30-A R.C. 3517.10
Ohio Campaign Finance Report Pn:scribed by Secrela,y of Stale 3/05 Regislration Number, if PAC
Full Name of Committee
Gardner for Mayor Full Name of Candidate
G. Andrew Gardner 38123
M~;~~
0
0
Sireel Address
l
Dodds Hill Dr.
l ;Wlby Hills
Ci1y
Type of Report (place X to the left of r,port type)
El 1Zip ~ 4 0 9 4
o ~tale
Willoughby Hills Pre-Primary
Post-Primacy
July Monlhly
Monthly
■
August
Annual Year
Pre-General
Post-General
Seplember Monthly
Termination
Semiannua l
M Amended Report?
i!1 Yes ::J No Report Electronically Filed?
[J Yes
~ No
1
Date of Election
,.,,
1
lo
y
D
5
1
9
For candidat~ onJy, during an election year: if total contributions and expenditures each Iola.I $500 o r less during the combined pre- and post-periods at one election, check box D No other forms are required for a post-primary or post-general period, if above statement applies. See R.C. 3517.1 O(H) for details.
$(
00
1. Amount brought forward from last report
$
2. Total monetary contributions {From Form No. 31-A)
s
3. Total other income (From Form No. 3 l-A-2)
$
4. Total funds available (sum of lines 1, 2, 3)
$
$17,145 00
5. Total monetary expenditures {from Form No. 3 1-8)
s
$3,66€ 49
6. Balance on band (line 4 minus line 5)
$
7. Value of in-kind contributions received (From Form No. 31-J-1)
$
8. Value of in-kind contributions made {From Form No. 31-J-2)
$
9. Outstanding loans owed by committ« {From Form No. 31-C)
$
$1 , 50( 00
10. Outstanding debts owed by committee (From Form No. 31-N)
$
$45 00
11. Outstanding loans owed to committee {From Form No. 31- K)
$
12. Value of independent expenditures made {From Form No. 31-U)
s
$15,64~ 00
$1 , 50( 00
$13,47€ 51
$5~ 11
$( 00
$( 00
$( 00
13. For Elec:tronk: Filing Entities only Sum of lines 2, 7, and amount of any new loans received this period $
THE INFORMATION CONTAINED IN THIS REPORT IS MADE UNDER THE FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
LSIFICATION. WHOEVER COMMITS ELECTION
G. Andrew Gardner, Treasurer
05/26/2020 Date
Print Name and Title (Treasurer and Deputy Treasurer only)
Contribut ion pages,_ _
Expenditure _
_
pages_ _ _ _
Other pages._ _ __
Tolal Q page.-.,_ _ _ __
3 1-A R.C. 3517.10
Page _l _ _
Statement of Contributions Received Prescribed by Secretary of State 3/0S
Name of Committee in Full
Gardner for Mayor Full Name of Contributor
Registration Number, if PAC
Abigail l. Gardner Street Address
Employer/Occupation/Labor Organization•
58O1-B
I
Halle Farm Drive
City
State
Willoughby
0
Zip Code
H
44094
Full Name of Contributor
Fonn (Cash, Check, etc.)
l l
Check Amount
M D y 0 18 2 1 7 1 1 9 Registration Number, if PAC
1000.00
John Lillich Street Address 37830
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
Milann Dr.
:l"'ity
State
Willoughby Hills
0 I
12.ip Code H
44094
Full Name of Contributor
I I
Check Amount
M D y 0 19 2 3 1 9 Registration Number, if PAC
200.00
Gary Pratt Employer/Occupation/Labor Organization•
Street Address 2955
Form (Cash, Check, etc.)
Canterbury Court
City
st
Willoughby Hills
0
i'°
H
12.i~ ~~2
Full Name of Contributor
Check
I I
Amount M D y 0 19 2 13 1 1 9 Registration N,uuber, if PAC
50.00
Karen J. Schaller Employer/Occupation/Labor Organization•
Street Address 2512
I
Red Fox Pass
City
State
Willoughby Hills
0 I
Zip Code
H
44094
Full Name of Contnl>utor
Form (Cash, Check, etc.)
Check
I I
Amount M D y 0 1 9 2 14 1 9 Registration Number, if PAC
25.00
Ronald J. Caporossi Employer/Occupation/Labor Organization•
Street Address 38231
Form (Cash, Check, etc.)
Dodds Hill Dr.
City
State
Willoughby Hills
0 I
' Zip Code H
44094
Full Name ofContnl>utor
I I
Check Amount
M D y 0 19 2 15 1 1 9 Registration Number, if PAC
50.00
Marygail Michalski 38285
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
Street Address
I
Dodds Hill Dr.
City
State
Willoughby Hills
0
Zip Code
H
44094
Full Name of Contributor
1
~
Check
!Amount M D Y 0 19 2 19 1 9 Registration Number, if PAC
25.00
Roy J. Streetz Street Address 2950
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
Gatsby Ln.
City
Willoughby Hills
0
State H
12.i~
94
Full Name of Contributor
I
I
Check
Amount M D y 1 1001119 Registration Number. if PAC
25.00
Leighann Cesar Street Address 2848
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organizatioo•
Fowler Dr. st
City
M 0 19
,I
D 3 10
l
Check Amount
y 1 19 • Reqmred for contnbullons from mdiV1dua1s over SI 00 to stateW1dc and general assembly candidates. If contnbutor 1s self-employed. the occupauon and lhc munc uf the individual's business, if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate of$ I00, the labor
Willoughby Hills
O
i'° H
12.i~
94
75.00
organization of which the employees are members, if any, must appear. [RC. 3Sl7. IO(BX4)] Page Total S
1,450.00
f
3 1-A R.C. 3517.10
Page _2 _ _
Statement of Contributions Received Prescnbed by Secrelary of State 3/05 Name of Committee in Full
Gardner for Mayor Full Name of Contributor
Registration Number, if PAC
Marcie Levine Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
28806 Eddy Road
Check
City
Amount
Willou11:hbv Hills
50.00
Full Name ofContnbutor
Registration Number, if PAC
Frank Omerza Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
38305 Dodds Hill Dr.
Check
K;ity
IZip Code
State
Willou11:hby Hills
0
H
44094
Full Name of Contributor
500.00 Registration Number. if PAC
Molly F. Nash Street Address
Employer/Occupation/Labor Organization•
Fonn (Cash, Check, etc.)
