30-A RC. 151710
Ohio Campaign Finance Report
LAKE BOARD OF E'..._EC.,.~ON OCT 2li 20:9 PM2:02
Prescribed by Secma,y of Stale Jl'05
RCgLStrauon Number. if PAC
Full Name ofComm1nce
Friends of Chris Hallum Full Name of Canchdalc
Christopher Hallum IOIT£e Sought Councilman
Strecet Address
2937 Lamplight Ln tty
D,stnct
3 Stale
Willoughby Hills
0
H
44094 AmuaJYear
:ry,,..,._,
Pre-Primary
~
July
August
September
Monthly
Monthly
Monthly
x ....... .,_,
~)
X
Post-Pnmary
Post-General
Pre-General
Semiannual
Tcrmmaoon
report Electrorucally filed?
Amended R_,-,
□ Yes
12'P Code
0 No
□ Yes
0No
M
°"""'-
1
y
D
5
1 I 0
9
1
Foe candidates only, durtn1 an elCCtJon year: 1f total oontnbullons and e,q,endi1ures each 1olaJ SSOO or less dunng the comb med pre- and post-pcnod:s at one dccnon. chock box. No ocher" forms are required at a post-pnmll)' or post-general penod. 1fabo\·e statement apphes See R.C JS 17 IO(H) for dct&ls
$ I Amount brought forward from last repon
3,366.44
s 2 Total monetarycontnbunons(From form No JI-A)
3,545.00
s J Totalotherincome(FromformNo Jl-A-2)
0.00 $
4 Total funds available (sum of Imes 1, 2, 3)
6,911.44 $
5 Total monetary expenditures (From Form No J 1-8)
1,837.04 $
6 Balanc.c on hand (hne 4 minus hne S)
5,074.40 $
7 Value of in.kind contnbuuom recei~ (From Form No J1.J.J)
20.00 $
8 Value of in-kind contnbuuons made (From Form No 3 I •J•2)
0.00
s 9 Outstandmg loans owed by committee (From Form No JI •C)
0.00 $
10 Outstanding debts owed by corrurunec (From Form No 31 •N)
i
c.>
Iii!
Q
1J
w
Ill::
~ w
0.00
s 11 Outstanding loans owed to commmce (From Form No 3 l·K)
_, Q
z
0.00 $
w
12. Value of independenl expenditures made (From Form No JI •U)
~
13 for Electronic Filing Entiucs only Sum of Imes 2, 7 and amoun1 of any ~ loans re<:et\'Cd dus pcnod
0.00 $
3,565.00
THE INFORMATION CONTA INED IN T HIS REPORT IS MADE U ' DER THE PENALTI' OF ELECTION FALSIFICATION. WIIO[ \ICR
/0-2'--I ~2.pf 9 Date
Contributton pag,s
Expmd1turc
P'i" _ _l_
To<~
6_
pages _ _ _
I
31-A RC 351710
Page _l _ _
Statement of Contributions Received Prcscnbed by Secretary of State 3/05
Name of Committee m Full
Friends of Chris Hallum Full Name ofContnbutor
Registration Number. if PAC
Lyle Hallum Street Address
Employcr/Occupauon/Labor Organization•
fonn (Cash. Check. etc.)
