Fillable Uribe Robert 3rd Qtr Campaign Finance Report (City of Douglas)

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Uribe Robert 3rd Qtr Campaign Finance Report (City of Douglas)

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STATE OF ARIZONA
COMMITTEE ID NUMBER
COMMITTEE CAMPAIGN
FINANCE REPORT
Under A.R.S. § 16-926(B)(5), a campaign finance report must be certified by the committee
treasurer under penalty of perjury that the contents of the report are true and correct.
By filing this report, you certify that, under penalty of perjury, you have examined the contents
of this report, and the contents are true and correct.
_________________________
Printed Name of Committee Treasurer Signature of Committee Treasurer Date
Arizona Secretary of State Revision 12/12/19 (fillable format)
Mary Sanchez
10/14/2020
Arizona Secretary of State Revision 12/12/19 (fillable format)
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
COMMITTEE ID NUMBER
SUMMARY OF RECEIPTS (Schedule A):
Receipts
Cash Equit
y
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 12/12/19 (fillable format)
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)
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 C
ontributor Information Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
2
Name
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
3
Name
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
4
Name
Date Contribution Received
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 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
Arizona Secretary of State Revision 12/12/19 (fillable format)
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY
CONTRIBUTIONS RECEIVED FROM INDIVIDUALS - $50 OR LESS (AGGREGATE):* SCHEDULE A(1)(b)
Cumulati
ve 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 contr
ibutions 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM CANDIDATE COMMITTEES: SCHEDULE A(1)(c)
Candidate Com
mittee 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 Contribution Received
2
Committee Name
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Received
3
Committee Name
Street Address
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(c))
Schedule A(1)(c), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES: SCHEDULE A(1)(d)
Politic
al 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 Contribution Received
2
Committee Name
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Received
3
Committee Name
Street Address
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(d))
Schedule A(1)(d), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM POLITICAL PARTIES: SCHEDULE A(1)(e)
Politic
al 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 Contribution Received
2
Committee Name
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Received
3
Committee Name
Street Address
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(e))
Schedule A(1)(e), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM PARTNERSHIPS: SCHEDULE A(1)(f)
Partnershi
p 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 Contribution Received
2
Partnership Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
3
Partnership Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
4
Partnership Name
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(f))
Schedule A(1)(f), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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
Corporation/LLC Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
2
Corporation/LLC Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
3
Corporation/LLC Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
4
Corporation/LLC Name
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(g))
Schedule A(1)(g), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM LABOR ORGANIZATIONS: SCHEDULE A(1)(h)
Labor Organizat
ion 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 Contribution Received
2
Labor Organization Name
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Received
3
Labor Organization Name
Street Address
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(h))
Schedule A(1)(h), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS FROM CANDIDATE’S PERSONAL MONIES: SCHEDULE A(1)(i)
Candidate Inf
ormation Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
2
Name
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
3
Name
Date Contribution Received
Street Address
City
State
ZIP
Occupation
Employer
4
Name
Date Contribution Received
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 1(i))
Schedule A(1)(i), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REFUNDS GIVEN BACK TO CONTRIBUTORS: SCHEDULE A(1)(k)
Contributor
Information
Amount Refunded
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Date Contribution Refunded
Street Address
City
State
ZIP
ID Number (if applicable)
Date of Original Contribution
2
Name
Date Contribution Refunded
Street Address
City
State
ZIP
ID Number (if applicable)
Date of Original Contribution
3
Name
Date Contribution Refunded
Street Address
City
State
ZIP
ID Number (if applicable)
Date of Original Contribution
4
Name
Date Contribution Refunded
Street Address
City
State
ZIP
ID Number (if applicable)
Date of Original Contribution
5
Name
Date Contribution Refunded
Street Address
City
State
ZIP
ID Number (if applicable)
Date of Original Contribution
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
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOANS RECEIVED: SCHEDULE A(2)(a)
Lender Informat
ion
Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
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)
3
Lender Name
Date Loan Received
Street Address
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
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
FORGIVENESS ON LOANS RECEIVED: SCHEDULE A(2)(b)
Lender Informat
ion 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REPAYMENT O
N LOANS MADE: SCHEDULE A(2)(c)
Borrower I
nformation 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTERES
T 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REBATES
AND REFUNDS RECEIVED: SCHEDULE A(3)
Payor Inform
ation
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
Payor Name
Date Rebate/Refund Received
Street Address
City
State
ZIP
Original Purchase Amount
Reason for Refund/Rebate
3
Payor Name
Date Rebate/Refund Received
Street Address
City
State
ZIP
Original Purchase Amount
Reason for Refund/Rebate
4
Payor Name
Date Rebate/Refund Received
Street Address
City
State
ZIP
Original Purchase Amount
Reason for Refund/Rebate
5
Payor 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTERES
T ACCRUED ON COMMITTEE MONIES: SCHEDULE A(4)
Cumulati
ve 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 12/12/19 (fillable format)
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
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 c
ontributions 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS RECEIVED FROM INDIVIDUALS - $50 OR LESS (AGGREGATE):* SCHEDULE A(5)(b)
Cumulati
ve 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 contr
ibutions of more than $50 are listed on Schedule A(5)(a), do not include them on Schedule A(5)(b).
