2510505 2/20

OFA CANDIDATE FOR STATE OFFICE

January 10,2012 _

FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTION

A. Name of Ca.ndidllt~: / L.. PII c. t<

Address: p () e,,)( 2 7 7

City and Zip Code: T YKO I /< 5 b 7 3 ~ ti-­ County: )v1 (7

Office Sought: S1tt1£. R6.fRI15$NII"'ltI~ District: / I

09:24:23 a.m. 01-10-2012

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORT

B. Check only ifappropriate: ~_ Amended Filing __ Termination Report

C. Summary (covering the period from .January 1, 2011 through December 31,2011)

1. Cash on hand at beginning ofperiod ~ - . 1'-/) ,(16 if, fS'

2. Total Contributi0!ls and Other Receipts (Use Schedule A) ; _ .. II I J 2 5'. 10 i

:-3. Cash uvailable this period (Add Lines 1and 2) . 25; 189, '-IS­,

4. Total Expenditures and Other Disbursements (Use Schedule C) . '1 e& 'if, '17

5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . L~ 'l!..O,j$

6. In-Kind Contributions (Use Schedule B) 7 g I () & -­

7. Other Transactions (Use Schedule D) ; .

. 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."

Date Signa.ture of Candidate or Treasurer

GEe Form Rev, 200t

2510805 3/20 09:24:322.m. 01-10-2012

SCHEDULE A CONTRIBUTIONS AND OTJJF;R RECEIPTS

, Virgil Peck

(N~llle of Candidate) ,

Dwle

Name and Add..." •• or CObtribulur

~

Occupation 8< IDdu~try of, Indl~idlllli Givin~ More

Than 'H50

Check Apprfll'rJ.I.: Do.l

Amonlltol C.uh, Cb.:cll,

Luan or Other Receipt

Cull C~...k L"Cl&11 CHlu;;r

,

1/28/11 Jeanelt Witwer 1691 CR 4325 CoffeyviUe, KS 67337

.f $70.00

1128/11 Jerry Wallace 708 W Main ciierryvale. KS 67335

.f $70.00

1/28/11 Marrilyn Smith 1684 CR 3700 Coffeyvills, KS 67337

.f $70.00

3/11/11 Dwayne Umbarger Campaign reimbursement for

Coffeyville Debate Team Lunch

.f $69.55

3/15/11 Jeff King for Kans<'ls Senate reimbursement for Caney

Debale 1eam Lunch .f $69.55

9/23/11 Windsor Place. LLC 29~1 W. 1s1 ColTeyville. Ks 67337

-

.f $100.00

9/27/11 Ruth Belcher

.{ $50.00

9/26/11 PeiR's of Erie, Inc. PO Box 794 P<'lrsons,KS 67357

Convenience Store

.f' $250,00

9/22/11 Dennis Bayless

.f $25,00

9/26/11 Belle Stapleton PO Box 243 Dearing, KS 67340 .f ' $100.00

9/26/11 Rebecca araes 522 N Maple Cerryvale KS

.f $100.00

Subtutlll Thi. Page $974.10

i.

2510505 4/20 09:24:39 a.m. 01-10-2012

SCI-lEDULEA CONTRIBUTIONS AND OTHER RF.CBIPTS

Virgil Peck (Name ,,[ Candidate)

c Oeeupatinn & Industry uf Cheek Amouutllf -Indlvldolll Glviol: More Appropriate RnT . Casb, Check,Name 3nd "ddr""s

'rhan :';151/Uate uf Coolribotnr LOOb ur lOut Clla:" Utl1trLtll'l1Z

Other.Recelpt

LaVerna Huneycutt 9/27/11 .; $50.00

Insuranc:e CompanyFam1ers A1liancelnsuranc:e 9/27/11 1122 N. Main $250.00.f

McPhsr!>on. KS 67460 .. \

HousewifeLila Aitken "9/28/11 1726 Hwy 186 Husband in oil field $200.00I

business

Can GarriGon

Caney. KS 67333

9/30/11 "2 ')..). It! f..,./( & ; $100.00./37L CJff't!'i(,/IL.L.Jt 1< 5 (J73

Robert Gill 9/30/11 $25.00./

TnJdy Windsor 10/2/11 $25.00.;

Charles Clough 9/29/11 3406 W. 1st $100.00.f

Coffeyville, KS 67337

Thomas Morton 9/29/11 $50.00./

Susan Newby 1012111 $30.00./

Phyllis Griffith 9/28/11 $10.00

-.

