30-day Post General - Termination Report October 23, 2017 -- November 17, 2017 - Koellisch, Robert - 12/4/2017'1
Section t
Name of Candidate or Pohhcal Commaree and Chanpur on
Robert J. Koellisch
mathflg Address
1434 W Franciscan Drive
Name or POIIImGar ireawwrer
Tracey L. Koellisch
RECEIVED & FILED
CITY OF EAGLE
CAMPAIGN FINANCIAL DISCLOSURE REPORT DEC 0 4 2017
SUMMARY PAGE
(Please Pnnt or Type) File'
Route to:
Caw Sought ($ tan4 a;e)
City Council
Lay aro tip fumeP'nOnO wank 'mono 83616 208-939-2002 NIA
C-2
Rev 12/14
Oland (d any)
m img acaressUryWOrK Phone
1434 W Franciscan Drive lEagainde Llp 83616 1 Homo Phone
208-939-2002 N/A
Change of address for Candidate or Political Committee 0 Potnccal Treasurer 0
Section 11 TYPE OF REPORT
This filing is an: 0 Onpinal 0 Amendment
This report is for the pend from 10/23/2017 Through 11/1-42017 r
0 7 Day Pre -General ReportII
❑ October 10 Pre -General Report
30 Day Post -General Report 0 Annual Report
Is this a Termination Report: ® Yes 0 No
Section 10 STATEMENT OF NO CONTRIBUTIONS OR EXPENDITURES
Directions If you had no contnbutions or expenditures dunng this reporting pend, 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 0, Section IV
0 1 hereby certify that I have received no contnbubons and have made no expenditures during this reporting penod
Section IV SUMMARY
To reach your Calendar Year to Date figure: Add this report's Column 1 COLUMN I COLUMN 1I
figures to the Column II figures of your previous report (except on line 6) This Penod Calendar Year
to Date
Line 1 Cash on Hand January 1, This Calendar Year $ XXXXXX $ 0.00
Line 2' Enter Beginning Cash Balance" $ 1,347.22 $ XXXXXX
Line 3. Total Contnbutions (Enter amount from line 5. page 2) $ 1,703.11 $ 4,704 50
Line 4. Subtotal (Add Innes 1.2 and 3) S 3,050.33 $ 4,704.50
Line 5. Total Expenditures (Enter amount from Ire 11, page 2) $ 3,050.33 $ 4,704.50
Line 6 Enter Ending Cash Balance (Subtract line 5 from line 4) $ 0.00 $ 0.00
Line 7: Outstanding Debt to Date (Enter amount from tine 18 page 2) S 0.00
'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
ELECTRONIC SUBMITAL
REQUIRED Submit to:
efrOeityofeeegte.org
2084396827 FAX
Eagle City Clerk
600 E. Civic ln.
Eagle, ID 83816
2084396813
I, Tracey L. Koellisch , hereby certify that the information in this
Name Pf PatItical Treasurer
report is a true. complete and correct Campaign Financial Disclosure Report as required by law.
