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
Zip Code
State
Willoughby Hills
0 I
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
IZip Code
State
Willoughby Hills
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
IZip Code
State
Chardon
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 !Standing Balance
Address City
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 Employer/Occupation/Labor Organization•
SITCCI Address
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
Form(Cash,Cbeck,erc)
Zip Code
H
Willou hb Hills
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
Zip Code
State
Willou hb Hills
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
Zip Code
State
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
Zip Code
State
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
Willou hb Hills
Form(Cash,Check,ctc)
Zip Code
State
C ity
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 Zip Code
State
Willou hb Hills
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 Zip Code
S1a1e
Willou hb Hills
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
Zip Code
State
Willou hb Hills
M
D
Y
1 0 0 11 1 19 1
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
1001
44094
o Whom Paid
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)
/
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
IZ1p Code
State
Willoue-hbv Hills
0
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
IZip Code
State
Willoughby Hills
0
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
IZtp Code
State
Fairport Harbor
Fonn (Cash. Check, etc.)
Employer/Occupation/Labor Organi7.ation•
688 Second St., Unit 2
0
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 D M
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 D s M
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
II
n
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
State
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
30-A R.C. 3517. 10
7019 Ohio Campaign Finance Report Prescribed by Secretary of Swe 3/0S
FullNameofCowniuee
Registration Number, if PAC
armuszkiewicz For Council FulJ Name of Candmte
Jose hJarmuszkiewicz Street Address
Office Sought
31301 Edd Rd.
District
Ci Council
AtLar e
State
ity
o
Zip Code
h
44094 AmualYear
Pr~Primary
Pre-Ga>enl
July
August
September
Monthly
Monlhly
Monthly
X
Semiannual
Termination
Report Electronically filed? □
Yes
Post-Ocneral
M
0 No
1
y
D
1
5
0
9
1
For candidates only, during an election year: iftotal contributions and expenditures each total SSOO or less during the combined pre- and post-periods al one election, checl; box.
No other forms are required at a post-primary or post-general period, irabo,·e statement applies. See R.C. 3517. IO(H) for details.
$ I. ArnoWlt brought forward from last report
$ 2. Total monewyeontributions (From Fonn No. 31-A)
2,865.00 $
3. Total other income (From Fonn No. 31-A-2)
1,500.00 $
4. Total funds available(sum of lines I , 2. 3)
4,365.00 $
S. Total monetary expenditures (From Form No. 31-8)
1,105.09 $
16. Balance on hand (line 4 minus line S)
I IJ
II I
3,259.91 $
7. Value of in-kind contributions received (From Form No. JI-J-1)
20.00 $
8. Value of in-kind contributions made(From Form No. 31-J-2)
0.00 $
9 . Outstanding loans owed by committee (From Fonn No. J 1-C)
1,500.00 $
10. Outstanding debu owed by committee (From Fonn No. 31-N)
0.00 $
I I . OulStanding loans owed 10 committee (From Fonn No. 31-K)
0.00 $
12. Value of independent expenditures made (From Fonn No. 31-U) 13. For Eloc:tronic Filing Entities only
0.00 $
Swn of lines 2. 7 and amount of any new loans roc:eived this period ;
THE INFORMATION CONTAINED IN THIS REPORT IS MADE UNDER THE PENAL COMMJlS ELECTION FALSIFICATION IS CUILTY OF A FELONY OF
D
Joseph J Jarmuszkiewicz Print Name nf Title (Treasurer and Deputy Treas ~•- r_ e r_o_nly ;_)_ _ _ __
I
Con~b:.,
I
Expenditure Pl&"
8
I
31 -A R.C. 1517. 10
Statement of Contributions Received Prescribed b)• Secretary of State 3/05
Name of Committee in Full
Ja rmuszkiewicz For Council Full Name of ConlribulOr
Registration Number, if PAC
Philomena Lastoria Sueet Add,ess
(Cosh. Chcd., etc.) check5461
EmplO)'et/Occupation/Labor Organization•
Fonn
31300 Eddy Rd City
Swe
Willou1thby Hills
o
I
h
r •p Code 44094
Full Name of Concnbutor
M
I
D
I
Amounl
y
200.00
o l s 1 12 1 19 Registration Number, if PAC
Nancy K Helton Street Addras
(Cosh. Chcclt. etc.) check 7100
Emplo,-a/Occupation/Labor OrJaruzation•
Fonn
37500 Eagle Rd K;ity
IZip Code
State
Willoughby Hills
o
I
h
44094
Full Name ofContnbulor
M
I
D
I
y
o l s 1 19 1 19
-
50.00
Registration Number, if PAC
Gloria Majeski ~lrectAddrcss
(Cosh. Check. Cl<.) check 9350
Employa/Occupation/Labor Organization•
Fonn
2717 Graylock ~ ii)'
SIAIO
Willou1thby Hills
o
I
h
r •pCode 44094
FuU Name ofContnbutor
M
,1
D
I
Amounl
y
100.00
o l 9 o l 3 1 19 Registration Number, if PAC
Cuvier Lu kat Stred Address
Emplo,'ff/Occupauon/Labor Organization•
Fonn (Cuh, Check, etc )
22 High Point Ln
check 1436
K;ity
Willoughby
O Sic
h
r•P=~4
FuD Nune orc-,i,.,.,,
M
,I
D
I
Amounl
y
1,500.00
0 19 0 16 1 19 Registration Number, i f PAC
David Reichelt ~ - Address
Emplo)"etlOcc~ Orpnintion•
Fonn (Cosh. Check."'-)
5900 Som Center Rd Ste 12 #167
check3866 IZ,p Code
SLate
~ •I)'
Willou1thby
o
I
h
44094
M
I
D
I
Amounl
y
25.00
0 19 1 13 1 19 Registration Number, if PAC
Full Name of Contnbutor
Pe1tl!V A Pawar Street Address
EmplO)fl/Occupation(Labor Organization•
Form (Cash. Check. etc..)
