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CampaignFinanceReport Fillable 1-3-17

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STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
COMMITTEE ID NUMBER
COMMI
TTEE INFORMATION (required):
CANDIDAT
E INFORMATION (only if filing as a candidate committee):
REPORT
ING PERIOD (check one):
REPORT
ING PERIOD REPORT DUE
2016 4
th
Quarter Report: October 28, 2016 to December 31, 2016 January 1, 2017 to January 15, 2017
2017 March Pre-Election Report (Local Only): January 1, 2017 to February 25, 2017 February 26, 2017 to March 4, 2017
2017 1
st
Quarter Report (Local Only): February 26, 2017 to March 31, 2017 April 1, 2017 to April 15, 2017
2017 1
st
Quarter Report: January 1, 2017 to March 31, 2017 April 1, 2017 to April 15, 2017
2017 May Pre-Election Report (Local Only): April 1, 2017 to April 29, 2017 April 30 , 2017 to May 6, 2017
2017 2
nd
Quarter Report (Local Only): April 30, 2017 to June 30, 2017 July 1, 2017 to July 15, 2017
2017 2
nd
Quarter Report: April 1, 2017 to June 30, 2017 July 1, 2017 to July 15, 2017
2017 August Pre-Election Report (Local Only): July 1, 2017 to August 12, 2017 August 13, 2017 to August 19, 2017
2017 3
rd
Quarter Report (Local Only): August 13, 2017 to September 30, 2017 October 1, 2017 to October 15, 2017
2017 3
rd
Quarter Report: July 1, 2017 to September 30, 2017 October 1, 2017 to October 15, 2017
2017 October Pre-Election Report (Local Only): October 1, 2017 to October 21, 2017 October 22, 2017 to October 28, 2017
2017 4
th
Quarter Report (Local Only): October 22, 2017 to December 31, 2017 January 1, 2018 to January 15, 2018
2017 4
th
Quarter Report: October 1, 2017 to December 31, 2017 January 1, 2018 to January 15, 2018
2018 March Pre-Election Report (Local Only): January 1, 2018 to February 24, 2018 February 25, 2018 to March 3, 2018
2018 1
st
Quarter Report (Local Only): February 25, 2018 to March 31, 2018 April 1, 2018 to April 15, 2018
2018 1
st
Quarter Report: January 1, 2018 to March 31, 2018 April 1, 2018 to April 15, 2018
2018 May Pre-Election Report (Local Only): April 1, 2018 to April 28, 2018 April 29 , 2018 to May 5, 2018
2018 2
nd
Quarter Report (Local Only): April 29, 2018 to June 30, 2018 July 1, 2018 to July 15, 2018
2018 2
nd
Quarter Report: April 1, 2018 to June 30, 2018 July 1, 2018 to July 15, 2018
2018 August
Pre-Election Report: July 1, 2018 to August 11, 2018 August 12, 2018 to August 18, 2018
2018 3
rd
Quarter Report: August 12, 2018 to September 30, 2018 October 1, 2018 to October 15, 2018
2018 Oct
ober Pre-Election Report: October 1, 2018 to October 20, 2018 October 21, 2018 to October 27, 2018
2018 4
th
Quarter Report: October 21, 2018 to December 31, 2018 January 1, 2019 to January 15, 2019
Final C
ampaign Finance Report Prior to Committee Termination End of Previous Period through Today’s Date
FINANCI
AL SUMMARY (required):
Activity
Cash Activity This
Reporting Period
Election Cycle to
Date
(a) Committee value at the beginning of this reporting period
(i.e. ending balance from the
previous reporting period)
(b) + Total receipts (from “Summary of Receipts,” line 13 (cash column) for this reporting period)
(c) - Total disbursements (from “Summary of Disbursements,” line 16 (cash column) for this reporting period)
(d) = Balance at close of reporting period
Check here if no financial activity during the reporting period. Lines (a)-(d) still must be completed, but only this cover page need be filed.
Commi
ttees with financial activity must file the cover page, summary of receipts, summary of disbursements, and any schedules that contain financial activity.
All reports are deemed to be filed under penalty of perjury by the committee treasurer (all committees) and candidate (candidate committees only).
