7-Day Pre GeneralCAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
Section I
C-2
Rev. 12/14
Name of Candidate or Political Committee and Chairperson
Office Sought (if candidate)
District (if any)
Palmer for Meridian
Mayor
ai ing ressi
an ip
Home Phone
Work rnone
1524 N. Meridian Rd
Meridian 83642
208 941 2039
208 941 2039
Name of PoliticalTreasurer
Jeff Black
Mailing Address
ity an Zip
Home Phone
Work Phone
482 W. Davenport St.
Meridian 83646
208 599 1346
208 363 4702
Change of address for: Candidate or Political Committee ❑ Political Treasurer
Section II TYPE OF REPORT
This filing is an: D Original ❑ Amendment
This report is for the period from 10/01/2019 through 10/20//2019 /
❑October 10 Pre -General Report
® 7 Day Pre -General Report ❑ 30 Day Post -General Report ❑ Annual Report
Is this a Termination Report: ❑ Yes 10 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 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 COLUMN I COLUMN II
figures to the Column II figures of your previous report (except on line 6). This Period Calendar Year
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)
$ XXXXXX
$ 41,2Uti.43
$ 17,625.00
$ 59,831.43
$ 34,772.23
$ 25,059.20
$ 0.00
to Date
$ 0.00
$ XXXXXX
$ 80,605.00
$ 80,605.00
$ 55,545.80
$ 25,059.20
*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
Please remit to:
City Clerk's Office
City of Meridian
33 E. Broadway Ave.
Suite 104
Meridian, ID 83642
(208)888-4433
cityclerk@merrdiancity.org
Jeff Black , hereby certify that the information in this
Name of Political Treasurer
report is a true, complete and correct Campaign Financ'al Disclosure Report as required by law.
G. &OJ4
Page 1
Signature
12
13
14
15
16
17
18
DETAILED SUMMARY
Name of Candidate or Committee; Palmer for Meridian
Expenditures
Total This Period
Contributions
+ $0.00
_
Unitemized Contributions ($50 and less) # of Contributors 5
+ $225.00
Itemized Contributions (Total of all Schedule A sheets)
+ $17,400.00
In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets)
+ $0.00
Loans (Total of all New Loan amounts from Schedule D sheets)
+ $0.00
Total Contributions (Transfer this figure to page 1, Section IV, Line 3)
_ $17,625.00
Expenditures
Unitemized Expenditures (Less than $25) # of Expenditures o
+ $0.00
Itemized Expenditures (Total of all Schedule B sheets)
+ $34,772.23
In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets)
+ $0.00
Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets)
+ $0.00
Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets)
+_$0.00
Total Expenditures (Transfer this figure to page 1, Section IV, Line 5)
= $34,772.23
Loans, Credit Cards and Debt
Outstanding Balance from previous reporting period
+ $0.00
New Loans received during this reporting period
+ $0.00
(Total of all New Loan amounts plus Accrued Interest from Schedule D sheets)
= $0.00
New Credit Card and Debt incurred this reporting period
+ $0.00
(Total of all New Incurred Debt amounts from Schedule E sheets)
Subtotal
= $0.00
Repayments of Loans made during this reporting period
0.00
- $
(Total of all Loan Repayment amounts from Schedule D sheets)
Repayments of Credit Card and Debt this reporting period
0.00
- $
(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)
_ $0.00
Pledged Contributions
Unitemized Pledged Contributions ($50 and less) # of Pledges
+ $0.00
Itemized Pledged Contributions this Period (Total of all Schedule F sheets)
