O Other Advertising: Expenditures associated with the production and purchase of advertising on billboards, yard signs and campaign paraphernalia such as buttons, bumper stickers, T-shirts, etc. P Postage: Expenditures for stamps, postage, United Parcel Service, Federal Express and direct mail services. Use code L for design and other production costs associated with producing campaign literature. S Surveys and Polls: Expenditures associated with polls, reports on election trends, voter surveys, telemarketing, telephone banks, etc. T Travel Expenses: Expenditures associated with travel. If a travel expenditure is more than $50, describe the type of expenses (e.g., lodging, airfare, meals, gas, mileage, etc.) U Utilities: Expenditures for telephone, internet access, electricity, etc. W Wages, Salaries, Benefits: Expenditures associated with hiring campaign employees (including wages, employment taxes, insurance, etc.) .Z Preparation and Production of Advertising: Payments associated with the preparation or production of broadcast, newspaper or other periodical advertising. If payment is made to an agent for purchase of advertising, use code A. 1. If an in-kind expenditure is made on behalf of another committee, the purpose description must include the purpose of the expenditure, state that it is an in-kind contribution and name the recipient candidate or committee. 2. If an expenditure is an independent expenditure on behalf of a candidate, measure or political committee, the purpose description must include the purpose of the expenditure, state that it is an independent expenditure, name the candidate, measure or political committee and indicate support or opposition. The Campaign to Elect Michael Balocca Municipal Judge of Ashland 850 Siskiyou Boulevard --~ Suite 9 ~-. Ashland, Oregon 97520 phone: 541-488-0067 ~-- 488-8281 - fax: 541-488-8899 e-mail: mbalocca~intemetcds.con~ - web: baloccaforjudge.com Jolie Balocca, Campaign Manager Michael Balocca, Treasurer Barbara Christensen, City Recorder City of Ashland December 19, 2002 IN-HAND DELIVERY THIS DATE Re: Final Reporting Period Financial Reports; General Election 2002; reports enclosed. Dear Barbara; Here are my corrected schedules / reports. Hopefully I have correctly completed them this time. (I am obviously not an accountant.) 'Thanks for your patience, guidance and the blank forms! Wishing you and your family happy and healthy holidays, I remain, Truly yours, Michael Balocca Campaign Treasurer finance, rpt.cover/wpd.campaign/(10/02) City of Ashland City Recorder's Office Barbara Christensen, City Recorder (541) 488-5307 (phone) City Hall 20 E. Main St. Ashland, Oregon 97520 (541) 488-5311 (far) December 10, 2002 Committee to Elect Michael Balocca 1233 Orchid Street Ashland, OR 97520 I have examined your Post-Election contribution and expenditure report for the General Election of November 5, 2002 and found the following:: Your committee report is not sufficient in the following way(s): le Summary Statement of Contributions & Expenditures Form# Line# PC 1 1 through 10 Cumulative totals for this election have not been brought forward. Form# Line# PC1 42 PC6 form has not been attached to Summary Statement Reminder: Line 44 (Balance/Deficit) must equal zero before committee can be considered closed. You must either show contributions to cover these expenses or list as forgiven personal expenditures. You can list these expenditures .on a PC3 and if they are personal expenditures to be forgiven use PC2 to show as Type 1 with purpose listed as "forgiven personal expenditures." All requested information on this exam letter must be submitted by December 17, 21002 to avoid penalties. For your convenience, I have enclosed a copy ,of your original report that indicates areas where correction is needed and additional forms that may be needed. If you have any questions regarding this examination letter, or need assistance with 'the reporting forms, please feel free to contact my office. hristensen,~ - City Recorder/Treasurer Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. PC 1 Rev. 12/01 Page 1 of 2 Candidate or PoJ.itical Committee Name l(use full nam, e): , Jl I., t' _ i ff'~ i Mailing Address as it A~ppears otn St~ement of Organization (st~et, route or bq0x number, cigy, stat~, zip code): Treasurer's Name: , {~eC~ r Office [ --I0~ ~ ~ ~ {'ff~ ~ (~ T~7 Number (day): Co~i(tee ID Number: ' ~ Co~ttee ~e, ~eas~umber o : r, /~~ lA Primal20 General20 ~~ ~ O~er_ __ Original ' --~- ~ 2nd Pre-election ~ost-elect~on [~ September Supplemental mendment 1st Pre-election A-TOTALS/'FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PE~OD ]FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions (Accounting Period Total from PC 2) 2. Loans Received (Non-Exempt) ar (Accounting Period Total from PC 2) 3. Total Cash Contributions = (lines 1+ 2) 4. + In-Kind (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS (lines 3 + 4) EXPENDITURES o Cash Expenditures (Accounting Period Total from PC 3) 7. ar Loan Payments (Non-Exempt) (Accounting Period Total from PC 3) Total Cash Expenditures (lines 6 + 7) 9. In-Kind (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES (lines 8 + 9) 11. CASH BALANCE Beginning Cash Balance (Ending Cash Balance from previous report) 12. Total Contributions (line 5) 13. Other Receipts (Accounting Period Total from PC 4A) 14. Loans Received (Exempt) (Accounting Period Total from PC 4A) 15. CONTRIBUTION SUBTOTAL (lines 11 + 12 + 13 + 14) 16. Total Expenditures (line 10) 17. Other Disbursements (Accounting Period Total from PC 4B) 18. Loan Payments (Exempt) (Accounting Period Total from PC 4B) 19. EXPENDITURE SUBTOTAL (lines 16 + 17 ~- 18) 20. ENDING CASH BALANCE (line 15 minus line 19) Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. Candidate or PoliticalCommigtee ~Name: i ~[~Ori~in'a'l [ [~] Primary 20 Amendment I [--[ 1st Pre-election LOAN SUMMARY 21. Beginning Outstanding 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 + 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. 