3030 Worrell Road
Check
City
Amount
Willou11:hbv Hills
50.00
Full Name of Contributor
Registration Nwnber, if PAC
Gail Anderson Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
2306 River Road
Check
City
State
Willou11:hby Hills
0
IZip Code
H
Amount
44094
Full Name of Contributor
200.00 Registration Number, if PAC
Sharon Scott Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
Check
37215 Beech Hills City
Amount
Willoughby Hills
50.00
Full Name of Contnbutor
Registration Number. if PAC
Sue NemeU1 Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
Check
2895 Millgate Dr.
Amount
City
100.00
Willoughby Hills Registration Number, if PAC
Full Name of Contributor
Gloria Maieski Street Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
Check
2950 Gatsby Ln. City
State
Willou11:hby Hills
0
IZip Code
H
Amount
44094
200.00 Registration Number. if PAC
Full Name of Contnbutor
Denise Niedermeyer Street Address
Employer/Occupation/Labor Organization•
2821 Larnpli11:ht Ln.
Form (Cash, Check, etc.)
Check Amount
City
50.00
Willou11:hbY Hills • Reqwred for contnbuuons from 10dJV1duals over $ 100 to statewide and gencraJ assembly cand1dates. If contnbutor 1s self-employe~ the occupauon and the name of the
individual's business, if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed lhe aggregate of$ I00, the labor
j
organization of which the employees arc members, if any, must appear. [R.C. 35 17. IO(BX4)l
( Page Total $ _ _1-•~200~.00~
~
31-A R.C. 3517.10
Page_3__
Statement of Contributions Received Prescribed by Secretary or State 3/05
Name or Committee in Full
Gardner for Mayor Full Name or Contributor
Registration Nwnbcr, if PAC
Toni Delaney Street Address
Employer/Occupation/Labor Organii.ation•
Form (Cash, Check, etc.)
38445 Berkshire Hills Dr.
Check
City
Willou!!hbv Hills
0
Amount
' Zip Code
State
H
44094
Full Name ofContnl>utor
100.00 Registration Nwnbcr, if PAC
Lisa Cummins Street Address
Employer/Occupation/Labor Organization'
Form (Cash, Check, etc.)
38087 Dodds Hill Dr.
Check
Ci1y
Willoul!hbv Hills
250.00
Full Name of ContriWor
Registratioo Nwnbcr, if PAC
Robert Weger Street Address
Employer/Occupation/Labor Organization•
38195 Dodds Hill Dr.
Form (Cash, Check, etc.)
I I 0 19 2 15 1 19
City
M
Willou!!hbv Hills Full Name of ContriWor
D
y
Check Amount
250.00
Registration Number. if PAC
Teffrey M. Ross Street Address
Employer/Occupation/Labor Organization•
Fonn (Cash, Check, etc.)
2867 Camelot Ct.
Check
City
State
Willoughby Hills
0
' Zip Code
H
44092
Full Name or CootriWor
50.00 Registratioo Nwnbcr, if PAC
Holly Lessick Street Address
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organii.ation'
36436 Lakeshore
Check
City
State
Eastlake
0
I
' Zip Code
H
44095 Registration Nwnbcr, irPAC
Full Name of Cootributor
Douglas McLaughlin Street Address
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organiz.ation•
Check
38033 Dodds Hill Dr.
Amount
City
250.00
Willoughby Hills Registration Nwnbcr, if PAC
Full Name of Contributor
F. William Ruple Street Address City
State
Kirtland
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
10956 Woodlake Dr. 0
' Zip Code
H
44094
I I 1 10 0 2 1 M
D
Check IAmoont
y
9
250.00
Registration Nwnbcr, if PAC
Full Name ofCootributor
Edward McKenna Street Address
Employer/Occupation/Labor Organization•
Check
2963 Lamplight City
State
Willoughbv Hills
Form (Cash, Check, etc.)
0
I H
' Zip Code
Amount
44094
100.00
• Reqmred for contnbuuons from 1nd1V1duals over $ 100 to stateW1de and general assembly candidates. If contnbutor 1s self-employ~ the occupauon and the name of the individual's business, if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSI OO, the labor
organization or which the employees are members, if any, must appear. [R C. 3517 IO(BX4)1 Page Total S
J 1,300.00
1
31 -A
R.C. 3517 10
Page _4__
Statement of Contributions Received Prescribed bySecretary of Slate 3/05
Name ofCornmiltee ia Full Gardner for Mavor Full Name ofContribulor Gregory West S1ree1 Address 2356 River's Edge Cily Willou!!hbv Hills Full Name ofContribu1or Hallie Schiavoni S1reet Address 2460 Parsons Dr. Ci1y Willoul!:hbv Hills Full Name ofContribulor Charles J. Latsa Slreel Address 28914 Eddy Cily Willou!!hbv Hills Full Name ofCon1ribu1or Barry Reutter S1reet Addr=l 2543 Hanna Dr. Ciiy Willoul!:hbv Hills Full Name of Contributor Loreto Iafelice S1reet Address 38650 Florence Dr. City Willoughby Hills Full Name of Contributor Marv DiTirro S1rcet Address 355 E. 271st St. Ciiy Euclid Full Name of Contributor George A. Gardner Strcel Address 38158 Dodds Hill
Regislralion Number, if PAC Employer/Occupation/Labor Organization•
Q S1i'c H 1Zi~
Employer/Occupation/Labor Organization' S1a1c
0
I
H
IZip Code 44094
l l
Form (Cash, Check, elc.) Check Amounl M D y 100.00 1 10 0 13 1 9 RcgiSlration Number, if PAC
I I
Form (Cash, Check, etc.) Check
Employer/Occupation/LaOOr Organization•
0 Slj'° H 1Zi~";92
Employer/Occupation/Labor Organiution•
Q S1ate H
1Zi~~~ 4
Employer/Occupation/Labor Organizalion•
0 sit H 1Zi~~~4
M
l I D
y
0
s't
