arlen siegfreid 913-764-3643 pethics.ks.gov/cfascanned/house/2006eleccycle/... · arlen siegfreid...

11
Arlen Siegfreid 913-764-3643 p.1 KANSAS GOVERNMENTAL ETHICS COMI\iISSION 0 r- ('~l v .t:"Crf* RECEIPTSANDEXPENDITURES REPOR1i\!: Y I: ~. ~ U OF A CANDIDATE FOR STATE OFFICE JAN 0 S 2006 January 10,2006 Govemmenta! o:thicsCommission 1091/v'EST 9TH STREET FILE WITH SECRETARY OF STATE AND CANDIDATE'S COUNTY E1Boo:r~lS}\~:CER SEE REVERSE SIDE FOR INSTRUCTIONS A. Name of Candidate: A r Je.h. S ~ t=. 9P rc.. i d Address: / t' C1J °, P rCt ; r I c.. 7C, I-"..:l.. ~ e City and Zip Code: {J; Ia fA ~ ~~ott/ County: J"o A n ..s 0 It /5 Office SDUght ~ I- a. h:. Rc. fJ r-c. oS~ h fA J..; b'C...s District: B. Check only if appropriAte: _Termination Report - A.mended Filing C. Summary (covering the period from January 1,2005 through December 31, 200S) 1. Cash on hand at beginning of period ,..., ,.......... 2. Total Contributions and Other Receipts (Use Schedule A) .......................................- 3. Cash available 1his period (Add Lines 1 and 2) :....................... 4. Total Expenditures and Other Disbursements (Use Schedule C) ..m ""'''''''''''''''' 5. Cash on hand at close ofpenod (Subtta.ct Line 4 from 3) -'''''''''''''''''''''''''''''''''''''''''' 6. In-Kind Contributions (Use Sch<:duleB) "''''.'' .; fOP 1/ 7. Other Transactions (Use Schedule D) -."'''''''''' "of?5..l ~y I 31.;;.5 ~ IIIS77~ 1'191,y.. 17077 1..1 D. "1 deciaretha.tthis report, including any a.t:companyiDg schedules and statements, has been examined by me md to the best army knowledge and belief is 1rue, correct and cornplete. I understand that the intentional failme to :filethis document or intentionally filing a false document is a class A misdemeanor." //9pObS Date ~~J~ Signature of Treasu er GEC Form Rev, 2001

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Page 1: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 p.1

KANSAS GOVERNMENTAL ETHICS COMI\iISSION

0 r- ('~l v.t:"Crf*RECEIPTSANDEXPENDITURESREPOR1i\!: Y I: ~. ~ U

OF A CANDIDATE FOR STATE OFFICE JAN0 S 2006January 10,2006 Govemmenta! o:thicsCommission

1091/v'EST 9TH STREET

FILE WITH SECRETARY OF STATE AND CANDIDATE'S COUNTY E1Boo:r~lS}\~:CERSEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Candidate: A r Je.h. S ~ t=. 9 Prc.. i dAddress: / t' C1J °, PrCt ; r I c.. 7C, I-"..:l..~ e

City and Zip Code: {J; IafA ~ ~~ott/ County: J"o An ..s 0 It

/5Office SDUght ~ I- a. h:. Rc. fJ r-c. oS ~ h fA J..; b'C...sDistrict:

B. Check only if appropriAte: _Termination Report- A.mendedFiling

C. Summary (covering the period from January 1,2005 through December 31, 200S)

1. Cash on hand at beginning of period ,..., ,..........

2. Total Contributions and Other Receipts (Use Schedule A) .......................................-

3. Cash available 1hisperiod (Add Lines 1 and 2) :.......................

4. Total Expenditures and Other Disbursements (Use Schedule C) ..m ""''''''''''''''''

5. Cash on hand at close ofpenod (Subtta.ct Line 4 from 3) -''''''''''''''''''''''''''''''''''''''''''

6. In-Kind Contributions (Use Sch<:duleB) "''''.'' .; fOP 1/

7. Other Transactions (Use Schedule D) -."''''''''''

"of?5..l ~yI 31.;;.5 ~IIIS77~

1'191,y..17077 1..1

D. "1 deciare tha.tthis report, including any a.t:companyiDg schedules and statements, has been examined by memd to the best army knowledge and belief is 1rue, correct and cornplete. I understand that the intentionalfailme to :filethis document or intentionally filing a false document is a class A misdemeanor."