2678 Alan Drive
check6585
ity
IZip Code
Stale
Willou 1thby Hills
o
I
h
44094
M
I
D
I
Amounl
y
50.00
0 19 1 13 1 19 Registration Number, if PAC
Full Name ofContnbutor
Edward McKenna Slleel Address
Fonn (Cosh. Chcclt. 01<.)
Employer/Occupation/Labor Orpni1.ation•
ity
Willoughby Hills
o Si h l,;p~ 4
I
D
I
y
75.00
Form (Cash. Check. etc.)
Emplo)-or/Occupalion/Lobo, <>,pni,ation'
check 6854
SW<
ity
Willoughby Hills
M
0 19 1 13 1 19
Registration Number, if PAC
Full Name olContnbucor
Darleen Weger s.... Addnss 38195 Dodds Hill Drive
-
check8869
2963 Lamplight Ln
o
I
r pCodc h 44094
M
I
D
I
Amounl
y
100.00
0 19 1 13 1 19
• Required ror contnbutions rrom md1vtduab o,·er SIOO to statewide and ienenJ assembly canchdatcs. tr contnbutor n: selr-ffllplo)'ed, the occupauon and 1he name or the individual's business, ir any, ra&her than employer should be listed. Jr two or more emplO)"CeS contribute ,·i• pa)Toll deduction and exceed the aggregate o r SI 00, the labor orpnizaoon or which che employees are members. if any. must appear. IR C. 3517. 1 0(B)(◄)I
PagoTotaJS
2,100.00
GJ
31-A R.C. 3517. I0
Statement of Contributions Received Prcsmbed by Seaetary or Stale JJ05
IName ofCommitloe 11'1 FuU
Jarmuszkiewicz For council Full Name of Contnbutor
Registration Number, if PAC
Michael P Germa no Street Address
rty
Willou2hbv Hills
fo,m (Cash, Check. et~)
EmplO)u/Occupationll.&t Orpnization•
3008 Oakview Dr
o
Si
check 1160 h IZ.p~2
Full Name of Contributor
M
I
D
I
Amounl y
100.00
o l 9 1 17 1 19 Registration Number, if PAC
Marcia Levine Stree1 Address
c;.,
EmplO)-er/OccupationlLabor Organiu twn•
28806 Eddy Rd Willou2hbv Hills
o
si
fo,m (Cosh.
Check. etc.)
check 5255
h lz;p=~2
Full Name o r e -
M I D I y 0 19 1 17 1 19
.......,,
50.00
Re&,istration Number, if PAC
Barbara Mahovlic Stred Address
Emplo)-u/Occupation/Labor Orgaruuuon•
3035 Rockefeller ily
Willou2hbv Hills
~--
o
Si•
h lzjp=~4
f ull Name of Concributor
Fonn (Cosh.
Check.=>
check 2434 M ,I D I y 0 19 2 10 1 19
Amount
50.00
Registration Number, if PAC
Mary Ann Seline
2511 River Rd
Crtr
Willoui!hby Hills
Fonn (Cosh.
Emplo),er/Occupation/Labor Orpuuuon•
0Sie
h IZ.p; ;4
Full Name of ConvibulOf
Check. =>
check5573 M ,I D I y o l 9 2 10 1 19
Amounl
75.00
Registration Number, if PAC
Carrie Biro ~ ueetAddress
2821 Forest Lane !Ci'Y
Willoughby Hills
Form (Cash. Check. etc.)
EmplO)'ff/OccupationlLabor Oraanization•
0Sie
h IZ.p; ;4
Full Name of Contribu&or
check 5017 M
I
D
I
Amounl y
50.00
0 19 2 17 1 19 Registration Number, if PAC
Christine Klun StreetAddrm
Employer/Occupation/Labor Or&,WU7.ation•
Fonn (Cosh.