H 1Zi~732
Employcr/Occupat,on/Labor Organization• S1a1c
0
H
'Zip Code 44094
Employer/Occupation/Labor Organization•
0 Sit H 1Zi~
45
Amount
1 10 0 12 1 19 Regislration Nwnber, if PAC
50.00
Form (Cash, Check, elc.) Check Amounl M D y 50.00 1 10 0 12 1 19 RcgiSlralion Nwnber, if PAC
I I
Form (Cash, Check, elc.) Check Amount M D y 1 10 0 14 1 19 100.00 Rcgislration Number, if PAC
l l
Form (Cash, Check, etc.) Check
Employer/Occupation/Labor Organization•
Cily
Willoul!:hbv Hills Full Name of Contributor Matthew Jones Strcel Address 4075 Brewster Dr. Ciiy Westlake
94
Form (Cash, Check, elc.) Check Amounl M D y 100.00 0 19 3 0 1 19 RegiSlration Number, if PAC
M
T T D
y
Amowit
1 10 1 10 1 19 Registralion Number, if PAC
50.00
Form (Cash, Check, etc.) Check Amounl M D y 1000.00 1 10 1 9 1 9 RcgiS1ra1ion Number. if PAC
I I
Form (Cash, Check, elc.) Check Amounl M D y 200.00 1 10 0 19 1 19
I I
• Required for contnbut1ons from md1V1duals over SIOO to statewtde and generaJassembly candidal'es. lfcontnbutor 1s sclf-employed, 1he occupauon and the name of the
individual's business. if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSIOO, the labor
organizalion of which lhc employees arc members, if any. must appear. [R.C. 3517 IO(BX4)1 Page Toial $
J 1,650.00
1
31-A
R.C. 3517. 10
Page_5__
Statement of Contributions Received Prescribed by Secretary or State 3/05 Name or Committee in Full Gardner for Mayor Full Name or Contributor Donald Beirut Street Address 20612 Beachwood Dr. City Rockv River Full Name orContnbutor Edward Hren Street Address 11625 Blue H e ron Dr. City Chardon Full Name orContributor Donald Sheeh y Street Address 7825 Country Ln. City Cha!!rin Falls Full Name or Contributor Mike H enry Street Address 16559 Messinger Road City Auburn Two. Full Name or Contnbutor Joseph Dorsey Street Address 2921 Gatsby Ln.
Registration Number, irPAC Employer/Occupation/Labor Organization•
State
0
H
IZip Code 44116
State IZip Code 0 ' H 44024 Employer/Occupation/Labor Organization•
t
st 0
H 1Zi~";23
Employer/Occupation/Labor Organization•
t
st
0
H 1Zi: ;23
Employer/Occupation/Labor Organization•
State IZip Code Willoughby Hills 0 H 44094 Full Name of Contributor Cuvier Lukal Street Address Employer/Occupation/Labor Organization• 6153 Peooe rwood Ct. City State Mentor O I H 1Zi: ;60 Full Name of Contributor Contributions from Form 31-E (10-10-19 Event) Street Address Employer/Occupation/Labor Organization• State
I
Full Name of Contributor Dominic Soric Street Address 38048 Dodds Hill Dr.' City Willou!!hbv Hills
I
Employer/Occupation/Labor Organization•
'"'ity
City
Fonn (Cash, Check, etc.) Check M D I y Amount 1 0 0 19 1 19 200.00 Registration Nwnber, irPAC
IZip Code
I I
Fonn (Cash, Check, etc.) Check
M D y Amount 1 10 0 19 1 19 Registration Number, ir PAC
200.00
Fonn (Cash. Check, etc.) Check Amount M I D I y 1 10 0 18 1 19 200.00 Registration Number, irPAC Form (Cash, Check, etc.) Check Amount M I D y 1 10 0 19 1 9 200.00 Registration Number, irPAC
I
Form (Cash, Check, etc.) Check Amount M I D I y 100.00 1, 00 1919 Registration Number, if PAC Fonn (Cash, Check, etc.) Check Amount M I D I y 2,000.00 1 10 1 0 1 9 Registration Number, ir PAC Form (Cash, Check, etc.) M
D
Amount
I I I I ,
5 745.00
Registration Number, if PAC Employer/Occupation/Labor Organization• State IZip Code 0 I H 44094
Fonn (Cash, Check, etc.) Cash M I D I y Amount 100.00 1 10 1 10 1 19
• Required for contnbullons from mdtVlduaJs over SI 00 to statew,dc and general assembly candidates. If contnbutor 1s self-employed, the <X:cupat1011 and the uamt: of the individual's business, if any. rather than employer should be listed. If two or more employees conl:ribute via payroll deduction and exceed the aggregale ofS100. the labor
organiza1ion ofwhich the employees are members, if any, must appear. {R.C. 35 17. IO(BX4)) Page Total S
J1
8,745.00
31-A R.C. 3517. 10
Page _6 _ _
Statement of Contributions Received Prescribed by Secretary of Stale 3/05 Name of Committee in Full
Gardner for Mayor Full Name of Contributor
Registration Number, if PAC
Peg:gy Pawar Slreel Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, elc.)
2678 Alan Dr.
Check
City
State
Willoughby Hills
IZip Code
0 I H
Amounl
44092
Full Name of Conttibulor
50.00 Registration Number, if PAC
Amanda Leben Stteel Address
Employer/Occupation/Labor Organization•
Form (Cash, Check, elc.)
9079 Bascom Rd.
Check
City
State
Chardon
IZip Code
H
0
44024
Full Name ofContributor
100.00 Registration Number, if PAC
Ronald D. Hollingsworth Slreel Address
Employer/Occupalion/Labor Organization•
Form (Cash. Check, elc.)
38451 Eagle's Nest Dr.
Check
City
Stale
Willou!!hbv Hills
0
IZip Code
I H
Amounl
44094
Full Name of Contributor
300.00 Registration Number, if PAC
Tonathon Ruple Stteet Address
Employer/Occupalion/Labor Organization•
Form (Cash, Check, elc.)
11545 Glenmora Dr.
Check
City
Chardon
100.00
Full Name of Contributor
Registration Number, if PAC
Michael Neundorfer S1ree1 Address
Employcr/Occupalion/Labor Organization•
Form (Cash, Check, clc.)