1261 Settlers Bay Ct
Check
tty
State
Bellbrook
0
IZ1p Code H 45305
Fu11 NameofContnbutor
I D I y 1 0 0 2 1 9 M
Amount
500.00
Reg1strat1on Number. 1f PAC
Frank Mahnic Street Address
Fonn (Cash. Check. etc )
Empk,ycr/Occupauon/Labor Orgamzauon•
12795 Brockway Dr
Check
r,ty
State
Valley View
0
IZ1p Code H 44125
Full Name ofContnbutor
I D I y 0 9 2 6 1 9 M
Amount
100.00
Registration Number. tf PAC
Michael Germano Street Address
Employcr'Occupa11on/Labor Organ1zat1011•
3008 Oakview Dr City
State
Willou~hbv Hills
0
12,pCode H 44092
Full Name of Contributor
Fonn (Cash. Check. etc )
ID I 0 19 1 13 1 M
y
Online Amount
60.00
9
Registration Number, 1f PAC
Carvier Lukat Street Address
Employer/Occupat1on/Labor Organization•
fonn (Cash. Check. etc )
6153 Pennerwood Ct
Check State
~ •ty
Mentor
0
IZ1p Code H 44060
Full Name ofCmtnbutor
I D I y 0 9 2 7 1 9 M
'Amount
750.00
Reg1stra11on Number. 1f PAC
Calvin Schroek ~ wAddress
Employ,,./Oc<:"l""ian/Labo< CJ<san12,u,oo•
Fonn (Cash, Check. e\C)
2873 Lamplight Ln
Check State
~ •ty
Willoul!:hbv Hills
0
IZ1p Code H 44094
Full Name of Contributor
I D I y 0 9 1 4 1 9 M
Amount
50.00
Reg1strat1on Number. 1f PAC
Marie Louise Kittredge Street Address
Employcr/Occupat1on/Labor Organ1zat1on•
Form (C,uh. Check. etc)
6927 Indiana Ave
Check
City
State
Cleveland
0
IZ1p Code H 44105
M
Amount
0 9 12D 7 1/ 9
100.00
Registration Number, 1f PAC
Full Name ofContnbutor
Chuck Sumrada Street Address
Fonn (Cash. Check. etc.)
Employcr/Occupat1on/Labor Organization•
2316 River Rd State
~ •ty
Willoughby Hills
0
IZ1p Code H 44094
M
1
ID I 0 0 7 1
y
Check Amount
25.00
9
Registration Number. 1f PAC
Full '.Jame ofContnbutor
Roy Streetz ISU"CCtAddress tty
iz1p Code
State
Willoul!:hbv Hills
Fonn lCash. Check. etc)
EmplO)cr 'Occupa11on/La'oor Organ17.ation•
2959 Gatsby Ln 0
H
44092
Check AmOW11
M
0 9 1/ 9 1/ 9
200.00
• Required for contnbut1ons from md1V1duals over SI00 to statewide and general assembly candidates If contributor 1s self•employcd, the occupation and the name of the md1v1dual's business, if any, rather than employer should be lmed If two or more employees contnbute via payroll deduction and exceed the aggregate ofSIOO. the labor orgamzat1on of which the employees are members, if any, must appear [R C. 3517 IO(BX4)) Page Total s _~ l ~,7~8=5~.00 ~
31-A RC.35171 0
Page _2_ _
Statement of Contributions Received Prescnbed by Secretary of State 3/05
Name of Committee in Full
Friends of Chris Hallum Full Name of Contributor
Registration Number. 1f PAC
Nancv Glinski Street Address
Employer/Occupation/Labor Orgamzation•
Fonn (Cash, Check, etc.)
2903 Lamplight Ln
Check
City
S1ate
Willoughby Hills
0
IZip Code
H
44092
FuJI Name of Contributor
M
I D
Amount
I y
50.00
0 9 2 7 1 19 Registration Number, if PAC
Lawrence Kletecka Street Address
Employer/Occupation/Labor Organization•
2953 Gatsby Ln City
Willou!!hbv Hills
O State H
lz\~~~2
Full Name of Contributor
Form (Cash. Check, etc.)
Cash M
I D
Amount
I y
0 9 2 6 1 9
45.00
Registration Number. if PAC
Daniel Yeckley Street Address
Fonn (Cash, Check, etc.)
Employer/Occupat1on/Labor Organi:r.ation•
2942 Lamplight Ln ~ity
Willoue-hbv Hills
Check
0
State H
t p~~~4
Full Name ofContnbutor
M
I D
Amount
I y
1 0 0 ,4 1 9
50.00
Registration Number. if PAC
Joseph Smigelski Street Address
Employer/Occupat1on/Labor Organization•
Fonn (Cash, Check, etc.)