//9pObSDate

~~J~Signature of Treasu er

GEC Form Rev, 2001

Page 2: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 p.2

SCHEDULE ACONfRIBUTIONS AND OTHER RECEIPTS

/lrlen ~'~f(e;d(Name ofCandidat~Party Committ or Political Cornmrttee)

Date Name and Addnssof Contributor

OccupatiDn ofIndividuaJGiving More Than Sl.50

Amount ofCull, Check,

Loan QrCash Other Other Receipt

7/1'1/051);e ~oe;", Co. (De.f. s,P",...G ,.f. o. ~~ ?7.30WiG.~i~, Ks.

(p7;J, 77-773(3Hq rrQ /, oS

rO.:13 CJ,e:r~r red.I"?e,..,;:;h" S I '7"etllH. 3;>/1 '7

I>~tJO" ~

~/~%.s 10(150. c10

~~I

k.s. Co.hfe TV PA-c.YOS f',{). B O~ 30~?

W; c:.,h',+Q.J k.s c:,7;).. 0 I

;~5" JI

Sprin-r .sra-f e FAGII /05 gOD ~ IN Ja.c.t:..rOh Su.i-r( lIoP

7"O('Q1:0.)Ks, ~" /.:l.

'CYS-/ !Po/~;ne.I/,/JJ..41T'oywe/H!/'7 ()S ~ Sk ~/f he;,"-'700 W. J{?"" J'T: Jr. /o() D

: C. P?o. ~ 'I1I;L

IDJ / 1

13r... ~ kJ ~ i ..r e,.

" 0.5 <9t1.e Bu..:c:.k PiQ.~e.

sr; J..c)I.J,.;Jjl'"'\.tJ tc.3J1,p

/t'JII

() i1" 0 ? a.c..it-' c.

/,;J}/0 S p""t H ~b b~} ns S'OC.POD Jc.J:'.rcr- J'L.r,.;+c.9/'fr,; ~t' J:;J' , (. ("I~ - .J.21¥

I "keu/,. G;!., ~ r-.~

'.:J..5 'II .s. H ~ 5. ~ LPo.'" ...

~k..n..., Ks. ~ r.0 " .:L

!%I

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")'7/0S J7fJ W' W ~J".~+Q.~.P.v, C3D;)l 3$;L

Ls.~efl. K.r. ~ 71. GoS.A. ..fcoff R/rch;-e.IIIp. (). /J lI>' 7 J>31gFW:<:J.; +0-, 14. b 7.17 l' ...) J p Y

:ZoD ~

~50 of?!.

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}f)I

IJ.7/iJSI3tLl1.l2 t:.r S

J~50 ~

:.2S ~

(]; ( we-!f ~5. ~

Page-.L of~

Page 3: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 f:.3

SCHEDULE ACONTRIBUTIONS AND OTIIER RECEIPTS

,Ar/-tn ");'~t("~rJ(Name of Candidate,Party Committee 0 olitical Comnnttee)

Date Nam~ and Addressof CoJrtribu1or

Occupation oflDdividlJalGiving More Thn S150

Check Amount ofAppropriate Box CaJh. Check,

Loan or

CsdJo Other Other Rec~ipt

Ini

t::r. /J.JJru;,. c)f Ho-aS' .J.

7010/' ~5 J~r&ljc...~~"A,,/",~/" .s.G. pn. .f"'.

-/"/tJ{) ~

'~0s '¥'c1...s- ""

'"c1. S t[f!

{),"/ 13U$i 1Ir:.sS

110/0.5

/',/ 'l/os

~S2Iv ~

100/0 S-";tJD ~

'oJI.s-o ~

/'I?(.(I'f; 17

Wl4ter .sr. S~i+e :100

(Jj I Su.~ j I\e.>'s

.JJ6~

II/If) 0 S

Page~of~

Page 4: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 pA

SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

hl'/erJ S,~c('d(Name ofCandida.!e,Party C ee or Political Comrmttee)

K.s. COht r ac..r£>l".r 1i,g(Jc.$p. c. ~ b~ .so" /

TOf,d::4.; k.r. G.,"wo.s

IIII

Gat.!:e,..s, IJr4.o!e,., I3c.irb4!oG!'.21/0S ~.t.s J. ,/:.1'./4~e. .s~;n GO!)