30. PC 1 Rev. 12/01 Page 2 of 2 ~(~C{'-' ~([' '~~i ~'~'~dCc~"~mmitteelDNumber:' 3 General 20 (-~ 7_/ [-'} Other 2nd Pre-election ~ Post-election E'-] September Supplemental TOTAL OUTSTANDING LOANS ~ (line 24 minus line 28) := PERSONAL EXPENDITURE sOM MAR Beginning Outstanding Personal Expenditures (line 36 of previous report) 31. Personal Expenditures (Accounting Period Total from PC 3A) 32. PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) 33. Personal Expenditure Reimbursements (Total expenditures on PC 3 with purpose code R) 34. Forgiven Personal Expenditures (Total personal expenditures forgiven this acctg, period) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) 36. OUTSTANDING PERSONAL EXPENDITURES (line 32 minus line 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTIN(~ PERIOD 37. Ending Cash Balance (line 20) Accounts Receivable (Accounting Period Total from PC 5) 38. 39. SUBTOTAL (lines 37 + 38) 40. Total Outstanding Loans (line 29) Outstanding Personal Expenditures (line 36) 41. (Accounting Period Total from PC 6) + 43. SUBTOTAL (lines 40 + 41+42) = (line 39 minus line 43' indicate + or - balance) " {~~~j~ ~1 ~.{(,/~,,( of candidate or treasurer), hereby certify that the above i, Statem'~'~ an~t~e ~"~ache~orting reports are true and correct. Signature of candidatS~ea~sure~r~'~~'-- Date s~g~ned / PC 2 Rev. 12/01 Cash Contributions, Loans Received and In-Kind Candidate~ or Political .C°mmittee Name:. - Election; - / ~J[-'-] Primary 2; ' ~General 20(2) ~'~ Report: ['-1 1 st Pre-election r I I 2nd Pre-election SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS Committee ID Number: Other Page /of ~ ,,, /~ost-election [""] September Supplemental CODE 1: Contributor Type Line # L 0 P Date Received Business Entity Political Committee (includes business and union PACs) Candidate's Immediate Family (includes candidate) Individual Labor Organization Other Political Party Committee Name and Address of Contributor . . See Instructions on Back and in Campaign Finance Manual PC 2 Occupational Information, Contributing Committee's ID#, or Description if Code 1 is "0" Page Totals (Add all amounts with the same contribution type. Do not include aggregates.) Cash (CA) i "~ In-Kind (IK) Loans Received CODE 2: Contribution Type CA Cash CO Cosigner Obligation IK In-Kind LR Loan Received Amount of Contribution Contributor Aggregate In-Kind Purpose (see manual for suggested purpose codes) Code I Code 2 Accounting Period Totals (Complete only for last page and transfer these amounts to the Summary Statement, PC 1.) Cash (CA) $ ' Enter on Summary~A, Line 1 In-Kind (IK) $ Enter on ~;~ff~ary Statement, Column A, Lines 4andY Loans Received (LR)~_ __ J Enter on Summary Statement, Column A, Line 2 Gash £×penditures and Loan Payments .tv. CandiClat--~: '0r political Committee Name: ~ (~ ~7' ' Co~ittee ID Number: ............. Election: ~ Prima~ 20 ~ General 20 O~ ~ Other Report~ ~ 1st Pre-~ection ~ 2nd Pre-election ost-election .... ~1 S?.tember Supplemental PURPOSE CODES (see back of form for instruction's and Code definiti6ns) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Adve~ising CA Cash B Broadcast Advertising (Radio, TV) O Other Adve~ising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls i[over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~wices Z Preparation and Production of Advertising ......... . ....... Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) ././ to ~P ................ (" , ...... ,. . ,. ,/"' ........... ~' ,,, 3. /./ .................................... ~ " .................. ...... ...................... I [[[ .......... ........................... ...................../ ,, ~, . 9. $ ................. q0. $ ........................ Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and Se~ expenditure t~e.) transtar these amounts to the Su~na~ Statement, PC 1.) lnstrt, ctions ~ on Back and Cash (CA) $ Cash (CA) $ ill Campaign " Enter on Summa~/i~temen[, Column A, Line 6 Finance Loan Payment (LP) $~ ~ Loan Payment (LP) $ ' Manual ~ En(er on Sum~: m A. Linc 7 PC 3 , , ~,~ ,, , , , , , ,.,, ,.,,, City of Ashland City Recorder's Office Barbara Christensen, City Recorder (541) 488-5307 (phone) City Hall 20 E. Main St. Ashland, Oregon 97520 (541) 488-5311 flax) November 5, 2002 Committee to Elect Michael Balocca 1233 Orchid Street Ashland, OR 97520 I have examined your 2nd pre-election contribution and expenditure report for the General Election of November 5, 2002 and found the fi>llowing: ~'/Your committee report is not sufficient in the following way(s): 1. Occupational Information, Contributing Committee's ID#, or Description if Code 1 is "O" is missing. All requested information on this exam letter must be submitted by November 15, ;!002 to avoid penalties. For your convenience, I have enclosed a copy of your original report that indicates areas where correction is needed. If you have any questions regarding this examination letter, pl[ease feel free to contact my office. Sincerely, Barbara Christensen City Recorder/Treasurer Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. PC 1 Rev. 12/01 Page 1 of 2 Candidate~r Political Committee Name (use full name):,., Mailing Address as it Appear~,on_Stoje~ent or Organization (~treet, rgute or box numbe'r,_city, stat_e, zip code): Treas~ro~"s Name: - ~ , e [ -Telephone Number (day): ,'ch eJ locc I Committee ID Number: I Committee_Tvp,e,.Measure Number or Office: ~'briginal [-1 Primary 20__ ~._~General 20 [-1 Amendment I--! 1st Pre-election /J~ 2nd Pre-election [--I Post-election .