Office Sought
:
Statewide Office:
State Legislature:
County Office: City/Town Office:
Committee Information: Committee Name:
Arizona Secretary of State Revision 1/03/17
$ 0.00
$ 0.00
$ 0.00
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
COMMITTEE ID NUMBER
SUMMARY OF RECEIPTS (Schedule A):
Receipts
Cash Equity
1. Monetary Contributions Received
(a) Individuals - More than $50
(b) Individuals - $50 or Less (Aggregate)
(c) Candidate Committees
(d) Political Action Committees
(e) Political Parties
(f) Partnerships
(g) Corporations & Limited Liability Companies (PACs & Political Parties Only)
(h) Labor Organizations (PACs & Political Parties Only)
(i) Candidate’s Personal Monies (Candidate Committees Only)
(j) Monetary Contributions Subtotal (add 1(a) through 1(i))
(k) Refunds Given Back to Contributors
(l) Net Monetary Contributions (subtract 1(k) from 1(j))
2. Loans
(a) Loans Received
(b) Forgiveness on Loans Received
(c) Repayment on Loans Made
(d) Interest Accrued on Loans Made
(e) Loans Subtotal (cash: add 2(a), 2(c) & 2(d))
3. Rebates and Refunds Received
4. Interest Accrued on Committee Monies
5. In-Kind Contributions Received
(a) Individuals - More than $50
(b) Individuals - $50 or Less (Aggregate)
(c) Candidate Committees
(d) Political Action Committees
(e) Political Parties
(f) Partnerships
(g) Corporations & Limited Liability Companies (PACs & Political Parties Only)
(h) Labor Organizations (PACs & Political Parties Only)
(i) Candidate’s Personal Assets or Property (Candidate Committees Only)
(j) In-Kind Contributions Subtotal (equity: add 5(a) through 5(i))
6. In-Kind Donations Received (Non-Contributions) (Political Parties Only)
7. Extensions of Credit
(a) Extensions of Credit Received
(b) Payments on Extensions of Credit Received
(c) Net Extensions of Credit (subtract 7(b) from 7(a))
8. Joint Fundraising / Shared Expense Payments Received
9. Payments Received for Goods / Services
10. Outstanding Accounts Receivable / Debts Owed to Committee
11. Transfer In Surplus Monies / Transfer Out Debt (use cash and/or equity as applicable)
12. Miscellaneous Receipts
13. Total Receipts (cash: add 1(l), 2(e), 3-4, 8-9, 11-12; equity: add 2(b), 5(j), 6-7, 10-12)
Arizona Secretary of State Revision 1/03/17
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
COMMITTEE ID NUMBER
SUMMARY OF DISBURSEMENTS (Schedule B):
Disbursements
Cash Equity
1. Disbursements for Operating Expenses
2. Contributions Made
(a) Candidate Committees
(b) Political Action Committees
(c) Political Parties
(d) Partnerships
(e) Corporations & Limited Liability Companies (PAC & Political Parties Only)
(f) Labor Organizations (PAC & Political Parties Only)
(g) Monetary Contributions Subtotal (add 2(a) through 2(f))
(h) Contribution Refunds Provided to the Reporting Committee
(i) Monetary Contributions Total (subtract 2(h) from 2(g))
3. Loans
(a) Loans Made
(b) Loan Guarantees Made
(c) Forgiveness on Loans Made
(d) Repayment of Loans Received
(e) Accrued Interest on Loans Received
(f) Total Loans
(cash: add 3(a), 3(d) & 3(e); equity: add 2(b) & 2(c))
4. Rebates and Refunds Made (Non-Contributions)
5. Value of In-Kind Contributions Provided
(a) Candidate Committees
(b) Political Action Committees
(c) Political Parties
(d) Partnerships
(e) Corporations & Limited Liability Companies (PAC & Political Parties Only)
(f) Labor Organizations (PAC & Political Parties Only)
(j) Contributions Subtotal (add 5(a) through 5(f))
6. Independent Expenditures Made
7. Ballot Measure Expenditures Made
8. Recall Expenditures Made
9. Support Provided to Party Nominees (Political Parties Only)
10. Joint Fundraising / Shared Expense Payments Made
11. Reimbursements Made
12. Outstanding Accounts Payable / Debts Owed by Committee
13. Transfer Out Surplus Monies / Transfer In Debt
(use cash and/or equity
as applicable)
14. Miscellaneous Disbursements
15. Aggregate of Disbursements - $250 or Less
16. Total Disbursements (cash: add 1, 2(i), 3(f), 6-11 & 13-15; equity: add 3(f), 5(j), & 12-15)
Arizona Secretary of State Revision 1/03/17
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
COMMITTEE ID NUMBER
MONETARY CONTRIBUTIONS RECEIVED FROM INDIVIDUALS - MORE THAN $50 DURING ELECTION CYCLE:* SCHEDULE A(1)(a)
Individual Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
2
Name
City State ZIP
3
Name Date Contribution Received
Street Address
Occupation Employer
4
Name
City State ZIP
Occupation Employer
5
Name Date Contribution Received
Street Address
City State ZIP
Occupation Employer
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(a))
*If contributions of $50 or less are listed on Schedule A(1)(b), do not include them on Schedule A(1)(a).
Schedule A(1)(a), page of
Date Contribution Received
Street Address
City
Occupation Employer
Date Contribution Received
Street Address
Occupation Employer
City State ZIP
Date Contribution Received
Street Address
ZIP State
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS RECEIVED FROM INDIVIDUAL
S - $50 OR LESS (AGGREGATE):* SCHEDULE A(1)(b)
Cumulative Amount this Reporting
Period
Cumulative Amount
this Election
Cycle
Cumulative Contributions from Individuals - $50 or Less
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(b))
*If contributions of more than $50 are listed on Schedule A(1)(a), do not
include them on Schedule A(1)(b).
