7 Day Pre-General - Laughlin, Jeff - 10/26/2011OCT -26-2011 07:39 From:Kathleen Roma Assoc To:91
396827 Page:2,'10 _V
CAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
Section I
Name of Cand`�ate or Poetical Committee and Chairperson Office 5i
Change of address for Candidate or Political Committee ❑4 Political Treasurer ❑
Section 11 TYPE OF REPORT
This filing is an; 1 Original ❑ Amendment /O Z 1
This report is for the period from /O / 0 rough
❑ October 10 Pre -General Report 7 Day Pre -General Report
❑ Annual Report
Is this a Termination Report: ❑ Yes ❑ No
CITY OF EAGLE
F 2011
G-2
File:
ev, 0 O7
Route to
Seat (if any)
❑ 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 11 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
This Period
COLUMN II
Calendar Year
to Date
$ XXXXXX
$
$ —,�'
$ XXXXXX
$ J .,5, D�
$
$
$
$ 024r. D
$
$
'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) 9396813
Fax: (208) 939-6827
hereby certify that the information in this
Name of Politi Treasurer
repo a true, complete and cofr�Campaign Fi cial Disco re Report as required bylaw.
11114W1a I I I it F
DETAILED SUMMARY
Jame of Candidate or Committee: J e 'r� uk% mm,m
--._—_.....,_.__._..._._._-----_....w.._r�-----------------,.._--------------,�.,_,--------� --Total This Period
; Contributions------_.-�---------��--------_...,.. ,---------------------.: -'-� �r- ---- ---- ---------------..�_ _,_.�
i� Unitemized Contributions ($50 and less) # of Contributors _ + $-- - - -
2Q i Itemized Contributions (Total of all Schedule A sheets) - - — - —y� + -$ _ --
i In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets) -- — + $ —�
® Loans (Total of all New Loan amounts from Schedule D sheets) + $
t� `Total Contributions (Transfer this figure to page 1, Section IV, line 3) _ $
Expenditures
a Unitemized Expenditures ($25 and less) - -_ # of Expenditures �— -'- ) + $
T:
Itemized Expenditures (Total of all Schedule B sheets)
_
8 In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets) + $
g Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets) , + $
10 Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets) - + $
11 Total Expenditures (Transfer this figure to page 1, Section IV, Line 5)
--- ------------
Loans,
----------
Loans, Credit Cards and Debt
l
Outstanding Balance from previous reporting period----^ - — —
New Loans received during this reporting period
+ -$ --
'
+ $
Total of all New Loan amounts plus Accrued Interest from Schedule D sheets)
( p
New Credit Card and Debt incurred this reporting period
+ $
(Total of all New Incurred Debt amounts from Schedule E sheets)
Subtotal
I = $
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 7)
_ $
Pledged Contributions
19 Unitemized Pledged Contributions ($50 and less) # of Pledges + $
®0 Itemized Pledged Contributions this Period (Total of all Schedule F sheets) + $
Total Pledged Contributions this period =
Page 2
OCT -26-2011 07:40 From:Kathleen Roma Assoc To:9396827
SCHEDULE A
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Pa9e:4110
Page o
1 117
Name of Candidate or Committee: Je � Ukkqh—\11
Date Received
zo
full Name, 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
5.
$
Calendar Year -To -Dale
I /
6.
$
Calendar Year -To -Date
%.
$
Calendar Year -To -Date
8.
$
$
Calendar Year -70 -Date
9.
I 1
$
$
Calendar Year -To -Date
10.
$
Calendar Year -To -Date
Total This Page:
$
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line z.
OCT -26-2011 07:40 From:Kathleen Roma Assoc To:9396827
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
Name of Candidate or Committee: Rett k-auIalnk1n
- ,,
Page o '
Purpose Codes `►
Full Name, Mailing Address and Zip Code of Recipient
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.
$
2.
—J I_
$
3.
� I
$
4.
I /
$
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 -26-2011 07:40 From:Kathleen Roma Assoc To:9396827
SCHEDULE C
IN-KIND CONTRIBUTIONS and EXPENDITURES
Page o
l 1
Name of Candidate or Committee: JEkk
$
Purpose Codes v
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.
I!J
Contributor Name, Mailing Address and Zip Code
$
Calendar Year -To -Date
Expenditure Name, Mailing Address and Zip Code
Purpose Code
2,
I�J_
Contributor Name, Mailing Address and Zip Code
$
Calendar Year -To -Dale
Expenditure Name, Mailing Address and Zip Code
Purpose 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. -Dale
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, pa e 2 line 3)
OCT -26-2011 07:40 rom:Kathleen Roma Assoc To:9396827 Pa9e:7,'10
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
Dale:
Date:
Amount:
Amount:
2
Date:
date:
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;
Amount:
Amount:
$
$
Previous Received Interest Repayments Ending Balance
Previous Total $
Receive 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: Transfer the combined total of all Accrued Interest and Received Loans to the Detailed Summary, page 2 line 13)
OCT -26-2011 07:40 From:Kathleen Roma Assoc To:9396827 Page:8/10
SCHEDULE E
CREDIT CARDS and DEBT
Each incurred expense not yet paid (.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 and of this
(Candidate, Individual or Business)
last reporting period
reporting period
period
reporting period
1,
Date:
Dale:
Amount:
Amount:
2.
Date:
Date:
Amount:
Amount:
3,
Date,.
Date;
Amount:
Amounl;
4_
Date:
Date:
Amount:
Amount:
5.
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 & 17)
Ending Balance Total: $
OCT -26-2011 07:40 From -Kathleen Roma Assoc To:9396827
SCHEDULE E-1
CREDIT CARD and DEBT ITEMIZATION
r5g0-F
1"1-17
Name of Creditor from Schedule E:
Farh Creditor listed on Schedule E with a New Debt amount tAst have a Schedule E-1 accomoanvina 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
Dale Incurred
Full Name, Mailing Address and Zip Code of Expenditure
Purpose Code
Amount
1.
2.
3.
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 -26-2011 07:40 From:Kathleen Roma Assoc To:9396827
SCHEDULE F
PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED
Name of Candidate or Committee:
\1Y)
age o
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 Pledged
Full Narne, Mailing Address and Zip Code of Contributor
Amount Pledged
1.
2.
3.
4.
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,