-tot~s ~o~ 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) 3. Total Cash Contributions (lines 1+ 2) 4. In-Kind (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS (lines 3 + 4) EXPENDITURES : ,3 o37, $o 303 . ,50 . Cash Expenditures (Accounting Period Total from PC 3) 7. Loan Payments (Non-Exempt) + (Accounting Period Total from PC 3) 8. Total Cash Expenditures = (lines 6 + 7) 9. + In-Kind (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES (lines 8 + 9) CASH BALANCE : 3o3 /· 3o3 . &o 11. Beginning Cash Balance (Ending Cash Balance from previous report) 12. Total Contributions (line 5) + 13. + 14. 15. Other Receipts (Accounting Period Total from PC 4A) Loans Received (Exempt) (Accounting Period Total from PC 4A) CONTRIBUTION SUBTOTAL (lines 11 + 12 + 13 + 14) 16. Total Expenditures (line 10) 17. 18. 19. 20. Other Disbursements (Accounting Period Total from PC 4B) Loan Payments (Exempt) (Accounting Period Total from PC 4B) EXPENDITURE SUBTOTAL (lines 16 + 17 + 18) ENDING CASH BALANCE (line 15 minus line 19) Summary Statement of Contributions and Expenclitures Please type or print legibly in black ink. Candidate or Political Committee Name:~._~_ C~?'t I~A~'~.,~ ~ ¥'O ~--'[c~(~ ~- ~r~ ('&l~ . /~ 0~)~°mmittee ID Number:' inal ] [--] er~mary'~2 ' [_J Other ~ .Amendment [ [-'] 1st Pre-election ~-] Post-election 21. [~General 20 ? ~"_2nd Pre-election LOAN SUMMARY Beginning Outstanding 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 + 22 + 23) 25. 26. + 27. 28. 29. Loan Payments (Non-Exempt) (line 7) Loan Payments (Exempt) (line 18) Forgiven Loans (Total loans forgiven during this accounting period) LOAN PAYMENT SUBTOTAL (lines 25 + 26 +27) TOTAL OUTSTANDING LOANS (line 24 minus line 28) PERSONAL EXPENDITURE 30. Beginning Outstanding Personal Expenditures (line 36 of previous report) 31. Personal Expenditures (Accounting Period Total from PC 3A) 32. PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) 33. Personal Expenditure Reimbursements (Total expenditures on PC 3 with purpose code R) 34. Forgiven Personal Expenditures + (Total personal expenditures forgiven this acctg, period) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) 36. OUTSTANDING PERSONAL EXPENDITURES (line 32 minus line 35) FINANCIAL STATUS AT CLOSE OF AC{ 37. Ending Cash Balance (line 20) 38. Accounts Receivable (Accounting Period Total from PC 5) 39. SUBTOTAL (lines 37 * 38) 40. Total Outstanding Loans (line 29) 41. Outstanding Personal Expenditures (line 36) 42. Accounts Payable (Accounting Period Total from PC 6) 43. SUBTOTAL (lines 40 ~ 41 + 42) 44. BALANCE/DEFICIT (line 39 minus line 43: indicate + or'- balance) statement and the attached supporting reports are true and correct. Signature of candidate or treasurer :OUNTING PERIOD PC 1 Rev. 12/01 Page 2 of 2 [--] September Supplemental FOR OFFICE USE ONLY Date si~Sd~~ (name of candidate or treasurer), hereby certify that the above Cash Contributions, Loans Received and In-Kind Candidate or Political Committee Name:, "J...k ' ' d~/~ ;~/~ ~,t "Committee ID Number: ! '"~e Ca bblj,~ (~ i~ '~0 ~(eC '~' '~'~ }(~r"~,,_., Page Election: - [ [~rimary 20 [~General 20 O~. [~ Other Report: [] 1 st Pre-election .~2nd Pre-election [--I Post-election SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS PC 2 Rev. 12/01 /of / [--1 September Supplemental 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 Line # Date Received Name and Address of Contributor Occupational Information, Contributing Committee's ID#, or Description if Code 1 is "0" Amount of Contribution Contributor Aggregate $ ¢~, O0, oo $ po In-Kind Purpose (see manual ~br suggested purpose codes) Code I [ Code 2 $ ,,v.&°°.W-- c"& ~X See Ins~l~ctio'ns on Ba~ek and" in Campait~n Finance'X. Manual " PC 2 .: Page Total~.(Add all amounts with the- same contribution typO: Do not include aggregates.) Cash(CA) $ In-Kind (IK) $ ~ Loans Received (LR) $ ~ Accounting Period Totals (Complete only for last page and transfer these amounts to the Summary Statement, PC 1 .) Cash (CA) $ I Enter on Summary Statement, Column A, Line 1 In-Kind (IK) $ Enter on Summary Statement, Column A, Lines 4 and 9 Loans Received (LR) $ Enter on Summary Statement, Column A, Line 2 PC 3 Cash Expenditures and Loan Payments Candidate or Political Committee Name: ~, I'; ~/A~. ~/ Committee ID Number: Election: 20 ~Gcnc,'a1200~ ~ Other Report: . .. ~ 1st Pre-election ~2nd Pre-election ~ Post-election ,September Supplementa} PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Advertising (Radio. TV) O Other Advemising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~ices Z Preparation and Production of Adve~ising .... Payee's Nome and Payee's ¢ommittoe I~, Exp. Amount of Line ~ Dote Chock ~ ff applicable Purpose Type Expenditure Paid (~s it 8ppears on inuoice, receipt or chock) to _ ,, .Ac .... lll, 57° ll. , ,, , , ,, , , ,, ual.. ,,, , , >, ~'. :,¢:/ , , , ~ ..... '~ '~,, Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and ~ " expenditure t~e.) transDr these amounts to the Smma~ Statement, PC 1.) on Back arid Cash (CA) $ Cash (CA) $ in Campaign ---- E.te~ on Summ Colu~, A, Line 6 ~oan Payment (LP) $ ~ Loan Pa~ent (LP) Manual ' -- -- Enter on Su,nma~ S%ment, PC 3 - , PC 3 Cash Expenditures and Loan Payments Candidate or Political Committee Name: Committee ID Number: Election: ~ Primary 20~ _ ~Gencral 2~~ ~ Other Report: ~ l st Pre-election ~2nd Pre-election . .. ~ Post-election ~. September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Advertising (Radio~ TV) O Other Advertising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Z Preparation and Production of Advertising ..... Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to NP ........ ..... .... .......... .... ,, II , , Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and See expenditure t~e.) transtar these amo~ts to the Sugary Statement, PC 1 .) lnStructi°nSFinance ~q~~ AF o~ B~ck ~ Cash (CA) $ ' Cash (CA) in Campaign Enter on Summa~ nt, Colu~ A, Line 6 Loan Pa~ent (LP) $ ~ Loan Payment (LP) $ . _ Manuai Enter on Su~a~ St;~m~ Column A, Line 7 PC 3 , ,,, Cash Expenditures and Loan Payments ~ , Candidate' or l'olitical Committee Name: Committee ID Number: ~ U Election: 1--'] Pri,nary 20 ~?cncral 200~ ~ Other Report: ~ 1St, Pre-election ~2nd Pre-election ~ Post-election ~] September Supplemental PURPOSE CODES (see back of form Dr instructions and code definitions) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Advertising (Radio. TV) O Other Adve~ising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postaoe F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) 1 Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~wices Z Preparation and Production of Advertising .......... , , . Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to NP ~ , , 4. $ .,, , , 5. $ ........ 7.~ $ ., 9. $ ,,, ~0. $ .......... Page Totals (Add all expendi~res with the same Accounting Period Totals (Complete only for last page and See expenditure t~e.) transtbr these amounts to the Su~a.~ Statement~ ~ 1 .) on Back and Cash (CA) S / Cash (CA) $ . ' in g~mp~ign ~ Enter on Summa~ Smtemem, Colu~ A. Line 6 Finance ko . , ko n P y ent <kP> * ~~[ / ' ~ Enter on Summa~ Statement, Column A, Line 7 PC 3 ,, , , PC 2 Cash Contributions, Loans Received and In-Kind ,~. Candidate or Political Committee Name: ~j,~/,.~,~ ~ ~ Committee ID Number: ' : ~ Prima~ 20 ~General 20 ~~ ~ Other Repo~: ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election [~ September Supplemental , SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS GODE ]: Gontributor Type GODE 2:~ C Political Co~ittee (includes business and union PACs) ~ ~ F Candidate's I~ediate Family (includes candidate) I~ ~ ~[~;~ I Individual ~~~~~ ~n Re~ei~ eL OtherLab°r Organization P Political Pa~ Co~i~ee Amount of In-Kin~ Line ~ Name an~ M~ress of Contributor Contribution (see manual for suggested purpo~odes) Occupational In[ormation, Contributin~ Contributor Code ;~ I Code 2 Date Received Commi~eo's I~, or Description ff Co~o ~ is "0" Aggregate 2. 3. log5 5. $ Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and See contribution ~e. Do not include ag~egates.) transfer these amounts to the Su~la~ Statement, PC 1.) Instructions on Back and Cash (CA) $ Iqq q2 Cash (CA) $ ) ~' in Campaign Enter on S~ary Statement, Colum A, Line l Finance In-Kind (IK) $ ~ In-Kind (IK) $ Manual Enter on Smw~umn A, Lines 4 and 9 Loans Received (LR) $ Loans Received (LR) $ PC 2 Enter on SmE~ Statement, Column A, Line 2 , , , Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. PC 1 Rev. 12/01 Page 1 of 2 Candidat. e.,~j~cr. Political~,Committee ~ame (use full name).;,, Mailing Address as it Appear~ on S~ent of~rganization (~treet, route orhox number, ci~, state, zip code): Treasur~'s Name: t t I Telephone Number (day): Comittee ID Number: ~ Co~i~T~?,Meas~e Number or OPec: I ~Original ~ Prima, 20 ~General 20 O~ ~ ~ther ~ ~ Amendment ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election .is ACCOUNTING PEmO. September Supplemental B-CUMULATIVE TOTALS FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions (Accounting Period Total from PC 2) Loans Received (Non-Exempt) (Accounting Period Total from PC 2) 3, Total Cash Contributions (lines 1+ 2) 4. In-Kind (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS (lines 3 + 4) EXPENDITURES 3 c>3q, Cash Expenditures (Accounting Period Total from PC 3) 7. Loan Payments (Non-Exempt) + (Accounting Period Total from PC 3) 8. Total Cash Expenditures (lines 6 + 7) = 9. + In-Kind (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES (lines 8 + 9) CASH BALANCE oZ, q. 8o 11. Beginning Cash Balance (Ending Cash Balance from previous report) 12. Total Contributions (line 5) 13. Other Receipts (Accounting Period Total from PC 4A) 14. Loans Received (Exempt) (Accounting Period Total from PC 4A) 15. CONTRIBUTION SUBTOTAL (lines 11 + 12 + 13 + 14) 16. Total Expenditures (line 10) 17. 18. 19. 20. Other Disbursements (Accounting Period Total from PC 4B) Loan Payments (Exempt) (Accounting Period Total from PC 4B) EXPENDITURE SUBTOTAL (lines 16 + 17 + 18) ENDING CASH BALANCE (line 15 minus line 19) .? FOR OFFICE USE ONLY Summary Statement of Contributions and Expen Please type or print legibly in black ink. Candidate or Political Cormnittee Name: j~. ,~]'Original [--] en~rnary"2~ ' [~General 200,~ ['-] Other [---1 Amendment [--1 l st Pre-election ~2nd Pre-election LOAN SUMMARY 21. Beginning Outstanding 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 + 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 line 28) = PERSONAL EXPENDITURE SUMMARY' 30. Beginning Outstanding Personal Expenditures (line 36 of previous report) 31. Personal Expenditures + (Accounting Period Total from PC 3A) ] . 32. PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) = 33. Personal Expenditure Reimbursements / (Total expenditures on PC 3 with purpose code R)/ 34. Forgiven Personal Expenditures + (Total personal expenditures forgiven this acctg, period) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) = 36. OUTSTANDING PERSONAL EXPENDITURES , (line 32 minus line 35) = FINANCIAL STATUS AT CLOSE OF ACCOUNTING ~ERIOD 3~. Ending Cash Balance (line 20) 38. Accounts Receivable (Accounting Period Total from PC 5) + 39. SUBTOT(lines 37 + AL38) 40. (line Total 29) Outstanding Loans ,, 42.41. (AccountingACCounts(lineOUtstanding36) PayableperiodPers°nalTotalEXpenditureSfrom PC 6) ++ '43. SUBTOTAL ~ (lines 40 + 41 + 42) =~ '44. BALANCE/DEFICIT (line 39 minus line 43: indicate + or - balance) -- I, ,~'C/~t~ ,~r ~/~~~__ (name of candidate or treasurer)~ statement and the attached supporting reports are true and correct. Signature of candidate or treasurer nditures Page 2 of 