Insert Fax Name of Committee Party James Jones Name of Committee Chairman Affiliation (if any) Miscellaneous (208) 444-1000 (208) 444-2322 Home Work Phone Cell Phone Measure 1800 W. Lincoln St., Any town, ID 83211 Committee Mailing Address Candidate/Measure citizens_for_change_committee@anyisp.com Chairman E-mail address CERTIFICATION AND APPOINTMENT I, Jones , hereby certify and appoint the following individual who is a registered elector of the Name of Candidate or Committee Chairman State of Idaho as the political treasurer for the above named candidate or committee: Mary Jones Name of Political Treasurer (208) 444-1000 (208) 444-2323 Home Phone Work Phone Cell Phone 1800 W. Lincoln St., Any town, ID 83211 Treasurer Mailing Address citizens_for_change_committee@anyisp.com Treasurer E-mail Address James Jones Signature of Candidate of Committee Chairman FILING CAMPAIGN FINANCIAL DISCLOSURE REPORTS Below is the schedule of reporting periods and due dates for filing Campaign Financial Disclosure Reports for 2015 and 2016. These dates are set pursuant to the provisions of Sections 67-6607 and 67-6608, Idaho Code. Primary Election - May 17, 2016 General Election - November 8, 2016 Type of Report …………………………. Period Report Covers ……………… Date Report is Due Semi-Annual Report (Mid-Year) January 1 – June 30, 2015 July 31, 2015 (non-active statewide Candidates only) Annual Report (Year End) July 1 - December 31, 2015 February 1, 2016 (Statewide Candidates Only) Annual (2015) January 1 – December 31, 2015 February 1, 2016 7 Day Pre-Primary January 1 – May 1, 2016 May 10, 2016 48 Hour Notice (Primary) May 2 – May 14, 2016 Within 48 after receipt of
NOTE: Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance Plus New Debt less any Repayments of Debt. Name, Mailing Address and Zip Code of Lender Candidate, Individual or Business Previous Balance of debt at the end of the last reporting period New Debt amount incurred during this reporting period Repayments of Debt during this reporting period Balance Outstanding at the end of this reporting period 1. Skyking Aviation P.O. Box 200 Any town, ID. 83211 $ 1,000.00 Date: / / Amount: $ Date: 05 /25 /16 Amount: $ 1,000.00 $ 0.00 2. All Marketing P.O. Box 4500 Any town, WA. 98000 $ 636.43 Date: / / Amount: $ Date: / / Amount: $ $ 636.43 3. $ Date: / / Amount: $ Date: / / Amount: $ $ 4. $ Date: / / Amount: $ Date: / / Amount: $ $ 5. $ Date: / / Amount: $ Date: / / Amount: $ $ 6. $ Date: / / Amount: $ Date: / / Amount: $ $ Previous Incurred Repayments Ending Balance Previous Total $ 1,636.43 Incurred Total: (Transfer combined total of all incurred debt to the Detailed Summary, page 2, line 14 $ 0.00 Repayments (Transfer the combined total of all debt repayments to the Detailed Summary, page 2, line 10 & 17) $ 1,000.00 Ending Balance Total: $ 636.43 COMPLETING THE CAMPAIGN FINANCIAL DISCLOSURE (C-2) FORM SCHEDULE E-1 - CREDIT CARDS and DEBT ITEMIZATION Each new debt listed on Schedule E must have a Schedule E-1 attached. This schedule itemizes the new debt with the date incurred, who it was incurred from, the purpose and the amount. The total of itemization for each Creditor should equal the New Loan amount on Schedule E. 1. At the top of Schedule E-1, enter the following information in the appropriate fields: a) The name of the Candidate or Committee submitting the report. b) The Name of the Creditor. c) The page number of this sheet and the total number of Schedule E-1 pages being completed and filed. i) Enter these numbers after you have completed all required Schedule E-1 pages.
