--- --- -- -

Jul 25 06 02:52p Mike Beatt~ 9706411767 p.8

KANSAS GOVERNMENTALETHICS COMWS'e:l -. ;;i'\,RECEIPTS AND EXPENDITURES REPORT EIVEu

OF A CANDIDATE FOR STATE OFFICE ~ ,JUL 25 200t'-'>av"'rn

January 10,2006 . 109~~U:trJics C<Jrn' ..

TOpr::K;,'" I 9TH STR:::~SSIonFILE WITH SECRETARY OF STATE AND CANDIDATE'S COUNTY ELEC11'61&~ICER

SEE REVERSE SIDE FOR INSTRUCTIONS

~., .. .

- 0., .. .. .. ...A. Name of Candidate: C l, 0-" It' ::> tS ~o '"Address: .3 Cr"(>f v; ~ tV 'p ;, "e

CityandZipCode: So-I,.; D\. b 7'f- (] J

Office Sought: '5 rJ-c. I:..t...pl"t,r~1I~.J.;.,,(.

County: ~ 1.70... 11'\.f...

District: 7 I s I-

a"'» ./B. Check only if appropriate: ~ Amended Filing - Termination Report

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

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

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

t t1~

5. Cash on hand at close of period (Subtracttine 4 from3) "..............

6. In-Kind Contributions (Use Schedule B) " n.

~F(J o. ...,.~fda."G.~~ 9J~ (.X-

II 'RF.t".~.

3. Cash available this period (Add Lines 1and2) :.......................

4. Total Expenditures and OtherDisbursements(UseScheduleC) "'"''''''''''''''''''''''''''

7. Other Transactions (Use Schedule D) ..............

D. "I declare that this report, including any accompanying schedules and statements, has been examined by meand to the best of my knowledge and belief is true, correct and complete. I understand that the intentionalfailure to file this document or intentionally filing a false document is a class A misdemeanor."

7/~/o/'I I

,(. /k~~ d:4-Signature of Treasurer

GEC Form Rev, 2001

Jul 25 06 02:53p Mike Beatt~ 9706411767 p.9

SCHEDULE ACONTRIBUTIONSAND OTHER RECEIPTS

Charles BRoth

(Name of Candidate,Party Committee or Political Committee)

Page .f;-:'of'- 7--:>--

,.;.-

.

...-

...--

,.......-

/'

I

0Iedt AmouDtof

Date Name and Address Occupatioa or lDd"nridual APPlfOpriateBox Cash, Check,ofCoQtribate.. GiriDg MOR:Tbao $150 Loao or

Cash Qcck ..... 0......Other Receipt

Mike Beatty Inoavidual - r"",.I(>f-J>D [Z] D D6/1105 121 Overbill Rd

...

Salina,Kansas 67401$100.00

BevertyEnterprises, Ine.

D7/8105 One Thousand BeverlyWay III D D $500.00FortSmithArkansas 72919-2500 "..-

AltriaCorporateServices, loe

D IlJ D1013105 120 Park Avenue DNewYork,NewYork10017-5592 $150.00 ...

Kansas ContractorsAssociation10/22/05 POBox5061 D [Z] D 0Topeka, Kansas66605 $100.00

AndersonFmancialServices.llC10/22/05 800 West 23rd St 0 IZJ D DLawrence,Kansa567401 $250.00

KansasGasServiceEmployee10/27/05 PACPO8ox25957 D III D 0Overland Park, Kansas66225 $100.00

Kansas OptometricPoliticalAction10/27105 Committee D III 0 01266SW TopekaBlvd $250.00

Topeka. Kansas 66612

Kansas MedicalSocietyPolitical10129/05 ActionCouncil

D [{] D 023 SW1OthAve. $500.00Topeka, Kansas 66612

KansasUvestock.AssociationPAC'

11/4/05 6031SW37thSlreet D [{] D 0Topeka,Kansas66614-5115 $150.00

Kansas Chamber OfCommerce&11/7/05 Industry D [lJ D 0835 SW Topeka Blvd. $250.00

Topeka Kansas 66612-16671. -

Subtotal This Page . $2,350.00

Ju1 25 06 02:53p Mike Beatt~ 9706411767SCHEDULE A

CONTRIBUTIONS AND OTHER RECEIPTS

p.10

Charles BRoth

(Name of Candidate, Party Committee or political Committee)