31400 Eddy Rd C i1y
Willoui!hbv Hills
o
si
h r p: ; 4
M I D I y 0 19 2 17 1 19
Amount
100.00
Registration Number, if PAC
Full Name ofContribulor
Denise Neidermever
s--
Fonn (Cash,
Employer/Occupation'Lab Orpuation•
2929 Lamplight Lane
ily
Willoui!hby Hills
o
Si
h IZ.p:~4
M I D I y 1 10 o l 4 1 19
Amounl
50.00
Registration Number, if PAC
Leie:hann Cesar Fonn (Cash,
Employer/Occupation/Labor OriJNution•
2848 Fowler Dr. rty
Willoui!hbv Hills
Check. =>
check 4985
Full Name of Contribu10r
Street Addrus
Check. =>
check 3052
o
si
h r p ~4
,I
Check.=>
check2205
M D I y 1 10 0 14 1 19
Amounl
75.00
• Required for c:ontn~ from indtveduals over SIOO to statewide and pnenl USffl1bi)' candtdates.. Jr contnbulor II sdf-emp~)'Cd, the occupatJOn and the name ofche
individ!.111'1 bumess., ifai,·, r'llher than emplO)-er should be listod. If two or more empk,)-ees cmtribute \"ll pa)TOII deduction and exceed the aggregate of S:1 00, the labor orpniution ofv,hich the emplo)-ees are members, if any. must appear. IR.C. 35 1 7. 10(8)(◄)1 Paae Tol&I s _
~550~.00~
31-A R C. 3517.10
Statement of Contributions Received Prescribed by Secretary of State ) ,0$ Name of Comnuuee in Full
Jannuszkiewicz For Council Full Name of ContnbulOr
Registra1ion Number, if PAC
Lynn M Fistek SttcetAddress
EmplO)"a/Occupationl'Labor Organi7.ation•
2972 Bishop Rd PY
lz;pcode
sta1e
Willoul!hby Hills
o
I
h
44092
Full Name ofContnbutor
Fonn (Cash, Check, ecc.)
I 1 l olo l 4 1 19 M
I
D
y
check 1745 Amount
50.00
Registration Number, if PAC
Jeffrey M Ross Street Address
Employer/Occupationflabor Orpniution•
Fonn (Cash, Check, etc.)
2867 Camelot Court
check543
!City
40.00
Willoul!hbv Hills Full Name of Contrixdor
Registration Number. if PAC
Marv R Cihula StrmAddress
Emplo)'et'/Occupalion/Labor 0rpuuuon•
Fonn (Cash. Check, etc.)
check 2170
35060 Dixon Rd. !City
IZip Code
Swe
Willoul(hby Hills
o
I
h
s--
25.00
44094 Registration Number, if PAC
Full Name of Contributor
Camille R. Schroeck
ity
lz;pcode
Sta1e
Willoul!hbv Hills
Fonn (Cash, Check, etc.)
Emplo)u/Occupatiowl..abor Or111nization•
2873 LampliS?;ht Ln. o
I
h
44094
M
I I D
check 1521 y
Amo...
50.00
1 10 o l s 1 19 Registration Number, if PAC
Full Name ofContri>utor
PatGrebenc Street Address
Employer/Occupatioo'Labor Oraanization•
Fonn (Cash, Check, etc.)
2265 River Rd. ity
check 2239 Swe
Willoul!hby Hills
IZipCode
Street Address
ity
50.00
o l h l 44094 Registration Number, if PAC
FullNameofC-
Empio)'er/Occupation/Labor Orpnization•
Stale
IZip Code
Fonn (Cash, Check, et~)
Amount
I Registration Number, if PAC
Full Name of Contributor
EmplO)'or/Oceupation/Labor Drpuzation•
!City
Swe
IZip Code
ity
Amount
Registration Number, if PAC
FuU Name of Contributor
Street Address
Fonn (Cash, Check, ecc.)
Emplo,u/Occupation/Labor Orpnization•
Stale
Fonn (Cash, Check, etc.)
Amount
I • Reqwo:I for contnbutioos from ind1,iduah o, er SI 00 to state\o\1de and general assembl) candidillCS. If con&nbutor IS self~p'°)-ecl, the occupauon and the name of the
individual's business. if ,ny, rather lhan emplO)-er should be listed. If two or more empk>)U:S contribute via payroll deduction and exceed the aggregate of SIOO, the labor orpniution of v.tuch the emplo,-ees are members. if any, mw t appear. IR.C. 35 I 7. IO(B)(4)1
P"8• Total s _ _2_1~5~ .00~
31-A-2 R.C. 3517. 10(8)
Statement of Other Income Prescribed by Seaewy oCSwe 2/01
Name ofCommittee in FulJ
Jarmuszkiewicz For Council Full Name
Registration Number, irPAC
Joseph J Jarmuszkiewicz Addnss
31301 Eddy Rd.
Tn,e•
~ity
Swe
Willou1<hbv Hills
M
L I N o
I
z;pcode
h
!full Name Add,ess
fC;ry
Amount
y
1,500.00
check 119 Registration Number, if PAC
Tn,e•
M
I fCity
D
Fonn(C""'-Ch«l<.etc)
44094
full Name
Add,es,
I I
0 19 0 14 1 19
Swe
I Zip Code
II I1
Amount
Fonn(C""'-Clleck.etc)
I Rqistr1tion Numhe,. ;rPAC
Tn,e•
M
I State
I Z;pCode
II I1
Amount
Fonn(Cash,Check.etc)
I Full Name
IAdd,es,
Registration Number, if PAC
Tn,e•
I !City
Swe
M
z;p Code
I
Ii I 1
Amount
Fonn(C""'-Ch«l<.etc)
I Full Name
Add,ess
Registnrion Number, ifPAC
Tn,e'
M
I ity
State
I Zip Code
Amount
I1ii
Fonn(Cosh,Ch«l<.etc)
I Full Name
Add,""
;ry
Registration Nwnber, ifPAC
Tn,e•
M
I State
I Zip Code
Amount
Ii Ii
Fonn(Cash,Check.etc)
I Full Name
Addnss
,~.,,
Registration Number. if PAC
Tn,e•
I State
Ml Zip Code
II I1
Amount
Fonn(C.,h_Check,etc)
I Registration Number, if PAC
Full Name Add,ess
M
Tn,e'
I
I ~ity
Swe
Zip Code
I I Ii
Amount
Fonn(C""'-Clleck.etc)
I • Pl.ace the two~ code an the Type bJock (one letter per square) which indicales the nature of the ()cha- Income ~ved; RE fOJ a refund. uncashed check or the
committee's own insuffiaa1t flnds check receiYed, place the letters IN for any 1n\'CStment or imerest income earned by the committee,
SA for the sale of committee assets, or LN fOJ payments re<:eived on a loan made.
