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Campaign Finance-General Election - Jackson-Heim, Jeanne - 9/7/2009DECLARATION OF CANDIDACY I, the undersigned, affirm that I am a qualified elector of the Ci Idaho, and that I have resided in the City of Eagle for at least t RECEIVED & FILED CITY OF EAGLE SEI' ", 2009 0.44 a ie, State of I hereby declare myself to be a candidate for the office City Council, for a term of four (4) years, to be voted for at the election to be held on the 3rd day of November, 2009 and certify that I possess the legal qualifi tions to fill said office, and the my residence address is '6 3 i%f©ra if. e.- ( Ia-G2/ c,J Subscribed and sworn to before me this „2.51& day of k Notary Public for the State .6f Idaho Residing at: My Commission Expires: 44/9-..00iy ndidate's Signature 2009 OFFICIAL USE ONLY Before accepting this Declaration of Candidacy, the City Clerk (or designee) must verify the following. This Declaration is accompanied by: The attached Petition of Candidacy signed by at least five qualified city electors with the attached verification from the county clerk, OR X. A nonrefundable filing fee of $40. b?.003 a The City Clerk (or designee) must verify that the person submitting this declaration is a qualified city elector as defined in Idaho Code 50-402(c) and that the residence address provided above matches the address on the individual's voter registration. This declaration was accepted by Name, Title lt42231.1).‘ on Ne.A if_. cid o9 at /O..''fi /y • Date Time V cp- K:\Clerks\ELECTION\General Election 2009\Declaration of Candidacy\Declaration of Candidacy.doc APPOINTMENT AND CERTIFICATION OF POLITICAL TREASURER "�� Ree. r17 A, ' FOR CANDIDATES AND COMMITTEES pipe:__....... . . :; A t. (Please Print or Type) Ro i 't:. ' r Pursuant to Section 67-6603(c1), Idaho Code. No contribution shall be received or expenditure made by or on behalf of a candidate or political committee until he or she appoints a political treasurer and certifies the name and address of the treasurer to the Secretary of State. Certification is for(check appropriate box below): Name of CANDIDATE: Jeanne Jackson-Heim � '',Candidate: Home 255-6399 Work 334-3285 Cell Phone: Phone: Phone: Offce Seat(if �-+ Sought: City Council applicable) Candidate Mailing address:463 Moraine Place, Eagle, ID 83616 Candidate email address:jackson-heim @hotmail.com Name of COMMITTEE: Committee: Name of Committee Chairman: Miscellaneous: Home Work Cell Phone: Phone: Phone: Measure: 1 1 Committee Mailing address: Candidate/Measure. Chairman email address: CERTIFICATION AND APPOINTMENT Jeanne Jackson-Heim do hereby certify and appoint the following individual who is a registered elector of Name of Candidate or Committee Chairman the State of Idaho as the political treasurer for the above named candidate or committee: Pomc Jeanne Jackson-Heim Political l Treasurer: Home 255-6399 Work Cell Cell Phone: Phone: Phone: Treasurer 463 Moraine Place, Eagle, ID 83616 Mailing address: s Treasurer email address:jackson-heim @hotmail.com • Signature of Cidate or Committee Chairman Jeanne Jackson-Heim do ereby accept the appointment as political treasurer for Name of Political Treasurer the above named candidate or committee. . • i Sign./-of Political Treasurer ■/05/2009 10: 35 FAX 0 001/001 • CITY or EAGLE • • ,, CAMPAIGN FINANCIAL DISCLOSURE REPORT OCT 20IJfiav 10107-2 moo, SUMMARY PAGE �St, 'z4 r (Please Print or Type) Fife: ,,,�,. ROUOB ttD: Section I i Name of Candidate or Political Committee and Chairperson !Office Sought(if candidate) Seat(if any) 1 Jeanne Jackson_ -Heim !City Council ______I -E,lailing Address I(,i an fp — i Home Phone -- Work Phone 463 Moraine Place lEagle 83616 1208-255-6399 208-334-3285 ('Name of PollltC51Treasurer Jeanne Jackson-Heim Mailing Address r City end Zip I Home Phone Work Phone 'Same Change of address for: Candidate or Political Committee ❑ Political Treasurer Section II TYPE OF REPORT This filing is an: ® Original ❑ Amendment This report is for the period from 9 /3 /2009 through 9 30 ;2009 0 October 10 Pre-General Report ❑ 7 Day Pre-General Report ❑ 30 Day Post-General Report ❑ Annual Report Is this a Termination Report: El Yes Q No Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contributions or expenditures during this reporting period.check the box next to the statement below and sign this report. Be sure to carry forward the appropriate"Calendar Year to Date"'figures in Column II,Section IV. El I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I COLUMN I COLUMN II figures to the Column II figures of your previous report(except on line 6). This Period Calendar Year to Date Line 1:Cash on Hand January 1,This Calendar Year' $ XXXXXX _ $ Line 2:Enter Beginning Cash Balance** $ _ $ XXXXXX Line 3:Total Contributions(Enter amount from line 5.page 2) $ $ Line 4:Subtotal(Add lines 1. 2 and 3) $ _ $ _. Line 5:Total Expenditures(Enter amount from line 11.page 2) $. $ Line 6:Enter Ending Cash Balance(Subtract line 5 from line 4) $ $ Line 7:Outstanding Debt to Date(Enter amount from line 18,page 2) $ This same figure should be entered on line 1 of all reports filed this calendar year_ **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed, If this is your first report,this amount is 0. Note:The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V 1. Jeanne Jackson-Heim_ hereby certify that the information in this Name of Political Treasurer report is a true,complete and correct Campaign Financial Disclosure Report as required by law. `t:i t-tip_ dil-C4047./. — ,` C,�'1'1- .