J-.- -Pae:e of -. -3>- - ---,...<-.;

-

-

,.-

....--

.---

~

---

,..---

,..--

I

Claeck Amouatof

Date Name aDdAddress Oa:upatma of Jadividual Appropriate Box Cash. Check.,OfCODtribotDr Girilig More TbaD 5150 Loan or

Casta Cha:k Lo:m 01IIerOther Receipt

Fanners ABiance Mutual Insurance J

D [ZJ D1117/05 Company D $.ooPOBox 14011122NorthMainMcPhezson.Kansas 67460

HCAKansas Good Government11/21/05 Fund D [{] D D $150.00CommerceBankand Trust

Topeka, Kansas 66611

Kansas Bankers AssoicationPAC11/23/05 POBox 4407 0 III D D $200.00Topeka.Kansas66604-M07

Kansas BeverageAssociationPAC1ii710S 5845 N 29thSf. D [(J 0 0Topeka,Kansas66614 $100.00

Kansas Cable PAC12/19/05 POBox 3021 D [l) D DWichita,Kansas 67201-3027 $200.00

Kansas Committeefor Rural. 11/10105 Electrification ' D fl] D 0POBox 790 $100.00

Meade. Kansas 61864

Kansas Restaurant and Hospitality11/14105 AssociationPAC D fZ] D 0359 Hydraulic $100.00

Wichila,Kansas 61211

PrairieBand PotawalomiNation11/14/05. 16281 Q Road 0 fl] D 0Mayetta,Kansas 66509 $250.00

<aR J Reyunolds

11121/05 POBox 2955 D [l] 0 DWinston-5alem,NorthCarolina $100.0027102

Southwestem BeDKansas Employee12/1/05 PAC. 0 fZ] 0 0220 E. 6th $250.00

Topeka Kansas 66603...-... .----

Subtotal this Page1

$1.700.00

Jul 25 06 02:53p Mike Beatt:::l 9706411767 p. 11

iSCHEDULE A

CONTRIBUTIONS AND OTHER RECEIPTS

Charles 8 Roth

(Name of Candidate, Party Committee or Political Committee)

Page :3 of~

PrintPage

I

Check Amount of

Date Name and Address Occupation oflodmdaal Appropriate Box Cash, Check,ofColltriburor GiYDtg Mere Than $156 I Loan or

Casb Check Loan OtherOther Receipt

Kansas Wine & Spirits Wholesalers-

D IZ]12/29/05 PAC D 0 $50.00

BuildersAssociationof Kansas-PAC12/29/05 212 SW 8th Avenue,Ste 201 D [Z] D D $100.00Topeka, KS 66603

I i1))

f "'-\! ({---{'{",...,,

f. 0 .6<1y- /7 0 '67 /t)<.t.s I ""f .!>-5 <t'I D [3' D D 1" 2-0 (}.",v

/,.4rcl.: /' F S

ii)f/v 1"'- t. I;(.r 0#.t..> Co. D Gj' D D lfJO.Q'c.P-o......H M. "I. f-h., I;l1 KW l.,. . y (..II J

ivjv1f IStrJc.t.. L",-,,( tt>-/-r;uD WO.' oJfJ rlJ. 6.0 Y-L.? !7b G D D

w .L.:h A \<--.5. Co72.fJI

D D D D

D D D D

D D D D<I.