Paa• Total S
1,500.00
31-B R.C. 3517.10
Statement of Expenditures Prescribed by Secretary ofState 2/01 Name of Committee in full
Tarmuszkiewicz For Council l'fo Whom Paid
M I D I v Amount
ol s 2 16 1 19
Hotcards Address
fC;ty
2400 Suoerior Ave East O eveland
CampaiQTI Palm Cards State tp Code n I h 44114
rroWhom Pud
fC;ty
36475 Euclid Ave
Willouimbv rroWhomPud Office Depot/Office Max Address
ToWhomPud Fulton Si= & Decal, Inc. Address
c;ty
7144 Ind ustrial Park Blvd.
Mentor rroWhomPud Fulton SiQTI & Decal, Inc. Address 7144 lnd ustrial Park Blvd . ity Mentor ToWhomPud Ohio Ethics Commision Addreu
c;ty
30 West Spring St L3 Columbus
Stamps for donation leters State IZip Code n I h 44094
P.O. Box 1558 EA1W37
Columbus ToWhomPud Address City
33.00
Check Number
MC3356 Amount
22.23
Purpose
I
Check Number
MC 3356 D y 0 19 1 11 1 19
M
,I I
Amount
830.32
Purpose
Campaign yard siims State rp Code n I h 44060
Check Number
MC3356 D y Amount 0 19 2 15 1 19
M
Purpose H frame sign suooorts State 12;p Code n I h 44060 Purpose Financial discloser payment n Site h 12;p Code 43215
I I
47.62
Chee.le.Number
MC3356 D I y Amount 0 19 2 17 1 19
M
I
35.00
Check Number
MC3356 D y Amount 1 10 1 15 1 19
M
Huntington Bank City
I I
~ 19 1°0 I 4 ly1 19
ToWhom Pud Address
MC3356 D y Amount 0 19 Oil 1 19
Purpose
CampaiQTI checks State lz;pCode
c;ty
Check Number
M
Giant Ealtle Address
133.92
Purpose
I I
3.00
Purpose
Statement Charge n SI h lz;p Code 43216
Check Number
Ml
I I Ii
Amount
Purpose
State
lz;pcode
Check Number
I
Page Total$ 1,105.09
31-C R.C. 3517.10
Paae _ _l_
Statement of Loans Received P«scribed by S.C..euwy of Sta1eJ,ll5
full Name of Committee
armuszkiewicz For Council From Whom Received
ose h
Prior Amount
Amt. Incurred this Period
armuszkiewicz
1,500.00 Outstanding Balance
Address
31301 Edd Rd
1500.00 Stale
0
Zip Code
Loa■s
h 44094
M
D
y
Rtteind This Period Date y D
0 9 0 4 1 9 ; 19 0 14 1 19
Pay111eab TIiiis Period
Date
Amount
Amount
M
D
y
1,500.00
Registration Number. if PAC
M
D
y
M
D
y
Employer/Oc:cupa1ioo'l.abor Organization•
M
D
y
M
D
y
Standard Machine Inc. From Whom Received
Prior Amount
Aml Incurred this Period
0.00 OutslMd;ng Balance
Address
0.00 State
Zip Code
Loans Received Tbis Period
Date
Payme:ats This Period
Date
Amount
Amount
M
D
y
M
D
y
Registration Numb«, if PAC
M
D
y
M
D
y
Employer/Oc:cupation'Labor Organization•
M
D
y
M
D
y
M
D
y
Aml Incurred this Period
Prior Amount
from Whom Received
0.00 Outstanding Balance
Address
0.00 State
M
Zip Code
D
LOHS Rtttived Tb is Period Date
y
Paymnts Tllis Period Amount
Date
Amount
D
y
M
D
y
Registration Nu.mW, ifrAC
M
D
y
M
D
y
Employcr/Occupation'Labor Organization•
M
D
y
M
D
y
• Required for contributions over $100 to statewide and general assembly candidates. lf 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 of S 100, the labor organization of whlCh the employees are members. ;f any. must appear. R.C. 3517.10(8)(4)
If a loan is fo,givcn. write •forgiven• in the •outstanding Balance• space. Transfer total of all loans received this period to the Statement of Other Income (Form No. 3 l•A-2) Transfer total of all payments made in this period to the Statement of Expenditures (Form No. 31-8). Transfer Total Outstanding Balance to the cover page (Form No. 30-A).