Schedule A(1)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM CANDIDATE COMMITTEES: SCHEDULE A(1)(c)
Candidate Committee Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
2
City State ZIP
3
Committee Name
Street Address
City State ZIP
4
Street Address
City State ZIP
Committee ID Number Date Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(c))
Schedule A(1)(c), page of
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
Committee Name
Street Address
Committee ID Number Date Contribution Received
Committee ID Number Date Contribution Received
Committee Name
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES: SCHEDULE A(1)(d)
Political Action Committee Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee ID Number Date Contribution Received
2
Committee Name
Street Address
City State ZIP
3
City State ZIP
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(d))
Schedule A(1)(d), page of
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
Committee Name
Street Address
Committee ID Number Date Contribution Received
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM POLITICAL PARTIES: SCHEDULE A(1)(e)
Political Party Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
City State ZIP
2
City State ZIP
3
City State ZIP
Committee ID Number Date Contribution Received
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Received
Enter total only if last page of sc
hedule
(transfer
the total received this period to
“Summary of Receipts,” line 1(e))
Schedule A(1)(e), page of
Committee Name
Street Address
Committee ID Number Date Contribution Received
Committee Name
Street Address
Committee ID Number Date Contribution Received
Committee Name
Street Address
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM PARTNERSHIPS: SCHEDULE A(1)(f)
Partnership Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
2
City State ZIP
3
City State ZIP
Corporation Commission File Number Date Contribution Received
4
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
5
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Enter total only if last page of sc
hedule
(transfer
the total received this period to “
Summary of Receipts,” line 1(f))
Schedule A(1)(f), page of
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Partnership Name
Street Address
Corporation Commission File Number Date Contribution Received
Partnership Name
Street Address
Partnership Name
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM CORPORATIONS AND LLCs: SCHEDULE A(1)(g)
Corporation / LLC Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
2
City State ZIP
3
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
4
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
5
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Enter total only if last page of sc
hedule
(transfer
the total received this period to “
Summary of Receipts,” line 1(g))
Schedule A(1)(g), page of
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Corporation/LLC Name
Street Address
Corporation Commission File Number Date Contribution Received
Corporation/LLC Name
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM LABOR ORGANIZATIONS: SCHEDULE A(1)(h)
Labor Organization Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Labor Organization Name
2
City State ZIP
3
City State ZIP
Corporation Commission File Number Date Contribution Received
4
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
5
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Enter total only if last page of sc
hedule
(transfer
the total received this period to “
Summary of Receipts,” line 1(h))
Schedule A(1)(h), page of
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Received
Labor Organization Name
Street Address
Corporation Commission File Number Date Contribution Received
Labor Organization Name
Street Address
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM CANDIDATE’S PERSONAL MONIES: SCHEDULE A(1)(i)
Candidate Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
2
Name
City State ZIP
3
Name
City State ZIP
Occupation Employer
4
Name
Street Address
City State ZIP
Occupation Employer
5
Name Date Contribution Received
Street Address
City State ZIP
Occupation Employer
Enter total only if last page of sc
hedule
(transfer
the total received this period to
“Summary of Receipts,” line 1(i))
Schedule A(1)(i), page of
Date Contribution Received
Street Address
City State ZIP
Occupation Employer
Date Contribution Received
Street Address
Occupation Employer
Date Contribution Received
Street Address
Date Contribution Received
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REFUNDS GIVEN BACK TO CONTRIBUTORS: SCHEDULE A(1)(j)
Contributor Information
Amount Refunded
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
ID Number (if applicable) Date of Original Contribution
2
Name Date Contribution Refunded
Street Address
ID Number (if applicable)
3
Name
City State ZIP
4
Name Date Contribution Refunded
Street Address
5
Name Date Contribution Refunded
Street Address
City State ZIP
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(k))
.
