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Oct 10 Pre-General - Reynolds, James D. - 10/5/2011Roma Rssoc To:9396827 CAMPAIGN FINANCIAL DISCLOSURE REPORT SUMMARY PAGE (Please Print or Type) �E Section I Page: 1/9 CITY OF EAGLE OCT 0 5 2011 Ffle: Rev. 101C Route to: Name of Candidate of Political Committee and Chairperson Office Sought (if candidate) Seat (f arty) e'10.r Y g cessQq Il vq N o. Sn ead, -PlaxeI:Eqqle- and zip ltd 361 me on tog- m --sow ne Za8'Sbl-`� S NaTp or FoRticalreasurer leer ' a maiang Addressan low �• IAnco • 15o ale S3Lit piy-�,-)6- e ne 1 b5z o one Z�g-88g- Ifs Change of address for. Candidate or Political Committee ❑ r Political Treasurer ❑ Section II TYPE OF REPORT This filing Is an ❑ Original El Amendment This report is for the period from b_l.09 l ?_o r t through 411 1 3 01 ,z" i t October 10 Pre -General Report ❑ 7 Day Pre -General Report ❑ 30 Day Post -General Report ❑ Annual Report Is this a Termination Report: 13 Yes E3 No Section III STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES Directions: K 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 tines 1, 2 and 3) Line 5: Total Expenditures (Enter amount from line 11, page 2) Line:6 Enter;Ending'•CashBalance (Subtract line 5 from line 4) Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) COLUMN i This Period $ XXXXXX a -& COLUMN II Calendar Year to Date -br *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 Sharon Bergmann City Clerk City of Eagle PO Box 1520 Eagle, ID 83616 (208) 939-6813 Fax: (208) 939-6827 1,4C14+) , hereby certify that the information in this Neme of Poetical Treasurer report is a true, complete and rrect Campaign Finan a ure Report as required by law. Signature o3fftdcal Treasurer Page 1 OCT -05-2011.'09:50 From:Kathleen Roma Assoc To:9396827 12 13 14 15 18 DETAILED SUMMARY Jame of Candidate or Committee: Page: 2, 9 i Expenditures _Total This Period Contributions L- I Unitemized Contributions ($50 and less) # of Contributors —— Unitemized Expenditures ($25 and less) # of Expenditures + $ Itemized Contributions (Total of all Schedule A sheets) -� - �yW _._ + $ 1 O p . DID -� i In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) + $ - i Loans (Total of all New Loan amounts from Schedule D sheets) + $ Total Contributions (Transfer this figure to page 1, Section IV, Line 3) I = $ 5T; -I-a- , i Expenditures Outstanding Balance from previous reporting period Unitemized Expenditures ($25 and less) # of Expenditures + $ Itemized Expenditures (Total of all Schedule B sheets) + $ New Credit Card and Debt incurred this reporting period In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) + $ L? Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) + $v $ Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) + $ (Total of all loan Repayment amounts from Schedule D sheets) I Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) _ _ $ - $ Loans, Credit Cards and Debt Outstanding Balance from previous reporting period $ New Loans received during this reporting period i (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)— + $ j Subtotal $ Repayments of Loans made during this reporting period (Total of all loan Repayment amounts from Schedule D sheets) $ I 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 1) _ $ .8 I Pledged Contributions 19 I Unitemized Pledged Contributions ($50 and less) # of Pledges-� + $ Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $ jTotal Pledged Contributions this period — —^� —�Mr— - $ Page 2 OCT -05-2011 09.50 From:Kathleen Roma Assoc To:9396827 SCHEDULE A ITEMIZED CONTRIBUTIONS of more than Fifty Dollars ($50,00) this period Paee:3/9 age / 1 Name of Candidate or Committee: c�SO�mt✓S e�a. 1�nb l l s Dale Received cull Name, Mailing Address and Zip Code o Contributor Cash or check 2/z9� �i 1 C� and /U /1'1�LG �''�yi�� $ -tom Ao. fox '324/6a$ goo. o0 Calendar Year -To -Cate 2, $ Calendar Year -To -Date 3. J___-/ $ Calendar Year•T>Dale 4. / l $ $ Calendar Year -To -Date 5, Calendar Year -To -Date 6. $ Calendar Year -To -Date 7. __.J ---J $ Calendar Year -To -Dale 8. $ Calendar Year -TD -Date $ $ Calendar Year -To -Date 10. $ Calendar Year-To-oate Total This Page; $ Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2line 2. OCT -05-2011 09:50 From:Kathleen Roma Assoc To:9396827 SCHEDULE B ITEMIZED EXPENDITURES Twenty -Five Dollars ($25.00) or more this period Name of Candidate or Committee: A inn 0 S A . /1? o . I rn n 1 Pa9e:4/9 Purpose Codes " Full Name, Mailing Address and Zip Code of Recipient 1�_; 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. $ 2. 