Total prior amount S Total ....,.;va1 ti.s period S
0.00 1,500.00
3 Total Payments th;, Period S
0.00
Total Outstanding Alliance $
1,500.00
(To Form No. 31-A-2) (aJso rc:oord on Form ll-8)
(To Form No 30.A)
31-J-I
P,., __1_
R.C. 3517.10
In-Kind Contributions Received Prauibcd byScactay JSl.atc 3"">
N-.ote:--•F..U
Jarmuszkiewicz For Council
--
Full Name fXComibuor
Empk,)u. Oocupatioa. Labor OrJUUution •
Resi1tratK>n Nwnbcr, if PAC
Dunkan Scott Oacription of hem or Sc:nice
36926 BeechHills Drive
Campaim Picture
Coy
Willoughby Hills
---
F.U Name o/Coatribalor
Sulc
0
~
--
I Emo&o,...
-City
---
FIIII NameofCoalribulor
c;cy
Full Name o f ~
c;,y
--
f"'1"-"~
City
°"""'""" ub«
Sulc
I
I I I IF'"'M...,.vwo
M
II
IZipCode
RccCft-ed at Fundraisina faenl?
I
IZipCode
□ YES ~
Oacription of licm or Sen-ice
Ml I Suto
IZipCodc
°"""'""" ub«
I
IZipCode
DclcriptKIII of hem or Senice
I
IZipCode
Emolo)... ~
ub«--.
Ocscriprioa of hem or Scnioc
s,...
I
Zi.Code 1
D NO
Nwnbcr, if PAC
I II
D YES C>,poiuti,o .
Ein~. ~ Labor Orpnization •
Sulc
r·••M-VM..
lfair Marut VahlC
Rccei\-ed at Fundraitina Evenc?
Dacripion ol ltcm or Scnice
-
11
Ra::en-ed at Fundrauina E\'Cftl?
... ~t..i.«0,p,wooo '
Employe,,
D NO
Rc&i1tt1tion Number, if PAC
M 1 11
Oacrip1klll of Item or Sc:nic:c:
I
□ NO
ReJituation Number, if PAC
DYES
Sulc
NO
I I I r,i,M..... Vwo
DYES
0,pniutioo •
Emplo)u, Occupetion,. Labor Orpuutioa •
-
0
□ YES
- -. ~PAC
Ml I
IZipCodc
20.00
RCICCf\'Cd at Fundrai1ina fa·cn1?
Oacripboa of hem or Scnice
c;cy
F.U N111e oleo.riNDI'
-°"""""""ub«°"""""""'
Suto
c;,y
Full NameolContritu:w-
IZip eoa. 44094
Dctcription ofllc:m ot Sc:n'ice
~.,
Full N.- o l ~
h
I
; I91Ol 3111 l,i<Mm<VMuo Rcc:civcd a Fundrailina E\'Cftl:7
□ NO
Rqi111ration Nwubcr, if PAC
Ml I
I I I IF'"'M...,.Vwo
Rece"-ed at Fundni1ina fam?
Q YliS D Resistration Number, if PAC
Ml I
NO
I I I r•i,MwkdVMuo
Rccei\'Cd at Fundrai•ina E,'ffll?
0
YES
D
NO
Rc1,ittnticm Number, if PAC
Ml
1, 11 r ,i,M..... VM..
Roeei\'Cd II Fundtaisina E,UK? □ YES
D NO
• Requin,d forconaribuliml rrc- individiaal, over $10010 swewide andacncraJ aucmbly cudidat,cs. lfcoatribulor is tdf-employcd. the oc:a.ipation and the umc olthe
iadn...,, .,___, if-,,, radtcr tb1a eeployer ahould be listed. Iftwo or more cmplo)us contribule ,ia pl)TOII dodllCbon Md exc:cod the aaaregaae olSIOO, the~ orpaweimof•tiidridiempk,rea wemmbus. itaay, must appear. [R.C. )Sl7 IO(BX4)J
Pa1e Total S
20.00
~0/9 f?e.c-
30-A RC 3517.10
GEAJ,£/C,#-l _
Ohio Campaign Finance Report PrucribedbySecrewyof~arcJro5 Full Name of Committee
Registrar ion Number, if PAC
Committee to Elect Kline Full Name of Candidate
Michael E Kline S1rce1 Address 38531
Office Sought
Dodds Landing Dr
Willoughby Hills
ty1..)
Am•ndcd Rcpon7
0
Yes
1 s,,tc OH
Ci1y
Type or Report (place X to the left of report
District
City Council
L .J
Pre-Primary
n
July Monthly
□
n
r
Au1u>1 Monthly
0
[!) No Rcpon El«:tronically Filed?
f.!J
Poll-Primary
Yes ~ No
Pre-General September Monthly
Dale of Election
n r 1
M
IZipC:i094
C A~
Post-General
n ...c=J Semiannual
Tcnnination
lo
1
[
5
For candidates only, during an election year: if 10181 con1ribo1ions and expenditures each 10181 $500 or less during the combined pre- and post-periods a1 one clcc1ion, check box No other forms arc required for a post-primary or post-general period, if above Slalcmcnt applies. Sec R.C. JS 17. IO(H) for details.