.;

.;

$840,00SlIbhlt,!1 This Paee

Page 2 of /0

09:24:46 a.m. 01-10-2012 5/202510505

SCHEDlJLEA CONTRIBUTIONS AND OTHER RECElPTS

Virgil Peck

(NlI1llc of Candidale)

NIUl\I;' lind Addren . Dste of Contributor

09/20/11 KS Bankers Association PO Box 4407 Topeka, KS 66604

09/14/11 Sylvia Rutledge

09/19/11 Delbert Scott

09/21/11 Faith Carinder

09/15/11 LU8 Bamdollar

J. Richard Conklin 09/16/11 2506 W. 8th

Coffeyville. KS 67337

09/15/11 Keith Fouts

09/19/11 Noblestone Oil & Gas

09/16/11 Frank laForge

09/19/11 William Richey

Linda Moley 09/17/11

Subtolltl This PIlKC

-

oecupation & Industry of Individual GMng More

Tblin $lSD

~

PAC

, ~

Check Appropriate Dol:

Amount or Casb, Check,

Loan or Other Re\."eipt

Cliu,h Chock 1.0... ICrunch ""Qii;;"

.; $200.00

.f -

$50.00

.f $25.00

.f $50.00

.f $50.00

.f $100.00

~ $25.00

.; $50.00

if $25.00

.f $50.00

.f $50.00

$675.00

Page.3 of /'0" .............,-- - ­

2510505 09:24:57 a.m. 01-10-2012 6120

SCHEDULE A CONTRIBUTIONS AND OTHER RECIGI.PTS

Virgil PecK . (Name of Candidate:)

Date

..

09/19/11

09/18/11

09/20/11

10/07/11

10/12/11

10/11/11

10/20/11

10/18/11

11J02l11

11J02/11

11/10J11

Nllme: Hod Address IIf Contributor

Melvin Burkhead

Tom Tatman

Dickie Rolls 410 N, Bradley Caney, KS 67333

KS Rural Electrification PO Box 790 Meade, KS 67864

~."". ,.

Marilyn Calhoun

Susan Newby 809 Lincoln Coffeyville, KS 67337

SuzanflB Boggs

KS Restaurant & Hospitality Assn. 3500 Rock Rd. #1300 Wichita, KS 67226

BNSF Railway Company 2500 Lou Menk Dr. Fort Worth, TX 76131

KS Medical Society 623 SW 10th Topeka, KS 66612

Robert Rogers

Subtotall'hb Pajte

Occupation & Indu~try of .lJldividual Givln2 More

ThaD SI50 .

Check Allpropriate BOll

Amounlof Cash, Check,

Loan or Other Receipt.

C~~h Chock In... E RIll'" Oth...

./ $20.00

./ $50.00

.f $100,00

Electric suppliers

./ $250.00

a

.f $25.00

-

.f $90:00

t/ $50.00

,

PAC .; $250.00

Railroad

.f $300.00

-"'-'­

$250.00 PAC

.f

.f $25,00

$1,410.00

2510605 7/20 09:25:07 a.m. . 01-10-2012

SCHEDULE A CONTRIBUTIONS AND OTHER RIGCF..lPTS

Virgil Peck (Nnllle uf Camliuiltc)

Date Name and Address

of Contrlbuwl"

OccupatioD & Industry of Individual Giving MOl"e

ThllD $150

Check AlJpl"opl"iate BOI

Amount of ClIsh, Check,

Loan or Other Rl'Ceipt

·C..b Ch,d, T.n'-I)

• l!: lUll'" ~

10/19/11 Keith Rogers

.f $10.00

10/10/11 Terry Byrd

.. .f $20.00

..­10/11/11

f---'.

