IUNSAS GOVERNMENTAL ETHICS COM.MISSlON li" CrEWED
RECEIPTS AND EXPENDITURES REPORT OF A CANDIDATE FOR STATE OFFICE
1\5 Govern>jN::!I"'~1""'h f~," r_[ 'cs t-January 10, 2017 - , \.-.OfTIml
FILE WITH SECRETARY OF STATE SEE REVE'RSE SIDE FOR INSTRUCTIONS
A. Name ofCandida{c: _Slwt:. l-1uC.~g-.r_··-+-,--_ --'-_.'--
Addross: _._1.P. (CJ. ~.,\ ~\\cC ..b
City and Zip Co~-_\l1l.1L:J ~-e..",,1-e< /<5.," /.."I !.'f2 County: &~lcK Office ~ought: ,~~Y~\'~~"1 ',-I,e.,. ,_.__ District: .. ,~~__
B. Check only If appropriate: __.Amended filing ___ Tennina\ion Report
C. S~lmmary (covering (he pcriod from Octoher 28,2016 through DeccmbeJ' 31, 2016)
1. Cnsh 011 hand !.It beginning ofperiod " , ", . JJ J,1l2..i_~7 2. Tot~l Contribwtlol13 ul1d Other Receipl~ (Use S~nccfule A) , ", "." . _~;J.~i) .
3. Cash available (11is period (Add Lines 1 and 2) , .. He ~ J?-- •3'1 ~ ,-.
4. Total Expenditures and Other Disbillsements (Use Schedule C) .. ".5r;J..7Q.:!~~.. 5. Cash on hand at close of period (~ubu'aet Line 4 from 3) " " .. J~4'Y ,.S~'
6_ In-Kind Contribulions (Utie Schedule B) ....,.... _,,~ 7. Other Transactions (Usc Bchedllie D) ... "........ ~
D. t'l declare that this report, including any accompanying schedulos and :>tt\tcment~, has been exam1ned by me and to the best of my knowledge and bcliefis t1.'ue, con-cct andcumplete. rUndel':;land that \.he intcnt1nnfll failure to file this document or intcnthmally filing a fuls.f;l document is a class A Inisdemeanor. H
Date jty\(L~4!£-=H21~:,~~dr--L-.o.' Signaturo OfCMdidate or ~(lsur~r
~~
GEe Form Rev, 2016
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Rece Ived Time Jan. 13. 2017 10: 18AM No, 1489
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
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AmounlorOCC\1 pntion of Check CAsh, Check,NlIme lIud Alh.ll·c~s Jlldlvt<funl Gtvlllg More Appl'OprhHe Box
LOIlIl or OtherPnte of ContriJmto \' Thnn $150 .;r'lII'ICJ,en.sll Ch«k LORt! ltecelptIIlher
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Received Time Jan. 13, 2017 10: 18AM No. 1489
SCHEDULE A CONTIUDUTIONS AND OTHER RECEIPTS
~----=-=------=-:-7""'"""":5=-. .. L'h1_·.::--(~_-_·b~e,,---H...:J..'_~...;. ~_ (Name of Cllndioate)
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Oecuplltion of Nnme and Address lndlvidusl Glvln~ More
of Contl'ibHtor Thon S150
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en,h Choo. Lcnu \'. rl/lll~' Olilor
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SnbtotRI This Page ~/~
Complete if last page of Schodulo A
Tolal Itemized Receipts for Period JJ ?DO Totol Unllomized Conlrlbutions ($50 or Jess)
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Sale of PuJilic~1 Mlllcrilll~ (Unitemlzt:<!) .,--Totftl COHtl'llmtlons When Contributor Not KJ10\\11 /'"
TOTAL RgCEIPTS TIIlS PERlO}) (to line 2 or Summuy) JtaW
Page. ~.. o(~
Received Time Jan. 13. 2017 10: 18A~ No, 1489
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SCHEDULEC EXl'ENDITURES AND OTHER DISRUHSEMENTS
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Putt' Naillll and Addresll Purpose of Expenditure
or Dishul'sement Amoun{
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Subtotal Tills Pugll
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Received Time Jan. 13. 2017 10: 18AM No. 1489
-.---- ............... - -0 .....
SCHRDULEC EXP.F.NI>lTURES AND OTHER DISBURSEMENTS
Hlle.~ (Name ofCanJiuate)
Date Name and AtJuresl) Purpose ofExpcuditu1'6
or Disburllcment Amount
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Subtotal Tills Page
Complete lfI1\st Pil~C of Schedule C
TOLal TLcmli'.ed F.xptmdilures Thl:- {'Ol'ioll LJ 'i<f) l/ s:.. Total Unitemized Expenditures of$50 or less 4~&;/:D TOTAL EXPENDITURES & OTHER DlSBURSR~NTS. TillS PElUO:V (to line 2 of Summary) 5:>..,o.7~
Page ~2.....; ot.'2.... _
Recei vedT ime Jan. 13. 20 17 10: 18 AM No. 1489
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