10 f'e I;t:.,);'6'. "''' ~'.2.

iJII

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Q.>e..-lo...4 A:o.rk1 ~ ",..J.:I. S

jif.I

?erer.soY\ ~ jr::ga...t'kQ.h

~:.2~O.5 1:2.0~ LV. I ()-r..-;.~ i:c." 1::4, (.,~ i) 'f -/~ 'i I

BOrr.bGrcliet' fkri)~ fc.ce.Ltarj~t - p.o. U 0)1. 77 ()"7

Wic:1;tQ.J h. r..7:J7'J" ')7() 7

/:.$. r",JtpeWl.cJt.,t 0: ~ ~ c:;........IDS ,s. '3r~c:.oI~r..Yr S"';+, SoO

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Jy..j

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1,/

~

,o eG"'-;IChl"S Ass..", c;r

IJ oj c;.recJlr j;c. p.+c./0 oS ~O() E. /'() 3"'" Jr.

k.C. /110. "'1131 - '(,Job

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/ i/f) 5 ,;)/..). S W ¥' n. h--. .J1t. ,j.<J1ope.Kc.),~, "" ~0.3- 39..16

Date

III

/ IS; OS

11/

.a.y 0.5

11/

~YD..s

Name and AddrelsofCmrlributor

Occupation of Incfiv:iduaJGiving More Than Sl~

AmmmtofCash, Check,

Loan or

CadI Otbcr Other Receipt

.,:)()O ~

:.t/cJ() ~

.,J..00 ~

~/()t) ~

-1" ~

JCJrJ

J'S() ~

JJ..lJ C) ~.

;JSD ~

~ SO rc?

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Page3- of ro

Page 5: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 ~,5

SCHEDULE ACONTRIBUTIONS AND OTIIER RECEIPTS

Arlo> J:-si'r€id .(Name ofC<L.'1didate,Party Co 't1~e or Political Committee)

Loan

Amount of

ClI5h, Check,Loan or

Other Receipt

Date Name aDd Addressof Contributor

Occupation of IndividualGiving Mor~ Than $]50

CheckAppropriate Box

Cash CJa.ell. O,her

~JI

KJ. [)o.i '" ~.r.,~ .SI.4",fr"loIcr .4t'"/ 1/ () 5 V~/f) WJrM~rl: A-u ~.

VV""_i.Ou) /;'.$, "r. S'I7

~Ij

,Ero..J S, ()j)t- (Ks. &.w11.[""",...If.

11/ DS ff()O Sw J~<.t.strro .n: .!k;t. ¥u¥'7~tlr:~" ~J'. (,.H../::J - /2 72

/~I

kJ'. Of'ni"rti!t,.; ?//Cf){).)IJ.c'b JwJ r~eX~ (jJv,,/.

/opel:.a./4. (.lo (P12

IJI1

/:1'. !J.sJ. (;. of h'~/t'). PI~IU

'/ /)OJ f;lo~ J uJ ,o""'.sr. P;t-G7>r-eh ,~, ~s..'()'1 ~ 120'/

/. KJ. ~ro Vea..lel"5 £lec.f,'un~f los l

Ad. Cr;.........../ I i CJD ~ w .Jo.clt:.r;0'" .sr. J"''' fr IJI0

,-, ~

t.r. &hte...,S t9oJcJO(;, PfiC

/';'/1/0.5 k. o. ~o;,. l{¥ D7Tit? e/:c.) Kr. C.(p" olf - Ol.{{)7

8u..i 1.,(ft'..! IfS..tbC, uf /:s fAG:;;1.J I .s

/ I oS J./.2 J'/,J :in.. .4v~. \.0".rot~JT'f1&Aj J;:s. '" ~03-39'J (:.

}J.!Jl

/Cs. r3e~r- W],6}e.J4-/"r-s /Jur-

10.5 foc) Jet d:J'o" J'k..fC JOI[fK..

/~ftrc.) !iJ, "''''1::2-

10/, IKs. w/"w {..sfi,..;f-Wh()/~So I~,..sII p.s ~/.:l .r.w. In ft~~. S.;f..)o;:.4 c:-

, ,'-l"Q3

Po/.s J~8/'" /.sI.cJ foy-~lfyS~r/~4o.J

700 W, J(7'11t,Sr. ,j,,;t't: /000C. /'1'Jo. t:,';I/

f / ?Jt)~

JJSO ~

1.)"0250 ~

I sa ~

"J..(}O ~

~s-o ~

30tJ ~

-/sotJ ~

f;Of)IN--

f/ttf) q.:;

""'"'''''

1

'''

!Mi§E''>i~.'':' ':1 100i@~%~2t:Jl.. .