___Sure of Political Treasurer y Page 1 ,- RECEIVED & FILED CITY OF EAGLE _` ,,.Ift, CAMPAIGN FINANCIAL DISCLOSURE REPORT C-2 - SUMM A PAGE OCT 7 7 20 v.10/07 .'i (Please Print or Type) . -.;-�.y- Filr Section I Route to: Name of Candidate or Political Committee and Chairperson Office Sought(if candium0 'Seat(rf any' Jeanne Jackson-Heim Eagle City Council Mailing Address City and Lip Home Phone Work Phone 463 Moraine Place Eagle, ID 83616 208-255-6399 208-334-3285 Name of Political Treasurer Jeanne Jackson-Heim Mailing Address City and Zip Home Phone Work Phone same Change of address for: Candidate or Political Committee ❑ Political Treasurer ❑ Section II TYPE OF REPORT This filing is an: IN Original ❑ Amendment This report is for the period from 10 /1 /2009 through 10 /18 ,(2009 ❑ October 10 Pre-General Report 0 7 Day Pre-General Report ❑ 30 Day Post-General Report ❑ Annual Report Is this a Termination Report: ❑ Yes p No Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contributions or expenditures during this reporting period,check the box next to the statement below and sign this report. Be sure to carry forward the appropriate"Calendar Year to Date"figures in Column II,Section IV. ❑ I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I COLUMN I COLUMN II figures to the Column II figures of your previous report(except on line 6). This Period Calendar Year to Date Line 1:Cash on Hand January 1,This Calendar Year* $ XXXXXX $ 0.00 Line 2:Enter Beginning Cash Balance** $ 0.00 $ )O(X)O(X Line 3:Total Contributions(Enter amount from line 5,page 2) $ 6,088.78 $ 6,088.78 Line 4:Subtotal(Add lines 1,2 and 3) $ 6,088.78 $ 6,088.78 Line 5:Total Expenditures(Enter amount from line 11,page 2) $ 1,918.82 $ 1,918.82 Line 6:Enter Ending Cash Balance(Subtract line 5 from line 4) $ 4,169.96 $ 4,169.96 Line 7:Outstanding Debt to Date(Enter amount from line 18,page 2) $ 2,466.38 *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed.If this is your first report,this amount is 0. Note:The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V l Jeanne Jackson-Heim ,hereby certify that the information in this Name of Political Treasurer report is a true,complete and correct Campaign Financial Disclosure Report as required by law. nit CL .L- �_ a C -- • nature of Political Treasurer ;J Page 1 DETAILED SUMMARY Name of Candidate or Committee:Jeanne Jackson-Heim Total This Period Contributions 1� Unitemized Contributions($50 and less) #of Contributors + $0.00 20 Itemized Contributions(Total of all Schedule A sheets) + $4,710.00 30 In-Kind Contributions(Total of all Contribution amounts from Schedule C sheets) + $250.00 ® Loans(Total of all New Loan amounts from Schedule D sheets) + $1,128.78 50 Total Contributions(Transfer this figure to page 1,Section IV, Line 3) _ $6,088.78 Expenditures © Unitemized Expenditures($25 and less) #of Expenditures + $0.00 70 Itemized Expenditures(Total of all Schedule B sheets) + $1,668.82 ® In-Kind Expenditures(Total of all Expenditure amounts from Schedule C sheets) + $250.00 O Loan Repayments(Total of all Loan Repayment amounts from Schedule D sheets) + $0.00 10 Credit Card and Debt Repayments(Total of all Repayment amounts from Schedule E sheets) + $0.00 11 Total Expenditures(Transfer this figure to page 1,Section IV, Line 5) = $1,918.82 Loans,Credit Cards and Debt 12 Outstanding Balance from previous reporting period + $0.00 New Loans received during this reporting period 13 (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) + $1 ,128 78 14 New Credit Card and Debt incurred this reporting period (Total of all New Incurred Debt amounts from Schedule E sheets) + $ 1 ,337.60 337.60 15 Subtotal = $2,466.38 Repayments of Loans made during this reporting period 16 (Total of all Loan Repayment amounts from Schedule D sheets) - $0.00 17 Repayments of Credit Card and Debt this reporting period 0.00 (Total of all Debt Repayment amounts from Schedule E sheets) - $ 18 Total Outstanding Balance at close of this period(Transfer this figure to page 1, Section IV, Line 7) = $2,466.38 Pledged Contributions 1 g Unitemized Pledged Contributions($50 and less) #of Pledges + $0.00 @0 Itemized Pledged Contributions this Period(Total of all Schedule F sheets) + $0.00 Total Pledged Contributions this period = $0.00 Page 2 SCHEDULE A Page of ITEMIZED CONTRIBUTIONS of more than Fifty Dollars($50.00)this period Name of Candidate or Committee:Committee to Elect Jeanne Jackson-Heim Date Received Full Name,Mailing Address and Zip Code of Contributor Cash or Check 1.Barker, Bradley 250.00 10/15/09 500 E. Shore Dr. $ Eagle, ID 83616 $ 250.00 ® General _Calendar Year-To-Date 10 10 09 2.Bastian, Stan $ 100.00 i- 1369 E. Nestview Ct. Eagle, ID 83616 $ 100.00 IN General Calendar Year-To-Date 10 15 09 3.Blakely, Cathy $ 50.00 /—/— 393 S. Waterton Ave. Eagle, ID 83616 $ 50.00 ® General Calendar Year-To-Date 10 6 09 4.Brooks, James $ 50.00 i - 380 S. Golden Eagle Lane Eagle, ID 83616 $ 50.00 III General Calendar Year-To-Date 10 17 09 5.Building Contractors Assn of Southwest Idaho $ 1 ,000.00 —i i— 6206 N. Discovery Way, Suite A Boise, ID 83713 $ 1,000.00 ® General Calendar Year-To-Date 10 13 09 6.Butler, Joann $ 100.00 —/ /— 515 W. Linden St. Boise, ID 83706 $ 100.00 ® General Calendar Year-To-Date 10 15 09 7.C Barton Investments Inc. $ 50.00 —L___ 11589 S. Cloverdale Road Kuna, ID 83634 $ 50.00 II General Calendar Year-To-Date 8.Dawson, Barbara $ 100.00 10/15/09 523 Locust St. Boise, ID 83712 $ 100.00 ® General Calendar Year-To-Date 10 15 09 9.DeLorenzo, Julie $ 250.00 / /- 3775 La Fontana Way Boise, ID 83702 $ 250.00 ® General Calendar Year-To-Date 10 15 10 Dishion, KaLinn $ 100.00 /-09 3512 W. Grover Ct. Boise, ID 83705 $ 100.00 El General Calendar Year-To-Date Total This Page: $2,050.00 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULE A Page of ITEMIZED CONTRIBUTIONS 2 of more than Fifty Dollars($50.00)this period Name of Candidate or Committee:Committee to Elect Jeanne Jackson-Heim Date Received Full Name,Mailing Address and Zip Code of Contributor Cash or Check 10 15 09 1.Enrico, Linda &Andy $ 250.00 i—I 2183 Rockridge Way Boise, ID 83712 $ 250.00 ® General Calendar Year-To-Date 10 15 09 2 Fitzgerald, Ryan $ 100.00 /—/- 348 E. Ironstone Ct. Meridian, ID 83646 $ 100.00 ® General Calendar Year-To-Date 10 15 09 3.Gamblin, Mike $ 50.00 —i - 5727 W. Pheasant Circle Boise, ID 83714 $ 50.00 la General Calendar Year-To-Date 10 15 4 Hartnett, Gail $ 100.00 —L—i 09- 3688 S. Crosspoint Avenue Boise, ID 83706 $ 100.00 M General _ Calendar Year-To-Date 10 15 5. Idaho Assn of REALTORS PAC $ 1 ,000.00 —i 09- 301 S. Capital Blvd. Boise, ID 83702 $ 1 ,000.00 ® General Calendar Year-To-Date 10 15 09 6. IDN Inc. $ 50.00 —/—/- 507 W. Water Grove Dr. Eagle, ID 83616 $ 50.00 ® General Calendar Year-To-Date 7.Lebowitz, Mark $ _10 t______15/.