2 ID Number: ['-'l September Supplemental 'FOR .OFFICE USE ,ONLY PC 1 Rev. 12/01 g~ hereby certify that the above / Cash Contributions, Loans Received and In-Kind Political Committee Name: ''J,-k ' -aA"~'~/l ~ ,I Committee ID Number: Candidate or 4-0 g(ec ,C Icrc Election: [~rimary 20 [~General 20 O,~TZ~ [-'] Other Report: [--] 1 st Pre-election J~r'2nd Pre-election [--1 Post-election SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS PC 2 Rev. 12/01 [-1 September Supplemental 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 Line # Name and Address of Contributor Date Received Occupational Information, Contributing Committee's ID#, or Description if Code I is "0" 3. s ~ 1%N S;e I Inshmcfi6hs on Ba~; and' in Campail~n Finance ,'N~ Manual % PC 2 Page Total~ (Add all amounts with the same contribution typ~: Do not include aggregates.) Cash(CA) $ Iq'fq.q~ In-Kind (IK) Loans Received (LR) Amount of Contribution Contributor Aggregate $ $ po · $ ,2&°° In-Kind Purpose (see manual for suggested purpose codes) I Code 1 [ Code 2 I Accounting Period Totals (Complete only for last page and transfer these amounts to the Sununary Statement, PC 1 .) Cash(CA) $ I Enter on Summary Statement, Column A, Line 1 In-Kind (IK) $ Enter on Summary Statement, Column A, Lines 4 and 9 Loans Received (LR) $ Enter on Summary Statement, Column A, Line 2 PC 3 Cash Expenditures and Loan Payments Candidate or Political Committee Name: itY~t~ ~..//[~ ~ Committee ID Number: E gctioT: ~ ~ ~mm7 20 _ ~Gcneral 20.0~ ~ Other ..... Rep0rt~ .... ~ let Pre-election ~2nd Pre-election ~ Post-election ~] September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) ]EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Advertising (Radio. TV) O Other Adve~ising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) 1 Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Z Preparation and Production of Advertising .................................... Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if appficable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to NP .......... A C ............. ' " q, gl.o cask[uol be ......... , , , vol.. ................................ ............... ? 10.: ~....~. Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and expenditure t~e.) transtar these amounts to the S~mmau Statement, PC 1.) on Back arid Cash (CA) $ Cash (CA) $ Slatemcnt, hl Cal~p~ig~ Enter on Summ~ Colu~ A, Linc 6 Finance Loan Payment (LP) $ ~ Loan Payment (LP) $ Manual ' ~ -- Enter on SummauS~ Column A. Linc 7 P(; 3 ~, , .,.,, , PC 3 Cash Expenditures and Loan Payments ~. Candiqate or political Committee Name: Committee ID Number: Election: ["-I Primary 20___. '~:~General 200~ ~ Other ........ Report~ ... ~ 1st Pre-election .~ 2nd Pre-election ~ Post-ele~ti.pn ~1 September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Adve~ising (Radio, TV) O Other Adve~ising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~ices Z Preparation and Production of Advertising ............ Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to NP Vol, io.11.o2 " N ,,s O " : ....................... ............... Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and · See expenditure t~e.) transl~r these amounts to the Su~a~ Statement, PC 1.) InStructi°nSFinance qqW~ AF on Back and Cash (CA) $ t Cash (CA) [11 Campaign Enter on Summa~ Colu~ A, Line 6 Loan Payment (LP) $ ~ Loan Payment (LP) $ M a~ll al Enter on ~ }S~em~ Column A, Line 7 PC 3 , ,,, , , ,,, ,,, Cash Expenditures and Loan Payments ~°~' Candidate or Political Committee Name: Committee ID Number: ~~tttp~-.(,~(~l} b,, ~(~ ~"~.~~/~~.6~.. ,,, Page Election: ~ D ~ Prima~ 20 ' ~Gcncral 20 O ~ Other Report~ ~ 1st Pre-election ... '~nd Pre-election ~ Post-el~ction ~l.S~ptember Supplemental PURPOSE CODES (see back of form for instructions and eerie definitions) EXPENDITURE TYPES A Agent N Newspaper and Other Periodical Advertising CA Cash B Broadcast Advertising (Radio, TV) O Other Advertising (yard signs, buttons, etc.) LP Loan Payment C Cash Contributions P Postage F Fundraising Event Expenses R Reimbursement G General Operational Expenses (describe S Surveys and Polls if over $50) T Travel Expenses (describe if over $50) I lnlercst Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~ices Z Preparation and Production of Advertising .............. Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to NP ............ xlol 'a . ' .............. ,. /o' s.oa eas/ G ................ : ............................ ...... .......... 9. $ ...................... .............. Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and See expenditure t~e.) transl~r these amounts to the Sm~a~ Statement,, P~ 1.) on Back and Cash (CA) $ _ / _ Cash (CA) $_ ' in Campaign Enter on Summa~ Statement, Colmm A, Line 6 Finance Loan Payment (LP) $ ~ Loan Payment (LP) $ M an llal - Enter on Summau Statement, Column A Linc 7 PC 3 ~ , ,, ,,, ,, ,,, ,,,, ,,,,, City of Ashland City Recorder's Office Barbara Christensen, City Recorder (541) 488-5307 (phone) City Hall 20 E. Main St. Ashland, Oregon 97520 (541) 488-5311 (fax) October 8, 2002 Committee to Elect Michael Balocca 1233 Orchid Street Ashland, OR 97520 I have examined your first pre-election contribution and expenditure report for the General Election of November 5, 2002 and found the following: Your committee report is sufficient. If you have any questions regarding this examination letter, please feel free to contact my office. Barbara Christensen City Recorder/Treasurer Summary Statement of Contributions and Expenditures Please type or print legibly in black ink. pc Rev. t2/0 Page l of 2 Candidate or Political Committee Name (use,full frame):: t ,o / Mailing Address a~ it A~eara on Statement of Organization (street, rome or box number, city, state, zip code): Treasure(s Na~e: J Telephone Number (day): Committee ID Number: { Commi~ ~e, Measure Number or Office: ]~ Amendment I~lst Pre-elec~i~ ~ 2nd Pre-eleCtion ~ Post-election September Supplemental A-TOTALS FOR THIS ACCOUNTING PERIOD B-.CUMULATIVE TOTALS FOR THIS ELECTION CONTRIBUTIONS I. Cash Contributions (Accounting Period Total from PC 2) 2. Loans Received (Non-Exempt) (Accounting Period Total from PC 2) 3. Total Cash Contributions (lines 1+ 2) 4. In-Kind (Accounting Period Total from PC 2) 5. 