365 RoyaJ Oak Blvd
Check
City
IZip Code
State
Richmond Heie-hts
0
H
44143
Full Name of Contributor
M
I D
Amount
I y
25.00
0 19 2 7 1 9 Registration Number. if PAC
Loreto Iafelice Sttcet Address
Empl,oyel'f0cc.upati.on/La00f Orsarwz.at\00•
F<><m (Cash, Check, Cl<)
38650 Florence Dr
Check
City
State
Willoue-hbv Hills
0
IZ1p Code
H
44094
Full Name of Contributor
M
I D
Amount
I y
100.00
1 0 0 13 1 9 Registration Number. if PAC
Denise Neidermeyer Street Address
Employer/Occupation/Lnbor Organization•
Fonn (Cash, Check, etc.)
2929 Lamplight Ln
Check
City
State
Willoughby Hills
0
IZip Code
H
44094
Full Name of Contributor
M
I D
1
I
Amount
y
50.00
1 10 0 6 1 9 Registration Number. 1f PAC
Pete Mizeres Street Address
Employer/Occupation/Labor Orgamzation•
963 Hanley Rd "'ity
State
Lvndhurst
0
IZip Code
H
44124
Form (Cash, Check, etc.)
I 1 10 0 M
D
Check Amount
I y
100.00
6 1 9
Registration Number. if PAC
Full Name of Contributor
Tesse Baden !Street Address
Fonn (Cash, Check, etc.)
Employer/Occupat1on/Labor Organization""
Check
2921 Lamplight Ln c;ty
State
Willoughbv Hills
0
121p Code
H
44094
M
1
ol1~ 3 1/
Amount
9
100.00
• Required for contnbut1ons from md1v1duals over$ I 00 to statewide and general assembly candidates If contributor 1s 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 contnbute via payroll deduction and exceed the aggregate of SIOO, the labor organization of which the employees arc members, if any, must appear. (RC. 3517. I O(B)(4))
eage ·1otal s __~5~ 2~ □~ .00 ~
3 1-A RC351710
Pagc _3 _ _
Statement of Contributions Received Prcscnbed by Secretary ofState 3/05 Name ofConumttcc m Full
Friends of Chris Hallum Full Name ofContnbutor
Registration Number, 1f PAC
Frank Cihula Street Address
Employcr/Occupat1on/Labor Organization•
Form (Cash. Check. CIC )
35060 Dixon Rd
Check
,ty
Staie
Willou2"hbv Hills
0
IZ,p Code
H
44094
FuJI Name ofContnbutor
M
~mount
1 o l oD7 1/ 9
25.00
Registration Number. 1f PAC
Katherine Pasouale Street Address
Employcr'Oc:cupatlOn/Labor Organ1zat1on•
371 Pebblebrook Dr. r,ty
Stale
Willou!!"hbv Hills
0
IZ1p Code
H
44094
Full Name ofContnbutor
Form (Cash. Check, CIC )
ID I 1 0 0 1 1 9 y
M
Check Amoont
50.00
Reg1strauon Number. 1f PAC
Kathy Longo Street Address
Employcr/Occupat1on/Labor Organ1ution •
Form (Cash. Check. etc)
9285 Kathleen Dr. ,ty
State
Mentor
0
IZ1p Code
H
44060
Check
I
D y 0 9 3 ,0 1 9 M
I
AmoWtt
50.00
Registration Number. 1f PAC
Full Name ofContnbutor
Ron Zele Strcct Address
Employcr/Occupat1on/Labor Organization•
Fonn (Cash, Check. etc.)