D D D 0

D D D D

Subtotal This Page $150.00

Jul 25 06 02:53p Mike Beatt~ 9706411767 p.12

SCHEDULE CEXPENDITURES AND OTHER DISBURSEMENTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

P.age 1 of '?----

Date Name aDdAddress Purpose ofExpendilnre Amountor Disbursement

DeluxeCheck Supplies -6/28/05 $107.75

Bennington State Bank Bank Charges7/29/05 $1.00

Bennington State Bank Bank Charges8/31/05 $1.00

Bennington State Bank Bank Charges9(30105 $1.00

Charles B Roth Meals & Entertainment

11/23/05 $254.11

Chartes BRoth Dues

11/23/05 $282.00

Chartes BRoth Education

11/23/05 $174.00

Charles BRoth Travel11f23fOS $233.16

)Charles B Roth Postage

"

11/23/05 $208.00

Charles BRoth Printingand Reproduction11/23/05 $223.46

Subtotal This Page $1,395.48

Jul 25 06 02:54p Mike Beatt~ 9706411767SCHEDULE C

EXPENDITURES AND OTHER DISBURSEMENTS

p.13

Charles 8 Roth

(Name of Candidate, Party Committee or Political Committee)

Complete if last page of Scbedule C

Page~of ~

.Date Name and Add' -Purpose of Expenditure Amountor Disbursement

Charles BRoth Computer11/23/05 $1,5f9.17

..

.'

,.

Subtotal This Page $1,519.17

Total Itemized Expenditures This Period $2.914.65

Total Unitemized Expenditures of$SO or less $0.00

TOTAL EXPEND:rnJRES & OTHER DISBURSEMENTS$2,914.651THIS PERIOD (to liDe 4 of Summary)

Jul 25 06 02:54p Mike Beatt:t 9706411767 p. 14

i -

Charles B. Roth

State Representative, 71st District3 Crestview DriveSalina, Kansas 67401785827-3712

Invoice No, 001

INVOICE----

~ 1~IQ_~ I

Name MikeBeatly-CampaignTreasurer Rothfor legislatureAddress 121 Overhill RoadCity SalinaPhone 785 825--9134Reimbursement of campaign and legislative expenses

StateKS ZIP 67401

Date Description Price TOTAL10/25/2005 Ticket to Amazing 100 MUesLuncheon $ 20.00 $ 20.0010/2512005 Lunch with Rep Clark Shultz $ 16.90 $ 36.90312212005 Dinner with Reps Owens, Loyd and George $ 169.91 $ 206.8111i312005 Dinner with Rep Kenny Wilk $ 27.30 $ 234.113/612005 Republican House Reelection Conbibution $ 100.00 $ 334.114/512005 Salina Chamber Dues $ 182.00 -!-. 516.115i2112005 Hawver News-Capitol Report $ 174.08 $ 690.1910/512005 Chamber Lunch Hall of Fame ticket $ 20.00 $ 710.1911/1912005 Lodging for Republican Retreat-Doubletree Hotel KC $ 214.88 c!-. 925.0711/1912005 Fuel to RepublIcan Retreat $ 1828 $ 943.356/2/2005 Postage $ 111.00 ,- 1,054.35101612005 Postage $ 74.00 $ 1,128.355/1312005 Postage-postcard stamps $ 23.00

'-'------$ 1,151.35

912212005 Mow Prtg-stationary $ 180.65 $ 1,332.006/3/2005 Office Max-labels for mailing $ 42.81 $ 1,374.813/3/2005 ISG Purchase laptop $2,279.09 less personal use $760.00 $1.519-09 $ 2,893.90

-----------'--.--'--------

----------

-----._--

. - --

-------

--.--.---- -----.-.---..

--.-_..- ---

Total .1--- -2,893.9_0.-

Reset'Page

KANSASGOVERNMENTAL ETHICS COMMI~,s~~~>\ ..~

;- \ :.:: ;,,' .,"

RECEIPTS AND EXPENDITURES REPORTOF A CANDIDATE FOR STATE OFFICE .'. r '? ,

January 10,2006

- ~

, ~ ~

, .' -- .. - ,--

FILE WITH SECRETARY OF STATE A..~DCANDIDATE'S COUNTY ELECTION OFFICERSEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Candidate: Charles BRoth

Address: 3 Crestview Drive

City and Zip Code: Salina 67401

Office Sought: State Representative

County: Saline

District: 71 st

B. Check only if appropriate: L Amended Filing - Termination Report

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

1. Cash on hand at beginning of period """''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

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

3. Cash available this period (Add Lines I and 2) ,.....................................................

.00

4200.00

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

5. Cash on hand at close of period (Subtract Line 4 from 3) ...........................................

4200.00

2914.65

1335.35

6. In-Kind Contributions (Use Schedule B) """'"

7. Other Transactions (Use Schedule D) ..............

.00

.00

D. "I declare that this report, including any accompanying schedules and statements, has been examined by meand to the best of my knowledge and belief is true, correct and complete. I understand that the intentionalfailure to file this document or intentionally filing a false document is a class A misdemeanor."