Page 1
4, 4
Signature of Pa iUcat Treasurer
DETAILED SUMMARY
1Name of Candidate or Committee: Robert J. Koetlisch
Total This Period
Contnbutions
.J Unitemized Contnbutions (550 and less; # of Contnbutors 1+ $25.00
Itemized Contributions (Total of all Schedule A sheets) + $1,417.75
In -Kind Contnbutions (Total of all Contribution amounts from Schedule C sheets) + $0.00
® Loans (Total of all New Loan amounts from Schedule D sneets) T $260.36
0 Total Contnbutions (Transfer this figure to page 1, Section IV. Line 3) = $1,703.11
Expenditures
0 Unitemized Expenditures (Less tnan $25) # of Expenditures 2
Itemized Expenditures (Total of all Schedule 8 sheets)
In -K nd Expenditures (otal of all Expenditure amounts from Schedule C sheets)
Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets)
1 p Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets)
a tial Expenditures (Transfer this figure to page `, Section IV. Line 5)
Loans. Credit Cards and Debt
Z Outstanding Balance from prey ous reporting penod
1 S New Loans rete ved during th s reporting period
(Total of all New Loan amounts plus Accrued Interest from Schedule 0 sheets;
14 New Credit Card and Debt incurred this reporting pe^od
(Total of all New Incurred Debt amounts from Schedule E sheets)
15 Subtotal
Repayments of Loans made during this reporting period
1 fi (Total of all Loan Repayment amounts from Schedule D sheets)
Repayments of Credit Card and Debt ths reporting period
(Total of all Debt Repayment amounts from Schedule E sheets)
18 Total Outstanding Balance at close of this period (Transfer th s fgure to page 1, Section IV. Line 7)
Pledged Contnbut ons
1 g Unitemized Pledged Contrioudons ($50 and less) # of Pledges
Item zed Pledged Contributions this Penod (Total of all Schedule F sheets)
Total Pledged Contribt,tions this period
Page 2
$25.55
T $259.81
$0.00
+ $1,417.75
+ $1,347.22
53, 050.33
+ S2,504.61
+ 5260.36
50.00
= 52,764.97
$1,417.75
- 51,347.22
50.00
.. 50.00
- 50.00
50.00
SCHEDULE A
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate ar Committee: Robert J. Koellisch
Dale Received
Page a'
1 I 1
Full Name. Mail rg Address and Zp Code 01 Cc tutor Cash or Check
1, Robert J. Koellisch
11 /17 17 1434 W Franciscan Drive
Eagle, IO 836'6
2.
3.
4.
5.
6.
7.
8.
9.
10.
1,417.75
$ 1,417.75
Calendar Year--c-Date
$
$
$
$
S
$
$
$
S
Calendar `rear-'o-Oate
^aknc a� Year- 7rrDax
Calenda•Year--a- Da:a
Calendar Year -7o -Date
Caknaar Year-Ta.Qate
5
$
Calendar 'rear -To -Date
s
C
5
5
5
5
Calw_+arYear• o.Da:e
Calendar tieae. o-Jate
Calencar si ar= aDate
offal Th s Page: $1,417.75
Transfer the combiied tote of a. Schedule A pages to the Detailed Summary on page 2 I ne 2.
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty -F ve Dollars (S25 00 or more this penod
1
`Name of Candidate or Committee. Robert J. Koellisch
Purse codes (Enter up to 3 purpose rimes per Expenditure.)
A All Travel Expenses (Airfare Fuel. Lodging & Mileage) N Newspaper & Other Penodreai Advertising
B Broadcast Advertising (Radio. TV Internet & Telephone) 0 Other Advertising (Yard Signs Buttons, etc )
C Contnbubons to Candidates & PAC's P Postage
D Donations & Gifts S Surveys & Polls
E Event Expenses T Tickets (Events)
F Food & Refreshments U t)titihes
G General Operational Expenses W Wages Sa`anes Benefits & Bonuses
11 Independent Expenditures Y Petition Circulators
L Literature, Brochures Pnnting Z Preparation & Production of Advertising
M Management Services
nate spent ru .game. hiading Address ana tip code or t{eclptent 1-1 4YswttpdGM' cash or cneck
1. Facebook.00m B
1 Hacker Way
Menlo Park, CA 94205
10 31 17
/ /
11 3 17
/
11 3 17
1 1
11 4 17
2 USPS
141 N. Palmetto Ave.
Eagle, ID 83616
3 USPS
141 N. Palmetto Ave.
Eagle, ID 83616
4. Faoebook.com
1 Hacker Way
Menlo Park, CA 94205
5
6
7
P
P
P
44.81
102.00
$
68.00
S
$
t t $
8.
9.
t 1 $
10.