PageJLof~

Page 6: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643

SCHEDULE- ACONTRIBUTIONS AND OTHER RECEIPTS

Ar/Il;' ,C ~f~ d(Name of Candidate.Party Co ee or Political Commrttee)

Date Name and A..d~of Contributor

J~J - IWh"fh~Y OQ ~ ro~/1/()5! '719 .s. /.:;J. Av&

;;;-~kc., /:=,... "~1:l.

/:I!.

j

D~I//ol ~y~L r 4 Jr.

/3/0 S 9oJ-j ~htU!I (,.JayIN/" I-.rh: ) KJ, ~ ? J.o

<

1.21I

.J C C.

1/.2./ ~'!c)o r...J,'q" c,.~..~ FJ/'\r...>y./ {)S .It.4,'f' /..:t0

cJ\,I~rjll1.h.,c~.k"oJ. "r.. ;J. If).1:2 /

I

~..~f'\ ~ t'1" /JaJ..,.,d K"e..rlJ~ ,.c~s.

/ /~S '''00 vJ:1I ;0.,,",~ .r~. Wf.$f' fl."~::lo.s N. c)'Co fJla.l, .

1:rlll "". rY. 7 S03' ~3~¥"I

/:2/

I

k.s, riullp e~de ~..t 13""'h ,,os 8J~

7/~..> Ifls S. rr')Q.I'nLJ:vh;+-t, 1::01,(.?;!o.:l~37)'t

'hi

I

aN S of" £0..;) ..,)4.1 Cp,

(;; 10/ 05 ~ s oD LoU. N};JJ Ie" tY..

f1. LVo\'""'~ ~ T'JI 7~ 131

')./

I

koc;.J,\ :r:r.all..l1'r;~.r, r~c.11/'1/ p.O. ~'D,K.~:&.S\..

{os, ];d"';~1 jc;..s. '-7:1.01

p.B

Occ:upaiion of IndividualGiving More Thaa S150

Check

I

Amount of

Approprim ])ox Cuh, Check,Loan 0['

Cash I Check I Loom I oo..r I Other ~ipt

Iv, bbid. t:; I~

~ (j,~! Bu..~(l1.t:-s$

I f}f) ~

'!2S- ~

~so ~

(//S 0 ~

1S0 ~

w

/ OJ.$.

Page5 of~

Page 7: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 ~.7

SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

. /) r Ie.. t1 5 ;e9Pr~ ,d(Name of Candidate, Party Committee or Political Committee)

Date Name and Addressof ContriJiutor

Occupation of IndividualGiving More ThaD S150

CheckAppropriate Box

Cah a-k Lc>sn

Amount Df

C2!ih, Check,Loan or

Other Receipt0Cba-

1}:lJI

J:C- r oJ.J.. Po uJ~r PAC - 1:£.

. 7.JO/ OS f.O. Go~ 'I''i'- 7'K. c. m D. (. t{ll( I

1..l.s-oC'IJ-

J;)./I

kSO .P7~f.,r C~C'r.'C'...s ,4,r.tor..

1;"1 J J.90D..s'c...)'''fIb: GJ"d.1615 Ti>pr.J:Q,k.r. " (."JI

{lst?~

'-''i5(1) tYf)

Complete iflast page of Schedule A

Total Itemized Receipts for Period

Total Unite:mized Contribmians (S50 or less) .

Sale ofPotitical M.atcri&1s(Unitemized)

Tota! CDD!ributions When Conbibinor Nnt Known

--

,..--

Page 8: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 p,S

v

SCHEDULE BIN-KIND CONTRIBUTIONS

, /II" Jell '" s>~ ~/cf(Name of Candidate,Party Co . ee orPolibcal Comrmttee)

DateName, Addxull and Occupation

or ContriDutocList occIXpationfor those ~

an in-kindmore~ $150

Description oflD-Kind

Contribution

Value ofIn-Kind

Contribution

,,~ rr- , .IF ''"''ocur~/~C ,~c~~r .

/3.5. D iI :5. /'7/;:,'J t it ,,'V-~_..,/)1.1 ' .1/' r' ./ I .}./ -:U' c..h,t r::, '\ ~ & b [..6 ..-

7'7'I.f f::;- ;,"/ r./ ,,~~:~..l

,/':-'" fJ r / i1 i-c r $~O() t.f

r f Ib19/0.<5

Comple~ if last page at Schedule B

Total Itemized (over $5D) ro-Kmd Contriburions

Page 9: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643

SCHEDULE CEXPENDITURES AND OTIIER DISBURSEMENTS

r9r-/Bh .J7 ~fr e.id(Ncme of Candidate, Party IIl1Il.ltteeor Polibcal Commrttee)

VDfe ha.,te rf>.O. 130"'- 1,),7.3'-1

Pa. ~Ao:::. k' J'

iJ eJr- JJ t.t) -'

Off;. H.f~ h.