+ $0.00
Total Pledged Contributions this period
= $0.00
Page 2
SCHEDULE A age
1 10'4
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee: Palmer for Meridian
Date Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
10
/01
/19
1. drew and Debra Eggers
2256 N. Waggle PI
Meridian, ID 83646
$ 100.00
$ 100.00
Calendar Year -To -Date
10
/04
/19
2. Kimberly Hansen
5675 N. Carlese Ave
Meridian, ID 83646
1,000.00
$
$ 1,000.00
Calendar Year -To -Date
10
/04
/ 19
3, Blake Hansen
5675 N. Carlese Ave
Meridian, ID 83646
1,000.00
$
$ 1,000.00
Calendar Year -To -Date
10
/05
/19
4. Gary Collins
2019 E. Massachusetts Ave
Nampa, ID 83686
250.00
$
600.00
$
Calendar Year -To -Date
10
/05
/ 19
5. Leon Johnson
2453 E. Wainwright Dr.
Meridian, ID 83646
$ 100.00
$ 100.00
Calendar Year -To -Date
10
/07
/19
6, Tom Loertscher
1357 Bone Rd
$ 150.00
Iona, ID 83427
150.00
Calendar Year -To -Date
10
/10
/19
7, Regence
P.O. Box 1106
Lewiston, ID 83501
1,000.00
$
$ 1,000.00
Calendar Year -To -Date
10
10
19
g, Tall Timber Consulting
14254 W. Battenberg Dr.
Boise, ID 83713
$ 1,000.00
$ 1,000.00
Calendar Year -To -Date
10
/ 10
/ 19
9, McCarter Moorhouse Construction
3536 W Ryder Cup Dr.
Meridian, ID 83646
500.00
$
$ 500.00
Calendar Year -To -Date
10
/ 15
/ 19
10. Dave Butzier
1684 E. Stonybrook Court
Eagle, ID 83616
250.00
$
$ 250.00
Calendar Year -To -Date
Total This Page:
$5,350.00
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.
SCHEDULE A Page of
2 4
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee: Palmer for Meridian
Date Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
10
15
19
1, Dave Evans
7761 Riverside Dr.
$ 1,000.00
$ 1,000.00
Garden City, ID 83714
Calendar Year -To -Date
10
15
19
2. DeBest Plumbing
11477 W. President Dr.
$ 1,000.00
$ 1,000.00
Boise, ID 83713
Calendar Year -To -Date
10
15
19
3, Jason and Darcy Neidigh
3802 N. Palatine PI
Meridian, ID 83646
100.00
$
100.00
$
Calendar Year -To -Date
10
15
19
4, Milford Terrell
1122 W. Ashbourne Dr.
Eagle, ID 83616
$ 1,000.00
$ 1,000.00
Calendar Year -To -Date
10
/ 15
19
5, Roger and Gayle Batt
25253 Graphic Ln
Wilder, ID 83676
500.00
$
$ 500.00
Calendar Year -To -Date
10
15
19
6, Hubble Homes LLC
701 S. Allen St. Ste 104
$ 1,000.00
$ 1,000.00
Meridian, ID 83642
Calendar Year -To -Date
10
15
7, Ron Minegar Real Estate Inc
656 E. Whitehall St.
100.00
$
$ 100.00
/19
Meridian, ID 83642
Calendar Year -To -Date
10
15
19
g, Ron Minegar Real Estate Inc
656 E. Whitehall St.
Meridian, ID 83642
$ 500.00
$ 600.00
Calendar Year -To -Date
10
15
19
9, Chris Conner
3517 S. Ashbury, Way
$ 100.00
$ 100.00
Boise, ID 83706
Calendar Year -To -Date
10
15
19
10. Carol and Scott Clark
12226 W. Pinewood River Ln
100.00
$
100.00
/
Star, ID 83669
$
Calendar Year -To -Date
Total This Page:
$5,400.00
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.
SCHEDULE A Page °
ITEMIZED CONTRIBUTIONS 3 4
of more than Fifty Dollars ($50.00) this period
[Name of Candidate or Committee: Palmer for Meridian
Date Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
10
1. Chistopher and Lisa Shaxted
4055 S. Mill Site Ave
100.00
$
$ 100.00
/15 /19
Boise, ID 83716
Calendar Year -To -Date
10
/ 15
/ 19
2. Mike and Linda Minegar
3041 E. Indian Creek
Meridian, ID 83642
500.00
$
$ 550.00
Calendar Year -To -Date
10
/ 15
/ 19
3, Primus Policy Group LLC
802 W. Bannock St. Ste 406-A
Boise, ID 83702
300.00
$
300.00
Calendar Year -To -Date
10
/ 15
/ 19
4, Tyson and Lorie Garten
1156 E. Rutherglen St.
Kuna, ID 83634
$ 500.00
500.00
$
Calendar Year -To -Date
10
/ 15
/ 19
5. Patrick Minegar
3940 E. Raja Dr.
Meridian, ID 83642
$ 500.00
$ 500.00
Calendar Year -To -Date
10
/ 15
19
6, Andy and Leigh Ann Schon
1687 E. Expedition Dr.
Meridian, ID 83646
100.00
$
100.00
$
Calendar Year -To -Date
10
/ 15
/ 19
7, Bryan and Dana Foote
8560 Vic Ln
Middleton, ID 83644
$ 100.00
$ 100.00
Calendar Year -To -Date
10
15
19
g, Horrocks Engineers, Inc
5700 E. Franklin Rd Ste 160
Nampa, ID 83687
$ 300.00
$ 300.00
Calendar Year -To -Date
10
/ 15
/ 19
9, Dan and Rebecca Richter
1714 E. Dunwoody Ct.
Meridian, ID 83646
250.00
$
$ 250.00
Calendar Year -To -Date
10
/ 15
/ 19
10. David Yorgason
14255 W. Battenberg Dr.
Boise, ID 83713
$ 1,000.00
$ 1,000.00
Calendar Year -To -Date
Total This Page:
$3,650.00
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.