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. Total Cash Expenditures = IS/'~0 0~ = (lines 6 + '7) 9. In-Kind + ,F~ + (Accounting Period Total fi'om PC 2) l 0. TOTAL EXPENDITURES (lines 8 +9) = ' ('-) = CASH BALANCE Il. Beginning Cash Balance (Ending Cash Balance from previous report) 12. Total Contributions (line 5) 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. 17. 18. Total Expenditures (line 10) Other Disbursements (Accounting Period Total from PC 4B) Loan Payments (Exempt) (Accounting Period Total from PC 4B) EXPENDITURE SUBTOTAL (lines 16 + 17 + 18) ENDING CASH BALANCE (line 15 minus line 19) 19. 20. FOR OFFICE USE ONLY Summary Statement of Contributions and Please type or print legibly in black ink. Expenditures PC Rev. 12/0 Page 2 of 2 ICroCi,date or PoliticaliCom~nittee Name: _ Original ~ Pmmary 20 [~General 20_0~ [] ~1~( __ _ Other Amendment ti~ st Pre-election [~] 2nd Pre-election [-'-I Post-election Commil:tee ID Number: [--] September Supplemental LOAN SUMMARY 21. Beginning Outstanding Loans (Total Outstanding Loans from previous report) 22. Loans Received (Non-Exempt) + (line 2) 23. + 24. Loans Received (Exempt) (linc 14) LOANS RECEIVED SUBTOTAL (lines 21 .+ 22 + 23) 25. Loan Payments (Non-Exempt) (line 7) 26. Loan Payments (Exempt) (line 18) 27. 28. 29. Forgiven Loans (Total loans forgiven during this accounting period) LOAN PAYMENT SUBTOTAL (lines 25 + 26 +27) TOTAL OUTSTANDING LOANS (line 24 minus line 28) PERSONAL EXPENDITURE SUMMARY~ 30. Beginning Outstanding Personal Expenditures (line 36 of previous report) 31. iPersonal Expenditures + (Accounting Period Total from PC 3A) 32. PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) 33. Personal Expenditure Reimbursements (Total expenditures on PC 3 with purpose code R) 34. Forgiven Personal Expenditures (Total personal expenditures forgiven this acctg, period) OUTSTANDING PERSONAL EXPENDITURES (line 32 minus line 35) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) = 36. -. FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37. Ending Cash Balance (line 20) 38. Accounts Receivable (Accounting Period Total from PC 5) + 39. SUBTOTAL (lines 37 + 38) 40. Total Outstanding Loans (line 29) 41. Outstanding Personal Expenditures (line 36) 42. Accounts Payable (Accounting Period Total from PC 6) 43. SUBTOTAL (lines 40 + 41 + 42) 44. BALANCE/DEFICIT (line 39 minus line 43: indicate + or - balance) Signature o'F can~~t~urer FOR OFFICE USE ONLY (name of candidate or treasurer), hereby certify that the above Date/igned / Cash Contributions, Loans Received and In-Kind Candidate or Political Cormnittee Name: ~t/[~C~e {' "5 .... Committee ID Number': Election: I~ri~aw 20__ ~General 20 0 ~ ~ Other Repom ~lst Pre-election ~ 2nd Pre-election ~ Post-election PC Rev. 12/0 of I September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE CODE 1' Contributor Type Line # DEFINI~~-~,~~ ~/~2~ntribution Type Business Entity lin~ I -'"'~--~t1~ Eash Political Cormnittee (includes business an~r~/~ P~ ,, C~ Ii[Cosigner Obligation Candidate's Immediate Family 0nclude In Kind Individual ~ Loan Received Labor Organization Other Political Party Committee Amount of In-Kind Purpose Name and Address of Contributor Date Received 1. 2. q-lq-o? . Occupational Information, Contributing Committee's ID#, or Description if Code 1 is "0" I o S55 - (ece~'~ ' Contribution Contributor Aggregate $ $ 130,37 $ qS-,o° (see manual for suggested purpose codes) I Code I [ Code 2 F cA (,4- Accounting Period Totals (Complete only for last page and transfer these amounts to the Summary Statement, PC 1.) / Cash (CA) $.. 1~31'"~0 ..'..0.~~' . Enter on Summary Statement, Column A, Line 1 In-Kind (IK) $ ~ Enter on Summary olumn A, Lines 4 and 9 Loans Received (LR) $ Enter on Summad~ Column A, Linc 2 See Instructions on Back and in Campaign Finance Manual PC 2 Page Totals (Add all amounts with the same contribution type. Do not include aggregates.) Cash (CA) $ In-Kind (IK) $ Loans Received (LR) , , , PC 3 Cash Expenditures and Loan Payments ~. Candiqate or Political Committee Name: '~ ~.. ~"~e~-_. Committee ID Number: Election: ~ Primaw 20 ~. General 20 O~ ~ Other PURPOSE' CODES (see ;ack of form for instructions and code definitions)' [~} ~~TURE TYPES A Agent N Newspaper and Other Periodical A B Broadcast Advertising (Radio, TV) O Other Adve~ising (yard signs, button~/~/ C Cash Contributions P Postage /a~/ ~ ~,na:~,i~ng ~nt ~p~=~s ~ ~m~ur~,~n, / -~ ": ;~,, /// /// ~r ow~ ss0~ z ~,-av~l E~p~n~ Cd¢~ribe it o~' ~~ '~.. ////// I Interest Payment U Utilities ~.. L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Se~ices Z Preparation and Production of Advertising Payee's Name and Payee's Committee I~, Exp. Amount of Line ~ Date Check ~ if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to ,,, . , 8. $ ,,, 9. $ ....... .... qO. ........... , , Page Totals (Add all expenditures with the same Accounting Period Totals (Comple, te only for last page and See expenditure type.) transtar these amounts to the Su~a~ Statement, PC 1.) Instructions onBackand Cash(Ca) $ I U{U~' )q Cash(Ca) $ iii Campaign Enter on Summa~ Statement. Colu~ A. Line 6 Finance Loan Payment (LP) $ ~ Loan Payment (LP) $ M anil al - Enter on St,nma~ - olumn A. Linc 7 PC 3 , , , ~, ,, Cash Expenditures and Loan Payments Candiqate or Political Committee Name: ~..~.