DOh ~~~hi- PhOTojt'''f'hy30} S. w. c;.."'j ~ J11vcl.

-L..1Lr~ A ,)~...r '" ,t. ()

~I

0 ;"Jo J fet- R., J ,-Co.{Z. f,.d

~I//o.s (~E'~to.. bun -:K-~)

Date

~/h5

,'los

l]/

I),)./~.)

Name and Addn:ss PiU'p(}!lCof Expenditureor Disburgement

p.9

AmaUDt

'SOtJv,)Ii i)'t e ~a. c- ?"h j

So f'f W"-io-~

!\l1frJ Lc..f-T-fJr

10-"

"J tJ 7 s~v(o'r

rp hi) f-os fro I"""'-

Je..r J' it; n

r;r»'--C Dhtr-; -.6\.0...}-; '0""

[]Y'ea J:J'a.{'r 2 r(,f~rJI//)S ~

J ?(J1)'-J

~nt/"" / Pl~," 6ttl-.rl;,P

6DI;" .3 .;..

page...L. of~

Page 10: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

Arlen Siegfreid 913-764-3643 p.10

SCHEDULE CEXPENDITIJRES AND OTHER DISBURSEMENTS

Hf/t?h ~~r-l;d(Name"of Candidate,Party Co 'ttee or PoliticalCommittee)

J Oh:r.~c Co 1A-P"'+.1

Rt.p.-.~I"c,.: ,. '? Q I" T}'~)( G..; J:J

'IJ.- ,/ R4 p..b r.LA" G. '" f"-;~h C;'" ~: /r..J ~OS ~i'~) i:.r j (Y}1?1Yahe r.J,I;~

~ I Jc;n~#'( re c.k ./ 0.,5 /?1-.s.s;~Q~.? hI'! of. ICot? Ir/ 64r/Dh

~~os

jO/ /fdr/;"ce- d- H;dIb/o.5 /1031 W, 7tS' 17 ~.

S l..:tILJ

Iry;J D;:s~J~~ Ve ~r-4.hS/'QS 90.,).5 pflv red.

~Ael<Q..;::"'. ~b:2) S,

De h "';.tJ- 0 ~0121::.r

Q/fi,TAl' J Kr

Date

~/t\S

/%10

Name and Address Purp05e of Expenditureor Disbursement

Amount

/l h n 4d j7} fJ...,I,.,,f.('I' I::j- 0 eN

~~ ~v

,/ -.5/) ,r1J

'

0/ a 7?. C I .b,r 0 f t:''" ,.."M..,/< '" I /'7f'" /;, rJ /,/() /. '17.~./ J".r . ,

1//6 ~ I~

eo h tr i b {.(,r;'D /').-'

"'i~ ~

COh -r-'t'"j bu +,'D{) 1Js- ~ ..'

G-ra.pJ.,;G l)e-s;8t\ 1/ ..-0drn. p 0..,o, h L/;Ie r u;/~ r t.- '7 t7lJ

Df-f:. " c ~PoJ Tij ~ ~7" vO

;<. BD5 l'.r:-.,

Complete if last page of Schedule C

Page ~ of L..

Total [trolized Expenditures This Period .t../O(;rJ.. .....

Total Unitemized Expenditures ofS50 or less . (" /i.:J.< -TOTAL EXPENDmmES & OTIIER DISBURSEMENTS .:J '1 ;TInS PERIOD (fo line 4 ofSIUIl.b1.aI'Y) 7(/P?' -:-:.:...

Page 11: Arlen Siegfreid 913-764-3643 pethics.ks.gov/CFAScanned/House/2006ElecCycle/... · Arlen Siegfreid 913-764-3643 ~,5 SCHEDULE A CONTRIBUTIONS AND OTIIER RECEIPTS (Name Arlo>ofC

m-m__- ------ -m - n______---- - __n --_om

Arlen Siegfreid 913-764-3643

SCHEDULE DOTHER TRANSACTIONS

A t"/~ n .5-, e..~~r<:..;d(Name ofCc.ndidate,Party Committee or PoliticalCommittee)

Date Name and Address Nature of AttOunt or Loan- payable or Loao Rueivable

I TOTAL OTIIER TRANSACTIONS (to line 7 of S'IIIIJIIUII)'} -

p.11

BaJance atC[oaeofPeriod

] c)

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