740 Pebblebrook Dr.
Check
!Coty
12'P Code
State
Willoughby Hills
0
H
44094
1Amoun1
M
1 o l oD 1 I / 9
25.00
Rcg1stra11on Number. tf PAC
Full Namt ofCmmbutor
Susan Gral.nick Sue« A.ddrc~~
Fonn(Ca.sh.0-k. <t<:)
E.mployu{()c(.upat~ ~ \U.t\(,)t\•
2518 Chagrin Dr. ,ty
State
Willoughby Hills fu]l
IZ,pCodc
H
0
44094
Name of Contnbutor
Check
I
D y 1 0 0 1 1 9 M
I
Amount
50.00
Reg1strauon Number. 1f PAC
David Chervenic Strttt Address
Employer/Occupahon/Labor Organization•
Form (C4sh. Check. etc )
Check
3185 North Dover Rd. City
12•PCode
State
Silver Lake
0
H
44224
Full Name ofContnbutor
D I y 0 / 9 3 0 1 19 M
I
Amount
50.00
Registration Numbt-r. 1f PAC
Darlene Weger Street Address
Employcr/Occupa11on/Labor Organization•
Form (Cash, Check, etc.)
38195 Dodds Hill Dr. fC,ty
Slate
Willou2"hbv Hills
0
iz,p Code
H
44094
Fu11 Name ofContnbutor
Check
I
M D I y 0 9 3 0 1 9
AmOWll
100.00
Registration Number, 1f PAC
Dennis Cocco Strcct Address
E.mploycr'Occupat1onfLabor Orgamzauon•
Form (Cash. Check. etc)
2933 Lamplight Ln
Check
,ty
State
Willoughby Hills
0
IZtp Code
H
44094
Amount
M
0 9 12D4 1/ 9
75.00
• Required for contnbut1ons from md1v1duals over SI 00 to statewide and general assembly candidates If contnbutor 1s self-employed, the occupation and the name of the md1v1dual's business, 1fany, rather than employer should be listed lf ty..o or more employus contribute via payroll deduction and exceed the aggregateofSIOO. the labor orgamzat1on of which the employees are members, if any, must appear (R C. 3517 10(8)(4)) (•age I otal s _ _-" 42 :S ,a.a..OO =-
31 -A R.C. 3517 10
Pag~
Statement of Contributions Received Prescnbed by Secretary of State 3/05 Name of Committee in Full
Friends of Chris Hallum Full Name ofCootributor
Registration Nwnber. if PAC
Edward McKenna Street Address
Employer/Occupa1ionl'Labor Organ1zat1on•
Fonn (Cash, Check, etc.)
2963 Lamolight Ln
Check
Jty
State
Willou11:hbv Hills
0
H lz;~ ~4
'
Full Name of Contributor
M
I
D
I
Amount
y
0 9 2 10 1 9
100.00
Registration Number. if PAC
Thomas Majeski Street Address
Employer/ Occupation/Labor Organization•
2717 Gravlock Dr. City
Willou11:hbv Hills
0
Check
IZ,p Code
Stale
H
Form (Cash, Check, etc_)
44094
Full Name of Cootributor
M
I
D
I
Amount
y
0 19 1 3 1 9
100.00
Registration Number, if PAC
Christopher Collins Street Address
City
State
Fairport Harbor
Fonn (Cash. Check, etc.)
Employer/Occupation/Labor Organi7.ation•
688 Second St., Unit 2
0
IZtp Code
H
44077
Full Name of Contributor
I I 0 9 2 10 1 9 M
D
y
Check Amount
50.00
Registration Number, if PAC
Robert Sacerich Street Address
Employer/Occupation/Labor Organization '
Fonn (Cash, Check. etc.)
2947 Rockefeller Rd.
Check
City
State
Willoughby Hills
0
IZ1p Code
H
44094
Full Name of Contributor
M
I
D
I
Amounl
y
50,00
0 19 1 2 1 9 Registration Number. if PAC
Michael Kirsch Street A.ddrC'i.'i
Fonn (Cash, Chc<,k, <te.)
E.mpl.oy«(Occupat\00/L&OCK' 0-r~\-zat\Of\•
33850 Parkview Rd
Check
City
State
Willoughby Hills
0
IZip Code
H
44092
M
I
D
I
Amount
y
0 19 1 18 1 19
100.00
Registration Number, if PAC
Full Name of Contributor
Marie Ann Federico Street Address
Employer/Occupation/Labor Organization •
2392 Trailard Dr City
Willou11:hbv Hills
O S1a1e H
12i~ ~~
4
Full Name of Contributor
Form (Cash, Check, etc.)