~-- /Y'd~Date

;(-~ ~Signature of Treasurer

GEC Form Rev, 2001

Print Page

- n - - -- - - -- - --- - -- --

SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

Date

6/1/05

7/8/05

10/3/05

10/22/05

10/22/05

10/27/05

10/27/05

10/29/05

11/4/05

11fl/05

Name and Addressof Contributor

Mike Beatty121 Overhill RdSalina, Kansas 67401

Beverly Enterprises, Inc.One Thousand Beverly WayFort Smith Arkansas 72919-2500

Altria Corporate Services, Inc120 Park AvenueNew York, New York 10017-5592

Kansas Contractors AssociationPO Box 5061 .

Topeka, Kansas 66605

Anderson Financial Services, LLC800 West 23rd StLawrence, Kansas 67401

Kansas Gas Service EmployeePACPO Box 25957Overland Park, Kansas 66225

Kansas Optometric Political ActionCommittee1266 SW Topeka Blvd.Topeka, Kansas 66612

Kansas Medical Society PoliticalAction Council23 SW 10th Ave.Topeka, Kansas 66612

Kansas Livestock Association PAC6031 SW 37th StreetTopeka, Kansas 66614-5115

Kansas Chamber Of Commerce &

Industry835 SW Topeka Blvd.Topeka Kansas 66612-16671

.. -"'- '..;' >--:-. - - - --w- -. -

Sllb~tat'filiSJj~f

Occupation of IndividualGiving More Than $150

Individual

Check

Appropriate Box

Cash Check u.ao Other

DHZJIDID

DI[ZJIDID

DI[ZJIDID

DI[ZJIDID

DI[ZJIDID

DI[{]IDID

DI[ZJIDID

DI[{]IDID~

DI[ZJIDID

DI[ZJIDID

Amount ofCash. Check,

Loan or

Other Receipt

...

$100.00

$500.00

$150.00

$100.00

$250.00

$100.00

$250.00

$500.00

$150.00

$250.00

$2,350.00

Page .1=';.of -;>- -".--

-- ---

SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

~ -f :3Paae ,.~- 0 ---"---'"'- .

Check Amount of

Date Name and Address Occupation of Individual Appropriate Box Cash, Check,, of Contributor Giving More Than $150 Loan or

Cash Check Loan OtherOther Receipt

Farmers Alliance Mutual Insurance I

11/7/05 Company D [l] D D $250.00POBox 1401 1122NorthMainMcPheffiOn.Kansas67460

HCAKansasGoodGovernment11/21/05 Fund D [l] D DCommerceBankand Trust $150.00

Topeka,Kansas66611

Kansas BankersAssoicationPAC11/23/05 POBox 4407 D [l] D D $200.00

Topeka,Kansas66604-0407

Kansas BeverageAssociationPAC11/7/05 5845 SW29thSt D [{] D DTopeka,Kansas66614 $100.00

Kansas Cable PAC12/19/05 POBox 3027 D [l] D DWichita,Kansas 67201-3027 $200.00

Kansas CommitteeforRural'11/10/05 Electrification D [{] D DPOBox 790 $100.00

Meade,Kansas 67864

Kansas Restaurantand Hospitality11/14/05 Association PAC D [l] D D359 Hydraulic $100.00

Wichita,Kansas 67211

PrairieBandPotawatomiNation11/14/05 16281Q Road D [l] D DMayetta,Kansas 66509 $250.00

"R J Reyunolds

11/21/05 POBox 2955 D [l] D DWinston-Salem,NorthCarolina $100.0027102

SouthwesternBellKansasEmployee12/1/05 PAC D [l] D D220 E. 6th $250.00

Topeka Kansas 66603ls"cti'

f,0:Ji;Z)(f1fir'.",'

"",i " i'iF - '+iJih':rr';''''';.. Subtotal- sPage $1,700.00

Reset,Page

SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

Page "3 of..2..