I. Amount brou1bt ro,,.ard fro■ lut report
s
1. Total moaellry coatrlbutloaa (From Fo,.. No. JI-A)
$
'
Q
w z
~
Q
IJ
~
I
;l u
4. Total fuada nailable (aum or liaea I, 1, 3)
s
$2,8OE
5. Total monetary eipeadlturea (Fro■ For■ No. 31-8)
s
$2,12f .34
6, Balance•• baad (line 4 mi■ua liae 5)
s
$67€ .66
7. Value ofln-kind coatrlbutloaa realved (Pro■ For■ No. 31-J-1)
$
I. Value of ia-klad coatrlbutleu ■Ide (Pro■ For■ NO: 31-J-1)
s
9. Outstandin& loans owed by committee (From Form No. JI~)
$
$550 .00
10. Outstandi•& debts owed by commitlee (Fro■ Fo,.. No. 31-N)
s
$615 . 85
.oo
$2~ .00
LAKE COUNT''
jg'
Q
1J !:;
Ii: w Q iii a: z u ~ w Ill 1111: w ~
11, Value of lndependcat expeadltura made (From Form No, JI-U)
s
13. For Electroaic Flli•I Eadtlea Hly Sum of liaea 1, 7, Hd a■Mllt or aay aew loau received this period
s
D
$55( .00
s
s
19
$2,25€ .00
J. Total other income (From l'o,.. No. 31-A-1)
II. Outslladia1 loaaa owed to co■■illee (Fro■ l'o,.. No. 31-K)
1
AAD OF ELECTJON§
.OCT 2 .2 2019 /:J-/rr/41 .J
Tl!£ INFORMATION CONTAINED IN THIS REPORT IS MADE UNDER THE PENALTY OF ELECTION FALSIFICATIO . WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
Michael Kline - Deputy Treasurer
10/21/2019 Date
Print Name and Title (Treasurer and Deputy Treasurer only)
Co11tribo1ton
pages_3__
Expendilurc
1
pajlCS_ __
Olhcr pages_ 4_ __
Total
pages_8_ __
31-A R.C. 3517.10
Page
Statement of Contributions Received
1
Prescribed by Sccteta,y of State 03/05
Name of Committee on full
Committee to Elect Kline Full Name of Contributor
Registration Number, if PAC
Thomas J & Gloria J Majeski Sireet Address
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
2717 Graylock Drive
Check
City
SU,e
OH
Willoughby Hills
bis l \ i
'Zip Code
44094
11
Full Name ol Contributor
Amount
$100.00
Regostration Number, ff PAC
Peter A Kamis
.
S1rc.:1 Address
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization
36701 Rogers Road City
sute
OH
Willoughby Hills
Check
I
b1 ~p
Zip Code
4409-4
Full Name of Contributor
11
~
Amounl
$100.00
Regoslration Number, if PAC
Madeleine B Smith Street Address
Fonn (Cash, Check. etc.)
Employer/Occupllioo/Labor Organization•
38220 Dodds Hill Dr Cioy
sute
Willoughby Hills
OH
Check
I
Amount
Zip Code
44094
$25.00
o1al113l1 !9
Reaostrauon Number, Ti' PAC
Full Name of Contributor
Karen J Schaller Street Address
2512 Red Fox Pass
.
CH)
Willoughby Hills
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organizalion'
Sta+e
OH
Check
I44094
b j8~~ ~~
Zip Code
Full Name of Contributor
Amount
$25.00
Regostration Number, if PAC
Marygail & James E Michalski Str.:et Address
Cuy
Willoughby Hills
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
38285 Dodds Hill Dr St,fe
OH
Check
I
Amount
Zip Code
44094
01812~!1 1 9
Full Name or Contributor
$25.00
Regostratoon Number, of PAC
John & Carol Lillich Street Address
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization
Check
37830 Milann Dr City
Willoughby Hills
Stal•
OH
1Zip Code .
o1~~~)
44094
.
Paula M Cross
Willoughby Hills
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization
2429 Trailard Dr Cioy
$100.00
Registration Number, ii PA
Full Name of l.:ontnbutor
Street Address
Amount
sute
OH
Check
I
Zip Code
44094
b1 ~ \
Amount
11 \
$100.00
Registration Number, ii PAC
Full Name of i;ontributor
Gregory & Lindsey Resnick Street Address
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
2404 Allen Blvd City
Beachwood
Check Stale
OH
Amount
!Zip Code
44122
oj 9 l213 l1 l9
$36.00
• Required for co~tributions from individuals over $100 to stalCwidc 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. Iftwo or morc employees contribute via payroll deduction and exceed the aggregate of $100, the labor organization of which the employees arc members, if any, must also appear. [R.C. 3517.10(8)(4)) Page Total $ 511 ,00
31-A R.C. 35 17.10
Page
Statement of Contributions Received
2
Prescribed by Secrelary of State 03/05 Name of Committee in Full
Committee to Elect Kline Full Name ofCootnbu1or
Rci;is1ra1ion Number, if PAC
Rudy & Rosemary Strauss Str!!d Address
.
Ci1y
Willoughby Hills
Fonn (Cash, Check, e1c.)