2771 River Road
Check
City
S1a1e
Willoug:hby Hills
IZip Code
H
0
Amounl
44094
Full Name of Contributor
200.00 Registration Number, if PAC
Comm..illee lo Re-Elect Dr. Lynn Smith Coroner Stteet Address
Employer/Occupalion/Labor Organization•
Form (Cash, Check, CIC.)
820 Mentor Ave.
Check
City
Stale
Painesville
IZip Code
H
0
Amounl
44077
Full Name of Contributor
300.00 Registratioo Number, if PAC
William D. Gardner S1ree1 Address
Employer/Occupa1ion/Labor Organization•
Form (Cash, Check, elc.)
258.68 ('/4~e,~
38069 Dodds Hill Dr. City
S1a1e
Willoug:hbv Hills
0 , H
IZip Code
44094
Cily
250.00 Registration Number, if PAC
Full Name of Contributor Sttee1 Address
Amount
Employer/Occupalion/Labor Organization• Slale
IZip Code
Form (Cash, Check, CIC.)
1Amoun1
I • Required for contnbuuons from mdJVldua1s over SI 00 to statew,de and general assembly candidates. If contnbutor 1s self-employed, the O(;CUpaUon au<l Litt: nruue of the
individual's business. if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregat·e of$100, the labor
organization of which the employees are members, if any, must appear IR.C. 3517. 10(6 )(4)1
/
Page Tola! s _""'l"",3:a,;00=.00=-
31-A-2 R.C. 3517.IO(B)
f_
Page _ _
Statement of Other Income Prescribed by Secretary or State 2/0 I Name of Committee in Full
Gardner for Mayor Full Name
G. Andrew Gardner Address
38123 Dodds Hill Dr. City
Willoughby Hills
State
OH
Full Name
Address
Type•
RE City
Stale
OH Full Name
Address
Type•
RE City
State
OH Full Name
Address
Type•
RE City
State
OH Full Name
Address
Type•
RE City
State
OH Full Name
Address
Type•
RE City
State
OH Full Name
Address
Type•
RE City
State
OH Full Name
Address
Type•
RE City
State
OH • Place tht: two letter code in the Type block (one letter per square) which indicates the nature of the Other Income Received; RE for a refund, uncashed check or the committee's own insufficient funds check received, IN for any investment or interest income earned by the committee, SA for the sale of committee assets, or LN for payments received on a loan made.
1,500.00 Page Total$
31-8 R.C. 3517 10 Page
1
Statement of Expenditures Prescribed by Scc,-etary of State 2/0 I Name of Committee in Full
Gardner for Mavor To Whom Paid
Address
2400 Su erior Ave. E City
D
M
Hotcards.com
y
Amount
0 9 0 9 1 9 Purpose
14.03
v
Business Cards State
Cleveland
Check Number
Zip Code
H
44114
To Whom Paid
Debit Card M
X Press Printin Services Addr65
4405 Glenbrook Rd. City
Purpose
Candidate Ni ht Palm Cards Zip Code
State
Willou hb
Check Number
44094
H
To Whom Paid
X Press Printin Services Address
4405 Glenbrook Rd. City
1001 M
D
y
1 10 0 16 1 Purpose
Postcards State
Willou hbv
H
To Whom Paid
X Press Printin Services Address
4405 Glenbrook Rd. City
Purpose
Postcards State
44094
Willou hb o Whom Paid
X Press Printin Services Address
4404 Glenbrook Rd.
Purpose
Gardner for Ma or Postcards State
ity
Check Number
Zip Code
I H
Willou hb
44094
To Whom Paid
I
X Press Printin Services Address
4404 Glenbrook Rd.
D
y
I
Purpose
Posta e Reimbursement State
City
1003 M
Check Number
Zip Code
H
Willou hb
44094
1003
To Whom Paid
United States Postal Service Address
1500 Cha ¡ River Rd.
Purpose
Posta e State
City
Check Number
Zip Code
H
Gates Mills
44040
1004
To Whom Paid
Ex enditures from Form 31-F 10-10-19 Event Address City
Purpose
State
Zip Code
Check Number
3 666 49 V .___I Page Total S
3 1-C R.C. 3517.10
Page _ _l_
Statement of Loans Received
..... ......
Prescribed by Secretary of State3/05 Full Name ofCommittee
Gardner for Mavor
,1,500.00 .....
-,
From Whom Received
G. Andrew Gardner Address
Outstanding Balance
38123 Dodds Hill Dr. City
1500.00 State
Willoughbv Hills Date Loan was originally
Incurred
Zip Code
Loans Received This Period Date y M D s
O IH 44094
oMIs
I 2 19 1
y
D
M
D
y
Employer/Occupation/Labor Organization•
M
D
y
D
y
D
y
Amount
Date M
1,500.00
9 0 8 2 19 1 9
Registratioo Number, if PAC
D
Payments This Period Amount y s
From Whom Received
M I Ml
0.00
I
I
I
Prior Amount
Amt. Incurred this Period
Address City
!Standing Balance State
Date Loan was originally Incurred
Zip Code
I
Ml
D
I
Registration Number, if PAC
I
Loans Received This Period Date y M D s
y
I
Employer/Occupation/Labor Organization•
Payments This Period Date
Amount
D
Ml Ml
D
y
D
y
I M
D
y
M
D
y
Amount
s
y
M
I
I
I From Whom Rece,ved
Amt. Incurred this Period
Prior Amount
g Balance
Address City
State
Zip Code
I Date Loan was originally lnCWTCd Registration Number. if PAC
Ml
D
I
I
Loans Received This Period Date y $ M D
y
I
I M
D
I Employer/Occupation/Labor Organization•
M
D
I
y y
Payme nts This Pe riod
Amount
Date M
D
M
D
Amount
s
y
I
I
y
I
I M
D
I y
I
I
• Required for contributions over S 100 to statewide and genera] assembly candidates. If contributor is self-employed, occupation and the name of the individual's business, if any, rather than employer should be listed. If two ormore employees donate via payroll deduction and exceed the aggregate ofSIOO. the labor organization of which the employees are members. if any, must appear. R.C. 3517. IO(BX4) If a loan is forgiven, write "Forgiven" in the "Outstanding Balance" space. Transfer toral of all loans received this period to the Statement of Other Income (Form No. 31-A-2). Transfertotal of all payments made in this period to the Statement of Expenditures (Form No. 3 1-B). Transfer Total Outstanding Balance to the cover page (Form No. 30-A). Toral prior amount S 2 Total received this period S
3 Total Payments this Period S 4
Total Outstanding Balance S
0.00 1,500.00 0.00 1500.00
(To Form No. 3 t-A-2) (also record on Form 31-B) (To Form No. 30-A)
J
3 1-E
Event Date
R.C. 3517.10(B)
Page
10.10.19 1
Statement of Contributions Received at a Social or Fundraising Event Prescribed by Secre1ary of Slale 3/05 Name ofCommiuee in Full
Gardner for Ma or Full Name of Contribulor
Registration NumbeT, if PAC
Alexandra Uk.mar Sttcet Address
Employer/Occupation/Labor Organiz.ation•
2909 Oakwood Dr. City
M
y
D
1 0 1 7 1 9 State
Willou hb Hills
Zip Code
H
Fonn(Cash,Checlc,ctc)
44094
Check
Full Name of Contributor
Kimberl Hudson Sttcct Address
Employer/Occupa1ion/Labor Organizalion•
38165 Glenbur Ln. City
M
D
Y
1 10 1 0 1 9 S1a1e
Willou hb
Zip Code
H
Fonn(Cash,Check,etc)
44094
Check
Full Name ofCootn"bulo,
ennifer Mills Sttcet Address
Employer/Occupation/Labor Organiz.ation•
2854 Winthro City
M
y
D
1 0 1 10 1 9 Slale
Shaker Hts.
