Campaign Finance Receipts and Expenditures Report Page 1 of 1

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( Campaign Finance Receipts Governmental Ethics Commission & Expenditures Report 109 W. 9th, Suite 504 1110/2017 Topeka, KS 66612

Phone (785) 296-4219 Fax (785) 296-2548

www,kansas,gov/ethics

Check only if appropriate Amended Filing Termination Report

Campaign Finance Candidate Name:J.R. Claeys

Filing Report Address: 2157 Redhawk Ln

Address2:

City: Salina Zip: 67401 County: Saline

Home Phone: (785) 250-5758 Business Phone:

Office Sought: State Representative District: 69

SUMMARY (covering the period from 10/28/2016 through 12/31/2016)

1 CASH ON HAND AT BEGINNING OF PERIOD 8882.96

2 TOTAL CONTRIBUTIONS AND OTHER RECEIPTS (Schedule A) view/print $2,000.00

3 CASH AVAILABLE THIS PERIOD (Add Lines 1 and 2) $10,882.96

4 TOTAL EXPENDITURES AND OTHER DISBURSEMENTS (Schedule C) view!print $10,283.99

5 CASH ON HAND AT CLOSE OF PERIOD Subtract Line 4 from 3) I $598.97

6 IN-KIND (NON.MONETARY) CONTRIBUTIONS (Schedule B) view/print $2,080.00

7 OTHER TRANSACTIONS (Schedule D) view/print 10000.00

'" declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete, I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor,"

Electronically filed on: 1/7/20171:37:46 PM Signature of Candidate or Treasurer: J.R. Claeys

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1/9/2017http://www.kssos.org/elections/cfr_viewer/reports/exp_report_main.aspx

Campaign Finance Schedule A Report Page 1 of 1

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SCHEDULEA

CONTRIBUTIONS AND OTHER RECEIPTS

Candidate: J.R. Claeys

Date Name and Address of Contributor

Type of Payment Occupation And Industry of Individual Giving More Than $150

Amount Cash, Check, Loan, Other

12/30/16

Kansans for Conservative Values PAC P.O. Box 283 Paola KS 66071

Check $500.00

12/02/16

Kansas New Energy Economy PAC 610 Brazos St Ste 2JO Austin TX 6870 I

Check $500.00

11/05/]6

Ellis County Republican Party N/A Hays KS 67601

Check $500.00

I II02/] 6

Blue Beacon Intemational, Inc. P.O. Box 856 Salina KS 67402

Check $500.00

Total Itemized Receipts for Period

Total Unitemized Contributions ($50 or less)

$2000.00

$0

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known

$0

$0

TOTAL RECEIPTS THIS PERIOD $2000.00

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1/9/2017http://www.kssos.org/elections/cfr_viewer/reports/schedule_aJeport.aspx

Campaign Finance Schedule B Report Page I of I

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SCHEDULE B

IN-KIND (NON-MONETARY) CONTRIBUTIONS

Candidate: J.R. Claeys

Date Name and Address of Contributor

Occupation And Industry oflndividual Giving More Than $150

Description of In-Kind Contribution

Value of In-Kind Contribution

12/30/16

Kansas Republican Party State Operating Account 5601 SW Barrington Ct Topeka KS 66614

Mail $2,080.00

$2080.00

$0

$2080.00

Total Itemized (over $100) In-Kind Contributions

Total Unitemized ($100 or less) In-Kind Contributions

TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD

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Campaign Finance Schedule C Report Page 1 of2

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SCHEDULE C

EXPENDITURES AND OTHER DISBURSEMENTS

Candidate: J.R. Claeys

Date Name and Address Purpose of Expenditure or Disbursement

Amount

12/22/16 J.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) Hobby Lobby - Display Case

$43.49

12/22/16 J.R. Claeys 2157 Redhawk Ln Sal ina KS 6740 I

Candidate (self) Custom Lettering - Vinyl Door Lettering

$24.49

12/22/16 J.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) ALEC - Membership

$100.00

12/21/16 J.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Michael's - Certificate Frames

$43.64

12/2 ]/16 J.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) eBay - Challenge Coin Holders

$30.57

12/02/16 J.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Best Buy - Monitor Adapter

$39.76

12/02/16 J.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) Amazon - Converter

$11.98

12/02/16 J.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Gear - Photo Frames

$39.95

12/02/16 J.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) Sam's Club - Antenna

$54.24

12/02/16 J.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) Fanatics - Framed Photo

$184.60

12/01/16 $354.74

1/9/2017http://www.kssos.org/elections/cfr_viewer/reports/schedule_c_report.aspx

Campaign Finance Schedule C Report Page 2 of2

l.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Best Buy - Computer Monitor

12/0 I/16

11/25/16

l.R. Claeys 2157 Redhawk Ln Salina KS 67401

l.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

Candidate (self) eBay - Keyboard/Mouse

Candidate (self) Target - Computer Accessories

$125.00

$163.11

11/25/16

11/25/16

l.R. Claeys 2157 Redhawk Ln Salina KS 6740 I

l.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Target - Office Table

Candidate (self) X-Chair - Office Furnishings

$130.49

$1,079.98

I 1/25/16 l.R. Claeys 2157 Redhawk Ln Salina KS 67401

Candidate (self) Sam's Club - Television Monitor

$326.24

11/09/16

11/02/16

11/01/16

I I/O 1/16

11/01/16

Garrett Love 21506 12 Rd Montezuma KS 67867

Mine Creek Strategies 7909 Falmouth St. Prairie Village KS 66208

Kansas Republican Party - State 2605 SW 21 sl St. Topeka KS 66603

Sunflower Bank 3025 Cortland Ave. Salina KS 67401

l.R. Claeys 2 J57 Redhawk Ln Salina KS 67401

Miscellaneous Phones

Polling Phones

Donation/Contrib Contribution

Miscellaneous ACH Wire Fee

Candidate (self) Office Max - Postage Stamps

$201.90

$300.00

$6,957.81

$25.00

$47.00

Total Itemized Expenditures This Period

Total Unitemized Expenditures of $50 or less

TOTAL EXPENDITURES & OTHER DISBURSEMENTS THIS PERIOD

$10283.99

$0

$10283.99

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Campaign Finance Schedule D Report Page 1 of 1

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SCHEDULE D

OTHER TRANSACTIONS

Candidate: J.R. Claeys

Date Name and Address Nature of Account or Loan Payable or Loan Receivable

Balance at Close of Period

07/21/16 lR. Claeys 2157 Redhawk Ln Salina KS 67401

Loan - For General Campaign Expenses

$10,000.00

TOTALOTHERTRANSAcnONS I $10,000.00

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