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January 2012 Finance Report -- Roman Larson for School Board
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Transcript of January 2012 Finance Report -- Roman Larson for School Board
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8/3/2019 January 2012 Finance Report -- Roman Larson for School Board
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Roman Larson for School Board Finance Report
January 2012 Continuing Report
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8/3/2019 January 2012 Finance Report -- Roman Larson for School Board
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CAMPAIGN FINANCE REPORT
LOCAL COMMITTEES OF WISCONSIN
Is This Report an Amendment: Yes No
Instructions for completing schedules are on the back of each schedule.
COMMITTEE IDENTIFICATIONName of Committee
Street Address OFFICE USE ONLY
City, State and Zip Code
Please check if address is different than previously reported, and complete the Campaign Registration Statement in the back of this form.
NAME OF REPORT
January Continuing _____ Pre-Primary _____ Spring Fall SpecialTerminationRepor
July Continuing _____ Pre-Election _____ Spring Fall Special also complete Schedule
SUMMARY OF RECEIPTS AND
DISBURSEMENTS
Column A
This Period
Column B
Calendar
1. RECEIPTS Year-To-Date
1A. Contributions (Including Loans) from Individuals $ $
1B. Contributions from Committees (Transfers-In) $ $
1C. Other Income and Commercial Loans $ $
TOTAL RECEIPTS(Add totals from 1A, 1B and 1C) $ $
2. DISBURSEMENTS
2A. Gross Expenditures $ $
2B. Contributions to Committees (Transfers-Out) $ $
TOTAL DISBURSEMENTS(Add totals from 2A and 2B) $ $
CASH SUMMARY
Cash Balance Beginning of Report $
Total Receipts $
Subtotal $
Total Disbursements $
CASH BALANCE END OF REPORT $INCURRED OBLIGATIONS(Balance at the Close of This Period-3A) $
LOANS (Balance at the Close of This Period-3B) $
I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.
Type or Print Name of Candidate or Treasurer Signature of Candidate or Treasurer Date:
Daytime Phone:
NOTE: The information on this form is required by ss.11.06, 11.20, Wis. Stats. Failure to provide the information may subject you to the penalties ofss.11.60, 11.61, Wis. Stats.
GAB-2L (Rev. 12/09) This form is prescribed by the Government Accountability Board. Completed forms must be filed with your local clerk.
s
Roman Larson for School Board
9119 West Bonniwell Road
2012
400.00 400.00
0.00 0.00
0.00 0.00
400.00 400.00
7.37 7.37
0.00 0.00
7.37 7.37
0.00
400.00
400.00
7.37
392.63
0.00
0.00
Roman Larson
Mequon, WI 53097
January 30, 2012
262-993-0888
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SCHEDULE 1-A Page ____ of ____RECEIPTSContributions (Including Loans) From Individuals
Complete Committee Name
Instructions for completing schedules are on the back of each schedule.Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________Date
/ /
Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)
Amount CalendarYear-to-Date Total
Check if: In-Kind Loan Conduit Conduit Name:_______________________________
SUBTOTAL ITEMIZED CONTRIBUTIONS THIS PAGE $
TOTAL ITEMIZED CONTRIBUTIONS $
TOTAL UNITEMIZED CONTRIBUTIONS $20 OR LESS $
TOTAL CONTRIBUTIONS RECEIVED FROM INDIVIDUALS $
1 1
Roman Larson for School Board
400.00
400.00
0.00
400.00
12 21 11Roman Larson
9119 W Bonniwell Rd
Mequon, WI 53097
Student at Stanford University
PO Box 17559
Stanford, CA 94309
400.00 400.00
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SCHEDULE 2-ADISBURSEMENTSGross Expenditures
Page ___ of ___
Complete Committee Name
Instructions for completing schedules are on the back of each schedule.
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
Date
/ /
Full Name, Mailing Address and Zip CodeOf Person or Business to Whom Payment is Made
Check if: In-Kind Offset
Specific Purpose of Expenditure Amount
SUBTOTAL ITEMIZED EXPENDITURES THIS PAGE $
TOTAL ITEMIZED EXPENDITURES $
TOTAL UNITEMIZED EXPENDITURES $20 OR LESS $
TOTAL EXPENDITURES $
Roman Larson for School Board
0.00
0.00
7.37
7.37
1 1