(Please note the definition of independent expenditures and Section 67-6611; Page 55) Totaling $1000 or More Made in Support of or in Opposition to Any One Candidate, Political Committee or Measure Full Name: Citizens for Change Committee Telephone No: 208-444-1000 Mailing Address and Zip Code: 1800 W. Lincoln, Any town, ID 83211 2016 Elections 48 Hour Notice required for expenditures made: Primary Election – May 2, 2016 through May 14, 2016 General Election – October 24, 2016 through November 5, 2016 B Broadcast Advertising (Radio, TV, Internet) O Other Advertising E Event Expenses P Postage Purpose F Food & Refreshments S Surveys & Polls Codes L Literature, Brochures, Printing Z Preparation & Production of Advertising N Newspaper & Periodical Advertising ITEMIZED EXPENDITURES IN EXCESS OF DOLLARS Submit This Report To: Insert Clerk Name Insert County Insert Address Insert City and Zip Insert Phone Insert Fax Total Expenditure(s): $ 1500.00 I __Mary Jones ___________, hereby certify that the information in this report is true, complete and correct. ____Mary Jones___ __________ Signature
B Broadcast Advertising (Radio, TV, Internet) O Other Advertising E Event Expenses P Postage Purpose F Food & Refreshments S Surveys & Polls Codes L Literature, Brochures, Printing Z Preparation & Production of Advertising N Newspaper & Other Periodical Advertising ITEMIZED EXPENDITURES IN EXCESS OF FIFTY DOLLARS Submit This Report To: Insert Clerk Name Insert County Insert Address Insert City and Zip Insert Phone Insert Fax Total Expenditure(s): $ I ___________, hereby certify that the information in this report is true, complete and correct. _______ __________ Signature C-5 Rev. 12/15 48 HOUR NOTICE OF CONTRIBUTIONS/LOANS RECEIVED Of One Thousand Dollars ($1,000.00) Or More Directions: Use this form to report any contribution of one thousand dollars ($1,000) or more received after the sixteenth (16th) day before, but not more than forty-eight hours before, any primary or general election. Notification must be made within forty-eight (48) hours after receipt of such contribution. (Section 67-6607(c), Idaho Code.) 2016 Elections This requirement applies to all types of contributions, including but not limited to: Cash contributions In-kind contributions Loans Contributions or personal made by the candidate 48 Hour Notice required for contributions received: Primary Election May 2, 2016 through May 14, 2016 General Election October 24, 2016 through November 5, 2016
ITEMIZED EXPENDITURES IN EXCESS OF DOLLARS Submit This Report To: Insert Clerk Name Insert County Insert Address Insert City and Zip Insert Phone Insert Fax Total Expenditure(s): $ I _____ ___________, hereby certify that the information in this report is true, complete and correct. _______ __________ Signature C-8 12/15 REPORT OF ELECTIONEERING COMMUNICATION For use by a person who has expended $100 or more per year on electioneering communications. Any person incurring costs of $1,000 or more must file within 48 hours of incurring costs. Name of person/entity Address (Physical) City State Zip Mailing Address City State Zip Telephone TYPE OF REPORT:  7-day Pre-Primary  30-day Post-Primary  48 Hour Report  7-day Pre-General  30-day Post General Is this an amended report? No  Yes This amends a previous report filed on