Zip Code
H
Fonn(Cash,Check,e1c)
44120
Check
Full Name ofContributo,
Theodore R. Hach r. S1rcet Address
Employer/Occupation/Labor Organiz.ation'
7090 Mildon Rd. City
M
y
D
1 0 1 0 1 9 S1ate
Painesville
Zip Code
H
Fonn(Cash,Check,etc)
44077
Check
Full Name ofContributor
Kimberl Macek S1ree1Address
Employer/Occupation/Labor Organization• State
City
M
y
D
1 0 1 0 1 9
38051 Dodds Hill Dr. Zip Code
H
Willou hb Hills
Fonn(Cash,Check,etc)
44094
Check
Full Name ofCootn"buto,
Gordon Newton Stteet Address
Employer/Occupation/Lc1bor Organization•
38471 Ea le Nest Ln. S1a1e
City
M
y
D
1 0 1 0 1 19 Zip Code
H
Willou hb Hills
Fonn(Cash,Checlc,etc)
44094
Check
Full Name of Contributor
Kenneth A. Malecek S1rcet Address
Employer/Occupation/Labor Organization•
2540 Ma leview Ln. City
State
Willou hb Hills
M
y
D
1 0 1 0 1 19 Zip Code
H
Fonn(Cash,Check,etc)
44094
Check
• Required for contributions from individuals over S I00 to statewide and genera] assembly candidates. If contributor is self-<:mployed~the occupation and the name of the individual's business, if any, rather than employer should be listed. If two o, mo,e employees contribute via payroll deduction and exceed the aggrcgale of$ I00. the labor orgamzalion of which the employees are members, if any, must appcar. lR.C. 3517. IO(BX4)1 Fill in the boxes below only on the last page for this event. Transfer the TotaJ contributions for this event to fonn No. 31-A Under Full Name of Contributor state "Contributions from fonn No. 31-E" and list the date of the event in the date column. Total contributions this event
Total expenditures this cvenl ~ -Pa - ge _ T_ota _ l_S
_J
_2_50_0~-~1✓
Even! Dale
31-E
10.10.19
R.C. 3517.10(8)
2
Page
Statement of Contributions Received at a Social or Fundraising Event Prescribed by Secn:lary of S1a1e 3/05 Name of Committee in Full
Gardner for Ma or Full Name ofConlribulor
Registralion Number, if PAC
Friends of Malecek SITCCI Address
Employer/Occupation/Labor Organization•
2910 Cambrid e Cr.
M
y
D
1 0 1 0 1 9
Ci1y
Slate
Willou hb Hills
Zip Code
H
Form(Cash.Chcck,erc)
44092
Check
Full Name ofConlributor
Daniel Philli Street Address
Employer/Occupa1ion/Labor Organizalion•
2423 Pine Valle
M
y
D
1 0 1 0 1 9
Ci1y
Stale
Willou hbv Hills
Zip Code
H
Form(Cash,Cbeck,erc)
44094
Check
Full Name ofContributor
an Focke F.rnployer/Occupalion/Labor Organization•
SITCCI Address
37101 Ro ers Road
M
y
D
1 0 1 0 1 9
City
State
Willou hb Hills
Zip Code
H
Form(Cash,Check,etc)
44094
Check
Full Name ofCoolributor
Vicki Miller SITCCI Address
Employer/Occupation/Labor Organization'
2857 Ha es Dr.
M
D
Y
1 0 1 10 1 9
Ci1y
Slate
Willou hb Hills
Zip Code
H
Form(Cash,Cbeck,erc)
Check
44094
Full Name ofConlributor
Frank Germano Street Address
Employer/Occupation/Labor Organizalion•
2420 Somrack Dr.
M
D
Y
1 0 1 10 1 19 State
Ci1y
Zip Code
H
Willou hb Hills
Form(Cash,Cbeck,erc)
44094
Check
Full Name of Contnbutor
im Walsh Street Address
Employer/Occupation/Labor Organization'
