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Hudolin, Rick CAMPAIGN FINANCIAL. DISCLOSURE STATEMENT For State and Local Candldabs For Sing le-CandidaRa Com-nIIt- m 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE - a t-1- b t s _P; ~lnar d C 1-1 oao Lt VV 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 5-1 - a~t8 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone ko q A\ )e- v; IIe, -TN ~0 8~5 31u-3 4.b. CANDIDATE'S HOME ADDRESS (if different than 41.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) . t ~ ~ e, Y~ rAJ i 1J ❑Q ❑ ❑ 7. ' CATEGORY OR REPORT (Check one FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY_ AL B.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD q-t-aot8 y-al-aoig 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ro'l-his campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Finan ' isclosure ally, I/we swear or affirm that no campaign contributions have been expended for the personal financial t e cand' for ny other nonpolitical purpose as defined by the federal `internal revenue code. signature of candidate date CC~/ signature of political surer date 11. WITNESS SIGNATURE ,J c 7 6 - *e S41 at a of &ess at Lure f witness PM z AM- 2 12. SUMMARY $ 00 a. BALANCE ON HAND LAST REPORT 0 $ 5 00 , o v,2'' b. TOTAL RECEIPTSTHIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD 5 3 ati d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ ` $ _ 0 e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 14. REPORT COVERING THE PERIOD 13. NAME OF CANDIDATE OR COMMITTEE (In Full) FROM;4-j_ao,~ T0•1•~•_a a0,~ c.,hr~v'~ t~vd~o l~ Rl RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ p0 b. Itemized Contributions (over $100 from each source this period) • O ' OO Soo c. TOTAL CONTRIBUTIONS (other than bans and interest)(add 15.a. and 15.b.) _ O $ 16. LOANS RECEIVED THIS REPORTING PERIOD - O $ 17. INTEREST RECEIVED THIS REPORTING PERIOD 5 00 0 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) must be listed by category - e.g., printing, postage, gasoline) cb,R©h1-L31 C0,T1 &,-jag, $A-i I ~13 yi5~a0rinl'E USi N2S5 $ iCZ - lkWlt' S $ - YAK $ l ~k 1 $ $ $ $ $ Total of Expenditures ($100 or less each payee) payee this period) b. Itemized Expenditures (Over $100 each a 5 ~ add 19.a. and 19.b.) $ a c. TOTAL EXPENDITURES (other than loan repayments)(~~ 20. LOAN REPAYMENTS MADE THIS PERT 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c . 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ $ _p b. Itemized in-kind contributions (over $100 from each source this period) - d - c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) 2$, 05LIGATIONS a. Una mined Obligations Outstanding ($100 or less each) uE 3_ b. Itemized Obligations Outstanding (Over $100 each) , c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121) >~~of ri SS1133(Rev . X102) ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE ::ER EPORT COVERING THE PERIOD 1. NAME OF CANDIDATE OR COMMITTEE A; -a) - 018 10: 4 1- a1 i Ck~ 'd c L i tJ n 5©0, Oa 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 If first itemizecl page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than 5100 from an contributpr Amount of Contribution Flat Name Id * Name Contibution Received For Last NarrielOrparuration tJurie a M'Pri my Election ❑ General Election g r' c7O leAmI It l~a e e P C WJ ❑ Runoff (Local Elections Only) nddrass 3 ' cL~, Aggregate This Election l ei O.. 7'N 4 X1'1 0 L Date of conabution ooaPation 3 - `5 - ~ U 6npbyer First Name W"e Nan Contribution Received For. Mount of CoNribution Lag NamafOrpwizabm Name ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) sk* zip Code Date of C r&bubon Aggregate This Election City oeapauon Emplo~w Fret Name IM* Nam Contrtbution Received For. Amount of Conbtxdw ❑ Primary Election ❑ General Election IsdNeffarorganamoRNSOM Addma ❑ Runoff (Local Elections Only) OKY stare LP Code Date of ContRwtion Aggregate This Election Oaapabon Broom tiist Name hfiddk Name -Doritribubon Received « of Contrbution last N•me ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) Cay Stale Zip Code Date of Contrbtdion Aggregate This Election Oae "Wn Fargloyer 5. TOTAL ITEMIZED CONTRIBUTIONS ~bt7 (Carry forward to hem 3. or roars per K adWwW p 9a of Ns form are used.) IN ft is the last pop of Qw*b bons. sus amm t must be Wmn in hem 15b. of swmwy.) Page 3 of RDA 1159 SS-1131(Rev. 2106) ITEMIZED STATEMENT OF IN4UND CONTRIBUTIONS - CANDIDATE 2. REPORT COVERING THE PERIOD NAME OF CANDIDATE OR COMMITTEE FROM:4 -1--ai f 10: LA - 1 ap i 11. l " F-t mount ~D- 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION ,irrkind contributions totaling more than $100 from any