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CAMPAIGN FUND REPORT TITLE PAGE
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr
Name of Treasurer Sarah Raminhos
Name as Appears on Account
Checking Account Sandy Spring Bank Citizens for Julie Palakovich Carr
Other Accounts
•eNOTE: All pages of the Campaign Fund Report must be submitted when filinge
Bank Name
Due Date
Please Check Report: ,--, 10/03/2013 • Initial Pre-Election Report , __ J
All transactions through 09/30/2013 MUST BE HAND DELIVERED BY 5:00 PM
,- - ., I I 10/28/2013 • Second Pre-Election Report
All transactions from 10/01/2013 to 10/27/2013 MUST BE HAND DELIVERED BY 5:00 PM
I XI 12/05/2013 • Initial Post Election Reporte, __ ... All transactions from 10/28/2013 MAY BE MAILED (Must be Post-Marked by 12/05/2013)
IF HAND DELIVERED MUST BE RECEIVED BY 5:00 PMe
I I 11/08/2014 • Annual Report* , __ .J MAY BE MAILED (Must be Post-Marked by 11/10/2014)
IF HAND DELIVERED MUST BE RECEIVED BY 5:00 PM
Reports Are Mailed or Hand Delivered to:
Office of the City Clerk ,, -, · City Hall
City of Rockville
111 Maryland Avenue
Rockville MD 20850
Status of Report (please check one):
The report is:
�the current due date.
01 and the account has been/will be terminated.
Omendment to a previous report filed on (Date)
*Any deadline that falls on a day that City Hall i s closed (e.g, weekend, holiday, inclement weather) will be extended to thee
next City business day.e
12/3/1312:02 PM
Amended Report: 0 Yes 0 No
CAMPAIGN FUND REPORT SUMMARY SHEET
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr
CONTRIBUTIONS A I Contribution Receipts B.0 I Campaign Committees0C.0 Transfers in from Other Treasurers0D.0 Other0E.0 In-Kind Contributions0F. TOTAL RECEIPTS (A through E) EXPENDITURES G. Salaries and other Compensation0H. Office Rent, Supplies, other Expenses0I.0 Campaign Materials0J.0 Direct Mail0K. : Postage/Shipping0L. Fund-raising0M.0 Equipment Purchase0N. Transfers to Another Treasurer00. Transfers to petty cash0P.0 Media Advertising0Q. Interest payment0R. Other0S.0 In-Kind Contributions (Same as E) Note: Non Add Line T. I TOTAL EXPENDITURES (Add Lines G through RJ LOANS U.0 I Loans Received0V.0 I Loan Principal Repayment0SUMMARY
Current Period 275.00
0.00 0.00 0.00
20.00 295.00
Current Period 0.00
20.00 101.76 283.72 833.95
0.00 0.00 0.00 0.00
250.00 0.00 8.15
20.00 1,497.58
Current Period 0.00 0.00
Current Period
Initial Post Election Report
Prior Period(s) 7,790.00
0.00 0.00 0.00
110.68 7,900.68
Prior Period(s) 250
186.94 2842.47
262.99 895.3
0 0
2000 0 0 0
85.56 110.68
6,523.26 Prior Period{s)
ol 0
Prior Period(s)
Page 2 of 10
Total 8,065.00
0.00 0.00 0.00
130.68 8,195.68
Total 250.00 206.94
2,944.23 546.71
1,729.25 0.00 0.00
2,000.00 0.00
250.00 0.00
93.71 224.39
8,020.84i Total
0.00 0.00
Total W.0X. Y. Z. AA.
! Balance Forward (From last report Current Period line EE)0jAdd total receipts (Same as line F)0Add Loans (Same as line U)0Less total expenditures (Same as Line T)0Less loan principal repayment {line V)
1,377.42 295.00
0.00 1,497.58
7,900.68 0.00
6,523.26
8,195.68 0.00
8,020.84 0.00
174.84 174.84
0.00
174.84
0.00 0.00 BB. cc. DD.0EE.