Schedule A(1)(k), page
of
Date Contribution Refunded
Street Address
City State ZIP
City State ZIP
Date of Original Contribution
Date Contribution Refunded
Street Address
ID Number (if applicable) Date of Original Contribution
City State ZIP
ID Number (if applicable) Date of Original Contribution
ID Number (if applicable) Date of Original Contribution
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOANS RECEIVED: SCHEDULE A(2)(a)
Lender Information
Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
3
City State ZIP
Guarantor/Endorser Name Non-Electoral Purpose? (PACs and Political Parties Only)
4
Lender Name Date Loan Received
Street Address
City State ZIP
Guarantor/Endorser Name
Non-Electoral Purpose? (PACs and Political Parties Only)
5
Lender Name Date Loan Received
Street Address
City State ZIP
Guarantor/Endorser Name
Non-Electoral Purpose? (PACs and Political Parties Only)
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 2(a))
Schedule A(2)(a), page of
1
Lender Name Date Loan Received
Street Address
City State ZIP
Guarantor/Endorser Name Non-Electoral Purpose? (PACs and Political Parties Only)
2
Lender Name Date Loan Received
Street Address
City State ZIP
Guarantor/Endorser Name Non-Electoral Purpose? (PACs and Political Parties Only)
Lender Name Date Loan Received
Street Address
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
FORGIVENESS ON LOANS RECEIVED: SCHEDULE A(2)(b)
Lender Information Amount Forgiven
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Lender Name Date Forgiveness Received
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
2
Lender Name Date Forgiveness Received
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
3
Lender Name Date Forgiveness Received
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
4
Lender Name Date Forgiveness Received
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
5
Lender Name Date Forgiveness Received
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 2(b))
Schedule A(2)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REPAYMENT ON LOANS MADE: SCHEDULE A(2)(c)
Borrower Information Amount Repaid
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Borrower Name Date Repayment Received
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
2
Borrower Name Date Repayment Received
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
3
Borrower Name Date Repayment Received
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
4
Borrower Name Date Repayment Received
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
5
Borrower Name Date Repayment Received
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 2(c))
Schedule A(2)(c), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTEREST ACCRUED ON LOANS MADE: SCHEDULE A(2)(d)
Borrower Information
Amount of Interest
Accrued
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Borrower Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
2
Borrower Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
3
Borrower Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
4
Borrower Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
5
Borrower Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 2(d))
Schedule A(2)(d), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REBATES AND REFUNDS RECEIVED: SCHEDULE A(3)
Payor Information
Amount Rebated
or Refunded
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Payor Name Date Rebate/Refund Received
Street Address
City State ZIP
Original Purchase Amount Reason for Refund/Rebate
2
Borrower Name Date Rebate/Refund Received
Street Address
City State ZIP
Original Purchase Amount Reason for Refund/Rebate
3
Borrower Name Date Rebate/Refund Received
Street Address
City State ZIP
Original Purchase Amount Reason for Refund/Rebate
4
Borrower Name Date Rebate/Refund Received
Street Address
City State ZIP
Original Purchase Amount Reason for Refund/Rebate
5
Borrower Name Date Rebate/Refund Received
Street Address
City State ZIP
Original Purchase Amount Reason for Refund/Rebate
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 3)
Schedule A(3), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTEREST ACCRUED ON COMMITTEE MONIES: SCHEDULE A(4)
Cumulative Amount this Reporting
Period
Cumulative Amount this Election
Cycle
Account with Interest Earned (Bank Name / Type of Account)
Account with Interest Earned (Bank Name / Type of Account)
Account with Interest Earned (Bank Name / Type of Account)
Account with Interest Earned (Bank Name / Type of Account)
Account with Interest Earned (Bank Name / Type of Account)
Total
(transfer the total received this period to “Summary of Receipts,” line 4)
Schedule A(4), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS RECEIVED FROM INDIVIDUALS - MORE THAN $50 DURING ELECTION CYCLE:* SCHEDULE A(5)(a)
Individual Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Occupation Employer
2
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Occupation Employer
3
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Occupation Employer
4
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Occupation Employer
5
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Occupation Employer
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 5(a))
*If in-kind contributions of $50 or less are listed on Schedule A(5)(b), do not include them on Schedule A(5)(a).
Schedule A(5), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS RECEIVED FROM INDIVIDUALS - $50 OR LESS (AGGREGATE):* SCHEDULE A(5)(b)
Cumulative Amount this Reporting
Period
Cumulative Amount
this Election
Cycle
Cumulative In-Kind Contributions from Individuals - $50 or Less
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 1(b))
*If contributions of more than $50 are listed on Schedule A(5)(a), d
o not include them on Schedule A(5)(b).
