- Reportethics.ks.gov/CFAScanned/House/2006ElecCycle/200601/H090SH_2006… · SCHEDULE A...

6
'-- AS GOVERNMENTAL ETHICS COMMISSION - \ f\\-.~O ' \ RECEIPTS AND EXPENDITURES REPORT ,,? 1'Uf;JfQ OF A CANDIDATE FOR STATE OFFICE ~(>.\-\ G\-\ LlO?o\'\S ~ ?\~~,€. January 10,2006 , ...\,\' or- s\ "'"',0\'<- ..P,'t RETARY OF STATE AND CANDIDATE'S COUNTY ELECTION OFFICER SEE REVERSE SIDE FOR INSTRUCTIONS A. Name of Candidate: &be. ~e..("' 1: Address: (0 L9 /v ~ ~ ('C~ City and Zip Code; JQ U:J Q0-IM Office Sought: ~j' JJL C~ty:~ Dtstrtct: B. Check only if appropriate: - - Amended Filing - TerminationReport - C. Summary(coveringthe period from January 1,2005 through December 31,2005) 1. CashonhandatbegiDningof period , , ,. 2. TotalCODtn"butiOns andOtherReceipts (UseScheduleA) , , , ,........ 3. Cash available this period (Add Lines 1 and 2) ~....................... 4. TotalExpendituresandOtherDisbursements(UseScheduleC) , , ,... 5. Cash on hand at close of period (Subtract Line 4 from 3) ,.............. 6. In-Kind Conttibutions (Use Schedule B) ------ 7. OtherTransactions (UseScheduleD) ..~ -1~ I J$g.7~ " '"~0~()~'" I 1"$J \.J ~~. Iu, IIS&g.IJ ]3. &7'-1.r>$ , ' D. "I declare that this report, including any accompanying schedules and statementS, has been examined by me and to the best of my 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." ." ".J- 3 -05 Date ~~Qi~ Signature of Treasurer 8/l 'J 96£9 'ON 8lL 6-6U -9l £ MJOSSV~ A~JnlS_VWO (:0(_900l 'Nlir GEC Form Rev, 2001

Transcript of - Reportethics.ks.gov/CFAScanned/House/2006ElecCycle/200601/H090SH_2006… · SCHEDULE A...

  • '--

    AS GOVERNMENTAL ETHICS COMMISSION- \

    f\\-.~O '\ RECEIPTS AND EXPENDITURES REPORT,,? 1'Uf;JfQ OF A CANDIDATE FOR STATEOFFICE

    ~(>.\-\ G\-\LlO?o\'\S~?\~~,€. January 10,2006, ...\,\' or- s\"'"',0\'$, '

    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." ."

    ".J- 3 -05Date

    ~~Qi~Signature of Treasurer

    8/l 'J 96£9 'ON

    8lL6-6U -9l £ M JOSSV~ A~JnlS_VWO ( :0(_900l '£ 'Nlir

    GEC Form Rev, 2001

  • SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

    S LJQ, f4~~~ame of Candidate, Party Committeeor PoliticalCommittee)

    Date Name and Addressof Contributor

    OecupaUon ofIadMdualGiviDgMore Than $150

    Check

    I

    Amount of

    Appropriate Box Cash, Check,Loan or

    Ca.It 'Cheek I Lou I Other I Other Receipt

    \.A.,,\or-~C;{~C' R..~\\-'4-05> I ~OO-..)'t~oY' ti-'lf'-l .

    ~r~-Ks>. t ~s. (p~ I

    ~~":JC.u)\-Y~DSI 1'0 ~O)C 7'13.0

    JU ~(~~~) ~. (PJo..-'Lot;.rJ'{\Aj(

    \\-lo1>SIgDo 50J'~ ~ &~1O)~ t\S. L,{P&Ia

    Ks.. 1le..v~,,-q~~ A~c...

    J '-7-D51 ~Y5 $vJ aCJ-M,~ f t

    PA-c-

    fA

    d-.W

    150 aD

    (1)

    d.~

    5 cDaJ

    I00 00

    ~15{) oJ

    ):50(0.

    ~ 00 ()f)

    ~~oo.cp

    Page-L of ~8/£ 'd 96£9'ON

    8lL6-6ZL-9l£ M JOSS~~ A~JnlS, VNOl :0l_900Z '£ 'N~r

  • SCHEDULE ACONTRIBUTIONS AND OTHER RECEIPTS

    -e-VIL~ameof Candidate,party Committeeor PoliticalCommittee)

    ~7:5. oD

    Complete if last page of Schedule A

    TotalIremizedReceipts for Period ." '", .

    TotnlUDitemizr4Contributions(SSOor less) ~.d * pock. 01" ~C.LoOV.M ~~ ~Sale oiPolitical Materials (Unitcm1zed)

    Total ContributionsWhenContributor ~ Known

    8/t 'd 96£9 'ON8IL6-6GL-9!£ M JOSS~~ A~JnlS

    ~NO!:0l_900G'[ 'N~r-

    Cheek Amoant ofDate I Name and AddreJs

    I O"nmu I AroPNU&XCash, Ched(,

    of Contributor Giving More Than $150 I Loan 01'Cub Check Loan OtherOther ReceIpt

    I I

    Ph

  • --moo -.._---m-m n_m-m - m-

    00____.._--- "-nn no_unm-n- m_...

    SCHEDULE B

    SIN-KINDCONTRIBUTIONS

    \-+Lt.f.\)~-(d -~ameof Candidate,PartyCommitteeor PoliticalCommittee)

    DateName, Addrus and Occupation

    of ContributorLilt OCCUpiltioDfor 1bosegiving

    an in-kind more than $150

    Description ofIn-Kind

    ContriblitioD

    Complete If lut page of SchcdQlC B

    Total Itemized (over $50) In-Kind Contributioos

    TotalUniremizw (S50 or l~s) !n.KWd Contributions

    8/S 'd 96£9 'ON8lL6-6~L-9i£ M JOSS~~ A~JnlS vv~ol :0l_900~'£ 'N~r

    Value ofIn-Kind

    Contribution

    Page_of-

  • SCHEDULE CEXPENDITURES AND OTHER DISBURSEMENTS

    ~~ ~6-.~+~ameofCanclidate.Party Committee or Political Committee)

    Date

    d-Jl~os

    d'-lJ- OS

    ,-~-'~DS

    :S-d.D-CS

    (P-IDJDS

    LP'-13~

    3 '-LS-D5

    &-~

    o-asl5

    Name and Address Purpose of Expenditureor DbburseDlcatt

    Amount

    kLSART~«o, I Ks .

    "fh('K. V~tL:JAA-wsla..lPw ~~""lJ'lI I~)~..' k'~ /~7) 1'-11

    ~. H~ ~\t;rl~lOt .s D"\D

    tv\t. ttOf'l I \~. illiog

    ~ Rer""bH~~ ~O(tJI~.~ l \

    VNll:Ol900Gl 'NVf-- -96£9 'ON

    8[L6-6GL-9l£ M JOSSV ~ A~JnlS

  • SCHEDULE CEXPENDITURES AND OTHER DISBURSEMENTS

    SkuQ ~1lame of Candidate.Party Committee orPoIitical Committee)

    Date NaDle and Address

    )~~9Si