ITOTAL (!N-AA) Balance in Checking Account0Balance in Savings0TOTAL BALANCE (CC-DD)
CERTIFICATIONS: WE SWEAR THAT THE INFORMATION PROVIDED IS TRUE AND COMPLETE TO THE BEST OF OUR KNOWLEDGE AND BELIEF.
� �v4__ /)_-?, -a.o1,3 12/J'/is CAi?DIDATE DATE TRJ�f:� DATE
----- -- ---------------�---
� .-.�
----
Amended Report: DYes &No Initial Post Election Report
CAMPAIGN FUND REPORT - SCHEDULE 1 CONTRIBUTION RECEIPTS
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 3 of 10 ... , . , ,., •. _':,'.° ·. . . .·•·. ·':, _;, ·- \.'""', .: -.
Contributor Information Payment Type Source
Date Name
' i
i Address Check Cash Non-Campaign
Committee Campaign Committee
10/28/13 Jeffrey Watters !2802 Albemarle Dr. Alexandria, VA 22303 X 100.00 10/29/13 Stephen Edwards 1391 Kersey Lane Rockville, MD 20854 X 100.00 10/31/13 Nancy Breen 713 Ivy League Lane Rockville, MD 20850 X 25.00 11/06/13 Kate Osten 128 Calvert Rd, Rockville, MD 20850 ------ X 50.00
--------------i
-------------------------- ------·
.
$275.00 $0.00
---- --- - ----- .
Amen�mi�: !Jo Initial Post Election Report
CAMPAIGN FUND REPORT - SCHEDULE 1A TRANSFERS FROM ONE TREASURER TO ANOTHER
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 4 of 10
N/A N/A N/A
$0.00
Amended Report: 0Yes Cs] No Initial Post Election Report
CAMPAIGN FUND REPORT -SCHEDULE 1B
OTHER RECEIPTS AND IN-KIND CONTRIBUTIONS
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr
""-.,-,: _ "', -�----lil! _ 2i��� _cJE1'ifls[@;:;{:
": '" 0' <.. ' . y�- •."\ H jll'J!�
·"• •·• .-.c ;,.-,-£,,:
Date Contributor Information Received Name Address
10/31/13 Eric & Julie Palakovich Carr 107 Charles St. Rockville MD 20850
11/30/13 Eric & Julie Palakovich Carr 107 Charles St. Rockville MD 20850
_____ JL, .. Loans
Received
Page 5 of 10
..-.__ �-: _ I13-l : '""· � Other In-Kind -- - --(Misc) Contributions (value in dollars per item)
10.00 Hosting Website on Server
10.00 Hosting_Website on Server
.
........ ·•··············· ····-···
.
.
--------- ------······
$0.00 $0.00 $20.00
[15]
Ame0ed RepoO 0Yes [] No Initial Post Election Report CAMPAIGN FUND REPORT - SCHEDULE 2
SCHEDULES Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 6 of 10
EXPENDITURE CLASSIFICATION 1161 [171 1181 [19] [20] [21]
t'(enT/UTC To Whom Paid/Received From (In-Kind) Check#/ In Total Salaries/ Su pis/Other Campaign Date Name Address Kind (!Kl Amount Comp. Supls Materials
10/30/13 PaypalFee 1 221 N. First St. San Jose,CA 3.20 I UL ' ,�arrows Lane0
2 11/01/13 Direct Mail Express Silver Spring, MD 20906 95 1,117.67
11/04/13 Paypal Fee 3 221 N. First St. San Jose.CA 3.20 IV,J I n.Ovr..vlue r-lr..v
4 11/04/13 Staples Rockville, MD 20852 101.76 101.76 1vv I vvluvvw 1,Y. tv181110
5 11/04/13 Facebook Advertising Park, CA 94025 50.00 I 1vv, vvluvvw ,,u.. ,v,en,o
6 11/04/13 Facebook Advertising i Park, CA 94025 50.00 1vv, vvluvW '''-'-· ,v,e1110
11/05/13 Facebook Advertising Park, CA 94025 7 50.00 1vv I vvlllOW '''-'· ,v,e,,.o
8 11/07/13 Facebook Advertising Park, CA 94025 50.00 1601 Willow Rd. Menlo
9 ' 11/08/13 Facebook Advertising Park, CA 94025 50.00
10 11/08/13 PaypalFee 221 N. First St. San Jose,CA 1.75 , , u 1 1..,m,r,"" v,.