___09 100.00 2716 W. Good Court Boise, ID 83702 $ 100.00 M General_ Calendar Year-To-Date 8. Legarreta, Miguel $ 100.00 10/15/09 2790 S. Velvet Falls Way Meridian, ID 83642 $ 100.00 ® General Calendar Year-To-Date 10 15 09 9 Manship, Greg $ 60.00 —/ i- 9550 W. Bethel 60.00 Boise, ID 83709 $ M General Calendar Year-To-Date 10.Old Town I LLC $ _10 i_15/____09 300.00 839 E. Winding Creek Dr., Suite 201 Eagle, ID 83616 $ 300.00 ® General Calendar Year-To-Date Total This Page: $2,110.00 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULE A Page of ITEMIZED CONTRIBUTIONS 3 13 of more than Fifty Dollars($50.00)this period Name of Candidate or Committee:Committee to Elect Jeanne Jackson-Heim Date Received Full Name,Mailing Address and Zip Code of Contributor Cash or Check 1.Paulson, Jim $ 50.00 _10 15 09/ /— 645 Wickham Fen Way Boise, ID 83709 $ 50.00 ® General Calendar Year-To-Date 10 5 09 2.Pisca, Jeremy $ 250.00 -—/— 9089 W. Beachside Lane Boise, ID 83714 $ 250.00 General Calendar Year-To-Date 10 16 09 3.Retail Development of N. America $ 50.00 - P. 0. Box 2620 Eagle, ID 83616 $ 50.00 a General Calendar Year-To-Date 10 13 09 4.Sedlacek, Lynne $ 100.00 —/ /- 1200 Hereford Dr. Eagle, ID 83616 $ 100.00 • General Calendar Year-To-Date 10 7 09 5.Trinen, Debby $ 50.00 —/ /— 776 Upland Drive Sandpoint, ID 83864 $ 50.00 IE General Calendar Year-To-Date 10 15 09 6.Wood, Mandy $ 50.00 - 11854 W. Silver City Ct. Boise, ID 83713 $ 50.00 • General Calendar Year-To-Date 7. / / ®General Calendar Year-To-Date 8. $ / / IE General Calendar Year-To-Date 9. / / $ ® General Calendar Year-To-Date 10. / / $ $ ® General Calendar Year-To-Date Total This Page: $550.00 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULE B Page of ITEMIZED EXPENDITURES Twenty-Five Dollars($25.00)or more this period Name of Candidate or Committee:Jeanne Jackson-Heim Purpose Codes A All Travel Expenses(Airfare,Fuel,Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries,Benefits&Bonuses L Literature,Brochures,Printing Y Petition Circulators M Management Services Z Preparation&Production of Advertising Date Spent Full Name,Mailing Address and Zip Code of Recipient Purpose Code Cash or Check 1. 0 0 12 09 Saturn Printing, 611 E. 44th, Suite 5, Boise, ID 83714 $ 507.74 / 2. o 10,14/09 Saturn Printing, 611 E. 44th, Suite 5, Boise, ID 83714 $ 212.00 .3 L — 10 14 09 Meridian Resources, P. 0. Box 1671, Boise, ID 83701 $ 874.50 / / 4 F 10 15/09 Laurie Barrerra, 3190 W. Gerrard St., Boise, ID 83703 74.58 / $ 5. / / 6. / / 7. / / 8. / / 9. 10. / / Total This Page: $ 1 ,668.82 Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. SCHEDULE C Page of IN-KIND CONTRIBUTIONS and EXPENDITURES 1 1 Name of Candidate or Committee:Jeanne Jackson-Heim Purpose Codes A All Travel Expenses(Airfare,Fuel,Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries,Benefits&Bonuses L Literature,Brochures,Printing Y Petition Circulators M Management Services Z Preparation&Production of Advertising 1. Contributor Name, Mailing Address and Zip Code 250.00 10/15/09 Barrerra, Laurie $ 3190 W. Gerrard St. $ 250.00 IN General Boise, ID 83703 Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code Purpose Code Barrerra, Laurie 3190 W.Gerrard St. F Boise, ID 83703 $ 250.00 2. Contributor Name, Mailing Address and Zip Code / / $ $ ❑ General Calendar Year-To-Date Expenditure Name,Mailing Address and Zip Code Purpose Code $ 3. Contributor Name, Mailing Address and Zip Code / / $ $ ❑ General Calendar Year-To-Date Expenditure Name,Mailing Address and Zip Code Purpose Code $ 4. Contributor Name, Mailing Address and Zip Code / / $ $ ❑ General Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code Purpose Code $ 0.00 Expenditure Total: (Transfer the combined total of all Expenditures on Schedule C pages $250.00 to the Detailed Summary,page 2 line 8) Contributor Total: $250.00 (Transfer the combined total of all Contributors on Schedule C pages to the Detailed Summary,page 2 line 3) SCHEDULE D LOANS Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campaign, it must be listed as a separate item.Each new loan from any Lender must be listed as a new item from that Lender.You may have the same Lender listed more than once. Except for a candidate making a loan to his or her own campaign, loans from any Lender cannot exceed contribution limits laid out in Section 67-6610A,Idaho Code,even if it is repaid in full. Any loan(s)with a balance(s)appearing on the last report must be listed below with the amount in the Previous Balance column.Any new loan amounts should be listed in the New Loan column.Any interest accrued should be listed in the Interest Accrued column.If a payment was made on the loan,list it in the Repayments column. Note: Any loan that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus new loans and accrued interest less any repayments. Name,Mailing Address and Zip Previous Balance New Loan amount Interest accrued Repayments of Loan Balance Code of Lender of loan at the received during this during this during this reporting outstanding at (Candidate,Individual or Business) end of the last reporting period reporting period period the end of this reporting period reporting period 1. Jeanne Jackson-Heim Date: Date: 463 Moraine Place 0.00 10 •/14 /09 0.00 —/—/— 1,000.00 Eagle, ID 83616 Amount: Amount: Candidate $1,000.00 $ 0.00 2 Date: Date: 0.00 10 /1 /09 0.00 / / 128.78 Jeanne Jackson-Heim(candidate) Amount: Amount: $ 128.78 $ 0.00 3 Date: Date: / / / / Amount: Amount: $ $ - 4 Date: Date: / / / / Amount: Amount: $ $ 5 Date: Date: / / / / Amount: Amount: $ $ - 6 Date: Date: / / / / Amount: Amount: $ $ 7 Date: Date: / / / / Amount: Amount: $ $ -- Previous Received Interest Repayments Ending Balance Previous Total.