~ ~lflAt' i~-- Committee ID Number: pc 3 Rev. 12/01 £ kscP i'c( el Election: ~,~ri:nary 20 ~ General 20 (.,2~.~ - []]]] Other Report: ~ 1st Pre-election '["~ 2nd Pre-election ["-] Post-de( 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) 1 Interest Payment L Literature, Brochures, Printing M Management Services Instructions on Back and in Campaign Finance Manual Check # N Newspaper and Other Periodica O Other Advertising (yard signs, P Postage R Reimbursement S Surveys and Polls T Travel Expenses (describe U Utilities W Wages, Salaries, Benefits Preparation and Production of Advertising Date II Payee's Name and Payee's Committee ID#, if applicable (as it appears on invoice, receipt or check) PC 3 Page Totals (Add all expenditures with the same expenditure type.) Cash (CA) Loan Payment (LP) $ Page ~2Q~_ of 3 .[--] September Supplemental :PENDITURE TYPES et~c.) · Purpose · $ Amount of Expenditure $ 1 b"'O,°° $ · $107. b3 $ (oo,°° ~o Accounting Peried ~etals (Complete o~ly for last page and transtar these amounts to the SusaW Statement, PC l.) Cash (CA) $ Enter on Summa~~nt, Colm~ A, Linc 6 Loan Payment (LP) $ Enter on ~ ~tateme~C;~ A, Line 7 Cash Expenditures and Loan Payments Candidate or Political Committee Name: ""['[x ~_ COvlaOq f ~-ee Committee ID Number: % {iec¢ ,'Ctxae{ (5, bccc Page I oft Election' FI. Primary 20 /~f~ General 20 O_.~ [-] Other Report: J~ 1st Pre-election E] 2nd Pre-election [--] Post-election/~,Z~.<~_[-],,,.,, September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) ITURE TYPES ^ B Broadcast Advertising (Radio, TV) O Other Advertising (yard signs, buttj~lS/6,/q~.) ~,.oLP Loa~~'~'~ C Cash Contributions P PostageReimbursement //"/~'C' 'ff ~ ~"7:..~:, 7///// F Fundraising Event Expenses R G General Operational Expenses (describe S Surweys and Polls if over $50) T Travel Expenses (describe if eve $-~'~,,~.~~ 1 Interest Payment U Utilities L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Z Preparation and Production of Advertising Payee's Name and Payee's Committee ID#, Amount of Date Check # if applicable Purpose Expenditure Paid (as it appears on invoice, receipt or check) See Page Totals (Add all expenditures with the same expenditure type.) Instructions on Back and in Cmnpaign Finance Manual PC 3 Cash (CA) Loan Payment (LP) ? $ 13 ,oL¢ Enter on Summary olumn A, Line 6 $ Enter on Summary Staternent,~oiu~nn A, Line ? Loan Payment (LP) Cash (CA) Accounting Period Totals (Complete only for last page and transfer these amotmts to the Summary Statement, PC 1 .) FILING OF CANDIDACY FOR NONPARTISAN NOMINATION PLEASE TYPE OR LEGIBLY PRINT IN BLACK INK. NOTE: This information is a matter of public record and may be published or reproduced. ~] INCUMBENT FOR OFFICE OF JUDGE NAME OF CANDIDATE NAME SHOULD APPEAR ON BALLOT ASFOLLOWS TELEPHONE (HOME) FAX TELEPHONE (WORK) FILING FOR OFFIC~ OF $ ~ ~ DISTRICT, D~EPAR~VIENT OR~OSITI~ NUMBER COUNTY OF RESIDENCE EMAIL MAILING ADDRESS WHERE ALL CORRESPONDENCE WILL BE SENT [--~ SEC~TARY OF STATE OF OREGON ~-~ COUNTY ELECTIONS OFFICIAL OF __ _COUNTY 7~ER (AUDITOR), CITY OF ~ FILING OF CANDIDACY BY DECLARATION, WITH THE REQUIRED FILING FEE (ORS 249.056). FILING FEES OFFICE FILING OF CANDIDACY BY DECLARATION (ORS 249.056) STATEWIDE OFFICES CIRCUIT COURT JUDGE DISTRICT ATrORNEY MSD EXECUTIVE OFFICER, MSD AUDITOR MSD COUNCILOR COUNTY OFFICE CITY OFFICE JUSTICE OF THE PEACE * Set By Charter or Ordinance ~ Filing of candidacy by P_RROSPECTIV~EE petition, with the required proposed STATE VOTERS' PAMPHLET (ORS 251.095) $100 $1000 $ 50 $300 $ 50 $300 $100 $ 25 $ 50 * **$300 NONE ** For Cities With a Population of 50 one or more circulators will or will not be paid (SEL 300) (ORS 249.020). -~Filing of candidacy by COMPLETE_ _ _D petition, with the required signature sheets ls (ORS 249.020, 249.064). Primary Election 2002 FILING DATES Filing For Candidacy: First Day April 1, 2001 Filing For Filing For Candidacy: Last Day March 12, 2002 Filing For Candidacy: Deadline to Withdraw Candidacy: March 15, 2002 Deadline to Withdraw Candidl Filing For State Voters' Pamphlet: March 14, 2002 Filing For State Voters' Pamphlet: Augus (SEL 121) and statement 30,2002 INITIALS RECEIPT NUMBER OFFICE NUMBER FOR OFFICE USE ONLY CASH OR CHECK NUMBER CANDIDATE ID NUMBER PRINCIPAL CAMPAIGN COMMITI'EE ID # SEL 120REV. 11/01 ORS249.031 REQUIRED INFORMATION OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID) EDUCATIONAL BACKGROUND (SCHOOLS ATTENDED, use attachment if needed) Course of study (optional) Complete name of school - no acronyms Last grade level completed Diploma/Degree/Certificate (AA, BA, BS, MA, PhD, etc.) Other: PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED) :loc~xrnent, I shall acc~l~ THAT I shall qhalify for sa THAT all an is a matter of public record and may be published or reproduced. lte: the office indicated above; elected; and on this form, including my occupation, educational and occupational background, and prior the best of my knowledge. WARNING: Supplying false information on this form may result in conviction of a felony with a fine of up to $100,000 and/or prison for up to five years. (ORS 260.715). No person shall file a nominating petition or declaration of candidacy for more than one lucrative office before the date of the primary election, unless the person first files a written withdrawal with the officer who accepted the filing (ORS 249.013(2)). SEL 120 REV. 11/01 ORS 249.031 SEL 220 ORS 260.037 1,,01 Candidate's Statement of Organization o.s 260.039 ORS 260.041 Please type or print legibly in black ink. 1 Primary 20 General 20 Other election date ~0V, c.