10/11/11

C.F. Miller

.f $30.00

Ryan Byrd .f $25.00

10/11111 Cindy Facker

.f $25.00

10/11/11 John Redfern

.f $20.00

10/11/11 . Charles Clough 3406 W. 1st Coffeyville, KS 67337

Service Station Owner .; $70,00

10/11/11 . Cindy O'Neal 8 Windmere Ct. Hutchinson, KS 67502

.f $90.00

10/11/11 TIm Nordell PO Box 337 Sedan, KS 67360

.t/ $100.00

10/11/11 Donna Nordell PO Box 337 Sedan, KS 67360

t/ .~

$100.00

10/11/11 Cliff Bale 503 Swift Ln. - Dearing Coffeyville, KS 67337

.f $100.00 /

Subtotal This Page $590.00

6/2009:25:14 a.m. 01-10-20122510605

SCHIWULEA CONTRI BUTtONS AND 01'" F.R RECEIPTS

Virgil Peck

(Name of Cnndidalc)

Date

10/11/11

Nam~ and Addn!58 c

uf Contributor

~

Janette Gashi

Occupation & Indudry of Individual GivinK More

Tban$l50 CD,;h

.;

Check Appropriate B01

Ch...k Luon ~ . uthl:r

Amuunt of Cash. Check.

. UlIlD or Other Receipt

$50.00

10/11/11

10/11/11

Roger Peck 519 N. Wood Caney. KS 67333

Total of Miscellaneous Cash in Contribution ~asket at Fund Raiser

.;

.;

. $70.00

,

$96.00

10/11/11 Leland Fouts .; - .

$50.00

10/04/11

10/11/11

10/11/11

10/11/11

10/11/11

10/11/11

10/11/11

American Home Life 400 Kansas Ave. Topeka. KS 66601

ROdney Robson 103 Moming tn. . Coffeyville, KS 67337 ,

Doug Blex . 3131 CR2600 Independence. KS 67301

B.on Akin 405 Cheyenne Coffeyville, KS 67337

Max Williams 3408 W.1st Cciffeyville,KS 67337

Jeanett Witwer 1691 CR4325 Coffeyville, KS 67337

Rebecca King 106 W. Orange Caney, KS 67333

Subtotal This Paxe

r Insurance Company

Farming

Retired· KS Wildlife & Parks

Retired - Law Enforcement Officer

. ,

Retired - Teacher

.f

.f

.f

.;

.;

.f

.;

-'

$500.00

$500.00

$230.00

$240.00

$100.00

$109.00

$100.00

$2,036.00

Page ~ 011:2..­

912009:25:22 a.m. 01-10-20122510605

SCHEDULE A CONTRIBlJTIONS AND OTHER RECEIPTS

Virgil Peck

(Name of Camlidalc)

Date

10/11/11

10/11111

10/11/11

1-"""-­

10/11{11

10/04/1'

10/11/11

10/11/11

Nam<: lind Add"'~N

of Contributor

Earl Menefee

Dianne Schabel 2341 US Hwy 166 Caney, KS 67333

C.F. Miller PO Box 665 ,Independence, KS 67301

Steve Smith 609 W. 8th Coffeyville, KS 67337

Carla Robson 103 Morning Ln. Coffeyville, KS 67337

. Marilyn Smith 1684 CR 3700 Coffeyville, KS 67337

Evelyn Steele 2221 CR 4300 Coffeyville, KS 67337

Oc"uplttion & Industry of Individual (;1~1l'l~ More

Than $150 C.,h

.

Check Appropriate Box

Coh••k I.»all ~ Olll<r

I

.{

.f

I ..

.{

'';

.f

Amount of Cash, Check,

I.oan or Other Rt'Ceil't .

$50.00

$70.00

$70.00

$100.00

$140.00

$50.00

$120.00

_.­ ..

Subtohd This Pa~e $600.00

2510805 10/20

I

09:25:26 a.m. 01-10-2012

I, SCHEDULE A

CONTRlBUTIONSAND OTHER RECElPTS

Virgil Peck

(Name of Candidate)

Date

11/16/11

11/22/11

11/22/11

12/13/11 _....... ­12/12111

09/28111

12/09111

12115/11

12/21/11

12/12111

12/19/11

_. ..

Name and Addresft of Contributor

KS Beverage Association PAC 5845 SW 29th Street Topeka, KS 66614

HCA KS Good Govemment Fund 550 N. Hillside Wichita, KS 67214

Koch Industries, Inc. 4111 E. 37th Street N. Wichita, KS 67220

~,

Farmers Employees & Agents 8018 W. 113th Terrace Overland Par, KS 66210

.................