$0.00 Received Total: (Transfer the combined total of all received loans to the $ 1 ,128.78 Detailed Summary,page 2 line 4) Interest Total: $0 Repayments Total: (Transfer the combined total of all loan repayments to the $0.00 Detailed Summary,page 2 line 9&16) Ending Balance Total: $ 1 ,128.78 (NOTE:Transfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary,page 2 line 13) SCHEDULE E CREDIT CARDS and DEBT Each incurred expense not yet paid(i.e. credit card purchases and debt)should be listed on a separate line. Each time you make purchases with a credit card or incur debt,it is considered to be a separate item.However,you will maintain a single item for each credit card and add purchases to that item. Each Creditor listed below with a New Debt amount must have a Schedule E-1 accompanying it.The Schedule E-1 lists where and when the debt was incurred. Credit Cards are considered debt to the campaign. Regardless of whether the credit card is repaid when the statement is received, all credit card transactions will appear on Schedule E and E-1.However,only Repayments of Debt during this reporting period appear in the Expenditure Section of the Detailed Summary Page. Any creditor(s)with a balance(s)appearing on the last report must be listed below with the amount in the Previous Balance column.Any new debt should be listed in the New Debt column,including any accrued interest.If a payment was made on the debt,list it in the Repayments column.Note: Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus New Debt less any Repayments of Debt. Name,Mailing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debt Balance outstanding Creditor debt at the end of the incurred during this during this reporting at the end of this (Candidate,Individual or Business) last reporting period reporting period period reporting period 1 0.00 Date: Date: 17.60 10 /5 /09 / /_ Jeanne Jaccson-Heim personal VISA(kndidate) Amount: Amount: $ 17.60 $ 2. Date: 0.00 Date:/ 6 /09 / / 1,320.00 Jeanne Jackson-Heim personal VISA(candidate) Amount: Amount: $ 1,320.00 $ 3. Date: Date: / / / / Amount: Amount: $ $ 4. Date: Date: / / / / Amount: Amount: $ $ 5. Date: Date: / I / / Amount: Amount: $ $ 6. Date: Date: / / / /_ Amount: Amount: $ $ Previous Incurred Repayments Ending Balance Previous Total: $0.00 Incurred Total: (Transfer the combined total of all incurred debt to the $ 1 ,337.60 Detailed Summary,page 2 line 14) Repayments Total: (Transfer the combined total of all debt repayments to the $0.00 Detailed Summary,page 2 line 10&17) C Ending Balance Total: $ 1 ,337.60 SCHEDULE E-1 Page of CREDIT CARD and DEBT ITEMIZATION I1 Name of Creditor from Schedule E:Jeanne Jackson-Heim personal VISA Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it.The Schedule E-1 lists where and when the debt was incurred. Purpose Codes A All Travel Expenses(Airfare,Fuel,Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries,Benefits&Bonuses I Interest Accrued&Finance Charges Y Petition Circulators L Literature,Brochures,Printing Z Preparation&Production of Advertising M Management Services Date Incurred Full Name,Mailing Address and Zip Code of Expenditure Purpose Code Amount 1. 10 6 09 Valice, 902 W. Hays, Boise, ID 83702 Z 1 ,320.00 2. 10 5 09 US Postal Service, Boise, Idaho 83702 P 17.60 1 I $ 3. / / 4. / / 5. / / _ $ 6. / / $ 7. / / 8. / / 9. / / Total This Page: $ 1 ,337.60 The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor. R vow rim —.1 CITY OF EAGLE -. CAMPAIGN FINANCIAL DISCLOSURE REPORT C-2 SUMMARY PAGE NOV 3 0 2(0010/07 a * '± (Please Print or Type) ��uu'�� It-k3-'rc� ' File: sf Routs to: Section I Name of Candidate or Political Committee and Chairperson Office Sought(if candidate) Seat(if any) Jeanne Jackson-Heim City Council Mailing Address City and Zip Home Phone Work Phone 463 Moraine Place Eagle, ID 83616 208-255-6399 Name of Political Treasurer Jeanne Jackson-Heim Mailing Address City and Zip Home Phone Work Phone Same Change of address for: Candidate or Political Committee ❑ Political Treasurer 0 Section II TYPE OF REPORT This filing is an: MI Original ❑ Amendment This report is for the period from 10 /19 /2009 2009 through 11 /13 2009 ❑ October 10 Pre-General Report ❑ 7 Day Pre-General Report IN 30 Day Post-General Report ❑ Annual Report Is this a Termination Report: El Yes p No Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contributions or expenditures during this reporting period,check the box next to the statement below and sign this report. Be sure to carry forward the appropriate"Calendar Year to Date"figures in Column II,Section IV. ❑ I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I COLUMN I COLUMN II figures to the Column II figures of your previous report(except on line 6). This Period Calendar Year to Date Line 1:Cash on Hand January 1,This Calendar Year* $ XXXXXX $ 0.00 Line 2:Enter Beginning Cash Balance** $ 4,169.96 $ XXXXXX Line 3:Total Contributions(Enter amount from line 5,page 2) $ 1,750.00 $ 7,838.78 Line 4:Subtotal(Add lines 1,2 and 3) $ 5,919.96 $ 7,838.78 Line 5:Total Expenditures(Enter amount from line 11,page 2) $ 5,553.45 $ 7,472.27 Line 6:Enter Ending Cash Balance(Subtract line 5 from line 4) $ 366.51 $ 366.51 Line 7:Outstanding Debt to Date(Enter