I 0,9 1 8 1 9 M
I
D
y
Online Amount
25,00
1
Registration Number. if PAC
Carrie Biro Street Address
Fonn (Cash, Check, e1c.)
Employer/Occupation/Labor Organization•
2821 Forest Ln
Online
City
State
Willou11:hbv Hills
0
121p Code H 44094
Full Name of Contributor
M
I
D
I
Amount
y
50.00
0 , 9151.9 Registration Number, if PAC
PatGrebenc [Street Address
City
State
Willoughby Hills
Fonn (Cash, Oieck, etc )
Employer/Occupation/Labor Organization•
2265 River Rd 0
IZ1p Code
H
44094
I I 0 9 1 14 1 M
D
Online Amount
y
9
100.00
• Required for contnbutions from md1v1duals over $100 to statewide and general a ssembly candidates. If contributor 1s 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 contnbute via payroll deduction and exceed the aggregate ofSIOO. the labor organiz.ation of which the employees are members, if any. must appear [R C 3517 IO(BX4)}
Page Totals _ _-" 5"7"5"' .lJU "'--
31-A R.C 3517.10
Pase _5_ _
Statement of Contributions Received Prescnbed by Secretary of State 3/05
Name of Committee in Full
Friends of Chris Hallum Full Name of Contributor
Registration Number. if PAC
Claudine Daurudas Street Address 38213
Form (Cash, Check, etc.)
Employer/ Occupat1on/Labor Organization•
Dodds Hill Dr
Online
Cuy
IZip Code
State
Willoughby Hills
0
H
44094
Full Name of Contributor
Amount
M I D I y 0 19 1 4 1 9 Registration Nwnber, 1f PAC
50.00
Karen Schaller Street Address 36926
Form (Cash. Check, etc.)
Employer/Occupat1on/LaOOr Organization•
Beech Hills Dr
Gty
12ipCode
State
Willoul?hbv Hills
0
H
44094
Full Name o f Contributor
Online M 0 9
I
D 1 14
I
Amow,t
y 1
9
25.00
Registration Number, if PAC
CT Latsa Street Ad dress 28914
Employer/Occupation/Labor Organization•
Fonn (Cash. Check. etc.)
Eddy Rd
Online
City
IZip Code
State
Willoul?hbv Hills
0 , H
44094
Full Name of Contributor
Amount
M I D I y 0 19 3 9 Registration Number, if PAC
1
1
40.00
Joe Palmer Street Address
Employer/Occupa11on/Labor Organiz.ation•
Fonn (Cash. Check. etc.)
Online ·,-,ity
IZ1p Code
State
Willoul?hby
0
H
44094
Full Name of Contributor
Amount
M I D I y 0 19 1 2 9 Registration Number. if PAC
1
75.00
Jay Neidermeyer Street Addre<if. 2929
Emp!.oyu fOccupati.oo/LaOOf Otgani·ta\\(){\•
forn, (Cash, Chee~. etc.)
Lamplight Ln
Online
City
IZip Code
State
Willou1?hby Hills
0
H
44094
Full Name of Contributor
Street Address
City
City
1
State
! Zip Code
M
I
y
D
Amount
0 19 2 7 1 9 Registration Number, if PAC
Employer/Occupauon/Labor Organization•
State
12,p Code
Fonn (Cash, Check, etc )
M
~
I
AmOWlt y
Registration Number, 1f PAC
Full Name ofContnbutor
City
50.00
Form (Cash. Check, etc.)
I
~treet Address
1
Employer/Occupauon/Labor Organization•
Full Name of Contributor
Street Address
Amount M I D I y 0 9 2 9 Registration Number, 1f PAC
Form tCash, Otec'k, etc.)
