2A. Gross Expenditures 2B. Contributions to Committees (Transfers-Out) TOTAL DISBURSEMENTS (Add totals from 2A and 2B) 2. DISBURSEMENTS $3,245.06 $17,191.42 $0.00 $1,450.00 $3,245.06 $18,641.42 Street Address: P.O. Box 59 City, State and Zip: Merrill, WI 54452 Filing Period Name: Covers all activity from 07/26/2016 through 08/31/2016 September Continuing 2016 Name of Committee/Corporation: Citizens for Tiffany CAMPAIGN FINANCE REPORT STATE OF WISCONSIN ETHCF-2 COMMITTEE IDENTIFICATION 1. RECEIPTS 1A. Contributions (Including Loans) from Individuals 1B. Contributions from Committees (Transfers-In) 1C. Other Income and Commercial Loans TOTAL RECEIPTS (Add totals from 1A, 1B and 1C) Column A This Period Column B Calendar Year-To-Date $25,500.00 $121,792.61 $15,750.00 $33,607.10 $4.15 $16.91 $41,254.15 $155,416.62 SUMMARY OF RECEIPTS AND DISBURSEMENTS GAB ID: 0104212 OFFICE USE ONLY CASH SUMMARY Cash Balance Beginning of Report Total Receipts Subtotal Total Disbursements CASH BALANCE END OF REPORT INCURRED OBLIGATIONS (Balance at the Close of This Period-3A) LOANS (Balance at the Close of This Period-3B) $243,266.30 $41,254.15 $284,520.45 $3,245.06 $0.00 $0.00 $281,275.35 * * I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete. Signature of Candidate or Treasurer JSS Type or Print Name of Candidate or Treasurer: Date: Daytime Phone: Email: [email protected]Koth, James NOTE: The information on this form is required by 11.0204, 11.0304, 11.0404, 11.0504, 11.0604, 11.0804, 11.0904, Wis. Stats. Failure to provide the information may subject you to the penalties of ss. 11.1400, 11.1401, Wis. Stats. ETHCF-2 (Rev. 04/16) This form is prescribed by the Wisconsin Ethics Commission, P.O. Box 7984, Madison, WI 53707-7984, 608-266-8005. * Cash Balance as reported by committee
Transcript
2A. Gross Expenditures
2B. Contributions to Committees (Transfers-Out)
TOTAL DISBURSEMENTS (Add totals from 2A and 2B)
2. DISBURSEMENTS
$3,245.06 $17,191.42
$0.00 $1,450.00
$3,245.06 $18,641.42
Street Address: P.O. Box 59
City, State and Zip: Merrill, WI 54452
Filing Period Name:
Covers all activity from 07/26/2016 through 08/31/2016
September Continuing 2016
Name of Committee/Corporation:
Citizens for Tiffany
CAMPAIGN FINANCE REPORT STATE OF WISCONSIN
ETHCF-2COMMITTEE IDENTIFICATION
1. RECEIPTS
1A. Contributions (Including Loans) from Individuals
1B. Contributions from Committees (Transfers-In)
1C. Other Income and Commercial Loans
TOTAL RECEIPTS (Add totals from 1A, 1B and 1C)
Column A This Period
Column B Calendar Year-To-Date
$25,500.00 $121,792.61
$15,750.00 $33,607.10
$4.15 $16.91
$41,254.15 $155,416.62
SUMMARY OF RECEIPTS AND DISBURSEMENTS
GAB ID: 0104212
OFFICE USE ONLY
CASH SUMMARY
Cash Balance Beginning of Report
Total Receipts
Subtotal
Total Disbursements
CASH BALANCE END OF REPORT
INCURRED OBLIGATIONS
(Balance at the Close of This Period-3A)
LOANS (Balance at the Close of This Period-3B)
$243,266.30
$41,254.15
$284,520.45
$3,245.06
$0.00
$0.00
$281,275.35*
*
I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.
Signature of Candidate or Treasurer
JSS
Type or Print Name of Candidate or Treasurer: Date: Daytime Phone:
NOTE: The information on this form is required by 11.0204, 11.0304, 11.0404, 11.0504, 11.0604, 11.0804, 11.0904, Wis. Stats. Failure to providethe information may subject you to the penalties of ss. 11.1400, 11.1401, Wis. Stats.
ETHCF-2 (Rev. 04/16) This form is prescribed by the Wisconsin Ethics Commission, P.O. Box 7984, Madison, WI 53707-7984, 608-266-8005.
*Cash Balance as reported by committee
SCHEDULE 1-A RECEIPTS Contributions From Individuals
Complete Committee Name: Citizens for Tiffany
08/01/2016 Powers, Amy 116 Fawn Trl, Sturtevant, WI 53177
Actuarial Director $290.00 $290.00
08/01/2016 Ostert, Theresa 1032 Coprinus Ct, Green Bay, WI 54313
$200.00 $200.00
08/01/2016 Teff, Douglas 712 Danes Hall Dr, Louisville, KY 40206
Director $300.00 $300.00
08/01/2016 Seymour, Kristine 20440 W National Ave, New Berlin, WI 53146
Regional Vice President $500.00 $500.00
08/01/2016 Davis, Gary N62W27425 Trappers Run, Sussex, WI 53089
Insurance Agent $250.00 $250.00
08/01/2016 Matzke, Mark 2275 Meadow Ridge Dr, DePere, WI 54115
$200.00 $200.00
08/01/2016 Dickinson, Julie 333 E Wentworth Ln, Appleton, WI 54913
Director $260.00 $260.00
08/01/2016 Zacharias, Tod 5630 County Road BB, Gillett, WI 54124
Vice President $500.00 $500.00
08/05/2016 Ehlers, Steven 422 N 18th Pl, Sturgeon Bay, WI 54235
$25.00 $25.00
08/05/2016 Dahl, Michael 3105 Sherman St, Eau Claire, WI 54701
$100.00 $100.00
08/05/2016 Flynn, Daniel S11045 County Road Hh I, Eleva, WI 54738
$50.00 $50.00
08/02/2016 Lamont, Cori 4801 Forest Run Road, Madison, WI 53704
Realtor $100.00 $100.00
08/02/2016 Lak, Joseph 833 E Michigan St Ste 500, Milwaukee, WI 53202
Realtor $100.00 $100.00
08/05/2016 Cutler, Larry 418 Oakland Ave, Sun Prairie, WI 53590
$100.00 $100.00
08/05/2016 Antoine, Dale 2201 Nottingham Ln, Kaukauna, WI 54130
$25.00 $25.00
Conduit Contribution
Date Full Name Address Occupation Amount YTD
08/11/2016 Revolinski, Scott J. 2000 W Green Brook Rd, River Hills, WI 53217
Realtor $100.00 $100.00
08/11/2016 Shepherd, Thomas W.
1035 Katherine Dr, Elm Grove, WI 53122
Realtor $100.00 $100.00
08/11/2016 Purtell, Ned A. 1429 E Hermitage Rd, Milwaukee, WI 53217
Realtor $100.00 $100.00
08/11/2016 Provancher, Stephen B.
6108 N Shoreland Ave, Whitefish Bay, WI 53217
Realtor $100.00 $100.00
08/19/2016 Benjamin, Gary PO Box 843, Iron Mountain, MI 49801
