CAMPAIGN CONTRIBUTION AND EXFENDITURE REPORT

For County, Municipal and SchoolBoard Candidates

! Check if this report is an amendment

should be filsd with the Clerk of the in which the election is held
Candidate
I (Y-t

{Clerk's Fite

Does the have a campaign comrhittee? )Yes ( )No

If te the fol

bl*c: f-iLiii 1'i,i3ijr'i';-j iut 1'1:r-irriiit

'L;;;":,
i;=;; i.*i:=.1:i
il''i
;i*rr,
2. Type of Election: {check onlyone} , Year of Election__3f1i[
[1 Primary D Primary Runoff XGenerat fl General Runoft
Annualschi:ol il Annual School Runaff
3. Type of Report: (check one) This report covers wtrat period? { t|ll$raug 0\t 7
*l
,tr Preeleclion report *lf lhe campaign has nol
Final report (check method by which surplus campaign funds were disposed)" ended, disposal of
ilTreasurer of State (for benefit of General Revenue Fund Account of the $tate Apportionment Fund) campaign funds is not
U A politicat party as defined in Ark. Code Ann. $ 7-1-101 or a political party caucus of lhe Arkansas General required and lhe
Assembly, the Senaie, or the House of Representatives candidate may carry
E Contributors to the candidate's campaign forward any remainlng
n A nonprofit organization that is exempt from taxation under Section 501(c){3) of ihe lntemal Revranue Code campaign funds lo the
n Citles of the first class, cities of trE second class, or incorpcrated torvns next election in the cycte
for that same office.

CUIIULATIVE TOTAL
4. Balance of ca funds at
5. lnterest earned 0n cam n account
6. Total Loans (enter total from line I
7. Total Contributions (enter total from line
8. Total enter totalfrom line
9. Balance of funds at close of
'10. lf this is candidate's final report for an election, amount of carryover
funds or outstanding indebtednesS {use brackets to indicate
1 1 " ( ) NO ACIVITY lcnecx f you have not received contribrrtions, expenditures dunng this r€porting peilsd)

I certify to the best of my knowledge and belief that the i is a complete, true, and accurate
financial statement of my (the candidate's) campaign

Swom lo and subscrib€d before Connty, Arkansas, on this

.W-ffi:tu My Commission Expires:

Ark. Code Ann, $ 7-&202 provides that a person \,rho knowingty fails to comply Wth the provisions of subchapter 2 of chapter 6, Title 7 of the Arkansas Code
shdl upon convictlon be guilty of a class A misdemeanor
REVT'ED 08/2015
 {2. LOAN INFORMATION
Please Typa or Print
Do not list loans previously reported

NAME AND ADDRESS OF LENDING

TOTAL LOANS DURING REPORTING

IMPORTAN?

The lirnits on campaign contributions do not apply to loans or contributions made by a

candidate from his or her owil per$oftal funds to the campaign or to personal loans
made by financial institutions to the candidate and applied to his or her campaign. Any
loans made by a candidate to his or her campaign and any loans rnade by a financial
institution to a candidate and applied to his or her carnpaign shall be reported in Section
12.

lf a candidate desires to use or raise campaign funds to repay himself or herself for
personal funds which he or she contributed to the campaign, then he or she would need
to report those personal funds as a loan in $ection 12.

lf a candidate does not desire to use or raise campaign funds to repay himself or herself
for personal funds which he or she contributed to the campaign, then those personal
funds would not be reported in Section 12. lnstead, they would be reported as a
campaign contribution either in Section 1S or on line 18, depending upon the ar*ount.

lf a candidate has unpaid laans at the end of the primary, runoff, special, or general
election, the source, description and amount of each such loan should be itemized in
Section 29. Candidates ending their campaign in debt are permitted to raise funds to
retire the debt subject to the restrictions contained in Ark. Code Ann. $ 7-6-219.

Ark. Code Ann. S 7-6'202 provides lhat a person who knoningly fails to comply with the provisions of subchapter 2 of chapter 6. Title T of the Akansas Code
shall Upon convlcUon be guiity of a Class A misdemeanor.
REVISED O8i2O15
 14. NONMONEY CONTRIBUTIONS
Does not inckde volmteer services by individuals

Value of nonmoney
item

TOTAL NONMONEY CONTRIBUTIONS

IMPORTA[fr

ln addition to monetary contributions, candidates are required to report the

receipt of any nonmonetary ("in-kind") contributions. A candidate receives an in-
kind contribution whenever a contributor provides him with an itern or service
without charge or for a charge that is less than the fair rnarket value of the item
or service in question.

The value of an in-kind contribution is the difference between the fair market
value and the amount charged. ln-kind contributions are addressed in greater
detail in Sections 205 and 206 of the Commission's Rules on Campaign Finance
& Disclosure.