EmployerlOccupaUon/Labor Orgamzafton•
State
12,p Code
M
y
D
I
Am0Wll
I
• Required for contnbutions from md1v1duals over SI 00 to statewide and general assembly candidates. If contributor 1s 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 contribute via payroll deduction and exceed the aggregate of SI 00. the labor organization of which the employees are members, if any, must appear (R.C 3517.10(8)(4)) Page Total s ___ 2_4~0.~U~U-
31-B R.C. 3517.10
l_
Page _ _
Statement of Expenditures Prescnbed by Secretary of State 2/01
Name of Committee in Full To Whom Paid
M
Lance Brittain Photography Address
13132 West Geaul!a Tri City
Chesterland
Photos for campaign material State IZip Code n H 44026
7144 lndustrial Park Blvd Mentor
Political signs State IZip Code r, H 44060
WillouP-bv Hills
n
12ip Code
State
H
Political sil!OS State 121pCode r, H 44060
2937 LamPlil!ht Ln
Hotcards push card order
Willoul!bv Hills
n
12ip Code
State
H
110.00
1003 D
y
Amount
277.13
9
Check Number
1005
I l 1 10 2 3 1 9 D
y
Amount
157.67
M
,,
D
I
y
Amount
1 0 2 3 1 9
55.00
Purpose
Postal!e Stamps purchase from CVS Check Number State 1Z1p Code r. I H 44094 1006
To Whom Paid
M
Chris Hallum
,I I D
y
Amount
501.90
1 0 2 3 1 9 Purpose
2937 Lamplie:ht Ln
Repayment of Loan
Willoul!bv Hills
n
j,-.ity
1Z1p Code
State
H
Check Number
44094
IToWhom Paid
1007
M
I I D
City
Amount
Check Number
Chris Hallum
Address
y
I I 1 /0 2 3 1
44094
To Whom Paid
Address
D
Purpose
City
WillouP-bv Hills
1002
I I 1 0 1 1 1 19
M
Chris Hallum
2937 Lamoli!!ht Ln
685.34
Purpose
To Whom Paid
V'jty
Amount
9
Check Number
M
Fulton Si!!n & Decal
!Address
y
Check Number
44092
To Whom Paid
Address
50.00
Purpose
Postage Stamps
Mentor
D
1
28121 Chardon Rd
7144 Industrial Park Blvd
I I 9 2 3 1
M
City
l"ity
ount
Purpose
Marc's
Address
,r
1001
0
!lo Whom Paid Address
y
Check Number
M
Fulton Si!!n & Decal City
D
Purpose
To Whom Paid I.Address
I I
0 9 1 0 1 9
y
Amount
Purpose
State
,Z,p Code
Check Number
Page Total$
1,837.04
31-C R.C. 3517.10
Page _ __
Statement of Loans Received Prescribed by Secretary of State3/05 Full Name of Committee
Friends of Chris Hallum From Whom Received
501.90
NJ~w.-.<'__,
Address
2937 Lamplight Ln City
State
Willoughbv Hills uate Loan was lnamed
Amt. Incurred this Period
Prior Amount
Chris Hallum Zip Code
Loans Rtteived This Period Date y M D s
OH 44094 M
D
Amount
M
1 0 1 9 1/ 5
Registration Number, if PAC
M
Employer/Occupation/Labor Organization•
M
D
y
D
y
Date
Payments This Period Amount y
s
D
Ml M
D
y
D
y Amt.. Incurred this Period
Prior Amount
Address
Outstanding Balance State
uate Loan was onguwiy
M
Zip Code D
lnamed Registration Number, if PAC
I
Loans R«cived This Period Date y M D
Payments T his Period
Date
Amount
s
y
Employer/Occupation/Labor Organization•
Amount
M
D
y
M
D
y
M
D
y
M
D
y
Ml
D
y
From Whom Received
Outstanding Balance State
uate Loan was onguwiy lncuned Registration Number, if PAC
s
Amt. lncurrcd this Period
Prior Amount
Address City
501.90
1 0 2 3 1 9
From Whom Received
City
Outstanding Balance
M
Zip Code D
I
Loans R«cived This Period Date y M D s
y
Employer/Occupation/Labor Organi1.ation•
Payments This Period
Date
Amount
Amount
M
D
y
M
D
y
M
D
y
M
D
y
M
D
y
s
• Required for contnbutions over S 100 to statewide and general assembly candidates If contributor is self.-cmployed. occupation and the name of the indiV1dual's business. if any, rather than employer should be listed. If two onnore employees donate via payroll deduclion and exceed the aggregate o f SI 00, the labor organization of which
the employees arc members, if any, must appear. R.C. 35 17. 10(8)(4) lfa loan is forgiven. write "Forgiven" in the "Outstanding Balance" space. Transfer total of all loans received this period to the Statement of Other Income (Fonn No. 31-A-2). Transfer total of all payments made in this period to the Statement of Expenditures (Fonn No. 31-8). Transfer Total Outstanding Balance to the cover page (Form No. 30-A).
