~eciciyed - kansasethics.ks.gov/cfascanned/house/2012eleccycle/201207/h066cs_201207.pdf · .kansas...
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.KANSAS GOVERNMENTAL ETHICS COMMISSION ~ECICIYED
RECEIPTS A1\lD EXPENDITURES REPORT OF A CANDIDATE FOR STATE OFFICE JUL 26 2012
July 30, 2012 KS Governmental Ethics Commission
FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
A, Name of Candidate: ~fI> tV?:- y. eM.LIA)
~ddross: . I c. .rtJ S"U "'"1SLO e! j *'U:
CIty and ZIp Code: . tI1,ritVl-/I47'?tMI, f~J c.t rOl.. County: RI L ~ 1./7
Office Sought:. S '7A-"1'"~ R'l·ta-1.!(rr.4 rf tiC District: t Crtf,..
B. Check only if appropriate: ~ Amended Filing __ Termination Report
C. Summary (covering the period from January 1,2012 through July 26, 2012)
1. Cash on hand at beginning ofperiod ,
2. Total Contributions and Other Receipts (Use Schedul.c A)
3. Cash available this period (Ad.d Lines 1 and 2) ~
4. Total'Expenditures and Other Disbursements (Use Schedule C) ;
5. Cash on han~ at close of period (Subtract Line 4 from 3)
6. In-Kind Contributions (Use Schedule B) -6 ,--.
7. Other Transactions (Use Schedul~ D) ~ q S7, cJ 7
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.D. "I declare that this report, including any accompanying schedules and statements, has been ex.amined by me and to the best afmy knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."
-hltL-Date
GEe Form Rev, 2001
Occup:ltion & lndu!ltry of Checl~ Amount of Nome lind Addl'es!l IndividulIl Giving More Apprnpl"il\te Box Cash, Check,
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SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
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Occupation & lndustry of Name and Address Individual Giving More
Dnte of Contributor Than $150
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Loan 01" GQ~h Cllccll I.,~~n Other Other Receipt
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SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
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Occupation & Industry of Amount of Name and Address
Check Individual Giving Mote Cash, Check,
Date Appropriate Box
of Conttibutor Than $150 Loan or Other Receipt
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SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS.
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Date of Contl"ibutor Than $150 t----r---r---r-~--t Loan or Cnsb Cbeclc Lonn Olbcr Other Receipt
PageLof-1I
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SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
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Occupation & Industry of Amount of Name and Address
Check Cnsh. Check,
Date Individual Giving More Appropriate Box
Loan orThan $150 of Contributor C~~h ell ~.ch l.Aln II OthH Other Receipt
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Totlllltell1 ized Rocei pts fol' Period
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Sale (lfPolitical Mnterial~ (Unitemized)
Total Contributions When COlltTibul:or Not Known
P!lgc~Of~
(Name of Candidate) (
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,DSltc of Contributor Than $150 Lorin or Cnsb Chock LO~h OtJ'~.I' Otber Receipt
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Totfll Itemized Receipts for Period
Tota.l Unftemized Contributions ($50 or Jess)
Sale ofPolitical Materfals (Unit~mized)
PageL-of 7
SCHEDUlJE C EXPENDITURES AND OTHER DISBURSEMENTS
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SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
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