3. $ 4. I_J $ 5. 6. 7. $ 8. 9. $ 10. Total This Page: $ Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7. OCT -05-2011'09:50 From:Kathleen Roma Assoc To:9396827 Pa9e:5/9 1 SCHEDULE C Page o IN-KIND CONTRIBUTIONS and EXPENDITURES Name of Candidate or Committee: �LJI Il p ( s Purpose Codes 81w & Calendar Year -To -Date 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 Na��, Mailing Address and Zip Code $ Rip-0 �LJI Il V w -c G V/X z•L.e� /2Z/3 6- U 17ZoAJ"le $ , a� 81w & Calendar Year -To -Date UP ndAure Name, Mailing Address and Zip Code Purpose Code yi-T� Co%r Z�ns& $�a� 2. Contributor Name, Mailing Address and Zip Code /390 /U- YLO/V& jo A)2q $ / S Calendar Year -TO -Date Expend ure Name, Mailing Address and Zip CodePurpose 4 Code 3. Contributor Name, Mailing Address and Zip Code $ Calendar Year -To. -Date 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 $ JID% �?' to the Detailed Summary, page 2 line 8) l Contributor Total: the total Contributors Schedule C $ ftT y l! (Transfer combined of all on pages to the Detailed Summary, e 2 line 3) OCT -05-2011 09:50 From:Kathleen Roma Assoc To:9396827 Pa9e:6/9 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 4. Date: Date: Amount Amount: $ 2 5 Date: Date: Amount Amount $ - - 3. vale: LAM, Amount Amount: $ 4. Date: Date: Amount Amount; Date: 5 Date: Amount: Amount: $ Date: 6 Date: Amount: Amount; Date: 7 Date: Amount Amount Previous Received Interest Repayments Ending Balance Previous Total $ �~ (Transfer the combined total of all received loans to the $� Detailed Summary, page 2 line 4) Interest Total: l$ (Transfer the combined total of all loan repayments to the $ Detailed Summary, page 2 line 9 & 16) Ending Balance Total: $ (NOTE: Transfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary, page 2 line 13) OCT -05-2011 0119:50 From:Kathleen Roma Assoc To:9396827 SCHEDULE E CREDIT CARDS and DEBT Pa9e:7/9 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 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) last reporting period I reporting period period reporting period 1. Date: Dale: Amount: Amount i $ $ 2. Dale: Date: Amount; Amount: $ $ 3, Date: Date: Amount: Amount $ $ 4, Date: Date: Amount Amount: g. Date: Date: Amount: Amount: g, 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 10 817) ffm Ending Balance Total: I $ �� OCT -05-2011 09:51 From:Kathleen Roma Assoc To:9396827 SCHEDULE E-1 CREDIT CARD and DEBT ITEMIZATION Paee:8/9 age lame of Creditor from Schedule E: w f,5 I). Y) p � S Ach Creditor listed on Schedule E with a New Debt amount must have a Schedule &-d9accompanying it. The Schedule E-1 lists where and when the debt was Incurred. Purpose Codes A All Travel Expenses (Airfare, Fuel, Lodging & Mileage) B Broadcast Advertising (Radio, Tv & Internet) C Contributions to Candidates & PAC's D Donations & Gifts E Event Expenses F Food & Refreshments G General Operational Expenses I InterestAccrued & Finance Charges L Literature, Brochures, Printing M Management Services N Newspaper & Other Periodical Advertising 0 Other Advertising (Yard Signs, Buttons, etc.) P Postage S Surveys & Polls T Tickets (Events) U Utilities W Wages, Salaries, Benefits & Bonuses Y Petition Circulators Z Preparation & Production of Advertising Date Incurred Full Name, Mailing Address and Zip Code of Expenditure Purpose ode Amount 1. $ 2. 3. —1-1 $ 4. $ 5. 6. 7. 8. / $ 9. Total This Page: $ —� The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor. OCT -05-2011 09:51 From:Kathleen Roma Assoc To:9396827 Pa9e:9,9 SCHEDULE F PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED Page l / Name of Candidate or Committee: [, . 0 Dineclions: Complete this schedule If you were promised and agreed to accept a oontributio ring 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. Dale Pledged Full Name, Mailing Address and Zip Code of Contributor Amount Pledged 1. 2. 3. 4. �-1 5. 6. 7. 8. 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.