30 Day Post General MoberlyCAMPAIGN FINANCIAL DISCLOSURE REPORT
SUMMARY PAGE
(Please Print or Type)
jtECEIVED
DEC 0 4 20B"
CITY Ut— Dgry
CITY CLERKS OFFICE
Name of Candidate or Political Committee and chairperson
Office Sought (If candidate) Seal (ff any)
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C„ co.,�Ozi_,\ lQ
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name an
o one
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$ -k(A4-).a
ame of PoliticalTreasurer
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aingress
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oma Phone
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Change of address for: Candidate or Political Committee ❑ Political Treasurer
Section II TYPE OF REPORT
This filing Is an: Original ❑ Amendment
This report is for the period from,_II through _!!
❑ October 10 Pre -General Report
❑ Annual Report
❑ 7 Day Pre -General Report ❑ 30 Day Post -General Report
Is this a Termination Report: E] Yes N 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.
❑ 1 hereby certify, that I have received no contributions and have made no expenditures during this reporting period.
Section IV SUMMARY
To reach your CalendarYear to Date figure: Add this reporrs 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 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 16, page 2)
COLUMN I
COLUMN II
This Period
CalendarYear
to Date
$ X)O(W
$
yg-a1.t0
$ XXX .t0)
$ 72QAAr-L
$ -k(A4-).a
$ '3yp.52
$ 'x.12
$ 4c�yzR:24
$ q\$2.C4
$ y -_n .a2 $ Waz.53z
$ CD
'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
I, /V � hereby certify that the information In this
N e of Political T surer
report is a true, complete and correct Campaign Financial Disclosure Report as required by law.
ignature of Politicaleasurer
Page 1
12
13
14
15
16
0
1 ti
DETAILED SUMMARY
Name of Candidate or Committee:
Expenditures
Total This Period
Contributions _
+ $
Unitemized Contributions ($50 and less) # of Contributors
+ $
Itemized Contributions (Total of all Schedule A sheets)
+ $
In -Kind Contributions (Total of all Contribution amounts from Schedule C sheets)
+ $
Loans (Total of all New Loan amounts from Schedule D sheets)
+ $ 221a L
Total Contributions (Transfer this figure to page 1, Section IV, Line 3)
_ $ 0.00
Expenditures
Unitemized Expenditures ($25 and less) # of Expenditures
+ $
Itemized Expenditures (Total of all Schedule B sheets)
+ $ 3DWA
_
In -Kind Expenditures (Total of all Expenditure amounts from Schedule C sheets)
+ $
Loan Repayments (Total of all Loan Repayment amounts from Schedule D sheets)
+ $__a_ 1 Baa
Credit Card and Debt Repayments (Total of all Repayment amounts from Schedule E sheets)
+ $
Total Expenditures (Transfer this figure to page 1, Section IV, Line 5) _ _
_ $ 0.00� �,Zy
Loans, Credit Cards and Debt
Outstanding Balance from previous reporting period
+ $ O
New Loans received during this reporting period
+ $
(Total of all New Loan amounts plus Accrued Interest from Schedule D sheets)
+ $ �� 2
New Credit Card and Debt incurred this reporting period
(Total of all New Incurred Debt amounts from Schedule E sheets)
+ $
Subtotal _
_ $0.00 21.
Repayments of Loans made during this reporting period
(Total of all Loan Repayment amounts from Schedule D sheets) _
$ L
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)
_ $ 0.00 —�
Pledged Contributions
Unitemized Pledged Contributions ($50 and less) # of Pledges
+ $
Itemized Pledged Contributions this Period (Total of all Schedule F sheets)
+ $
Total Pledged Contributions this period
= $ 0.00
Page 2
SCHEDULER page °
ITEMIZED CONTRIBUTIONS
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee:
Dale Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
1.
$
❑ General
$
Calendar Year -To -Dale
2.
$
❑ General
Calendar Year -To -Dale
I I
3.
$
❑ General
$
Calendar Year -To -Date
/ .
4.
$
$
❑ General
Calendar Year -To -Dale
I I
5.
$
11 General
Calendar Year -To -Dale
/ /
6.
$
$
❑ General
Calendar Year -To -Dale
/ /
7.
$
❑ General
$
Calendar Year -To -Dale
I I
8.
❑ General
Calendar Year -To -Dale
/ /
9.
$
❑ General
$
Calendar Year -To -Date
1 I
10,
$
❑ General
$
Calender Year -To -Dale
Total This Page: 1$0.00
Transfer the combined total of all Schedule Apages to the Detailed Summary on page 2line 2.
SCHEDULE B
ITEMIZED EXPENDITURES
Twenty -Five Dollars ($25.00) or more this period
of Candidate or Committee:
A All Travel Expenses (Airfare, Fuel, Lodging & Mileage)
N
Newspaper & Other Periodical Advertising
B Broadcast Advertising (Radio, TV & Internet)
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
L Literature, Brochures, Printing
Y
Petition Circulators
M Management Services
Z
Preparation & Production ofAdvertlsing
Date Spent
Full Name, Melling Address and Zip Code of Reclplent
Purpose Code
Cash or Check
2.
3.
\\ l�\3
G'7b S•C�4S�cSsu.��_
�
anti �
$
�•�a
4.p
Qc \q�oOGr
5.
IcAw (2M \PVK VIA
6.
7.
8:
$
9.
—�—
$
10.
Total This Page:
$ 0.00
Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2line 7.
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
Code of Lender
(Candidate, Individual or Business)
Previous Balance
of loan at the
end of the last
New Loan amount
received during this
reporting period
Interest accrued
during this
reporting period
Repayments of Loan
during this reporting
period
Balance
outstanding at
the end of this
reporting period
reporting period
1, aur& (lldoeSla�
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O
�
Date:
io /13 /oe
.�
Date:
/�—
An—
Amount
2,
Date:
Dale:
Amount:
Amount:
3.
Dale:
Date:
Amount
Amount:
$
$
4,
Dale:
Date:
Amount:
Amount:
5.
Date:
Date:
I l
I I
Amount:
Amount:
$
$
6_
Dale:
Date:
Amount:
Amount:
$
$
7,
Dale:
Dale:
Amount:
Amount:
$
$
Previous Received Interest Repayments Ending Balance
Previous Total
Receive oto
(Transfer the combined total of all received loans to the $ 00
Detailed Summary, page 2 line 4)
Interest Total: $ 0
Repayments Total:
(Transfer the combined total of all loan repayments to the $ 0.00
Detailed Summary, page 2line 9 & 16)
Ending Balance Total: $ 0, 00
(NO 1 t: I ranster the combined total of all Accrued Interest and Received Loans to the Detailed Summary, page 2 line 13)