KS Health Care Assn.· PAC 117 SW 6th #200 Topeka, KS 66603

Almos Energy PAC 5430 LBJ Freeway #160 Dallas, Texas75240

Polsinelli & Shughart 700 W. 47th SI. #1000 Kansas City, MO 64112

KS Optometric PAC 1266 SW Topeka Blvd. Topeka, KS 66612

-AT&T Kansas PAC 220 E. 6th #500 Topeka, KS 66603

American Family Ins. KS PAC 1300 Southwest Arrowhead Rd. Topeka, KS 66604.

ks Automobile Dealers Assn. PAC 731 S. Kansas Ave. Topeka, KS 66603

Suhtntall'b!s Pltg~

Occupation & Indlldry or Indivldulll (~l"ing More

Than $150

~

Check Appropriate Box

Amount of CM8bt Check,

LOll8or Other Receipt

ellsl, ' Check l"on Etuncb l'i1ii'Of

PAC

t/ $250.00

Healthcare { $250.00

Manufacturing .{ $500.00

Insurance .{ $500.00

PAC

t/ $200.00

PAC

.f $100.00

Attorney -

t/ $250.00

PAC { ·$250.00

PAC .f $250.00

. , ...~". __.

$250.00 PAC

.{

PAC .{

~

$200.00

$3,000.00

rage~or12-

2510505 09:25:35 a.m. 01-10-2012 11/20

111111 II

SCHEDULE A CONTRIBUTIONS AND OTHER RECElPTS

Virg~ Peck

(Name of Candidale)

I, Occupation & Industry of Amount ofCI\l~ck

APl)roprilltc BUl: C~sh. Check.,NllDle lind Addreu I Indiddulll Givinll MQre IAJ91l1lr Otherof Coolrihutnr Th"n SI~ODate

Clt.,h C1....,ir. l.DDn To: funds Re.:('jpt~ ~ ..I'

Rabae<:a Detrick I: Relired Teacher 106 Edgewood Dr. I ' , $200,0012/19/11 {Coffeyville, KS 67337

KSCHamber of Commarc:e PAC PAC $500.0012/09/11 835 SW Topeka Blvd. .;

Topeka, KS 66612

;.KS Insurance Agents PAC PAC

12/21/11 $500,00815SW Topeka Blvd. ,f Topeka, KS 66612

, ;

-

c

$1,200.0QSuhllllld Tbi~ Pll~C

!'agc _~ of If'!..­

-

2510805 09:25:48 a.m. 01-10-2012 12/20

-SClllmULE A

CONT.RlllUTrQNS AND OTHER RECEIPTS

Pi!. c[< . (Name of Candidate)

Dale

NaRlc and Address of Contributor.

Oeeuplltlon & lnl;l\ldry of Individual GIving Morc

Thlln $150

Check Approprillte Box

Amount of Cnlih, Check,

Loan or Other Receipt

Complete iflast page of Schedule A

Total Itemized Receipts for Period

Total Unitemizcu Contributions ($50 or less)

Snle of Political Materials (Un itemized)

Tot!!l ContribuLiolls When Contributor Not Known

.tg:r.,~~':~Ecifirt§~~J~IB!{~ti.Ji~~JilMJ.~~;·~'!~)~:,:;4;~~1;::::~·:'~.;;·;,./:>'~;'0~~~~! I

.Cf t ~($1a

~ 3 :1 ~-; If)

Page JL of-.l.!L

2510805 09:26:08 a.m. 01-10-2012 . 13 /20

SCHEDULE B IN-KIND CONTRIBUTIO:,/S

Virgil Peck

(NIITnC of Cllnllil1ul~.)

.' ~

lJ~l OcclJplllin/l & II ate Nnmc nnd Addrc.~ Indunry for Those Giving

nf ContdhutDl­ an In-Kind GfMorc Than S1511

Kansas Chamber Jobs PAC 12/26/11 835 SW Topeka Blvd.

Topeka, KS 66612

--~"-_."~-'~--..- ­ ........ ,....

.._. ------,.. .. , ., ._----~

-_ .. " ..,_.._.............,.­~

~_.__.

-

- ... __... ~.- _.

Subtotal This Pnlle

Value of In-KindI)I'.criptioll of In-Kind

CllntrihutionCoulrilJ,,(lo'l

Enhanced voter file $78.00

..-.-.-._. ­

--_ .. _----1----... ---.. .

$78.00.1 - . -..

Complete if lust page of Scbedule g ._-._...

'I'<.\t" 1 It,:milCI.t (over $100) lll-Kiltl1 ClIlllrihu!ions .~ ...._.__..

T()t~llInitcl1ljzcd ($'100 or I~ss) Ill-K. ind C(lotributiolls

..

-e­......_­ - '."­ ...-...