~.Z)O~ [~] Will exist for more than one year 2 This filing is an: ]~ Original r-] Amendment [-] Discontinuation 3 Name of principal campaign co~i~ee Co~i~ee address (streeffroute, ci~, state, zip code) - no post office box numbers Name of treasurer 6~ rcf/[~e i Mailing address to which all co~i~ee co~espondence will be sent , Work phone number Home phone number Fax number E-mail address ff -5651 4 Name of candidate Residence address (streeffroute, ci~, s~te.zip code~ - no post office box numbers , Mailing address to which all candidate co~espondence will be sent~ Work p~ne number Home phone number Fax number E-mail address occupat,ono c ndid , ' / , . , . Name of office sought (include[o~W, position, depa~ment or z~ne numbeh if applicable) 5 ' ~ditio~al address that may be used on political publ] :atio~s ~ost office box o~ streeVmute, c~tme, zip code) , pa~ ~iat~a~(~o~plete only if filing for pa~isan office) ~"~"~De~r.a.[~c ~ Libe~an ~ Pacific Green ............ ' ~*~ ~ ~ Not a member of a paay ~ Other ~ Republican ..... . 7 Political co~i~ee intends to ~licit ~nds by (mark all that apply): ~irect mail ~/Personal contact ~ Radio ~ Television ~vents ~ewspaper ~ebsite ~ Other ~ , . ,, Please complete and sign the back side of this form. 8 Committee Directors (if any) Name Address (including zip code) Occupation Phone Number If two or more directors of this political committee are also directors of another political committee, list the names of those directors and the name and address of the other political committee. By signing this document I acknowledge that I am personally liable for any penalties imposed under ORS chapter 260. d~~ ~ Can Treasurer's si~amre (if different than candidate) Date~ ~~~ Date signed Important: Both the candidate and treasurer of a principal campaign committee must sign the Statement of Organization. Instructions Filin~ an original Statoment of Organization Ihs completed form must be filed within three business days of first receivin~ a contribution or makin~ an expenditure. A date stamped copy, which includes your identification number, will be returned to you as an acknowledgment of your filing. NOTE: A candidate may have only one principal campaign commi~ee. A candidate who se~os as the troasurer A candidate may either seine as the candidate's own treasurer or may appoint a separate treasurer. A candidate who se~es as their own treasurer and who does not expect to receive or spend more than $300 for the entire election is not required to file a Statement of Organization or contribution and expenditure repo~s. However, if at any time they exceed $300 in either contributions or expenditures, they must then file a Statement of Organization and contribution and expenditure repo~s. Amendin~ information on this form Any chan~e in the information on this form must be filed within ten (~ 0) days of the chan~e. To notify the filin~ officer of a chan~e in information, submit this form, completed in its entirety, and mark the "Amendment" box. Diseontinuin~ You must file a final contribution and expenditure ropo~ that shows a zero balance, alp "Discontinuation" bo~ marked. The final repo~ may be filed at any time. Initials Com~ee ID Number Office Nmber Candidate ~ Nmber 0 Z © r~ m 0 !' STATEMENT ONE OR MORE PETITION CIRCULATORS WILL BE PAID I/We hereby declare one or more petition circulators will be paid money or other valuable consideration for obtaining signatures of active registered voters on the attached petition or certificate. I/We understand the filing officer must be notified not later than the tenth day after I/we first have knowledge or should have had knowledge that no petition circulator will be paid for obtaining signatures. Identify Petition (Name of Candidate or Minor Political Party on Prospective Petition; or Subject of Initiative, Referendum Petition or Name of Officeholder on Recall Petition) Signed* Date signed Date signed Date signed *Statement must be signed by one of the following: · candidate for nomination; · all chief petitioners for initiative or referendum petition; · chief petitioner for recall petition; · chief sponsor for certificate of nomination; or · chief sponsor for minor political party formation petition. STATEMENT NO PETITION CIRCULATORS WILL BE PAID I/We hereby declare no petition circulator will be paid money or other valuable consideration for obtaining signatures of active registered voters on the attached petition or certificate. I/We understand the filing officer must be notified not later than the tenth day after I/we first have knowledge or should have had knowledge that one or more petition circulators will be paid for obtaining signatures. Identify Petition d (Name of Candidate or Minor Political Party on Prospective Petition; or Subject of Initiative, Re,ferendum Petition or (/,..)j/~.~ ... Name of Officeholder on Recall Petition)~~c=,~ Signed* _ v Date signed / Date signed *Statement must be signed by one of the following: · candidate for nomination; · all chief petitioners for initiative or referendum petition; · chief petitioner for recall petition; · chief sponsor for certificate of nomination; or · chief sponsor for minor political party formation petition. SEL 300 REV 11/01 ORS 248.008, ORS 249.061, ORS 249.078, ORS 249.740, ORS 249.865, ORS 250.045, ORS 250.165, ORS 250.265, ORS 255.135 8 0 ~Z 0 0 \, ~ o~ c~ z m > > > > > · ~ ~Z 0 z ~ t'rl z © ~Z © Jackson County Petition Statistics Report Michael Balocca Processed: 08/01/2002 3:10 PM Printed: 08/01/2002 3:10 PM Signature Requirements: 25 eligible registrants in the entire county Total Pages: 4 Total Lines: 34 Valid Signatures: Percent Needed: Percent Processed: Signatures Needed: Invalid Signatures: 29 -16.00% 116.00% 25 5 Status Reason Number Processed Percent Processed Accepted Rejected Out of City Rejected Inactive Rejected Inactive-moved Rejected Not Registered 29 1 1 1 2 85.29% 2.94% 2.94% 2.94% 5.88% Percent of Invalids Pending: Percent of Invalids Rejected: 0.00% 4100.00% Copyright © 2002 Election Systems and Software, Inc. Page 1 of 1