38755 Berkshire Hills Dr.
M
y
D
1 0 1 0 1 19 State
City
Willou hb Hills
Zip Code
H
Form(Cash,Check,etc)
Check
44094
Full Name ofConlributor
Michael P. Germano Employer/Occupation/Labor Organization'
SITCCI Address
M
D
Y
1 10 1 0 1 9
3008 Oakwood Dr. State
City
Form(Cash,□ieck,etc)
Zip Code
I H
Willou hb Hills
44092
Check
• Required for coolributions from individuals over SI00 to statewide and general assembly candidates. If conlributor is self-<:mployed, the occupation and the name of the individual's business, if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSIOO. the labor
organization of which the employees an: member.;, if any, must appear. IR.C. 3517. IO(BX4)1 Fill in the boxes below only on the last page for this event Transfer the T01al conlributions for this event lo form No. 31-A. Under Full Name of Conlributor state "Conlriburions from form No. 3 1-E" and list the date of the even! in the date column. Total contributions this event
I
Tolal expenditures this event Page Total S _
J
_6 ..,7 ._Q ....,. Q.,.. Q._
~
._______,
Event Date
31-E
10.10.19
R.C. 3517. 10(8)
3
Page
Statement of Contributions Received at a Social or Fundraising Event Prescribed by Secretary of State 3/05
Name of Committee in Full
Gardner for Ma or Full Name of Contributor
Registration Nwnbct-, if PAC
Robert T. Thomas Street Address
Employer/Occupation/Labor Organization•
4756 SOM Center Road
M
y
D
1 0 1 0 1 9
City
State
Moreland Hills
Zip Code
H
Form(Casb,Clicck.cte)
44022
Check
Full Name of Contributor
udith Shrefler Street Address
Employer/Occupa1ion/Labor Organjzation•
37120 Chardon Road
M
D
Y
1 10 1 10 1 19
City
State
Willou hb Hills
Zip Code
H
Form(Cash,Clicck.ctc)
44094
Check
Full Name ofContributor
Christo her Biro Street Address
Employer/Occupation/Labor Organization•
2821 Forest Ln.
M
y
D
1 0 1 0 1 9
City
State
Willou hb Hills
Zip Code
H
Fonn(Cash,Check,cte)
44094
Check
Full Name of Contnbutor
Adam W. Lintern Street Address
Employer/Occupation/Labor Organization'
38362 Berkshire Hills Dr.
M
y
D
101019
City
State
Willou hb Hills
Zip Code
H
Fonn(Cash.Clicck.ctc)
44094
Check
Full Name ofContributor
Theresa Richthammer Employer/Occupation/Labor Organization•
Street Address
5215A Frankl n Blvd.
M
y
D
1 0 1 0 1 9
City
State
Zip Code
I H
Willou hb
Form(Casb,Clicck.etc)
44094
Check
Full Name of Contnbutor
Thomas D. Ru le Employer/Occupation/Labor Organization•
Street Address
M
y
D
1 0 0 4 1 9
4756 Beidler Rd. H
Willou hb
Form(Cash.Chcck,etc)
Zip Code
State
City
44094
Check
Full Name ofContnbutor
Lisa Atkinson Employer/Occupation/Labor Organization•
Street Address
38122 Dodds Hill Dr.
M
y
D
1 0 0 2 1 9 State
City
Zip Code
H
Willou hbv Hills
Form(Cash,Check,ctc)
44094
Check
• Required for contributions from individuals over S100 to statewide and general assembly candidates. If contributor is self-employed, the occupation and the name of the individual's business, if any, rather than employer sho,~d be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSIOO, the labor organization of which the employees arc members, if any, must appear. lR.C. 3517.IO(BX4)J Fill Ul the boxes below only on the last page for this event Transfer lhe Tota] contributions for this event to fonn No. 31-A. Under Full Name of Contributor state "Contributions from fonn No. 3 1-E" and list the date of the event in the date column. Total contributions this event
I
Total expenditures this event Page Total S
)
I 600 ~ 0
r
~~
Event Date
31-E R.C. 35 17.IO(B)
Page
10.10.19 4
Statement of Contributions Received at a Social or Fundraising Event Prescribed by Secretary o f State 3/05 Name o f Committee in Full
Gardner for Ma or Full Name of Contributor
Registration Number, if PAC
Elizabeth A. Anderson Street Address
Employer/Occupation/Labor Organization•
15 Somerset Dr.
M
y
D
0 9 3 0 1 9
ity
State
Rock River
Zip Code
H
Form(Cash,Check,etc)
44116
Check
Full Name of Contributor
PatGrebenc Employer/Occupation/Labor Organization•
Street Address
2265 River Rd.
M
y
D
1 0 0 4 1 9
City
State
Zip Code
I H
Willou hb Hills
Form(Cash,Oicck,etc)
44094
Check
Full Name of Contributor
Brandon Carlson Employer/Occupation/Labor Organization•
Street Address
2505 River Ro ad
M
D
Y
1 0 0 11 1 9
City
State
Willou hb Hills
Zip Code
H
Fonn(Cash,Check,ctc)
44094
Check
Full Name of Contributor
Lar
Kravitz
Street Address
Employer/Occupation/Labor Organization'
M
y
D
1 0 Oi l 1 9
38710 Dodds Landin City
State
Zip Code
H
Willou hb Hills
Form(Cash,Check,etc)
44094
Check
Full Name of Contributor
Robert Ri Street Address
Employer/Occupation/Labor Organization•
38171 Pleasant Valle
M
D
Y
0 9 3 0 1 19
C ity
State
Zip Code
H
Willou hb Hills
Form(Cash,Check,ctc)
44094
Check
Full Name ofContnbutor
Ronald Ca orossi Ernployer/Oc<:upation/Labor Organization•
Street Address
38231 Dodds Hill Dr.
M
D
Y
0 19 3 10 1 9 State
C ity
Willou hb Hills
Form(Cash,Check,ctc)
Zip Code
H
Check
44094
Full Name of Contributor
Gloria Ma·eski Street Address
Employer/Occupation/Labor Organization•
2717 Gra lock Dr.
M
D
Y
1 0 0 13 1 19 State
City
Form(Cash,Check,etc)
Zip Code
I H
Willou hbv Hills
44094
Check
• Required for contributions from individuals over SI00 to statewide and general assembly candidates. If contributor is self-employed. the occupation and the name of the mdividual's business, if any, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSIOO. the labor organization of which the employees arc members, if any. must appear. [R.C. 35 17. IIJ(BX4)]
FilJ in the boxes below only on the last page for this event Transfer the Total contributions for this event to fonn No. 31-A. Under Full Name of Contributor stale ~contributions from fonn No. 31-E" and list the date of the event in the date column. Total contributions this event
I
Total expenditures this event Page Totals _
)(
_,8.,_.0.,_,0.....0"'0'--
...________.
