Annual Report - Pedersen, Eric - 2/10/2012CAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
-2
Rev. 1 107
File: FEB 2012
Roup
Name of Candidate or Political Cernmittee and Chairperson
office Sought (if candidate)
Seat (if any)
ITaIllimg Address
City and Zip
Home Phone
Work Prione
_lTa-m—eotpolitical Ireasurer
mailing Address
City and Zip
Home Phone
work Phone
Change of address for: Candidate or Political Committee ❑' Political Treasurer ❑
Section II TYPE OF REPORT
This filing is an: 1�,- Original ❑ Amendment
This report is for the period from I I through I I
❑ October 10 Pre -General Report ❑ 7 Day Pre -General Report ❑ 30 Day Post -General Report
Annual Report
Is this a Termination Report: ❑ Yes ❑ 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 cavy 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 $
Line 2: Enter Beginning Cash Balance** $ n $ XXXXXX
Line 3: Total Contributions (Enter amount from line 5, page 2) $ Y) $ '7)
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) $ gy �15_ $I
Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) $ 4—
*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:
Sharon Bergmann
City Clerk
City of Eagle
PO Box 1520
Eagle, ID 83616
(208) 939-6813
Fax: (208) 939-6827
I, ,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.
Signature of Political Treasurer