Schedule A(5)(b), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM CANDIDATE COMMITTEES: SCHEDULE A(5)(c)
Candidate Com
mittee 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES: SCHEDULE A(5)(d)
Politic
al 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 of Receipts,” line 5(d))
Schedule A(5)(d), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM POLITICAL PARTIES: SCHEDULE A(5)(e)
Politic
al 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 schedule
(transfer the total received this period to “Summary of Receipts,” line 5(e))
Schedule A(5)(e), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTR
IBUTIONS 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 schedule
(transfer the total received this period to “Summary of Receipts,” line 5(g))
Schedule A(5)(g), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS FROM LABOR ORGANIZATIONS: SCHEDULE A(5)(h)
Labor Organizat
ion 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 12/12/19 (fillable format)
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 Inf
ormation Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 5(i))
Schedule A(5)(i), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND DONATIONS RECEIVED (NON-CONTRIBUTIONS) (POLITICAL PARTIES ONLY): SCHEDULE A(6)
Source Informa
tion Amount Received
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 5(e))
Schedule A(5)(e), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
EXTENSIONS OF CREDIT RECEIVED: SCHEDULE A(7)(a)
Creditor I
nformation
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 7(a))
Schedule A(7)(a), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
PAYMENTS ON EXTENSIONS OF CREDIT RECEIVED: SCHEDULE A(7)(b)
Creditor I
nformation
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 schedule
(transfer the total received this period to “Summary of Receipts,” line 7(b))
Schedule A(7)(b), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS RECEIVED: SCHEDULE A(8)
Payor Co
mmittee 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 received this period to “Summary of Receipts,” line 8)
Schedule A(8), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
PAYMENTS RECEIVED FOR GOODS/SERVICES: SCHEDULE A(9)
Payor Infor
mation 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 schedule
(transfer the total received this period to “Summary of Receipts,” line 9)
Schedule A(9), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
OUTSTANDING ACCOUNTS RECEIVABLE / DEBTS OWED TO COMMITTEE: SCHEDULE A(10)
Informati
on 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 schedule
(transfer the total received this period to “Summary of Receipts,” line 10)
Schedule A(10), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
TRANSFER IN SURPLUS MONIES / TRANSFER OUT DEBT: SCHEDULE A(11)
Cumulati
ve 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MISCELLAN
EOUS RECEIPTS: SCHEDULE A(12)
Source Inf
ormation 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 schedule
(transfer the total received this period to “Summary of Receipts,” line 12)
Schedule A(12), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO CANDIDATE COMMITTEES: SCHEDULE B(2)(a)
Candidate Com
mittee Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
2
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
3
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
4
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
5
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(a))
Schedule B(2)(a), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
2
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
3
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
4
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
5
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(b))
Schedule B(2)(b), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO POLITICAL PARTIES: SCHEDULE B(2)(c)
Politic
al Party Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
2
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
3
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
4
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
5
Committee Name
Cash
Credit
Street Address
City
State
ZIP
Committee ID Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(c))
Schedule B(2)(c), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO PARTNERSHIPS: SCHEDULE B(2)(d)
Partnershi
p Recipient Information
Amount
Contributed
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Partnership Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
2
Partnership Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
3
Partnership Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
4
Partnership Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
5
Partnership Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(d))
Schedule B(2)(d), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
2
Corporation/LLC Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
3
Corporation/LLC Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
4
Corporation/LLC Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
5
Corporation/LLC Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(e))
Schedule B(2)(e), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MONETARY CONTRIBUTIONS TO LABOR ORGANIZATIONS: SCHEDULE B(2)(f)
Labor Organizat
ion Recipient Information
Amount
Contributor
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Labor Organization Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
2
Labor Organization Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
3
Labor Organization Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
4
Labor Organization Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
5
Labor Organization Name
Cash
Credit
Street Address
City
State
ZIP
Corporation Commission File Number
Date Contribution Made
Enter total only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 2(f))
Schedule B(2)(f), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
CONTRIBUTION REFUNDS RECEIVED: SCHEDULE B(2)(h)
Contributor
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 disbursed this period to “Summary of Disbursements,” line 2(h))
.