amount from line 18,page 2) $ 0.00 *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed.If this is your first report,this amount is 0. Note:The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V Jeanne Jackson-Heim ,hereby certify that the information in this Name of Political Treasurer report is a true,complete and correct Campaign Financial Disclosure Report as required by law. gt cage1 C � � Signature of Political Treasurer Page 1 DETAILED SUMMARY Name of Candidate or Committee:Jeanne Jackson-Heim Total This Period Contributions 0 Unitemized Contributions($50 and less) #of Contributors o.00 + $0.00 0 Itemized Contributions(Total of all Schedule A sheets) + $1,750.00 30 In-Kind Contributions(Total of all Contribution amounts from Schedule C sheets) + $0.00 0 Loans(Total of all New Loan amounts from Schedule D sheets) + $0.00 50 Total Contributions(Transfer this figure to page 1,Section IV, Line 3) _ $1,750.00 Expenditures 0 Unitemized Expenditures($25 and less) #of Expenditures o.00 + $0.00 70 Itemized Expenditures(Total of all Schedule B sheets) + $3,087.07 0 In-Kind Expenditures(Total of all Expenditure amounts from Schedule C sheets) + $0.00 O Loan Repayments(Total of all Loan Repayment amounts from Schedule D sheets) + $1,128.78 10 Credit Card and Debt Repayments(Total of all Repayment amounts from Schedule E sheets) + $1,337.60 11 Total Expenditures(Transfer this figure to page 1,Section IV, Line 5) _ $5,553.45 Loans,Credit Cards and Debt 12 Outstanding Balance from previous reporting period + $2,466.38 13 New Loans received during this reporting period O.00 (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) + $ 14 New Credit Card and Debt incurred this reporting period (Total of all New Incurred Debt amounts from Schedule E sheets) + $0.00 15 Subtotal = $2,466.38 Repayments of Loans made during this reporting period 16 (Total of all Loan Repayment amounts from Schedule D sheets) - s-1 ,128 78 CD Repayments of Credit Card and Debt this reporting period (Total of all Debt Repayment amounts from Schedule E sheets) - s-1 ,337 60 1 g Total Outstanding Balance at close of this period(Transfer this figure to page 1,Section IV, Line 7) _ $0.00 Pledged Contributions 0 Unitemized Pledged Contributions($50 and less) #of Pledges 0.00 + $0.00 @0 Itemized Pledged Contributions this Period(Total of all Schedule F sheets) + $0.00 Total Pledged Contributions this period = $0.00 Page 2 SCHEDULE A Page of ITEMIZED CONTRIBUTIONS 1 of more than Fifty Dollars($50.00)this period Name of Candidate or Committee: Jeanne Jackson-Heim Date Received Full Name,Mailing Address and Zip Code of Contributor Cash or Check 1. 100.00 10/24/09 Allen, Gary $ 1601 Garfield St. $ 100.00 ® General Boise, ID 83706 Calendar Year-To-Date 11 02 09 2.Boise Hunter Homes $ 300.00 -/-/- 1025 W. Bridgeway Place, Suite 290 Eagle, ID 83616 $ 300.00 ® General Calendar Year-To-Date 10 23 09 3' Fereday, Jeff C. $ 400.00 -/ /- P. 0. Box 2720 Boise, ID 83701 $ 400.00 a General _Calendar Year-To-Date 10 30 09 4.Priddy, Edward $ 250.00 _i_/_ P. 0. Box 4817 250.00 Boise, ID 83711-4817 $ WI General Calendar Year-To-Date 10 30 09 5.Priddy, John A. $ 250.00 -/ /- 10376 Hinsdale Ct. Boise, ID 83704 $ 250.00 ® General -- CalendarYear-To-Date 10,25 09 6.Seibert, Kail Q. $ 200.00 / /- 2807 Homer Road Eagle, ID 83616 $ 200.00 ® General Calendar Year-To-Date 10 30 09 7.Tate, Mark $ 100.00 -/ /- 1918 E. Spring Meadow Lane Boise, ID 83706 $ 100.00 ® General Calendar Year-To-Date 8.Windermere Real Estate $ 100.00 11 /13/09 501 West Front St. Boise, ID 83702 $ 100.00 8 General Calendar Year-To-Date 10 22 09 9.Yzaguirre, Rick $ 50.00 /-/- P. 0. Box 907 Eagle, ID 83616 $ 50.00 ® General Calendar Year-To-Date - 10. / / $ ❑ General $ Calendar Year-To-Date Total This Page: $1,750.00 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULE B Page of ITEMIZED EXPENDITURES 1 I1 Twenty-Five Dollars($25.00)or more this period Name of Candidate or Committee:Jeanne Jackson-Heim Purpose Codes A All Travel Expenses(Airfare,Fuel,Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries,Benefits&Bonuses L Literature,Brochures,Printing Y Petition Circulators M Management Services Z Preparation&Production of Advertising Date Spent Full Name,Mailing Address and Zip Code of Recipient Purpose Code Cash or Check 1. P 10/28/09 ESP Printing & Mailing, 317 E. 37th St., Boise, ID 83714 $ 1 ,020.14 2. L 11 /10/09 ESP Printing & Mailing, 317 E. 37th St., Boise, ID 83714 $ 1 ,284.91 3. o 10/30/09 Meridian Resources, P. 0. Box 1671, Boise, ID 83701 $ 402.60 4. L 10/19/09 Staples, 6299 Eagle Road, Boise, ID 83713 $ 20.67 5. Z - 11 /13/09 Valice, 2741 Airport Way, Boise, ID 83705 $ 318.75 6. N 10/30/09 Valley Times, P. O. Box 1970, Eagle, ID 83616 40 00 $ 7. / /_ $ - 8. / / $ 9. / / _$ 10. / / Total This Page: $3,087.07 Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. SCHEDULE C IPage of IN-KIND CONTRIBUTIONS and EXPENDITURES I1 1 Name of Candidate or Committee:Jeanne Jackson-Heim Purpose Codes A All Travel Expenses(Airfare,Fuel, Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries.Benefits&Bonuses L Literature, Brochures.Printing Y Petition Circulators M Management Services Z Preparation&Production of Advertising Contributor Name. Mailing Address and Zip Code I 8 ❑ General Calendar Year-To-Date Expenditure Name. Mailing Address and Zip Code Purpose Code 2. Contributor Name, Mailing Address and Zip Code / $ ❑ General te Calendar Year-To-DatT_4 Expenditure Name, Mailing Address and Zip Code Purpose Code 3. Contributor Name. Mailing Address and Zip Code / / ❑ General Calendar Year-To-Date Expenditure Name. Mailing Address and Zip Code Purpose Code � I 4. Contributor Name, Mailing Address and Zip Code / ❑ General Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code Purpose Code I f � s 0.00 i Expenditure Total: I (Transfer the