Total prior amowll S 2 Total received this period S
501.90 0.00
3 Total Payments this Period S
501.90
4 Total Outstanding Balance S
0.00
(To Fonn No. 31-A-2)
(also rCCO<d on Form 31-8) (To Form No. 30-A)
31-J- I
Page _ __
R.C. 3517 .10
In-Kind Contributions Received Prescribed by Secretary of State 3105 Name of Committee in Full
Friends of Chris Hallum Full Name of Contributor
Employer. Occupation. Labor Organization •
Gardner for Mavor Street Address
Description of hem or Service
38123 Dodds Hill Dr.
Postage
City
Willou11'hbv Hills Full Name of Contributor
In
State H
44094
Employer. Occupation, Labor Organization • Description of Item or Service
38123 Dodds Hill Dr. City
Willoul!hbv Hills Full Name of Contributor
n
Mailing Supplies State H ' Zip Code 44094
Employer. Occupation. Labor Organization •
Gardner for Mavor Street Address
Description of Item or Service
38123 Dodds Hill Dr.
CampaiITT1 Literature
City
Willoul!hbv Hills Full Name of Contributor
State
0 I OD
1
Y
9 1 9
IFair Market Value
61.11
OYEs □ No Registration Nwnber, if PAC
t
0 I OD
6
1/
9
lfair Market Value
19.10
Received at Fund.raising Event?
OYEs O NO Registration Nwnber, if PAC
t
0 I OD
4
1/
9
IFairMarket Value
75.82
Received at Fundraising Event?
IZip Code
II
n
t
Received at Fund.raising Event?
' Zip Code
Gardner for Mavor Street Address
Registration Nwnber, if PAC
44094
Employer, Occupation, Labor Organization •
OYEs □ No Registration Number, if PAC
Gardner for Mavor Street Address
38123 Dodds Hill Dr. City
Description of Item or Service
Camoaicm Literature State
' Zip Code
Full Name of Contributor
Employer, Occupation, Labor Organization •
Street Address
Description of Item or Service
City
State
' Zip Code
Full Name ofContributor
Employer. Occupation. Labor Organization •
Street Address
Description of Item or Service
City
State
' Zip Code
Full Name of Contnbutor
Employer, Occupation. Labor Organiza1ion •
Street Address
Description of hem or Service
City
State
' Zip Code
Full Name of Contributor
Employer, Occupation, Labor Organization •
Street Address
Description of Item or Service
City
State
' Zip Code
OM
I o 1/ IFairMarket Value 16.88 9 2 4 9
Received at Fund.raising Event?
O YEs □No Registration Nwnber, if PAC M
D
y
' Fair Market Value
I I Received at Fundr.using Event? OYEs ONO Registration Nwnber, ,f PAC M
D
y
' Fair Market Value
I I Received at Fw1<!raising Evenl? OYEs □ No Registration Nwnber, if PAC M
D
y
rair Market Value
I I Received at FWldraising Event? ONO □ YES Registration Nwnber. if PAC M
D
y
IFair Markel Value
I I Received at FWldraising Event?
□ YES
□ No
• 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 theindividual's business. if any. ratherthan 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 are members, if any, must appear. [R.C. 35 I 7. 10(8)(4)1
Page Total S
172.91