Employer/Occupation/Labor °'Janizalion
37720 Milann Dr SIIS•
OH
Check
I44094 Zip Code
o 1s
Full Name ofCootnbulor
~\
Amounl
11 \
$20.00
Regis1ra1ion Number, if PAC
John L & Marion L Wazney S1r«1 Address
Ci1y
Willoughby Hills
Fonn (Cash, Check, c1c.)
Employer/Occupation/Labor °'Janization•
38621 Dodds Landing Dr :)USC
OH
Check
I44094
p~~ i
Zip Code
D
Full Name ofCootnbutor
11
Amount
$100.00
Registration Number, if PAC
John Kleinbaum S1r«1 Address Ci1y
Willoughby Hills
:.cae
OH
Cash
I44094
Amount
Zip Code
Rcgislration Number, if PAC
Robert D & Kaye F Gongas
.
Willoughby Hills
Fonn (Cash, Check, e1c.)
Employer/Occupllion/Labor Dr¥anization
38561 Dodds Landing Dr C11y
$25.00
01912131119
Full Name ofCootnbulor
Strc:et Address
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor °'¥anization•
2572 Dodd Rd
:shf•
OH
Check
I44094
Amounl
Zip Code
$50.00
019~~~) Registration Number, if PAC
Full Name of Contributor
Robert M & Darleen A Weger S1r«1 Address Ci1y
Willoughby Hills
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Dr¥anization•
38195 Dodds Hill Dr :)USC
OH
Check
I44094
Amount
Zip Code
o19l2i3l11s
$100.00
Rcg1strat1on Number, if PAC
Full Name of Contributor
Daniel Kowall Str«1 Address Ci1y
Willoughby Hills
St...
OH
Cash
I
opp°p~)
Zip Code
44094
.
William J Ferree
Willoughby Hills
:shf•
OH
Check
I44094
/l> ~ i i
Zip Code
l1
.
Joseph & Denise M Jarmuszkiewicz
Willoughby Hills
$500.00
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Dr¥anization
31301 Eddy Rd City
Amount
Rcg1stra1ion Number, if PAC
Full Name of Contributor Street Address
$50.00
Fonn ((;ash.Check, etc.)
Employer/Occupllion/Labor Dr¥anization
38780 Dodds Landing Dr Cuy
Amount
IRegistration Number, if PAC
Full Name ofContnbutor
S1rcet Address
Fonn (Cash, Check, etc.)
Employer/Occupllion/Labor Dr¥anization•
38500 Berkshire Hills Dr
:.Ille
OH
I 44094
Check Amount
Zip Code
110 lo13 l119
$50.00
• Required for contributions from individuals over $100 to sta1ewidc and general assembly candidates. If contributor is self-employed, the occupation and the name of the individual's business, ifany, rather than employer should be lisled. lftwo or more employees contribute via payroll deduction and exceed the aggregate ofS I00, the labor organization of which the employees arc members, if any, must also appear. (R.C. 35 I 7. IO(B)(4))
Page Total $ 895 ,00
31-A RC. 3517.10
Page
Statement of Contributions Received
3
Prescribed by Sccret81)1 of State 03/0S Name of Commonec m Full
Committee to Elect Kline Full Name of Contributor
Registration Number, if PAC
Christopher Biddle Street Address
.
Form (Cash, Check, eoc.)
Employer/Occupation/Labor Organization
2655 Dodd Rd City
Willoughby Hills
Cash :st,fe
OH
I Zip Code
44094
11a
Full Name of Contributor
$100.00
1i
Registration Number. if PAC
Pat & Joe Grebenc Street Address
~\
Amount
.
Form (Cash, Check, Cle.I
Employer/Occupation/Labor Organization
2265 River Rd City
Willoughby Hills
Check Slife
OH
/p ~~
12ipCode
44094
Full Name ol Contributor
Amount
1~ $50.00
Registration Number. if PAC
Frank J & Mary R Cihula Sorc:ct Address
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization
35060 Dixon Rd City
Willoughby Hills
Check :sllle
OH
Amount
IZip Code
44094
Registration Number, if PAC
Edward & Jodie E McKenna Soro,, Address
$25.00
1101110 1j9
Full Name of Contributor
.
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization
2963 Lamplight Lane City
Willoughby Hills
Check ~e
OH
I Zip Code
44094
110
Full Name of Contributor
~1 l
Amount
$75.00
Registration Number, if PAC
Warren C & Janet A Sterrett Street Address
Form (Cash, Check, CIC.)
Employer/Occupation/Labor Organization
38751 Dodds Landing Dr City
Willoughby Hills
Check St...
OH
IZipCodo
44094
110 11
Cuvier I Lukat
.
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization
6153 Pepperwood Ct City
Mentor
State
OH
/p
tZip Code
44060
Cny
St,+e
$500.00
Form (Cash, Check, etc)
I
1
Zip Code
1
.
Form (Cash, Check, etc.)