11 10/31/13 Eric & Julie Palakovich Carr Rockville, MD 20850 In-Kind 10.00 10.00 1u, vr11::1.nes .... �.
12 11/30/21: Eric & Julie Palakovich Carr Rockville, MD 20850 In-Kind 10.00 10.00
13 0.00
14 0.00
15 0.00
' 16: 0.00
$1,497.58 $0.00 $20.00 $101.76
[22)
Direct Mail
[231
Postage/ Shippina
283.72 833.95
$283.72 $833.95
Amended Report: D Yes 0 No Initial Post Election Report
CAMPAIGN FUND REPORT - SCHEDULE 2 EXPENDITURES
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 7 of 10
EXPENDITURE CLASSIFICATION [24} [25] [26) [271 ; [28] [29}
'
[30) [31} [32] Purchase of Transfer to another Media Interest
FundraisinQ Equipment Treasurer Pettv Cash i Advertising Payment Loan Principal Savings/Interest
Other Repayment Bearing Account
1 3.20
2
3 3.20
4
5 50.00
6 50.00
7 50.00
8 50.00
91 50.00
101 1.75
11
12
13
$0.00 $0.00 $0.00: $0.00 $250.00 $0.00 $8.15 $0.00 $0.00
14
15
16
Amended Report: 0Yes IS] No Initial Post Election Report
CAMPAIGN FUND REPORT - SCHEDULE 2A
PETTY CASH REPORTING FORM
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 8 of 10
N/A N/A N/A N/A
------------- -------- --------
. / -,';;:".;.:, __ -,-�- :_·-,,;
------
------- -----
---------
----- ------------- -------
� ;i'!Jiif' 1:1:35]
------
Written Consent
DYes [8J No Amended Report: Initial Post Election Report
OUTSTANDING OBLIGATIONS
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 9 of 10
,: .. - 13Pl .. ' .· -•-•-[33] : " -
Name & Address of Date Obligation Balance of Creditor Incurred Previously Filed Filed Herewith Loan Balance Due Description
NIA NIA NIA NIA NIA NIA NIA
i
'
----------.
Chapter 8 of the Rockville City Code provides that no loan may be made to a candidate, or accepted on behalf of the candidate, without written consent of the candidate. A copy of the written consent shall be furnished to the lender at the time of the loan. This consent is given on Schedule 4 of the Campaign Fund Reporiing forms for the transacuon period for which the load is made.
------
----
Amended Report: Oves � No Initial Post Election Report
CAMPAIGN FUND REPORT: Schedule 4 REPORT ON LOAN TO CAMPAIGN FUND ACCOUNT
Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 10 of 10
This schedule must be attached to the Campaign Fund Report for the transaction period in which the loan was made. A copy should also be given to the lender.
I. CONSENT OF RECIPIENT Please print
in the amount of
N/A
NIA
, hereby acknowledge receipt of a loan on
made payable to N/A
NIA
(Date)
from NIA A copy of this consent has been supplied to the lender.
(Signature of Candidate) NIA
(Date)
II. TERMS OF LOAN Please print
Name of Lender: --'--'N:..:./A-'-------'---------------------------------------
Address of Lender: N/A
Are the terms of the loan stated in writing? N/A Yes N/A No
Schedule for repayment: N/A
Interest rate: N��/A�------------------------------------------------
N/A (Signature of Lender) (Date)