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7 Day Pre-General - Defayette, Mary - 10/28/2011CAMPAIGN FINANCIAL DISCLOSURE REPORT SUMMARY PAGE (Please Print or Type) Section I m. ,GITY " OFq' AQLF- q C-2 Ptie: m m m - u H,ormo mm m m Name of Candidate or Politi m ' and Chai Officeht (I candidate) °" Seat (f any) mailingAddress rill %� l� I/ Gay an zip O 641 ome n o e Name of PoliticalTreasurer G`r°. Mail"i Address /yCity ana zip 60q 60 Home one ork Phone 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 /0 / Q/ I A through /0 / 9/// ❑ October 10 Pre -General Report ❑ Annual Report Is this a Termination Report: ❑ Yes 017 Day Pre -General Report ❑ 30 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 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 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) COLUMN I This Period OW01 l COLUMN II Calendar Year to Date *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, A, hereby certify that the information in this N of Pol' ' report is a true, com tete and co ct Campaign Financial Disclosure Report as required by law. 12 13 14 0 16 18 DETAILED SUMMARY Name of Candidate or Committee: Page 2 Total I This Period? Contributions 1 Unitemized Contributions ($50 and less) # o,.. ..... ..°... ... .fContribut .°.. �,�....°.. ...... Contributors . .. .... ...°... + � .�.°.. ... . 1 Itemized Contributions.. 1 (Total of all Schedule A sheets) .. J + $ / J Z In -Kind Contributions Total ofContribution amounts from ( all Con Schedule C sheets) Loans Total o f all New Loan from Schedule D sheets) Total Contributions. Transff er er this figure to Page 1, Section IV, Line 3) ' + 7 J ...(Transfer .. ... .... 1 Expenditures Unitemized Expenditures ($25 and less) # ofnditures Ex + $.. Itemiz... ... .. ..... ... ed Expenditures (Total of all Schedule B shee ts) v n itures Total o Expenditures ( fall Expenditure amounts from Schedule C sheets) � + $.a a Loan Repayments (Total of al. ...... .... .dine .... . . I Loan Repayment amounts from Schedule D sheets) � + $ Credit Card and Debt Repayments Total of all Repayment amounts from Schedule E sheets) + Total ransfer this figure to e 1, Section IV, Line 5) Expenditures (Tpag - - .. ... ... ... .. .... ..... ....... ... .. .. � ..$ �... � #,,��,�..����, Page 2 SCHEDULE A age ITEMIZED CONTRIBUTIONS of more than Fifty Dollars (j50t00) this period Name of Candidate or Committee: V a fw-A I Date Received Full Name iling Addr s aWip Code of Contributor Cash or Check oea le 1] $ 00 Calendar Year -To -Date /o112 1 i 2. 1 �l4d e� �G 23 r56/& $ '750 $ 750 Calendar Year -To -Date L'911'3111 3. 4119y ZMVIS $S7 c !laccaalYbAf �� /"/%/J/pll% JD $ Calendar Year -To -Date l / 3 /i 4. DDJ G�zrso�✓ $ oZS� Calendar Year -To -Date 5. 1-G��; ��g�[sa c2&P W/ CbVi-Fek v� . $ �0� 02dh — Calendar Year -To -Date /o/ 18/11 6. /Cev> rr' tarp Me ye '75Y &aChWD6P Z)'e' jaV it, SD 9,34,r11P $ d $ Calendar Year -To -Date 0v8' t�h�7 S�a� 6 a5b J -D $ 106 CalendarYear-To-Date l l 12t,;& s )50b, 49 o � t $ ,a© Calendar Year -To -Date 9. Calendar Year -To -Date ,0. $ Calendar Year -To -Date Total This Page: $ // 2„50 d 0 Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2. SCHEDULE B ITEMIZED EXPENDITURES Twenty -Five Dollars ($25.00) or more this period Name of Candidate or Committee: -1 Page o Purpose Codes V t Purpose Code 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. j4A Z,0605 w 2. r Y&4 It ID guolto 3. t��Y�M&UA-) r $ 4. 1/ l�oa-qu jai 61 TV ` $ 5. 10 /47 11 d 172 V 6. ,—I— I I Is 7. I 10. Total This Page: $ H(01/ ._ Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. 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. 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: 7. Date: Date: l l I I 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: $ tNu i t: i ransfer 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. 2. 91 4. 5. 6. Name, Mailing Address and Zip Code of Previous Balance of Creditor debt at the end of the (Candidate, Individual or Business) last reporting period Previous Previous Total: 1100 Incurred Total: (Transfer the combined total of all incurred debt to the $ Detailed Summary, page 2 line 14) New Debt amount incurred during this Date: Amount: YA Date: Amount: Date: Amount: Date: I / Amount: Date: Amount: Date: Amount: Incurred Repayments of Debt during this reporting period Date: / /'/ // Amount: $ Date: Amount: Date: Amount: Date: / I Amount: Date: Amount: Date: Amount: Repayments Total: (Transfer the combined total of all debt repayments to the $ 60 Detailed Summary, page 2 line 10 & 17) Ending Balance Total: I $ Balance outstanding at the end of this Balance SCHEDULE E-1 Page of CREDIT CARD and DEBT ITEMIZATION Name of Creditor from Schedule E: o J Each Creditor listed on Schedule E with a New Debt amountl#ust havgq §6Vedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Purpose Codes Full Name, Mailing Address and Zip Code of Expenditure Purpose Code 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 5. Date Incurred Full Name, Mailing Address and Zip Code of Expenditure Purpose Code Amount 1. 6a to N Dprn�e v - y.4). box as?N D oa I 2. 3. I I g 4. / / g 5. 6. 7. I / � 8. / I � 9. I / $ Total This Page: Is Y40 The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor. SCHEDULE F PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED Name of Candidate or Committee: Page I of Directions: Complete this schedule if you were promised and aged to ac*t Montribution 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 Pledged Full Name, Mailing Address and Zip Code of Contributor Amount Pledged 1. 2. / I 3. 4. I / 5. / I 6. I / 7. 8. I / 9. 10. 11. Total Amount of Pledged Contributions: $ Transfer the combined total of all Schedule F pages to the Detailed Summary on page 2 line 20.