Schedule A(5)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM CANDIDATE COMMITTEES: SCHEDULE A(5)(c)
Candidate Committee Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
Enter total only if last page of schedule
(transfer the total received this period to “Summary of
Receipts,” line 5(c))
Schedule A(5)(c), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES: SCHEDULE A(5)(d)
Political Action Committee Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
Enter total only if last page of schedule
(transfer
the
total
received
this
period
to
“Summary o
f
Rec
eipts,”
line 5(d))
Schedule A(5)(d), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM POLITICAL PARTIES:
SCHEDULE A(5)(e)
Political Party Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Received
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f
Rec
eipts,” line 5(e))
Schedule A(5)(e), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM PARTNERSHIPS: SCHEDULE A(5)(f)
Partnership Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
2
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
3
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
4
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
5
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 5(f))
Schedule A(5)(f), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM CORPORATIONS AND LLCs: SCHEDULE A(5)(g)
Corporation / LLC Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
2
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
3
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
4
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
5
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f
Receipts,” line 5(g))
Schedule A(5)(g), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM LABOR ORGANIZATIONS: SCHEDULE A(5)(h)
Labor Organization Contributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
2
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
3
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
4
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
5
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Received
Enter total only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 5(h))
Schedule A(5)(h), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM CANDIDATE’S PERSONAL ASSETS OR PROPERTY: SCHEDULE A(5)(i)
Candidate Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Asset or Property Contributed
2
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Asset or Property Contributed
3
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Asset or Property Contributed
4
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Asset or Property Contributed
5
Name Date In-Kind Contribution Received
Street Address
City State ZIP
Asset or Property Contributed
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 5(i))
Schedule A(5)(i), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND DONATIONS RECEIVED (NON-CONTRIBUTIONS) (PACs AND POLITICAL PARTIES ONLY): SCHEDULE A(6)
Source Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name Date In-Kind Donation Received
Street Address
City State ZIP
Type of Item Donated
2
Name Date In-Kind Donation Received
Street Address
City State ZIP
Type of Item Donated
3
Name Date In-Kind Donation Received
Street Address
City State ZIP
Type of Item Donated
4
Name Date In-Kind Donation Received
Street Address
City State ZIP
Type of Item Donated
5
Name Date In-Kind Donation Received
Street Address
City State ZIP
Type of Item Donated
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 6)
Schedule A(6), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
EXTENSIONS OF CREDIT RECEIVED:
SCHEDULE A(7)(a)
Creditor Information
Amount of Credit
Extended
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Services or Goods Provided on Credit Date of Extension of Credit
2
Name
Street Address
City State ZIP
Services or Goods Provided on Credit Date of Extension of Credit
3
Name
Street Address
City State ZIP
Services or Goods Provided on Credit Date of Extension of Credit
4
Name
Street Address
City State ZIP
Services or Goods Provided on Credit Date of Extension of Credit
5
Name
Street Address
City State ZIP
Services or Goods Provided on Credit Date of Extension of Credit
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 7(a))
Schedule A(7)(a), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
PAYMENTS ON EXTENSIONS OF CREDIT RECEIVED: SCHEDULE A(7)(b)
Creditor Information
Payment Amount
on Credit
Extended
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Services or Goods Originally Provided on Credit Date of Original Extension of Credit
2
Name
Street Address
City State ZIP
Services or Goods Originally Provided on Credit Date of Original Extension of Credit
3
Name
Street Address
City State ZIP
Services or Goods Originally Provided on Credit Date of Original Extension of Credit
4
Name
Street Address
City State ZIP
Services or Goods Originally Provided on Credit Date of Original Extension of Credit
5
Name
Street Address
City State ZIP
Services or Goods Originally Provided on Credit Date of Original Extension of Credit
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 7(b))
Schedule A(7)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS RECEIVED:
SCHEDULE A(8)
Payor Committee Information Payment Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
2
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
3
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
4
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
5
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“Summary
of
Receipts,” line 8)
Schedule A(8), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
PAYMENTS RECEIVED FOR GOODS/SERVICES: SCHEDULE A(9)
Payor Information Payment Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Services or Goods Purchased Payment Date
2
Name
Street Address
City State ZIP
Services or Goods Purchased Payment Date
3
Name
Street Address
City State ZIP
Services or Goods Purchased Payment Date
4
Name
Street Address
City State ZIP
Services or Goods Purchased Payment Date
5
Name
Street Address
City State ZIP
Services or Goods Purchased Payment Date
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 9)
Schedule A(9), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
OUTSTANDING ACCOUNTS RECEIVABLE / DEBTS OWED TO COMMITTEE:
SCHEDULE A(10)
Information Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Type of Account Receivable or Debt Owed Date that Debt Accrued
2
Name
Street Address
City State ZIP
Type of Account Receivable or Debt Owed Date that Debt Accrued
3
Name
Street Address
City State ZIP
Type of Account Receivable or Debt Owed Date that Debt Accrued