combined total of all Expenditures on Schedule C pages $0.00 to the Detailed Summary,page 2 line 8) -- — Contributor Total: i$0.00 (Transfer the combined total of all Contributors on Schedule C pages to the Detailed Summary,page 2 line 3) ' — SCHEDULE D LOANS Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campaign, it must be listed as a separate item.Each new loan from any Lender must be listed as a new item from that Lender.You may have the same Lender listed more than once. Except for a candidate making a loan to his or her own campaign, loans from any Lender cannot exceed contribution limits laid out in Section 67-6610A, Idaho Code,even if it is repaid in full. Any loan(s)with a balance(s)appearing on the last report must be listed below with the amount in the Previous Balance column.Any new loan amounts should be listed in the New Loan column.Any interest accrued should be listed in the Interest Accrued column.If a payment was made on the loan,list it in the Repayments column. Note: Any loan that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus new loans and accrued interest less any repayments. Name,Mailing Address and Zip Previous Balance New Loan amount Interest accrued Repayments of Loan Balance Code of Lender of loan at the received during this during this during this reporting outstanding at (Candidate,Individual or Business) end of the last reporting period reporting period period the end of this reporting period reporting period 1. Jeanne Jackson-Heim Date: Date: 463 Moraine Place 28.78 / / 0.00 11 /11 /09 Eagle, ID 83616 Amount Amount: Candidate $o.00 $ 1.000.00 2 Date: Date: I / 0.00 11 /,s /os 0.00 Same Amount: Amount: $ $ 128.78 3 Date: Date: I l I / Amount: Amount: $ $ 4. Date: Date: / / / / Amount: Amount: $ $ 5 Date: Date: / I / / Amount Amount: $ $ 6. Date: Date: / / / / Amount: Amount: $ $ 7 Date: Date: / / / / Amount: Amount: $ $ Previous Received Interest Repayments Ending Balance Previous Total: $ 1 ,128.78 Received Total: (Transfer the combined total of all received loans to the $ 0.00 Detailed Summary,page 2 line 4) Interest Total: $0 Repayments Total: p Q (Transfer the combined total of all loan repayments to the $ I.1 .1, 1 28.78 Detailed Summary,page 2 line 9&16) Ending Balance Total: $0.00 (NOTE:Transfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary,page 2 line 13) SCHEDULE E CREDIT CARDS and DEBT Each incurred expense not yet paid(i.e. credit card purchases and debt)should be listed on a separate line. Each time you make purchases with a credit card or incur debt,it is considered to be a separate item.However,you will maintain a single item for each credit card and add purchases to that item. Each Creditor listed below with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Credit Cards are considered debt to the campaign. Regardless of whether the credit card is repaid when the statement is received, all credit card transactions will appear on Schedule E and E-1.However.only Repayments of Debt during this reporting period appear in the Expenditure Section of the Detailed Summary Page. Any creditor(s)with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column.Any new debt should be listed in the New Debt column,including any accrued interest. If a payment was made on the debt,list it in the Repayments column. Note: Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus New Debt less any Repayments of Debt. Name,Mailing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debt Balance outstanding Creditor debt at the end of the incurred during this during this reporting at the end of this (Candidate, Individual or Business) last reporting period reporting period period reporting period 1. 1,337.60 Date: Date: 11 0s I I I I 0,00 Jeanne Jackson-Heim personal VISA(candidate) Amount: Amount. $ 0.00 $ 1,337.60 2. Date: Date: / I / / Amount: Amount: $_ $ 3 Date: Date: / I / / Amount: Amount: $ S 4. Date: Date: / { / / Amount: Amount: 5. Date: Date: / I / / Amount: Amount: $ $ 6. Date: Date: I I I / Amount: Amount: $ $ Previous Incurred Repayments Ending Balance Previous Total: $ 1 ,337.601 Incurred Total: (Transfer the combined total of all incurred debt to the $0.00 Detailed Summary,page 2 line 14) Repayments Total: I (Transfer the combined total of all debt repayments to the $ 1 7 337.60 Detailed Summary.page 2 line 10& 17) _ I Ending Balance Total: $0.00 SCHEDULE El !Page of CREDIT CARD and DEBT ITEMIZATION 11 1 Name of Creditor from Schedule E:Jeanne Jackson-Heim Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it.The Schedule E-1 lists where and when the debt was incurred. Purpose Codes A All Travel Expenses(Airfare, Fuel,Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs, Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages.Salaries.Benefits&Bonuses I Interest Accrued&Finance Charges Y Petition Circulators L Literature. Brochures. Printing Z Preparation&Production of Advertising M Management Services Date Incurred ; Full Name.Mailing Address and Zip Code of Expenditure Purpose Code I Amount H.