-""-"" ~.-

Print Page

Check Amount of

Date Name and Address Occupation of Individual Appropriate Box Cash, Check,of Contributor Giving More Than $150 Loan or

Cash Check Loan OtherOther Receipt

Kansas Wine & Spirits Wholesalers-

D [Z] D D12/29/05 PAC $50.00

Builders Association of Kansas-PAC

12/29/05 212 SW8th Avenue,Ste201 D [Z] D D $100.00Topeka,KS 66603

D D D D

D D D D

D D D D

D D D D

D D D D

D D D D

D D D D

D D D D

Subtotal This Page $150.00

SCHEDULE CEXPENDITURES AND OTHER DISBURSEMENTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

P.age 1 of V~-

Date Name and Address Pnrpose of Expenditure Amountor Disbursement

Deluxe Check Supplies4

6/28/05 $17.75

Bennington State Bank Bank Charges7/29/05 $1.00

Bennington State Bank Bank Charges8/31/05 $1.00

Bennington State Bank Bank Charges9/30/05 $1.00

Charles BRoth Meals & Entertainment

. 11/23/05 $254.11

Charles BRoth Dues11/23/05 $282.00

Charles BRoth Education11/23/05 $174.00

Charles BRoth Travel11/23105 $233.16

'\

Charles BRoth Postage11/23/05 $208.00

Charles BRoth Printing and Reproduction11/23/05 $223.46

Subtotal This Page$1,395.48

SCHEDULE CEXPENDITURES AND OTHER DISBURSEMENTS

Charles BRoth

(Name of Candidate, Party Committee or Political Committee)

.Date Name and Address . 'Purpose of Expenditureor Disbursement

Amount

Charles BRoth Computer4

11/23/05 $1,519.17

"

,',~.".,;po

,

'\

subtollif~:':Page$1.519.17

<

Complete if last page of Schedule C

Page~ of '2--

Total Itemized Expenditures This Period $2.914.65

Total Unitemized Expenditures of$50 or less $0.00

TOTAL EXPENDITURES & OTHER DISBURSEMENTS$2.914.65THIS PERIOD (to line 4 of Summary)

Charles B. Roth

State Representative, 71st District3 Crestview Drive

Salina, Kansas 67401785827-3712

Invoice No. 001

INVOICE

Name Mike Beatty- Campaign Treasurer Roth for LegislatureAddress 121 Overhill RoadCity SalinaPhone 785 825-9134

Reimbursement of campaign and legislative expenses

Date 11/24/2005

State KS ZIP 67401

Date Description Price TOTAL10/25/2005 Ticket to Amazing 100 Miles Luncheon $ 20.00 $ 20.00 i

10/25/2005 Lunch with Rep Clark Shultz $ 16.90 $ 36.903/22/2005 Dinner with Reps Owens, Loyd and George $ 169.91 $ 206.8111/3/2005 Dinner with Rep Kenny Wilk $ 27.30 $ 234.113/6/2005 Republican House Reelection Contribution $ 100.00 $ 334.114/5/2005 Salina Chamber Dues $ 182.00 $ 516.115/21/2005 Hawver News-Capitol Report $ 174.08 $ 690.1910/5/2005 Chamber Lunch Hall of Fame ticket $ 20.00 $ 710.19

11/19/2005 Lodging for Republican Retreat-Doubletree Hotel KC $ 214.88 $ 925.0711/19/2005 Fuel to Republican Retreat $ 18.28 $ 943.356/2/2005 Postage $ 111.00 $ 1,054.3510/6/2005 Postage $ 74.00 $ 1,128.355/13/2005 Postage-postcard stamps $ 23.00 $ 1,151.359/22/2005 Arrow Prtg-stationary $ 180.65 $ 1,332.006/3/2005 Office Max-labels for mailing $ 42.81 $ 1,374.813/3/2005 ISG Purchase laptop $2,279.09 less personal use $760.00 $1,519.09 $ 2,893.90

Total $ 2,893.90