TOTAL l:'ol-KINO CON'l'WIIHlTlONS TUIS PEIHOII (to line 6 nf Summal')') 1r ::.:

Page of I

2510605 09:26:22 a.m. 01-10-2012 14/20

. .

II '. - '. • 'C.. '. _: _. • • :" ~. ~~.

(Name ofCnndidate)

. Date Name and Address . Purpose DC Expenditure

or Disbursement Amount

I-I

"~UN"'oOJ1'l6I'2.y CoUW-r"

l/-~H MIJf. 'fE#OtiNC£' : S

~

40

SCi), J 7

YA#-tH)

. ~D./7tfRN$. ·tJ{(..1- (N~

Fl<,rr~t:JS ()rflftk.. !S,t(rJW"I /YlAN.JIOr! (J& eO Z'f3

c oP.~i y'1/ fL. '- L. #.,5

19,1.3

2011 DullS

,A/1tI.£ At CoI4-""; t4 ~ L.( ~I£.

c.. A t?t1pA u;,1{

(h/FiS· CHI+""'.4.1,e

8S.NJl.!2t1 !4HC. 71t7N

2- If

I-I t

I-Itf

1-31 .

./-21

Page -.-1.- of. 7...

2510805 09:26:35 a.m. 01-10-2012 15/20

'_Iii

SCHEDULEC EXl)ENDITURES AND OTHER DISBURSEMENTS

Vt«C,('l. P;;c. r< ' (Name of Candidate)

Purpose of Expenditure Hate Name and Address , or Disbursement

J-.rS"

Amount

Yfttfoo 2-7 ' v'l •

TtY T~J?NB.. 7 5fLI.-/l1.f6 /2.9r

C&Pt=£ 'f J -I ./ 't. ~oGIFTS P".-e L.fl6i/.Sl-~n(.lfi.-

RfJ, IWl6. f,p( (.J, 1- ~t4 14(/ r tj/'ll'l~

FrJR DE. BIJ. iLJi'J f'~11J~'1 IYI ~ C.Oll,.,;'"

[)/'rtJ£ Hf£.(MI£l1l1

38 2.? s tv C 1\ f'1'I9 I{.f (J a..JL C. -r TtJ ~J.(..t4( '145 rlf.. I, (0J-30

12/.97

12~.Dr;

, 1S,/,7"

Jlage~ofl

--

2510505 09:26:51 a.m,· 01-10-2012 16/20

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENtS

J • fl'..c 1< " )VI f< 6ft.­(Name of Candidate)

Purpose of Expenditure Date or Disbursement Name llnd Address Amount

0' stf NG rW&I?K.. Pp-t bO.• ~

A L.A "('IN£.. 1-L fJ ~() or ~

I'tS~

·FL-,I'J.(;, F(j,( ,#£- 1'I~lIr

!l.Ufl S71f-1f M fJ 7/1#"- S4-y..

'YAH-if) '-f-s

5'7,4/t-1LS _2'-1()o SJl. WArH{"f67~ (Jt,..VO

4-(/ f!,oPr~TLIf..St/I(...L.ti (j!< 7£f()d~

S7 fJF t-<ANI' A s S (/- S S71'/-'1E H-t!lfJ ~S f/) iJK A-. -S VfJIJ i 2..

S-f, S'Il.37 c. 0 FFE. Yv (Lr.-g c.OA1lPl (,/.AI t-r'f (' (j '-C' t. tr.

,"i/-rf/ f- t{~~~t£ /<5 /#7:137 B£ftLf!.,1 / teK~ is.

s-(). (00.&&

'fA f'I.-{) 0

12,9S"

. ~age ._~, '.' ocJ_

2510805 09:27:05 a.m. 01-10-2012 17/20

SCHEDULEC . EXPENDITURES AND OTHER DISBUllSEMENTS

t/1~(i;L fflCf< (Name of Candidate)

Dale

5-/7

~ -{O

6- JtJ

7-7

7-J

Name pnd Address

$7AfL£S :ItJC.

(",1...') (/{(..(...,r ·1K 571£tJ £ . S~l 7f!

(,0'1 w. 87/1­ ~r-

c.~ P P /l . {/ It... (.. £ :'<S U 7 J 1 C'Q(I11MlIJ.N/7 't. g11t"fP $Ar(K

PfJBI'K:J.l.q CrjFf fir. fI It- l.- J. f<S" 73 37

/)U H Nt'TIf)II<I< [)£/pJO '.1 .