4
Name
Street Address
City State ZIP
Type of Account Receivable or Debt Owed Date that Debt Accrued
5
Name
Street Address
City State ZIP
Type of Account Receivable or Debt Owed Date that Debt Accrued
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to
“
Summary
o
f Receipts,” line 10)
Schedule A(10), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
TRANSFER IN SURPLUS MONIES / TRANSFER OUT DEBT: SCHEDULE A(11)
Cumulative Amount this Reporting
Period
Cumulative Amount this Election
Cycle
Source of Surplus Monies / Recipient of Transferred Debt
Source of Surplus Monies / Recipient of Transferred Debt
Source of Surplus Monies / Recipient of Transferred Debt
Source of Surplus Monies / Recipient of Transferred Debt
Source of Surplus Monies / Recipient of Transferred Debt
Total
(transfer the total received this period to “Summary of Receipts,” line 11)
Schedule A(11), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MISCELLANEOUS RECEIPTS:
SCHEDULE A(12)
Source Information Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Receipt Type Receipt Date
2
Name
Street Address
City State ZIP
Receipt Type Receipt Date
3
Name
Street Address
City State ZIP
Receipt Type Receipt Date
4
Name
Street Address
City State ZIP
Receipt Type Receipt Date
5
Name
Street Address
City State ZIP
Receipt Type Receipt Date
Enter total only if last page of sc
hedule
(transfer
the
total
received
this
period
to “
Summary
o
f
Receipts,” line 12)
Schedule A(12), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
DISBURSEMENTS FOR OPERATING EXPENSES: SCHEDULE B(1)
Recipient Information Amount Paid
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name Disbursement Date
Cash
Credit
Street Address
City State ZIP
Type of Operating Expense Paid Non-Electoral Purpose? (PACs and Political Parties Only)
2
Name Disbursement Date
Cash
Credit
Street Address
City State ZIP
Type of Operating Expense Paid Non-Electoral Purpose? (PACs and Political Parties Only)
3
Name Disbursement Date
Cash
Credit
Street Address
City State ZIP
Type of Operating Expense Paid Non-Electoral Purpose? (PACs and Political Parties Only)
4
Name Disbursement Date
Cash
Credit
Street Address
City State ZIP
Type of Operating Expense Paid
Non-Electoral Purpose? (PACs and Political Parties Only)
5
Name Disbursement Date
Cash
Credit
Street Address
City State ZIP
Type of Operating Expense Paid
Non-Electoral Purpose? (PACs and Political Parties Only)
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 1)
Schedule B(1), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO CANDIDATE COMMITTEES: SCHEDULE B(2)(a)
Candidate Committee Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 2(a))
Schedule B(2)(a), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES: SCHEDULE B(2)(b)
Political Action Committee Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
dis
bursed
this
period
to “
Summary
o
f Disbursements,” line 2(b))
Schedule B(2)(b), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO POLITICAL PARTIES: SCHEDULE B(2)(c)
Political Party Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disbursed
this
period
to
“Summary
of
Disbursements,” line 2(c))
Schedule B(2)(c), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO PARTNERSHIPS: SCHEDULE B(2)(d)
Partnership Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
2
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
3
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
4
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
5
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 2(d))
Schedule B(2)(d), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO CORPORATIONS AND LLCs: SCHEDULE B(2)(e)
Corporation / LLC Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
2
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
3
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
4
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
5
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 2(e))
Schedule B(2)(e), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO LABOR ORGANIZATIONS: SCHEDULE B(2)(f)
Labor Organization Recipient Information
Amount
Contributor
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
2
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
3
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
4
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
5
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
o
f Disbursements,” line 2(f))
Schedule B(2)(f), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
CONTRIBUTION REFUNDS RECEIVED:
SCHEDULE B(2)(h)
Committee Information
Amount
Refunded
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name Date Refund Received
Street Address
City State ZIP
Committee ID Number Date of Original Contribution
2
Committee Name Date Refund Received
Street Address
City State ZIP
Committee ID Number Date of Original Contribution
3
Committee Name Date Refund Received
Street Address
City State ZIP
Committee ID Number Date of Original Contribution
4
Committee Name Date Refund Received
Street Address
City State ZIP
Committee ID Number Date of Original Contribution
5
Committee Name Date Refund Received
Street Address
City State ZIP
Committee ID Number Date of Original Contribution
Enter total only if last page of schedule
(transfer the total disburs
ed this period to “Summary of Disbursements,” line 2(h))
Schedule B(2)(h), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOANS MADE:
SCHEDULE B(3)(a)
Borrower Information Amount Loaned
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Borrower Name
Street Address
City State ZIP
Guarantor/Endorser Name Date Loan Made
2
Borrower Name
Street Address
City State ZIP
Guarantor/Endorser Name Date Loan Made
3
Borrower Name
Street Address
City State ZIP
Guarantor/Endorser Name Date Loan Made
4
Borrower Name
Street Address
City State ZIP
Guarantor/Endorser Name Date Loan Made
5
Borrower Name
Street Address
City State ZIP
Guarantor/Endorser Name Date Loan Made
Enter total only if last page of schedule
(transfer the total disburs
ed this period to “Summary of Disbursements,” line 3)
Schedule B(3)(a), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOAN GUARANTEES MADE: SCHEDULE B(3)(b)
Guarantor Information
Amount
Guaranteed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Guarantor Name
Street Address
City State ZIP
Borrower Name Date Loan Guaranteed
2
Guarantor Name
Street Address
City State ZIP
Borrower Name Date Loan Guaranteed
3
Guarantor Name
Street Address
City State ZIP
Borrower Name Date Loan Guaranteed
4
Guarantor Name
Street Address
City State ZIP
Borrower Name Date Loan Guaranteed
5
Guarantor Name
Street Address
City State ZIP