Ark. Code Ann. $ 7€'202 provides that a p€rson u/iro knowingty fails to comply with the provisions of subchapter 2 of chapter 6. Tille 7 of the Artansas Code
shall upon conuiction be ouilty of a Class A misdemeanor.
REVtSfiD 0812015
 16. ITEMIZED MONETARY CONTRIBUTIONS OVER $50
Please Type or Prtnt
Use cooies of this Daoe as
Full Name and Mailing Address of Contributor Ournulative Total
From This
Contrlbutor

w 5 'le bnnrwl il&aof S^,

Tc,soo o
lC, 5oc
q,n d )a*wr trore b 1:b0,oo ,b r15' , ou
5hr+" 0&i'fr'
01 ?o ,$ { lo0 ,s Gla0,"o

snfu!8 0*5{dd,accx fuwt .

,500,n0 +,oQ,uu

nl,,ltb )ue Pl, V ul:intn s 4 i000,:' 6laao,"

nbl', Ant4w 4 tscfl 4 {oo,w

Uel"i^'t Jnt*lln i 1,CIr. @ uq,a sl

,
oo

I
Vafu*,e fr*..,c.* s
l*,|ac ,9q lo, foo,oo

5cl
Subtotal of Contributions This Pa

Ark. Code Ann. S 7-S202 provides that a person who kilowingly fails to comply wilh the provisions of subchapter ? of c+Hpter 6, Title 7 of the Arkansas Code
Shall upon conviction be guilty of a Class A misd€meaf}or.
REVISED O8i2O15
 ITEMIZED I''ONETARY CONTRIBUTIONS OVER $50
Please Tvoe or Print
Full Name and Mailing Address of Contributor

LolS ( * a, *;',\D^+,'dyL s oo
ft+ ^'l lr, ArD
@-

Dceneral n Oebl

trPrimary tr Run-Off
trGeneral tl Debt

trGeneral fl Debt

17. TOTAL ITEMIZED MONETARY CONTRIBUTIONS OVER

18. TOTAL NONITEMIZED MONETARY CONTRIBUTIONS
{9. TOTAL TI'IONETARY CONTR}BUTION$ THIS REPORT
(includes totals from lines l7 and 18!

Ad( Code Ann. $ 7-6-202 provides that a person who knowingly fails to comply !,{ith lhe proyisions of subchapter ? of chapter 8, Tille 7 of the Arkansas Code
shall upon convictiofl be guilty of a Class A misdemear.lor.
REVISED 08/2015
 20. CAMPAIGN EXPENDITURES BY CATEGORY
F/ease Type or Print

CATEGORY TOTAL AMOUNT

Fee
Television

Other Adverti
Office Supplies

Utitities
T

Direct Mail
Travel
Entertainmenl

Loans
Retrlrned Contributions
Consultant Fees
Polls
Paid t
ffi

21. TOTAL GAIUIPAIGN EXPENDITURES

2I, PAID CAMFAIGN WORKERS

NAME CIF WORKER

23. TOTAL PAID GAMPAIGN WORKERS

Ark. Code ,Ann. $ 7-6-202 provides lhat a p€rson v\ho knoivingly fails to comply wilh the provisions of subchapter 2 of chapter S" Tille 7 of the Arkansas Code
shall upon conviction be guifry of a Class A misdemeanor.
REVTS=D 08t2015
 24, ITEMIZED CAMPAIGN EXPENDITURES OVHR $1OO
Please Type or Print

Name end Address of

25. TOTAL ITEMIZED EXPENDITURES THIS REPORT

26. TOTAL HO}'IITEMIZEB EXPENDITURES THIS REPORT
27. TOTAL PAID CAMPAIGN WOR.KERS THI$ REPORT amount from line
28. TOTAL EXPENDITURES THIS

NOTE: Expenditures Reflected on Line$ 25JG and 27 Should EF Tp*,aled bv Cateqory in,qpction 20

Ark- Code Ann. $ 7-6-202 provides ihat a person who *nowingly fails to comply with the provisions of subchapter 2 of chapter 6, Title 7 ol the Arkansas Code
shall LFon convieticn be guilty of a Class A misdemeanor.
REVISED O8T2OI5
 29. OUTSTANDING CAMPAIGN DEBTS
{including unpaid loans}
To Be Gompleted On Candidate'e Final Report For An Election
Please Type or Print
Use a#r?ionarpaoes if ,lecessary

NAMEANB

TOTAL DEBT

Ark, Code Ann. S 7-C2O2 provides that a p€rscn wlu knowingiy fails to comply rjyith Itle provisiocs of subchapler 2 of chapter 6, Tifle ? ot the Ar*ansas Code
shall upon convicti$ be guilty of a Class A misdemeafior.
REVTSED 081201s