PA 1,.47/"'£ II-I­ (,rJ()sr

p, S71m AS 7E e

7 RO U ~73~ . )£.(I!L ,My f.9~ STA--7£

.. I

to fJlI I< A I !<.5 . C.AN£ f C#A.lJ$~ ~F

~;1,O lI,h 4 -ril­ ~ -+- . C fCtNI rei. ~

l~ If­ fifL {HIli Rl< D£p ..... ()fJi,"3P4- L. 1411/ (I'IVL. l-.1 qrt'5S

Purpose of Expenditure .or Disbursement

o.

(7 / F I c.fi.~.J:J Ft'-< 111$1$17£

·STItMt~S FIJI? Stl/2;;tl

L!.-7i£t< S

. Amount

5 'f. 70

57, 9s­

StJ.37

.sO.37

Page L orl

2510805 . 09:27:19 a.m. 01-10-2012 18120

SCHEDULEC EXPENDITURES AND OTHER tiISBUltSEMENTS

p~ c. f<· . (Name of Candidate)

nate NDme Dnd Address Plirpose or Expenditure

or Disbursement Amount

9·-s

1-t 1 pJ-J rf1Yl tfS"74.1(

I YIe () aI...t. S7A f)h'I .t.

cr- Ir l kc Cl)(,.~ il.c.,1l. ~ tf,,'J/..!l ScHPI'"

. 7~lfc/}f r::,.roc~'--f;:s ()OI'l.4 n tl4

$7'; t-12.S­ (/l S 4

Page 5 _ of. 7.__

2510605 09:27:33 a.m. 01-10-2012 19/20

IIIII

. SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

V(~C,/L' lIZ ct< .,' (Name of~andidate)

Purpose of Expenditure Date Nllme llnd Addre.ll$ or :DIsbursement Amount

/0 -5" 7CJ.37 I<.{ AL615 C P~,eLY /foe,{ s.E. 3 6' S. -:rN~l1.jJi!~G.K~ ,sT­a[),:... 4,«(.1\(6 5 1t7JLfrJ s§~v/.~ t!. ()f~/c..1L. $"1'1''-'1 fF+I/Z.1'( Sa'I'f'L tIL.! . 10 e- flt1·~ '- .sr~Pg, '-t Sf 4,1'1 FOt( fJ~-~t4tJ /i.CJ4 ~ COF"z/'?'/(,II'--f.,Jf. f<~ ~/J37

!o-((

I f), 2.r/9 -( 2-.

-C~L\

fl.. C 8tY tJ '- (} I!J C"; . f(~~M Ptl~ 1f41t18t.{C~M:2S:J.S tV. t;7H sr Hfj,N ~ Jf<.~71f{!";· rI ()~ ;icj /" 9. 72.L 4w ~lilli ~4 /<.5 b!l()lf Cf

7&.3 7

'3t.y 7II-2 . WA t.-- ';t'n14. ~ -r IUd Ci( 5' ')0 ~

COf-ftll'lot'-'--iF <5 {,7337 C!.14/\/PY POr< jJA-AA-KJe... . (2,1J.,A~1!!J fA-LtL S CtI,

14,fJCj S. t<~IVSAS At/£. , /b P{< ttl t<,S fJltf" { 2- FL A-C, Pi/'<?' /1.c.t< It//G. f+ (~ 5 7~ () &.- S'wnl7ft "0'1 w' 3' 1H 5'( C{)'~(l.Y()/(_LE.IfL.,5 ~733 / W£~SI7£.. U.h7~K

.1773.', ...

PllgeLor~

2510505 09:27:45 a.m. 01-10-2012 20/20

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

t/ l ~.e, (~PtZ C./< . (Name ofCandidate)

Purpose of Expenditure or I>Isbursemcnt AmountName and Address Date

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/2- Ct 4tf1J11. g.,.IIJli.N.CIZ 1<.5 II 738/ ~/II1M&. !=r/I( f/i.A.#I p L. CNi-P'f

V- Po.fl.fl ~AI~I,( ~"I£It(SIE. 53,4312- 2 7

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r:: /... 4·6 Fdtf L /8 ~A.It,/ ) (Y 1,ZIfS'-ll

.~ J 1/$3

Complete if last page of Schedule c

Tolal Hemized Expenditures This Period

Total Unitemized Expenditures of $50orless

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