Borrower Name Date Loan Guaranteed
Enter total only if last page of schedule
(transfer the total dis
bursed this period to “Summary of Disbursements,” line 3(b))
Schedule B(3)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
FORGIVENESS ON LOANS MADE:
SCHEDULE B(3)(c)
Borrower Information Amount Forgiven
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Borrower Name Date Forgiveness Made
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
2
Borrower Name Date Forgiveness Made
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
3
Borrower Name Date Forgiveness Made
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
4
Borrower Name Date Forgiveness Made
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
5
Borrower Name Date Forgiveness Made
Street Address
City State ZIP
Original Amount of Loan Amount Still Outstanding
Enter total only if last page of schedule
(transfer
the
total
dis
bursed
this
period
to “
Summary
o
f Disbursements,” line 3(c))
Schedule B(3)(c), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REPAYMENT ON LOANS RECEIVED:
SCHEDULE B(3)(d)
Lender Information Amount Repaid
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Lender Name Date Repayment Made
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
2
Lender Name Date Repayment Made
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
3
Lender Name Date Repayment Made
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
4
Lender Name Date Repayment Made
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
5
Lender Name Date Repayment Made
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary
of Disbursements,” line 3(d))
Schedule B(3)(d), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTEREST ACCRUED ON LOANS RECEIVED:
SCHEDULE B(3)(e)
Lender Information
Amount of Interest
Accrued
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Lender Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
2
Lender Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
3
Lender Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
4
Lender Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
5
Lender Name Date Interest Accrued
Street Address
City State ZIP
Original Amount Borrowed Amount Still Outstanding
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary
of Disbursements,” line 3(e))
Schedule B(3)(e), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REBATES AND REFUNDS MADE (NON-CONTRIBUTIONS):
SCHEDULE B(4)
Recipient Information
Amount Rebated /
Refunded
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name of Original Payor Date Rebate/Refund Made
Street Address
City State ZIP
Corporation Commission File Number (if applicable) Original Payment Amount Date of Original Payment
2
Name of Original Payor Date Rebate/Refund Made
Street Address
City State ZIP
Corporation Commission File Number (if applicable) Original Payment Amount Date of Original Payment
3
Name of Original Payor Date Rebate/Refund Made
Street Address
City State ZIP
Corporation Commission File Number (if applicable) Original Payment Amount Date of Original Payment
4
Name of Original Payor Date Rebate/Refund Made
Street Address
City State ZIP
Corporation Commission File Number (if applicable) Original Payment Amount Date of Original Payment
5
Name of Original Payor Date Rebate/Refund Made
Street Address
City State ZIP
Corporation Commission File Number (if applicable) Original Payment Amount Date of Original Payment
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 4)
Schedule B(4), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO CANDIDATE COMMITTEES: SCHEDULE B(5)(a)
Candidate Committee Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
Enter total only if last page of schedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 5(a))
Schedule B(5)(a), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES: SCHEDULE B(5)(b)
Political Action Committee Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
Enter total only if last page of schedule
(transfer
the
total
disbursed
this
period
to
“Summary o
f
Di
sbursements,” line 5(b))
Schedule B(5)(b), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO POLITICAL PARTIES: SCHEDULE B(5)(c)
Political Party Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
2
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
3
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
4
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
5
Committee Name
Street Address
City State ZIP
Committee ID Number Date In-Kind Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 5(c))
Schedule B(5)(c), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO PARTNERSHIPS: SCHEDULE B(5)(d)
Partnership Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
2
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
3
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
4
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
5
Partnership Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 5(d))
Schedule B(5)(d), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO CORPORATIONS AND LLCs: SCHEDULE B(5)(e)
Corporation / LLC Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
2
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
3
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
4
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
5
Corporation/LLC Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disburs
ed
this
period
to
“
Summary
of Disbursements,” line 5(e))
Schedule B(5)(e), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO LABOR ORGANIZATIONS: SCHEDULE B(5)(f)
Labor Organization Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
2
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
3
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
4
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
5
Labor Organization Name
Street Address
City State ZIP
Corporation Commission File Number Date In-Kind Contribution Made
Enter total only if last page of sc
hedule
(transfer
the
total
disbursed
this
period
to
“Summary of
Disbursements
,” line 5(f))
Schedule B(5)(f), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INDEPENDENT EXPENDITURES MADE: SCHEDULE B(6)
Expenditure Recipient Information
Expenditure
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Candidate(s) Supported (including % supported) Candidate(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year Office Sought
2
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Candidate(s) Supported (including % supported) Candidate(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year Office Sought
3