__ /_ _/_ __ 5. $ __ _ __ Primary General $ __ ____ Calendar year To Date __ /_ _/_ __ 6. $ __ _ ___ Primary General $ __ ____ Calendar year To Date __ /_ _/_ __ 7. $ __ ____ Primary General $ __ ____ Calendar year To Date __ /_ _/_ __ 8. $ __ ____ Primary General $ __ ____ Calendar year To Date __ /_ _/_ __ 9. $ __ ____ Primary General $ __ ____ Calendar year To Date __ /_ _/_ __ 10. $ __ ____ Primary General $ _ ____ Calendar year To Date This Page: $ Transfer the combined of all Schedule A pages to the Detailed Summary on page 2, line 2
SCHEDULE A ITEMIZED CONTRIBUTIONS Of more than fifty dollars ($50.00) this period Name of Candidate or Committee: Date Received Full Name, Mailing Address and Zip Code of Contributor/Lender Cash or Check __ /_ _/_ __ 1. $ __ __ __ Primary General $ _____ _ Calendar year To Date __ /_ _/_ __ 2. $ __ ____ Primary General $ _ _____ Calendar year To Date __ /_ _/_ __ 3. $ __ _ _ Primary General $ __ ___ Calendar year To Date __ /_ _/_ __ 4. $ _ _ ___ Primary General $ __ ___ Calendar year To Date __ /_ _/_ __ 5. $ _ _ ___ Primary General $ _ _ ___ Calendar year To Date __ /_ _/_ __ 6. $ _ _ ___ Primary General $ __ ___ Calendar year To Date __/_ _/_ __ 7. $ _ _ ___ Primary General $ _ _ ___ Calendar year To Date _/_ _/_ __ 8. $ _ _ ___ Primary General $ _ _ __ Calendar year To Date __ /_ _/___ 9. $ _ _ __ Primary General $ _ _ __ Calendar year To Date __ /_ _/_ __ 10. $ _ _ ___ Primary General $ _ __ Calendar year To Date Total This Page: $ Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2, line 2
SCHEDULE C IN-KIND CONTRIBUTIONS and EXPENDITURES Name of Candidate or Committee: Purpose Codes A. All Travel Expenses (Airfare, Fuel, Lodging & Mileage) N. Newspaper & Other Periodical Advertising B. Broadcast Advertising TV & Internet) O. Other Advertising (Yard Signs, Buttons, etc.) C. Contributions to Candidates & PAC’s P. Postage D. Donations & Gifts S. Surveys & Polls E. Event Expenses T. Tickets (Events) F. Food & Refreshments U. Utilities G. General Operational Expenses W. Wages, Salaries, Benefits & Bonuses L. Literature, Brochures, Printing Y. Petition Circulators M. Management Services Z. Preparation & Production of Advertising 1. ___/___/___ Primary General Contributor Name, Mailing Address & Zip Code: $ $ Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code $ Purpose Code 2. ___/___/___ Primary  General Contributor Name, Mailing Address & Zip Code: $ $ Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code $ Purpose Code 3. ___/___/___ Primary General Contributor Name, Mailing Address & Zip Code: $ $ Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code $ Purpose Code 4. ___/___/___ Primary General Contributor Name, Mailing Address & Zip Code: $ $ Calendar Year-To-Date Expenditure Name, Mailing Address and Zip Code $ Purpose Code Expenditure (Transfer the combined total of all Expenditures on Schedule C pages to Detailed Summary, page 2, line 8) $ Contributor Total: (Transfer the combined of all Contributors on Schedule C pages to Detailed Summary, page 2, line 3 $ SCHEDULE D
ITEMIZED EXPENDITURES FOR ELECTIONEERING COMMUNICATIONS Name of Person/Entity 1. Date Expended _ _/_ __/_ _ 2. Amount $  Cash  In-Kind 3. Name (last, first) 4. Address 5. City/State/Zip 6. Method of Communication(s) 7. Name of Candidate(s) referred to 8. Support Oppose 9. Purpose of Expenditure 1. Date Expended _ _/_ _/_ _ 2. Amount $  Cash  In-Kind 3. Name (last, first) 4. Address 5. 6. Method of Communication(s) 7. Name of Candidate(s) referred to 8. Support Oppose 9. Purpose of Expenditure 1. Date Expended _ __/_ __/_ __ 2. Amount $  Cash  In-Kind 3. Name (last, first) 4. Address 5. 6. Method of Communication(s) 7. Name of Candidate(s) referred to 8. Support Oppose 9. Purpose of Expenditure