� i I I � i 1 I !2. — - i ----1 ! � I I _ I 4, i I 5. I j I 6 i 1 7. i ! I I 8. I I i l 9. / Total This Page: $0.00 The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor. SCHEDULE F !Page of PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED -_ j Candidate or Committee: Name of Can Jeanne Jackson-Heim Directions:Complete this schedule if you were promised and agreed to accept a contribution during this reporting period but have not actually received the money. goods or services offered before the end of the reporting period. Do not include these entries on Schedule A until you actually receive the contribution. Pledged For Date Pledged Full Name,Mailing Address and Zip Code of Contributor Amount Pledged I j 1 �1. i f ! i ❑ General I 2. ❑ General I I j3. ❑ General / ❑ General ❑ General I-- I — -- ❑ General / f I ❑ General 1 — 8- ❑ General I 19. ❑ General 10. ❑ General 1 ' 11, ! I ❑ General j h -- - -� Total Amount of Pledged Contributions: $ 0.00 Transfer the combined total of all Schedule F pages to the Detailed Summary on page 2 line 20. RECEIVED & FILED CITY OF EAG.LE Y1 . CAMPAIGN FINANCIAL DISCLOSURE REPORT , Rev.10107 ; SUMMARY PAGE ; ,, rG ; (Please Print or Type) JAN 1 3 ga FII.: Section I Route ; Name of Candidate or Political Committee and Chairperson Office Sought(if candidate) - Coot(of ry) Jeanne Jackson-Heim City Council Mailing Address City and Zip Home Phone Work Phone 463 Moraine Place Eagle 83616 208-255-6399 Name of Political Treasurer Jeanne Jackson-Heim Mailing Address City and Zip Home Phone Work Phone Same Change of address for: Candidate or Political Committee ❑ Political Treasurer ❑ Section II TYPE OF REPORT This filing is an: El Original ❑ Amendment This report is for the period from 11 /14 /2009 through 12 /31 2009 ❑ October 10 Pre-General Report ❑ 7 Day Pre-General Report ❑ 30 Day Post-General Report ❑ Annual Report Is this a Termination Report: ❑ Yes '4 No Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contributions or expenditures during this reporting period,check the box next to the statement below and sign this report. Be sure to carry forward the appropriate"Calendar Year to Date"figures in Column II,Section IV. ❑ I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I COLUMN I COLUMN II figures to the Column II figures of your previous report(except on line 6). This Period Calendar Year to Date Line 1:Cash on Hand January 1,This Calendar Year* $ XXXXXX $ 0.00 Line 2:Enter Beginning Cash Balance** $ 366.51 $ XXXXXX Line 3:Total Contributions(Enter amount from line 5,page 2) $ 0.00 $ 7,838.78 Line 4:Subtotal(Add lines 1,2 and 3) $ 366.51 $ 7,838.78 Line 5:Total Expenditures(Enter amount from line 11,page 2) $ 250.00 $ 7,722.27 Line 6:Enter Ending Cash Balance(Subtract line 5 from line 4) $ 116.51 $ 116.51 Line 7:Outstanding Debt to Date(Enter amount from line 18,page 2) $ 0.00 *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. If this is your first report,this amount is 0. Note:The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V Jeanne Jackson-Heim ,hereby certify that the information in this Name of Political Treasurer report is a true,complete and correct Campaign Financial Disclosure Report as required by law. v. LQ�it,/�LXl x"71 ~ , pT�-i Signature of Political Treasurer Page 1 DETAILED SUMMARY Name of Candidate or Committee:Jeanne Jackson-Helm Total This Period Contributions 1O Unitemized Contributions($50 and less) #of Contributors + $0.00 0 Itemized Contributions(Total of all Schedule A sheets) + $0.00 3� In-Kind Contributions(Total of all Contribution amounts from Schedule C sheets) + $0.00 Loans(Total of all New Loan amounts from Schedule D sheets) + $0.00 0 Total Contributions(Transfer this figure to page 1,Section IV, Line 3) _ $0.00 Expenditures © Unitemized Expenditures($25 and less) #of Expenditures + $0.00 O Itemized Expenditures(Total of all Schedule B sheets) + $250.00 ( In-Kind Expenditures(Total of all Expenditure amounts from Schedule C sheets) + $0.00 O Loan Repayments(Total of all Loan Repayment amounts from Schedule D sheets) + $0.00 10 Credit Card and Debt Repayments(Total of all Repayment amounts from Schedule E sheets) + $0.00 11 Total Expenditures(Transfer this figure to page 1, Section IV, Line 5) _ $250.00 Loans, Credit Cards and Debt 12 Outstanding Balance from previous reporting period + $0.00 13 New Loans received during this reporting period (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) + $0.00 14 New Credit Card and Debt incurred this reporting period 0.00 (Total of all New Incurred Debt amounts from Schedule E sheets) + $ 15 Subtotal = $0.00 Repayments of Loans made during this reporting period 16 (Total of all Loan Repayment amounts from Schedule D sheets) - $0.00 Repayments of Credit Card and Debt this reporting period 17 (Total of all Debt Repayment amounts from Schedule E sheets) - $0.00 1 g Total Outstanding Balance at close of this period(Transfer this figure to page 1,Section IV, Line 7) _ $0.00 Pledged Contributions 19 Unitemized Pledged Contributions($50 and less) #of Pledges + $ Itemized Pledged Contributions this Period(Total of all Schedule F sheets) + $ g Total Pledged Contributions this period = $0.00 Page 2 SCHEDULE B Page of ITEMIZED EXPENDITURES 1 11 Twenty-Five Dollars($25.00)or more this period Name of Candidate or Committee:Jeanne Jackson-Heim Purpose Codes A All Travel Expenses(Airfare,Fuel, Lodging&Mileage) N Newspaper&Other Periodical Advertising B Broadcast Advertising(Radio,TV&Internet) 0 Other Advertising(Yard Signs,Buttons,etc.) C Contributions to Candidates&PAC's P Postage D Donations&Gifts S Surveys&Polls E Event Expenses T Tickets(Events) F Food&Refreshments U Utilities G General Operational Expenses W Wages,Salaries,Benefits&Bonuses L Literature,Brochures,Printing Y Petition Circulators M Management Services Z Preparation&Production of Advertising Date Spent Full Name,Mailing Address and Zip Code of Recipient Purpose Code Cash or Check 1. C 12/05/09 Idaho Assn of REALTORS PAC,301 S.Capitol Blvd, Boise, ID 83702 $ 250.00 2. / / $ 3. / / 4. / / $ 5. / / $ 6. / / $ 7. / / $ 8. / / $ 9. / / $ 10. / / $ Total This Page: $250.00 Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. CAMPAIGN FINANCIAL DISCLOSURE REPORT SUMMARY PAGE (Please Print or Type) Section I Name of Candidate or Political Committee and Chairperson Jeanne Jackson -Heim Mailing Address 463 Moraine Place Name of Political 1 reasurer Jeanne Jackson -Heim Mailing Address Same Change of address for: RECEIVED & FILED CITY OF EAGLE DEC 0 6 2010 Flier Route tri• Office Sought (n candidate) City Council City and up home Pnone Eagle 83616 208-255-6399 City ano