1
45.00
$
Total This Page- $ 259.81
Transfer the comb ned tota of all Schedule 8 pages to the Detailed Summary on page 2 tine 7
SCHEDULE D - LOANS
Name of Candidate or Committee: Robert J. Koellisch
Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campa•gn it must be 'tsted as a
separate item. Eacn new loan from any Lender must be listed as a new tem 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 omits laid out .n
Section 67-6610A. Idaho Code, even if It is repaid in foil.
Any loan(s) with a balacce(s I appearing on the last report must be I sted below with the amount in the Previous Balance co'umn. Any new loan amounts
should be listed in the New t.oan column. Any interest accmed should be listed in the Interest Accrued colutrn. If a payment was made on tie Loan, ;,st
it in the Repayments column. Note Any oan that was repaid in tut 1 a prev.ous reporting period does not need to be listed. The Outstand:ng
Balance column is the Previous Balance plus new loans and accrued Interest less any repayments.
Name, Mailing Address and Zip
Code of Lender
(Candidate. Individuai or Business)
1• Robert ... Koellisch
1434 W Francsan Dr.
Eagle. ID 83616
2.
3
4
5
6.
7
Previous Balance New Loan amount
of loan at the received dunng this
end of the last reporting period
reporting penod
1,157.39
Previous
Dam:
11 '3 :17
Amour!
s 260.36
Date:
r r
Amount
$
Date:
Interest accr.iea
during this
reporting penod
0.00
Repayments of Loan
during this reporteg
period
Date;
11 /17 j17
Amount
$ 1.417.75
Date'
—fes
Amot.nt
S
Date,
1
Amount. Amount.
$ 5
Date: Date:
1 r _1_l
Amount Amoun:.
$ 5
Date: Date:
r r r I
Amount Amount:
$ 5
Date: Date:
Ir _I_I
Amount Amount:
$ $
Date: Date:
I r I-1—
Arnow Amount:
$ $
Received Interest Repayments
Previous Total; S 1.157.39
Rece.ved dotal
(Transfer the combined total of a' rece•ved loans to the S 260.36
Decal ed Summary page 2 line 4)
Balance
outstanding at
the end of this
reporting period
0.00
Ending Baarce
Interest Teta.- $ 0.00
Repayments Total:
(Transfer the combined total of all loan repayments to the $1,417.75
Deta ed Summary. page 2 Zine 9 & 16)
Ending Balance Tota::1$ 0.00
(NOTE: Transfer the combined total of all Accrued Interest and Rece ved Loans to the Detai ed Summary, page 2 line 13)
SCHEDULE E - CREDIT CARDS and DEBT
Name of Candidate or Committee: Robert J. Koellisch
Each incurred expense not yet paid (le. 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 credrtor(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 penod does not need to be listed. The Outstanding Balance column is the Previous
Balance plus New Debt less any Repayments of Debt.
Name. Maaing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debi Balance outstanding
Creditor debt at the end of the incurred during this during this reporting at the end of this
(Candidata, Individual or Business) last reporting period reporting period period reporting period
1 Cabela's Club Visa Date- Date:
PO Box 82575 1 1 11 /6 /17
Lincoln, NE 68501 1,34722 Amount Amount: 0.00
5 0.00 $ 1,347.22
2 Date Date.
_ /—/
Amount: Amount
5 S
3 Date Date
/ 1 / /
Amount Amount
5 S
4. Date. Date
Amount: Amount -
5 Date. Date
1
/ / /
Amount- Amount
S S
6. Date Date.
1 1 _� 1
Amount: Amount
S S
Previous Total
Previous Incurred Repayments Ending Balance
$1,347.22
Incurred Total:
(Transfer the combined total of all incurred debt to the
Detailed Summary, page 2 line 14)
$ 0.00
Repayments Total:
(Transfer the combined total of all debt repayments to the $1,347.22
Detailed Summary, page 2 line 10 & 17)
Ending Balance Total: $ 0.00