31-E
Evenl Dale
R.C. 35 17. 10(8)
Page
10.10.19 5
Statement of Contributions Receive at a Social or Fundraising Event Prescribed by Secretary ofState 3/0S
Name of Committee in Full
Gardner for Mavor Full Name of Contributor
Rcgistra1ion Number, if PAC
Carol Lillich S1reetAddr=
Employcr/Occupalion/Labor Organizalion•
37830 Milann Dr. City
M
D
y
1 0 0 2 1 9 State
Willou hb Hills
Zip Code
H
Fonn(Cash,Oieck,ctc)
44094
Check
Full Name of Con1ribu1or
Lisa Cummins S1rce1 Address
Employer/Occupation/Labor Organization•
38087 Dodds Hill Dr. Ci1y
M
D
Y
1 0 0 14 1 9 S1a1e
Willou hb Hills
Zip Code
H
Fonn(Cash,Check,elc)
44094
Check
Full Name ofConlnbutor
Mar Cihula Slreet Addr=
Employer/OccupaJion/Labor Organi7..ation•
35060 Dixon Rd. Cily
M
D
y
1 0 0 1 1 9 Slale
Willou hb Hills
Zip Code
H
Fonn(Cash,Check,elc)
44094
Check
Full Name ofContribulo r
Darlene We er S1reetAddr=
Employer/Occupalion/Labor Organizalion•
38195 Dodds Hill Dr. Cily
State
Willou hb Hills
M
D
Y
1 0 0 11 1 19 1
Zip Code
H
Fonn(Cash,Check,etc)
Check
44094
Full Name ofContribulor
Gloria Ma·eski Slreet Addr=
Employer/Occupation/Labor Organization•
2717 Gra ,Jock Dr. State
ily
M
D
y
0 9 2 9 1 9
Willou hb Hills
Zip Code
H
Fonn(Cash,Check,ctc)
Check
44094
Full Name of Contributor
Claudine E. Dau · das Slreet Address
Employer/Occupalion/Labor Organization•
38213 Dodds Hill Dr. City
M
D
y
1 10 0 1 1 19 S1a1c
Willou hb Hills
Zip Code
H
Fonn(Cash,Chcck,elc)
Check
44094
Full Name of Contributor
Nicholas Virostko S1rect Address
Employer/Occupalion/Labor Organization•
2665 Deer Run S1a1e
City
Willou hb Hills
M
D
y
1 0 0 6 1 19 Fonn(Cash,Check,elc)
Zip Code
H
44094
Check
• Required for contributions from individuals over S I 00 10 Slalewidc and general assembly candida1es. If contributor is sclf-<0mploycd, the occupation and the name of the individual's business, if any, ralber lhan employer should be liSlcd. If lWo or more employees contribulc via payroll deduction and exceed the aggregalc of SI 00, the labor organiza1ion of which the employees arc members, if any, must appear. [R.C. 3Sl7. IO(BX4)} Fill in the boxes below only on the laSI page for this event Transfer the Total contributions for this event to fonn No. 31-A. Under Full Name of Contributor state ~contributions from fonn No. 3 1-E" and list the date of the event in the date column. Total contributions this event
Total expenditures this event
Event Date
31-E R.C. 3517.10(8)
10.10.19 6
Page
Statement of Contributions Received at a Social or Fundraising Event Prescribed by Secretary of State 3/05 Name of Committee in Full
Gardner for Ma or Full Name of Contributor
Registration Number, if PAC
Friends of ennifer Greer Street Address
Employer/Occupation/Labor Organization•
9868 Gardenside Dr.
M
D
y
1 0 1 0 1 9
City
State
Waite Hill
Zip Code
H
Fonn(Cash,Check,etc)
44094
Check
Full Name of Contnbutor
Dennis Slotta Street Address
Employer/Occupation/labor Organization•
2419 Michelle Ct.
M
D
y
1 0 1 0 1 9
City
State
Willou hb Hills
Fonn(Cash,Check,etc)
Zip Code
H
44094
Cash
Full Name of Contributor
oe
Focarello
Street Address
Employer/Occupation/Labor Organization•
M
D
y
1 0 1 0 1 9
34905 Martin City
State
Willou hb Hills
Zip Code
Form(Cash,Check,etc)
44094
H
Cash
Full Name of Contnbutor
PatGrebenc Employer/Occupation/labor Organization•
Street Address
2265 River Rd.
M
D
Y
1 10 1 10 1 9 State
ity
Zip Code
H
Willou hb Hills
Fonn(Cash,Check,etc)
44094
Cash
Full Name of Contributor
Contributor of $25 or Less Employer/Occupation/labor Organization•
Street Address
M
D
Y
1 101019 State
City
Fonn(Cash,Check,etc)
Zip Code
Cash Full Name ofContnbutor
Anita Focaretto Employer/Oc<:upationllabor Organization•
Street Address
M
D
y
101019
34905 Martin State
City
Form(Cash,Cheek,etc)
Zip Code
H
Willou hbv Hills
Cash
44094
Full Name of Contributor
Christine Slotta Employer/Occupation/Labor Organization•
Street Address
M
D
y
1 0 1 0 1 9
2419 Michelle Ct. State
ity
Fonn(Cash,Check,etc)
Zip Code
H
Willou hbv Hills
44094
Cash
• Required for contributions from individuals over SI 00 to statewide and general assembly candidates. If contributor is self-employed, the occupation and the name of the individual's business, if any, rather than employer should be listed. If two or more employees contnl>ute via payroll deduction and exceed the aggregate ofSIOO, the labor organization of which the employees are members, if any, must appear. (R.C. 35 I 7. IO(BX4)) FiU in the boxes below only on the last page for this event. Transfer the Total contributions for this event to form No. 31-A. Under Full Name of Contributor state "Contributions from fonn No. 31-E"' and list the date of the event in the date column
Total contributions this event
I
Total expenditures this event Page Total S _
....,. 5.._7.., 5..0.,.0,_
3 1-F
Event Date
R.C. 35 17.IO Page
10.10.19 1
Statement of Expenditures for Social or Fundraising Event ~bed by Secrelary of Slate 02/0 I Name of Committee in Full
