30 Day Post-General - Darnall, Jerry - 12/1/20112/0112011 11:24 Darnall & Assoc. (F ,. P.0011009
RECEIVED
CITY 0
_._ _e.,- . ........._. _.
CAMPAIGN FINANCIAL DISCLOSURE REPOR
SUMMARY PAGE File:
(Please Print or Type) Rowe to:
Section I
C-2
10107
Name ofate or Pol t1 'flee and ChakWt
COLUMN ii
This Period
ht (rT / Seat (if arty)
'
to Date
$ XXXXXX
_te)
`
�9h
1 lJ win "'n
rjZZ, Uny a
p
me e
Nam reasu
$
$ C:zn(-)
$ I ooa 0
r /
$ 5h•Ca
/I Llblliv v
y and
p
Horne Phone
4l& 9, i�
work Phone
y(g 4)L/
Change of address for. Candidate or PollticA
Committee E]el
Political Treasurer
❑
Section II TYPE OF REPORT
This filing Is an: .11�origlnal ❑ Amendment
This report Is for the period from L_lw�q k.,70 // through l oi0
❑ October 10 Pre -General Report
❑ Annual Report
Is this a Termination Report: ❑ Yes
❑ 7 Day Pre -General Report
❑ No
'd30 Day Post -General Report
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 il, 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
figures to the Column II figures of your previous report (except on line 6).
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)
COLUMNI
COLUMN ii
This Period
Calendar Year
to Date
$ XXXXXX
$
$ �'
$ XXX )=
$_5) �oo
$
$ C:zn(-)
$ I ooa 0
$ 56.00
$ 5h•Ca
'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 dosing cash balance for the current reporting period appears on the next report as the beginning cash on hand.
Section V
Return This Report To:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, ID 83616
(208) 939-6813
Fax: (208)939-6827
i, �r�f✓ F 1"1 Ute_, hereby certify that the information in this
Name of Poritical Treasurer
report is a true, complete and correct Campaign Financial Disclos a Report as required bylaw.
Signature of 011fical Treasurer
Page 1
1210112011 11:24 Darnall & Assoc.
12
13
14
15
16
17
18
DETAILED SUMMARY
Name of Candidate or Committee: lie r Q r
(FAX)208 846 8377 P.0021009
Expenditures
Total This Period
Contributions
+ $ O
Unitemized Contributions ($50 and less) # of Contributors �_
+ $ /5-0-00
Itemized Contributions (Total of all Schedule A sheets)
+ $ (),00
In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets)
+ $ •00
Loans (Total of all New Loan amounts from Schedule D sheets)
+ $
Total Contributions (Transfer this figure to page 1, Section IV, Line 3)
_ $
Expenditures
W
Unitemized Expenditures ($25 and less) # of Expenditures �_
+ $ O
Itemized Expenditures (Total of all Schedule B sheets)
+ $
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)
+ $ 0 C
Total Expenditures (Transfer this figure to page 1, Section IV, Line 5)
= $ O
Loans, Credit Cards and Debt
W
Unitemized Pledged Contributions ($50 and less) # of Pledges T
Outstanding Balance from previous reporting period
+ $
60 n
New Loans received during this reporting period
(Total of all New Loan amounts plus Accrued Interest from Schedule D sheets)
+ $
New Credit Card and Debt incurred this reporting period
(Total of all New Incurred Debt amounts from Schedule E sheets)
+ $
0 ,
Subtotal
= $
Repayments of Loans made during this reporting period
(Total of all Loan Repayment amounts from Schedule D sheets)
- $
Repayments of Credit Card and Debt this reporting period
(Total of all Debt Repayment amounts from Schedule E sheets)
- $
(�
Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section IV, Line 7)
_ $
Pledged Contributions
W
Unitemized Pledged Contributions ($50 and less) # of Pledges T
+ $ O p
Itemized Pledged Contributions this Period (Total of all Schedule F sheets)
+ $ 000
Total Pledged Contributions this period
= $
Page 2
1210112011 11:25 Darnall & Assoc. (FAX)208 846 8377 P.0031009
SCHEDULE A vage
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee: ` r
Date Received
Full NarrA, Mailing Address and Zip Code of Contributor
Cash or Check
! /
1.
$
Calendar Year -To -Date
2.
$
Calendar Year -To -Date
3.
Calendar Year -To -Date
!
4.
$
$
Calendar Year -To -Date
I I
5.
$
$
Calendar Year -To -Date
—! !
6.
$
Calendar Year -To -Date
I I
7.
$
$
Calendar Year -To -Date
I !
8.
Calendar Year -To -Date
/ I
9.
$
Calendar Year -To -Dale
1 /
10.
$
$
Calendar Year -To -Date
Total This Page:
Is
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.