contributor during the penod) In-Kind Contribution Received For: Value of In-Kind Contribution First Name Middle Name ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Date of In-Kind Contribution Aggregate this Election Address City Slate Zip Code Descnptwn of In-Kind CorNibut or Occupation Employer 41n-Kind Contrbution Received For. Value of In-Kind Contribution First Name 7MiddWNarne Primary Election ❑ General Election Last Nae Organ zatron Name Runoff (Local Elections Only) f In-Kind Contribution Aggregate this Election Address City State Zip Code Description of In-Kind Contribution Occupation Employer Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution First Name ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Date of In-Kind Contribution Aggregate this Election Address City State Zip Code Description of In-Kind Contribution ccupation m Yer Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution First Name ❑ Primary Election General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Date of IR*jnd Contribution Aggregate this Election Address City State zip Code Description of th-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Primary Election ❑ General Election Last NameOrganizatwnName ❑ Runoff (Local Elections Only) Date of In-Kind Contribution Aggregate this Election Address City Stale Zip Code Description of tri rid Contribution ccupa ron m yer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of in-kind contributors, this amount must be shown in item 22b. of summary.) Page of RDA 1159 SS-1128 (Rev. 2106) p J.r I I L ` Page of RDA 1159 SS-1129 (Rev. 4/02) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE 4-11,3 d 0 i i L 1\Ard L 1 n! 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 51 11 A019 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone l2.oa 1.Je_re_t+ AVe.. IM ~i LL.e- j N 3~t~3dy t8~s 31D 35 y'1 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) mmc ~s i f, M! _ +J- Sett \3 D e- rct, S r ` N 7. CAT O -Y OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 01- 1(, - o 1 03 31- 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of a paign contributions and expenditures required to be reported by the candidate committee by the Campaign Financial iscl sure I. ionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial ben of t can 'd r or ny other nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date signature of politics treasurer date 11. WITNESS SIGNATURE ~i7 - ~5 0 A 4 - t 183 signature of witne date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ Q a . Oo b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ - FtEC ~ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ Asa - 00 e. TOTAL LOANS OUTSTANDING TCOUNTI................................................................... $ 0 CON . r] f. TOTAL OBLIGATIONS OUTSTANDING 4 4) SS-1109 (Rev. 2/06) Page 1 of I RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROMfi I(~ I TO: 3 I RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ A4 o o b. Itemized Contributions (over $100 from each source this period) $ JD, y 0 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $5 OO 16. LOANS RECEIVED THIS REPORTING PERIOD $ ' t7 17. INTEREST RECEIVED THIS REPORTING PERIOD $ _ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ ')6a , GD DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ - b. Itemized in-kind contributions (over $100 from each source this period) $ ' } l D Oo c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding $100 or less each - b. Itemized Obligations Outstanding (Over $100 each) $ 614 ~ LA c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ (off L AI SS-1133 (Rev. 4102) Page 1 of q ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD G.d u ~t FROM:] I<, )tAm'o 3 3i I~ unt 3 . TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from any contributor) First Name, Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name L( Primary Election ❑ General Election C) hv'o a Y- Osc ~ o© Address ❑ Runoff (Local Elections Only) ~awuo br; ve. City Stat Zip Code Date of Contribution Aggregate This Election I"1r'c' J .i 11 e. T~~ '1 ~ 0 3 Occupation - ` y I a 0 i I Employer First Name Mi IeName Contribution Received For: Amount of Contribution Last Name/organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name iddleName Contribution Received For: Amount of Contribution Last Name /Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS ..pp, (Carry forward to item 3. of next page if additional pages of this form are used.) Fy a ls© • 00 (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) ~aa SS-1131 (Rev. 2106) Page 3 of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD 1.1 hr! FROM: I TO: 3 ) 1 Amount' 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name WILLIAM Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Lv7 primary Election ❑ General Election ~~t l Last Name/Organization Name q Q r- 0 Q i ( d f ❑ Runoff (Local Elections Only) Address Dateofln-Kind Contribution~~ Aggregate this Election a of City + t 1 S~ Zi Cod Description of In-Kind Contribution i. Occupation Employer l iQ M~0.1 Aa 1 ` 1 First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution 0,49-,15 Primary Election Last Name/Organization Name D ❑ General Election Va. ❑ Runoff (Local Elections Only) Address Date of In-KOnd Contribution ` Aggregate this Election t l 3 L~Gc~>~. ~.~uv~' a 1-A City MA I K03 U Sg~ Zi Code Description of In-Kind Contribution M Occupation Employer v e N N~ 1~ ~r~~~ N~ea ► N~ A!,:- cu w Ncil o First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganizationpame ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer 7-Address Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election E] General Election Name ❑ Runoff (Local Elections Only) Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) Q; f~ y~ r Do (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) ~~ff ( V SS-1128 (Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD t~ C L ~U c~.E~ vJ FROM:1 Ib 141 TO `3 3t k <Y mount 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3, of next page if additional pages of this form are used.) t-- - (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4/02) Page r of RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD I FR M: T0: tai i c4yky,. L 1 ~,1o L i o i 1 io w I$ 3 3 I Zo 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling morethan $100 from any source during the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of Loan ❑ Primary Election ❑ General Election City State Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City Slate Zip Code City Slate Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period) Received Pa ments (End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) - 0 C) 0 SS-1132 (Rev. 4/02) Page % of _ RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD R, C~\AVA, C, ~4-08,-- - -CJ FROM: i 1 ;,A of Y TO: '31311,2C)1'9 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments utsta ding Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) Flrst Name Middle Name RKC AAR Q C, Last Namel usiness Name Li G `1 5 3~ Address '~a0 Lv2r~~E. ~,ve> City State Zip Code NIAr vi 0-e. ~N 3'l o ~l Description of Ob igation First Name Middle Name R I LhA r~ C. Last NamelBusiness Name Address d 0 Nj V&(13 ~ - I aoy i=ve r2.t~ Ave City St_ ate Zip Code I, 11 ~ i 3 ~~~~I Description of OOb gation ;2 n 1 Flrs(,~]..a(~n a Middle Name t 1tL CJ- Last Nam /Business Name --o-5~i3,Sa 5~13r5a Address City F Std ZS Code: r ( t o ~"f Description of Obligation ~ ► ~ - Yard S , t~s First Name Middle Name Last NamelBusiness Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4. TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown in hem 23b. on summary page.) 4) SS-1127 (Rev. 4102) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE QR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE AJOOH ~Y' -5`- 1-Zll~ lk 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone ZU E o- e lit ~fbS - 5 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR Y - ND QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. t- This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 ,t and/or expenditures total more than $1,000 for this reporting period. 10. I/we do my swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate a unting of aign contributions and expenditures required to be reported by the candidate committee by the Campaign Fi ci sclosure t ionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial enef t ca di t for ny other nonpolitical purpose as defined by the federal internal revenue code. a signature of candidate date signature of po ical tre urer date NESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) ~ . $ A~ e. TOTAL LOANS OUTSTANDING $ OF, t N f. TOTAL OBLIGATIONS OUTSTANDING... .3.1../.,18...,,..,,,. w $ ~ ~ ELECTION ~ SS-1109 (Rev. 2/06) Page 1 of RDA 1159 h'arZL~LQ~6 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: T0: ' Z- RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions $100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ ' c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22. IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b. Itemized in-kind contributions (over $100 from each source this period) $ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ SS-1133 (Rev. 4102) Page of