Gardner for Ma or M
Chefs for Hire
D
y
Amount
1 0 1 0 1 9 Purpose
5700 Brecksville Rd.
Caterin Stale
Zip Code
Inde endence
Check Nwnber
44131
1005 M
X Press Printin Services, Inc. Address
D
y
0 9 2 4 1 9 Purpose
4405 Glenbrook Rd.
Invitation Flyers
City
S1a1e
Willou hb
Zip Code
H
0
Check Nwnber
44094
o Whom Paid
1001 M
G. Andrew Gardner Address
u
y
1 10 1 16 1 9 Purpose
38123 Dodds Hill Dr.
Reimbursement for Bevera
Cily
Zip Code
State
Willou hb Hills
Check Nwnber
44094
H
0
o Whom Paid
1006 M
D
y
G. Andrew Gardner Address
Purpose
38123 Dodds Hill Dr.
Reimbursement for Wine
Cily
Stale
Willou hb Hills
Zip Code
H
0
44094
To Whom Paid
Address
City
City
City
D
y
Purpose
Slale
Zip Code
Cheek Nwnber
M
D
y
Purpose
State
Zip Code
Cheek Nwnber
M
o Whom Paid
Address
1006 M
To Whom Paid
Address
Check Nwnber
D
y
Purpose
S1a1c
Zip Code
Cheek Number
Transfer total expenditures for this event to Fonn No. 3 l •B. Under the 'To Whom Paid.. state "Expenditures from Form 31-F' and list the date of the event in the date column.
Page Total S
1,042.87
✓
31-J-l
Page _ _l_
R.C. 3517.10
In-Kind Contributions Received Prescribed by Secretary of State 3/05
Name of Committee in Full
Gardner for Mavor Full Name ofCoolribulor
Employer, Occupation, Labor Organi,.ation •
Registration Number, if PAC
David Duncan Scott Street Address
Description of Item or Service
37215 Beech Hills Dr. City
Willoul!"hbv Hills Full Name of Contnbutor
n
sr
Photoirraohy H
' Zip Code
44094
Employer, Occupation, Labor Organization •
Teresa Richtharnmer Street Address
Description of Item or Service
5215A Franklyn Dr.
OfficeMax Credit
K:ity
Willoul!"hbv
State
n
I
9 10 4 111 9 r
44094
Full Name of Conlributor
Employer. Occupation, Labor Organization •
Street Address
Description of Item or Service State
IZipCode
Full Name of Conlribulor
Employer, Occupation, Labor 0rgani7.3tion •
Street Address
Description of Item or Service
0NO □ YES Registration Number, if PAC
t10
5 1/ 9 rair Market Value 33.11
I Ol
DYES 0NO Registration Nwnber, if PAC D
M
Slale
I
' Zip Code
Full Name ofContnbutor
Employer, Occupation, Labor Organi7.ation •
Street Address
Description of Item or Service Stale
I
IZipCode
Full Name ofConlribulor
Employer, Occupation, Labor Organi7.ation •
Street Address
Description of Item or Service
M
D
State
IZip Code
Full Name ofConlribulor
Employer, Occupacion, Labor Organi7.alion •
Street Address
Description of Item or Service
State
I
IZipCode
Full Name ofConlributor
Employer, Occupation, Labor Organizalion •
Scree! Address
Description of Item or Service
D
M
Stale
I
IZipCode
I
y
IFair Markel Value
I
I I Received al Fundraising Even!?
□ YES
□ No
Registralion Number, if PAC D
M
y
r air Markel Value
I
I I Received at Fundraising Event? ONO □ YES Registration Number, if PAC D
M
I
y
r air Markel Value
I
I I Received al Fundraising Evcnc?
□ No
□ YES
Registration Number, if PAC D
M
I
City
IFair Market Value
I
ONO □ YES Registration Nwnber, if PAC
I
Ciey
y
I I Received at FW1draising Event?
I
City
IFair Market Value
I
ONO □ YES Registration Number, if PAC
I
Ciey
y
I I Received at Fundraising E-,t?
I
City
20.00
Received at Fundraising Event?
I
City
air Market Value
Received at Fundraising Event?
IZip Code
I H
OMI
I
y
rair Market Value
I
I I Received at Fundraising Event?
□ YES
□ No
• Required for conlributions from individuals over $ I00 to stacewide and general assembly eandidales. If eonlributor is sclf-anployed. the occupation and the name of the individual's business, if any, rather lhan employer should be !isled. If two or more employees eonlribute via payroll deduction and exceed the aggregale of $ 100, the labor organization of wrueb the employees are members, if any, must appear. [R.C. 3517. IO(BX4)1
Page Total S
53.11
3 1-N R.C. 3517.10
Statement of Outstanding Debts Prescribed by Secre1ary of State 2/0 I Full Name of Committee
Gardner for Ma or To Whom Owed
Ami. Incurred this Period
Prior AmoUI1t
G. Andrew Gardner
0.00 Item oc Purpo<e fo, Debt
Address
38123 Dodds Hill Dr.
45.00 Outstanding Balance
Filin Fee
City
State Zip Code
Willou hb Hills
O \h Date Debt was originally Incurred M
Payments Made This Puiod
44094 y
D
Date
Amount
M
D
y
M
D
y
M
D
y
0 8 0 6 1 9 Registration Nwnber, if PAC
0.00
Arni. Incurred this Period
Item oc PWJ)Ose foc Debt
ddrcss
City
Stale Zip Code
Payments Made This Period Date
Date Debt was originally Incurred
M
y
D
Outstanding Balance
Registration Nwnber, if PAC
Amount
M
D
y
M
D
y
y
Arnt. Incurred this Period
Item or Purpo<e foc Debt
Address
State Zip Code
City
Payments Made This Period
Date
Date Debt was originally Incurred
M
y
D
Registratioo Nwnber, if PAC
Outstanding Balance
Amount
M
D
y
M
D
y
M
D
y
If a debt is focgi-, write "Forgiven" in the "Outstanding Balance" colwnn. Transfer total of all payments made this period to the Statement of Expenditures (Form No. 31-B). Total amount focgivca should be included in the In-Kind Contributions Received (Form No. 31-J- I). Transfer total ouistanding debt amount to the cover page. Total Payments this Period S
__________ _ ..;;0..;..0.:....;;0_
(also record on Fom, 31-8)
Total Ouistanding Balance S
_ __________= 45..;..0.:....;;0_
(also record on cover page)
/