Schedule B(2)(h), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOANS MADE: SCHEDULE B(3)(a)
Borrower I
nformation 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 received this period to “Summary of Receipts,” line 3)
Schedule B(3)(a), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
LOAN GUARANTEES MADE: SCHEDULE B(3)(b)
Guarantor Inf
ormation
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 received this period to “Summary of Receipts,” line 3(b))
Schedule B(3)(b), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
FORGIVENESS ON LOANS MADE: SCHEDULE B(3)(c)
Borrower I
nformation 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 disbursed this period to “Summary of Disbursements,” line 3(c))
Schedule B(3)(c), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REPAYMENT ON LOANS RECEIVED: SCHEDULE B(3)(d)
Lender Informati
on 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INTEREST ACCRUED ON LOANS RECEIVED: SCHEDULE B(3)(e)
Lender Informati
on
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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REBATES AND REFUNDS MADE (NON-CONTRIBUTIONS): SCHEDULE B(4)
Recipient Infor
mation
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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO CANDIDATE COMMITTEES: SCHEDULE B(5)(a)
Candidate Com
mittee 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 of Disbursements,” line 5(a))
Schedule B(5)(a), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES: SCHEDULE B(5)(b)
Politic
al 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 of Disbursements,” line 5(b))
Schedule B(5)(b), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO POLITICAL PARTIES: SCHEDULE B(5)(c)
Politic
al 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 schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 5(c))
Schedule B(5)(c), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO PARTNERSHIPS: SCHEDULE B(5)(d)
Partnershi
p 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 schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 5(d))
Schedule B(5)(d), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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 schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 5(e))
Schedule B(5)(e), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
IN-KIND CONTRIBUTIONS TO LABOR ORGANIZATIONS: SCHEDULE B(5)(f)
Labor Organizat
ion 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 schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 5(f))
Schedule B(5)(f), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
INDEPENDENT EXPENDITURES MADE: SCHEDULE B(6)
Expenditure R
ecipient Information
Expenditure
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Recipient Name
Mode of Advertising (TV, mail, etc)
Cash
Credit
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
2
Recipient Name
Mode of Advertising (TV, mail, etc)
Cash
Credit
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
3
Recipient Name
Mode of Advertising (TV, mail, etc)
Cash
Credit
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
4
Recipient Name
Mode of Advertising (TV, mail, etc)
Cash
Credit
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 disbursed this period to “Summary of Disbursements,”
line 6)
Schedule B(6), page of
Office Sought
Office Sought
Office Sought
Arizona Secretary of State Revision 12/12/19 (fillable format)
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)
Cash
Credit
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)
Cash
Credit
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)
Cash
Credit
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)
Cash
Credit
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 of Disbursements,”
line 7)
Schedule B(7), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
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)
Cash
Credit
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)
Cash
Credit
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)
Cash
Credit
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)
Cash
Credit
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 disbursed this period to “Summary of Disbursements,”
line 8)
Schedule B(8), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
SUPPORT PROVIDED TO PARTY NOMINEES (POLITICAL PARTIES ONLY): SCHEDULE B(9)
Benefitted C
andidate 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 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS MADE: SCHEDULE B(10)
Recipient C
ommittee Information Payment Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Committee Name
Payment Date
Cash
Credit
Street Address
City
State
ZIP
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (if applicable)
2
Committee Name
Payment Date
Cash
Credit
Street Address
City
State
ZIP
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (if applicable)
3
Committee Name
Payment Date
Cash
Credit
Street Address
City
State
ZIP
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (if applicable)
4
Committee Name
Payment Date
Cash
Credit
Street Address
City
State
ZIP
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (if applicable)
5
Committee Name
Payment Date
Cash
Credit
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
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
REIMBURSEMENTS MADE: SCHEDULE B(11)
Recipient I
nformation
Reimbursement
Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Cash
Credit
Street Address
City
State
ZIP
Services or Goods Reimbursed
Reimbursement Date
2
Name
Cash
Credit
Street Address
City
State
ZIP
Services or Goods Reimbursed
Reimbursement Date
3
Name
Cash
Credit
Street Address
City
State
ZIP
Services or Goods Reimbursed
Reimbursement Date
4
Name
Cash
Credit
Street Address
City
State
ZIP
Services or Goods Reimbursed
Reimbursement Date
5
Name
Cash
Credit
Street Address
City
State
ZIP
Services or Goods Reimbursed
Reimbursement Date
Enter tot
al only if last page of schedule
(transfer the total disbursed this period to “Summary of Disbursements,” line 11)
Schedule B(11), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
OUTSTANDING ACCOUNTS PAYABLE / DEBTS OWED BY COMMITTEE: SCHEDULE B(12)
Debt Inf
ormation 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 tot
al only if last page of schedule
(transfer the total received this period to “Summary of Receipts,” line 12)
Schedule B(12), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
TRANSFER OUT SURPLUS MONIES / TRANSFER IN DEBT: SCHEDULE B(13)
Cumulati
ve 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 14)
.
Schedule A(13), page of
Arizona Secretary of State Revision 12/12/19 (fillable format)
COMMITTEE ID NUMBER
STATE OF ARIZONA
COMMITTEE CAMPAIGN
FINANCE REPORT
MISCELLANEOUS DISBURSEMENTS: SCHEDULE B(14)
Recipient Inf
ormation Amount
Cumulative
Amount this
Reporting Period
Cumulative
Amount this
Election Cycle
1
Name
Cash
Credit
Street Address
City
ZIP
Disbursement Type
Disbursement Date
2
Name
Cash
Credit
Street Address
City
ZIP
Disbursement Type
Disbursement Date
3
Name
Cash
Credit
Street Address
City
ZIP
Disbursement Type
Disbursement Date
4
Name
Cash
Credit
Street Address
City
ZIP
Disbursement Type
Disbursement Date
5
Name
Cash
Credit
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 of Disbursements,” line 12)
Schedule B(12), page of
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Uribe Robert 3rd Qtr Campaign Finance Report (City of Douglas)

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Completed 22 January 2021

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