SCHEDULE A Page of
ITEMIZED CONTRIBUTIONS 4 4
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee; Palmer for Meridian
Date Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
10 / 15 / 19
1. Lucy Yorgason
14255 W. Battenberg Dr.
Boise, ID 83713
$ 1, 000.00
$ 1,000.00
Calendar Year -To -Date
10 / 16 / 19
2. Building Contractors Association of SW Idaho
6206 N. discovery Way Suite A
Boise, ID 83713
1,000.00
$
$ 1,000.00
Calendar Year -To -Date
10 /16 /19
3. David Zier
1974 E. Trail Blazer Dr.
Meridian, ID 83646
1,000.00
$
$ 1,000.00
Calendar Year -To -Date
4.
$
Calendar Year -To -Date
5,
Calendar Year -To -Date
6.
Calendar Year -To -Date
7.
Calendar Year -To -Date
8.
Calendar Year -To -Date
9.
Calendar Year -To -Date
10.
Calendar Year -To -Date
Total This Page;
$3,000.00
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
age1 o 2
I Name of Candidate or Committee: Palmer for Meridian I
rurpose uoaes ttnter up to 3 purpose coaes per txpenaiture.)
Date spent
A
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
N
Newspaper & Other Periodical Advertising
B
Broadcast Advertising (Radio, TV, Internet & Telephone)
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
H
Independent Expenditures
Y
Petition Circulators
L
Literature, Brochures, Printing
Z
Preparation & Production of Advertising
M
Management Services
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.
Date spent
FullName, Mailing Address and zip (;ode ot Kedpienturpose
o e s)
Gash or Gheck
1 Dylan Doan
M
2706 S. Kimball
10
04
19
Caldwell, ID 83605
800.00
2. Smart Food Service
F
2710 Sundance Rd
10
07
19
Nampa, ID 86351
109.32
3, Meridian Resources
M
P.O. Box 1671
10
08
19
Boise, ID 83701
4,900.00
4. Auto Sort
L
7286 W. Airway Ct.
10
08
19
Boise, ID 83709
240.00
/
1
$
5. Auto Sort
L
7286 W. Airway Ct.
10
09
19
Boise, ID 83709
1,036.53
g. Decalcomania
0
890 E. Franklin Rd #205
10
10
19
Meridian, ID 83642
180.00
I
I
$
7. Artech
0
520 E. Franklin Rd
10
10
19
Meridian, ID 83642
896.97
8. Meridian Resources
M
P.O. Box 1671
10
11
19
Boise, ID 83701
4,800.00
9, Meridian Resources
M
P.O. Box 1671
10
11
19
Boise, ID 83701
2,527.00
10. Athena Strategy
0
5832 N. Black Sand Ave
10
12
19
Meridian, ID 83646
2,174.65
$
Total This Page: Is
17,664.47
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.
SCHEDULE B Page2 2
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
I Name of Candidate or Committee: Palmer for Meridian I
n er up to purpose co es per xpen i ure,
Date
pen
A
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
N
Newspaper & Other Periodical Advertising
B
Broadcast Advertising (Radio, TV, Internet & Telephone)
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
H
Independent Expenditures
Y
Petition Circulators
L
Literature, Brochures, Printing
Z
Preparation & Production of Advertising
M
Management Services
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.
Date
pen
u ame,ai ing Address and Zip Uode ot Recipienturpose
Code(s)
Cas or GheCK
1.
D & B Supply
0
1725 E. Fairview Ave
10
15
19
Meridian, ID 83642
80.53
2.
Sweet Sensations
F
1735W. Franklin Rd
10
19
19
Meridian, ID 83642
27.23
3,
Meridian Resources
M
P.O. Box 1671
10
19
19
Boise, ID 83701
4,800.00
4.
Agency Creative Network
B
121 N. 9th St. Suite 101
10
19
19
Boise, ID 83702
10,950.00
5,
Agency Creative Network
B
121 N. 9th St. Suite 101
10
19
19
Boise, ID 83702
1,250.00
6.