Lip Candidate or Political Committee ❑ Political Treasurer Section II TYPE OF REPORT This filing is an: ® Original ❑ Amendment This report is for the period from 01 / 01 / 2010 through 12 / 31 / 2010 . ❑ 7 Day Pre -Primary Report ❑ 7 Day Pre -General Report ❑ 30 Day Post -Primary Report ❑ 30 Day Post -General Report ❑ Semi -Annual Report (Statewide Candidates Only) Is this a Termination Report: ® Yes ❑ No Home Phone C-2 R w 10/07 District (if any) Eaqle Work Ph 208-955-8481 Work Phone ❑ October 10 Pre -General Report Annual Report Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: If you had no contribufions or expenditures during this reporting period, check the box next to the statement below and sign this report. Be sure to carry forward the appropriate "Calendar Year to Date" figures in Column II, Section IV. ❑ I hereby certify that I have received no contributions and have made no expenditures during this reporting period. Section IV SUMMARY To reach your Calendar Year to Date figure: Add this report's Column I COLUMN I figures to the Column 1I figures of your previous report (except on line 6). This Period Line 1: Cash on Hand January 1, This Calendar Year* Line 2: Enter Beginning Cash Balance** Line 3: Total Contributions (Enter amount from line 5, page 2) Line 4: Subtotal (Add lines 1, 2 and 3) Line 5: Total Expenditures (Enter amount from line 11, page 2) Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4) Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) $ XXXXXX 116.51 0.00 $ 116.51 $ $ 116.51 $ $ 0.00 $ 0.00 $ $ COLUMN II Calendar Year to Date 116.51 XXXXXX 0.00 116.51 116.51 0.00 *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. If this is your first report, this amount is 0. Note: The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V Return This Report To: Ben Ysursa Secretary of State PO Box 83720 Boise ID 83720.0080 Phone: (208) 334-2852 Fax: (208) 334-2282 Jeanne Jackson -Heim Name of Political Treasurer report is a true, complete and correct Campaign Financial Disclosure Report as required by law. . hereby certify that the information in this 1912 -- Signature of Political Treasurer 1Nameof Candidate or Committee: DETAILED SUMMARY J eA n e_ 3izc-So r1- c vv‘ Expenditures Unitemized Expenditures (less than $25) # of Expenditures + $ 0.00 Itemized Expenditures (Total of all Schedule B sheets) + $ 116.51 In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) + $ 0.00 + $ 0.00 + $ 0.00 Loans, Credit Cards and Debt Outstanding Balance from previous reporting period $ 0.00 New Loans received during this reporting period (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) $ 0.00 New Credit Card and Debt incurred this reporting period (Total of all New Incurred Debt amounts from Schedule E sheets) Subtotal $ 0.00 $ 0.00 Repayments of Loans made during this reporting period (Total of all Loan Repayment amounts from Schedule D sheets) $ 0.00 Repayments of Credit Card and Debt this reporting period (Total of all Debt Repayment amounts from Schedule E sheets) $ 0.00 Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section IV, Line 7) $ 0.00 ; Pledged Contributions Unitemized Pledged Contributions ($50 and less) # of Pledges + $ 0.00 Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $ 0.00 Total Pledged Contributions this period = $ 0.00 Total This Period Contributions Unitemized Contributions ($50 and less) # of Contributors + $ 0.00 Itemized Contributions (Total of all Schedule A sheets) + $ 0.00 In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) + $ 0.00 Loans (Total of all New Loan amounts from Schedule D sheets) + $ 0.00 Total Contributions (Transfer this figure to page 1, Section IV, Line 3) _ $ 0.00 Expenditures Unitemized Expenditures (less than $25) # of Expenditures + $ 0.00 Itemized Expenditures (Total of all Schedule B sheets) + $ 116.51 In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) + $ 0.00 + $ 0.00 + $ 0.00 Loans, Credit Cards and Debt Outstanding Balance from previous reporting period $ 0.00 New Loans received during this reporting period (Total of all New Loan amounts plus Accrued Interest from Schedule D sheets) $ 0.00 New Credit Card and Debt incurred this reporting period (Total of all New Incurred Debt amounts from Schedule E sheets) Subtotal $ 0.00 $ 0.00 Repayments of Loans made during this reporting period (Total of all Loan Repayment amounts from Schedule D sheets) $ 0.00 Repayments of Credit Card and Debt this reporting period (Total of all Debt Repayment amounts from Schedule E sheets) $ 0.00 Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section IV, Line 7) $ 0.00 ; Pledged Contributions Unitemized Pledged Contributions ($50 and less) # of Pledges + $ 0.00 Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $ 0.00 Total Pledged Contributions this period = $ 0.00 SCHEDULE B ITEMIZED EXPENDITURES Twenty -Five Dollars ($25.00) or more this period Page je of 1 I1 Name of Candidate or Committee: Committee to Elect Jeanne Jackson -Heim Purpose Codes A All Travel Expenses (Airfare, Fuel, Lodging & Mileage) N Newspaper & Other Periodical Advertising B Broadcast Advertising (Radio, TV & Internet) 0 Other Advertising (Yard Signs, Buttons, etc.) C Contributions to Candidates & PAC's P Postage D Donations & Gifts S Surveys & Polls E Event Expenses T Tickets (Events) F Food & Refreshments U Utilities G General Operational Expenses W Wages, Salaries, Benefits & Bonuses L Literature, Brochures, Printing Y Petition Circulators M Management Services Z Preparation & Production of Advertising Date Spent Full Name, Mailing Address and Zip Code of Recipient Purpose Code Cash or Check 1. Town Branch Hope Center 5842 KY RT 2030 D Honaker, KY 41603 2. 12/ 05/10 $ 116.51 $ Total This Page: $ 116.51 Transfer the combined total of all Schedule B oases to the Detailed Summary on one 2 line 7.