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Candidate(s) Supported (including % supported) Candidate(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year Office Sought
4
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Candidate(s) Supported (including % supported) Candidate(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year Office Sought
Enter total only if last page of schedule
(transfer
the
total
dis
bursed
this
period
to
“
Summary
of Disbursements,” line 6)
Schedule B(6), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
BALLOT MEASURE EXPENDITURES MADE: SCHEDULE B(7)
Expenditure Recipient Information
Expenditure
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Ballot Measure(s) Supported (including % supported) Ballot Measure(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year
2
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Ballot Measure(s) Supported (including % supported) Ballot Measure(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year
3
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Ballot Measure(s) Supported (including % supported) Ballot Measure(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year
4
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Ballot Measure(s) Supported (including % supported) Ballot Measure(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast Election Month/Year
Enter total only if last page of schedule
(transfer
the
total
disbursed
this
period
to
“Summary
o
f Disbursements,” line 7)
Schedule B(7), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
RECALL EXPENDITURES MADE: SCHEDULE B(8)
Expenditure Recipient Information
Expenditure
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Supporting or Opposing Issuance of Recall Order? Candidate Sought to be Recalled
Date of First Publication, Display, Delivery, or Broadcast Office Held
2
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Supporting or Opposing Issuance of Recall Order? Candidate Sought to be Recalled
Date of First Publication, Display, Delivery, or Broadcast Office Held
3
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Supporting or Opposing Issuance of Recall Order? Candidate Sought to be Recalled
Date of First Publication, Display, Delivery, or Broadcast Office Held
4
Recipient Name Mode of Advertising (TV, mail, etc)
Street Address
City State ZIP
Supporting or Opposing Issuance of Recall Order? Candidate Sought to be Recalled
Date of First Publication, Display, Delivery, or Broadcast Office Held
Enter total only if last page of schedule
(transfer
the
total
dis
bursed
this
period
to
“
Summary
of Disbursements,” line 8)
Schedule B(8), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
SUPPORT PROVIDED TO PARTY NOMINEES (POLITICAL PARTIES ONLY): SCHEDULE B(9)
Benefitted Candidate Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Candidate Name Date Benefit Provided
Street Address
City State
ZIP
Type of Benefit Provided
Notes:
2
Candidate Name Date Benefit Provided
Street Address
City State ZIP
Type of Benefit Provided
Notes:
3
Candidate Name Date Benefit Provided
Street Address
City State ZIP
Type of Benefit Provided
Notes:
4
Candidate Name Date Benefit Provided
Street Address
City State ZIP
Type of Benefit Provided
Notes:
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary
of Disbursements,” line 9)
Schedule B(9), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS MADE:
SCHEDULE B(10)
Recipient Committee Information Payment Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
2
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
3
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
4
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
5
Committee Name Payment Date
Street Address
City State ZIP
Date of Joint Fundraising Event (if applicable) Type of Shared Expense (if applicable)
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 10)
Schedule B(10), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REIMBURSEMENTS MADE:
SCHEDULE B(11)
Recipient Information
Reimbursement
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Services or Goods Reimbursed Reimbursement Date
2
Name
Street Address
City State ZIP
Services or Goods Reimbursed Reimbursement Date
3
Name
Street Address
City State ZIP
Services or Goods Reimbursed Reimbursement Date
4
Name
Street Address
City State ZIP
Services or Goods Reimbursed Reimbursement Date
5
Name
Street Address
City State ZIP
Services or Goods Reimbursed Reimbursement Date
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary
of Disbursements,” line 11)
Schedule B(11), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
OUTSTANDING ACCOUNTS PAYABLE / DEBTS OWED BY COMMITTEE:
SCHEDULE B(12)
Debt Information Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Type of Account Payable or Debt Owed Date that Debt Accrued
2
Name
Street Address
City State ZIP
Type of Account Payable or Debt Owed Date that Debt Accrued
3
Name
Street Address
City State ZIP
Type of Account Payable or Debt Owed Date that Debt Accrued
4
Name
Street Address
City State ZIP
Type of Account Payable or Debt Owed Date that Debt Accrued
5
Name
Street Address
City State ZIP
Type of Account Payable or Debt Owed Date that Debt Accrued
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary
of Receipts,” line 12)
Schedule B(12), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
TRANSFER OUT SURPLUS MONIES / TRANSFER IN DEBT: SCHEDULE B(13)
Cumulative Amount this Reporting
Period
Cumulative Amount this Election
Cycle
Recipient of Surplus Monies / Source of Transferred Debt
Recipient of Surplus Monies / Source of Transferred Debt
Recipient of Surplus Monies / Source of Transferred Debt
Recipient of Surplus Monies / Source of Transferred Debt
Recipient of Surplus Monies / Source of Transferred Debt
Total
(transfer the total disbursed this period to “Summary of Disbursements,” line 13)
Schedule B(13), page of
Arizona Secretary of State Revision 1/03/17
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MISCELLANEOUS DISBURSEMENTS:
SCHEDULE B(14)
Recipient Information Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Street Address
City State ZIP
Disbursement Type Disbursement Date
2
Name
Street Address
City State ZIP
Disbursement Type Disbursement Date
3
Name
Street Address
City State ZIP
Disbursement Type Disbursement Date
4
Name
Street Address
City State ZIP
Disbursement Type Disbursement Date
5
Name
Street Address
City State ZIP
Disbursement Type Disbursement Date
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary o
f Disbursements,” line 14)
Schedule B(14), page of
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Cash
Credit
Arizona Secretary of State Revision 1/03/17
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