1210112011 11:26 Darnall & Assoc. (FAX)208 846 8377 P.0041009
Date Spent
Full Name, Mailing Address and Zip Code of Recipient
SCHEDULE B I
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
Name of Candidate or Committee:
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 & Polis
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.
2.
—�
$
3.
l�l
$
4.
5.
6.
7.
I I
$
8.
I I
$
9.
I I
$
10.
Total This Page:
$
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.
12101/2011 11:26 Darnall & Assoc. (FAX)208 846 8377
SCHEDULE C
IN-KIND CONTRIBUTIONS and EXPENDITURES
age
P.0051009
IName of Candidate or Committee:
Contributor Name, Mailing Address and Zip Code
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 & Palls
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
I /
$
Calendar Year -To -Dale
Expenditure Name, Mailing Address and Zip Code
Purpose Code
$
2.
Contributor Name, Mailing Address and Zip Code
Calendar Year -To Date
Expenditure Name, Mailing Address and Zip Code
Purpose Code
3.
Contributor Name, Mailing Address and Zip Code
1 1
$
$
CalendarYear-To-Dale
Expenditure Name, Mailing Address and Zip Code
Purpose Code
$
4.
Contributor Name, Mailing Address and Zip Code
/ !
$
$
Calendar Year -To -Date
Expenditure Name, Mailing Address and Zip Code
Purpose Code
$
Expenditure Total:
(Transfer the combined total of all Expenditures on Schedule C pages $
to the Detailed Summary, page 2 line 8)
Contributor Total:
(Transfer the combined total of all Contributors on Schedule C pages
to the Detailed Summary, page 2 line 3)
1210112011 11:27 Darnall & Assoc. (FAX)208 846 8377 P.0061009
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 f 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 InterestAccrued 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,
Date:
Date:
I l
l I
Amount:
Amount:
2.
Date:
Date:
Amount:
Amount:
3
e:
Date:
I I
I I
Amount:
Amount:
4.
Date:
Date:
Amount:
Amount:
5.
Date:
ate:
Amount:
Amount:
6.
Date:
Date:
Amount
Amount:
7.
Date:
Date:
Amount:
Amount:
Previous Received Interest Repayments Ending Balance
Previous Total $
Received Total:
(Transfer the combined total of all received loans to the $
Detailed Summary, page 2 line 4)
Interest Total: $
Repayments Total:
(Transfer the combined total of all loan repayments to the $
Detailed Summary, page 2 line 9 & 16)
Ending Balance Total: $
(NOTE: E: I ransfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary, page 2 line 13)
1210112011 11:27 Darnall & Assoc. (FAX)208 846 8377 P.0071009
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 [his reporting period appear in the Expenditure Section of
the Detailed Summary Page.
Any creditors) 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)
fast reporting period
reporting period
period
reporting period
1.
Date:
Date:
Amount:
Amount:
2.
Date:
Date:
I_I
l l
Amount:
Amount:
3.
Date:
Date:
Amount:
Amount:
4.
Date:
Date:
Amount:
Amount:
5.
Date:
Date:
Amount:
Amount:
6.
Date:
Date:
Amount:
Amount:
$
$
Previous Incurred Repayments Ending Balance
Previous Total: $
Incurred Total:
(Transfer the combined total of all incurred debt to the $
Detailed Summary, page 2 line 14)
Repayments Total:
(Transfer the combined total of all debt repayments to the $
Detailed Summary, page 2 line 10 & 17)
Ending Balance Total: $
12/01/2011 11:28 Darnall & Assoc. (FAX)208 848 8377 P.008/009
SCHEDULE E-1 e j
CREDIT CARD and DEBT ITEMIZATION
Name of Creditor from Schedule E: �Je Y(1' a r no I'
Hach 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 Advertlsing
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 & Polis
E Event Expenses
T
Tickets (Events)
F Food & Refreshments
U
Utilities
G General Operational Expenses
W
Wages, Salaries, Benefits & Bonuses
I InterestAccrued & 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.
$
2.
3.
4.
I /
$
5.
I /
$
6.
—J—1
$
7.
—/—/
$
8.
$
9.
$
Total This Page:
is
The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor.
12101/2011 11:29 Darnall & Assoc. (FAX)208 846 8377
SCHEDULE F
PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED
Name of Candidate or Committee:
P.0091009
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.
Date Fledged
Full Name, Mailing Address and Zip Code of Contributor
Amount Pledged
1.
1_J
2-
3.
1_J
4.
I I
5.
6.
I I
7.
_I 1
8.
I I
9.
I 1
I I
10.
11.
I 1
Total Amount of Pledged Contributions: $ SCJ
Transfer the combined total of all Schedule F pages to the Detailed Summary on page 2 line 20.