7.
8.
9,
10,
Total This Page:
$ 17,107.76
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.
SCHEDULE Cage
IN-KIND CONTRIBUTIONS and EXPENDITURES
Name of Candidate or Committee: Palmer for Meridian
Contributor Name, Mailing Address and Zip Code
Purpose Codes (Enter up to 3 purpose codes per Expenditure.)
A
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
N
Newspaper & Other Periodical Advertising
B
Broadcast Advertising (Radio, TV, Internet & Telephone)
0
OtherAdvertising (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
H
Independent Expenditure
Y
Petition Circulators
L
Literature, Brochures, Printing
Z
Preparation & Production of Advertising
M
Management Services
1.
Contributor Name, Mailing Address and Zip Code
$
Calendar Year -To -Date
Expenditure Name, Mailing Address and Zip Code
Purpose Codes)
2.
Contributor Name, Mailing Address and Zip Code
I I
$
$
Calendar Year-TaDate
Expenditure Name, Mailing Address and Zip Code
Purpose Code(s)
3.
Contributor Name, Mailing Address and Zip Code
$
Calendar Year -To -Date
Expenditure Name, Mailing Address and Zip Code
Purpose Code(s)
$
4.
Contributor Name, Mailing Address and Zip Code
Calendar Year -To -Date
Expenditure Name, Mailing Address and Zip Code
Purpose Code(s)
$
Expenditure Total:
(Transfer the combined total of all Expenditures on Schedule C pages $ 0.00
to the Detailed Summary, page 2 line 8)
0.00
Contributor Total:
(Transfer the combined total of all Contributors on Schedule C pages
to the Detailed Summary, page 2 line 3)
SCHEDULE D - LOANS
Name of Candidate or Committee: Palmer for Meridian
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.
Date:
Date:
Amount:
Amount:
2
Date:
Date:
Amount:
Amount:
3
Date:
1 I
Date:
I I
Amount:
Amount:
4.
Date:
Date:
Amount:
Amount:
g,
Date:
Date:
Amount:
Amount:
6
Date:
Date:
Amount:
Amount:
7
Date:
I l
Date:
I l
Amount:
Amount:
Previous Received Interest Repayments Ending Balance
Previous Total $
Received Total:
(Transfer the combined total of all received loans to the $
Detailed Summary, page 2 line 41
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)
SCHEDULE E - CREDIT CARDS and DEBT
Name of Candidate or Committee: Palmer for Meridian
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 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 end of this
(Candidate, Individual or Business)
last reporting period
reporting period
period
reporting period
1.
Date:
Date:
Amount:
Amount:
2.
Date:
Date:
Amount:
Amount:
3,
Date:
Date:
Amount:
Amount:
4.
Date:
Date:
I l
Amount:
I I
Amount:
5.
Date:
Date:
Amount:
Amount:
6.
Date:
Date:
Amount:
Amount:
Previous I Incurred
Previous Total: 1 $
Incurred Total:
(Transfer the combined total of all incurred debt to the 1 $
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: 1 $
Balance
SCHEDULE E-1 - CREDIT CARD and DEBT ITEMIZATION
Name of Candidate or Committee: Palmer for Meridian
Page o
Name of Creditor from Schedule E:
Each Creditor listed on Schedule E 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.
Purpose Codes (Enter up to 3 purpose codes per Expenditure.)
FullName, Mailing Address and Lip Code ot Expenditure
11urpose o e s
A
All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
M
Management Services
B
Broadcast Advertising (Radio, TV, Internet & Telephone)
N
Newspaper & Other Periodical Advertising
C
Contributions to Candidates & PAC's
0
Other Advertising (Yard Signs, Buttons, etc.)
D
Donations & Gifts
P
Postage
E
Event Expenses
S
Surveys & Polls
F
Food & Refreshments
T
Tickets (Events)
G
General Operational Expenses
U
Utilities
H
Independent Expenditure
W
Wages, Salaries, Benefits & Bonuses
I
Interest Accrued & Finance Charges
Y
Petition Circulators
L
Literature, Brochures, Printing
Z
Preparation & Production of Advertising
Date Incurred
FullName, Mailing Address and Lip Code ot Expenditure
11urpose o e s
Amount
/ r
1.
$
2.
3.
1 /
$
4.
I I
$
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.
SCHEDULE F I page 10,
PLEDGED CONTRIBUTIONS BUT NOT YET RECEIVED
Name of Candidate or Committee: Palmer for Meridian
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
Full Name, 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,