Employer/Occupation/Labor Organization
Stale
OH
Amount
I 1 Registration Number, if PAC
Full Name ol Contnbutor
CII)
1p
Employer/Occupation/Labor Organization
OH Sorc:ct Address
l1~
Check Amount
Rcg1strat1on Num ,er, TI' PA,
Full Name of Contnbutor
Street Address
$100.00
1j 9
Registration Number, if PAC
Full Name of Contributor
Strc:ct Address
~
Amount
I
Zip Code
1
11
1
Amount
â&#x20AC;¢ Required for co;tributions from individuals over $100 to sta1ewidc and general assembly candidates. If contributor is self-employed, the occupation and the name of the individual's business, ifany, rather than employer should be listed. If two or more employees contribute via payroll deduction and exceed the aggregate ofSI00, the labor organization of which the employees arc members, if any, must also appear. [R.C. 3S17. 10(8)(4))
Page Total $SSO.OO
31-A-2 RC ,517 10(B)
Page
Statement of Other Income
1
Prescribed by Secre1ary or Sla1e 2/0 I ~;1111c
ofConuniucc m Full
Committee to Elect Kline rull Name
Rcgis1ration Number, 1f PAC
Michael E Kline AJJrcss
38531 Dodds Landing Dr Willoughby Hills Full Name
Michael E. Kline
38531 Dodds Landing Dr Willoughby Hills Full Name
1\Jdrc:ss
,\Jdr<sS
Full Name
rull Name:
Full 'l'.amc:
Full Nam<
,\JJrc:ss
â&#x20AC;˘ Pia,~ the two lcner code in the Type block (one h:ner per square) which indicates the nature of the Other ln~o1111: R.:cdved: RE for a refund. un~ashed .:heck or the comminee's own insutlicient funds check received, IN for any investment or interest income earned by the com mince. S,\ for the sale of comminee assets, or LN for payments received on a loan made.
550.00 Page Total$
31-B R.C. 3517.10
Statement of Expenditures Prescribed by Secretll)' of State 2/0 I Name ofComminec in Full
Committee to Elect Kline To Whom Paid
M
Direct Marketing Solutions Address
33851 Curtis Blvd #211
0 9
OH
•
Zip Code
44095
Ciry
OH
•
Zip Code
4409-4
St •
OH
Zip Code
•
Zip Code
Ciry
y
D
y
Purpo,e
OH
•
Zip Code
Check Number
M
D
y
Purpo,e
s, •
OH
• Zip Code
Check Number
M
D
y
Purpo,e
St••
OH
Zip Code
Check Number
M
To Whom Paid
Address
D
Check Number
M
To Whom Pa,d
Address
y
Purpo,e
To Whom Paid
Ciry
D
Check Number
M
To Whom Paid
Address
Electronic Transrer
Purpo,e
OH
City
Check Number
M
Ciry
Address
y
Reimbursement for Campaign signs, flyers, cards &
To Whom Paid
Addr<ss
D
1 6 1 9
Purpo,e
To Whom Pa,
Address
1001
1 0
Ciry
Willoughby Hills
$715.29
Check Number M
Michael E Kline 38531 Dodds Landing Dr
Amounr
Direct mail - campaign flyer
To Whom Paid
Address
y
Purpo,e
c;,y
Eastlake
D
1 1 1 9
D
Y,
Purpo,e
SU,e
Zip Code
Check Number
OH
Page Total $2,129.34
31-C RC. 3517.10
1
Page _ __
'
Statement of Loans Received Pmcribed by Scactary of Slate 3/0S Full Name ofComm,nee
--··-·"~·
Committee to Elect Kline From Whom Received
Michael E Kline
$550.00
Address
Outstanding Balance
38531 Dodds Landing Dr
$550.00
City
5tlate
Willoughby Hills Date Loanwu o riginally Incurred Registra1ion Number, if PAC
Zip Code
OH
44094
M
9
0 11
I
Lou1 Received Tbil Period
Date
1ls
2 4 1
Paymt11ts This Period M
Date D
y
M
D
y
M
D
Amounl
M D 0 11 2 4
Y,
1Is ol s 1 1 11s
s
C
$500.00
I
I
C
Amount
$50.00
I
E111ployer/Occupation/l..abor Organization•
s
I
YJ
~
I
I Prior Amount
From Whom Received
Amt. Incurred this Period Ouu1anding Balance
Address
Cioy
Stiato
Zip Code Loa■•
OH Date Loan was originally Incurred Registration Number, if PAC
1 1I 1
Employer/Occupation/Labor Ori!anization•
Paymts1ts This Period
ReNlved 11111 Period
Date
I;\
Date D
y!
M
D
Y'
M
D
y
Amount
~
[
M
[
t.i
[
I
1
s
Y)
!
I
1
Amount
s
! Prior Amount
From Whom Received
Amt. lncuncd this Period Outstanding Balance
Address S(ate
C U)
Zip Code
Date Loan was originally Incurred Registration Number, if PAC
i
I
Payments This Period
Loae1 Received Tbil Period
OH
9 i
I1
Employer/Occupation/Labor Ori!aoization•
~
Date 0
M
Date D
y
v;
Amount
YI
s
Amount
s I
M
0
~
M
D I
i
1
[
y
M
D
Yj
I
.. over SIOO to statewide and aeneral assembly candnlates. If contributor 1s self-<:mployed, the occupauon and the name of • Required fon:ontnbuuons from md1vtduals 1hc 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 arc members, if any, must also appear. [R.C. 3SI 7.IO(BX4)) It' a loan is forgiven, write ..Forgiven" in the "Outstanding Balance" space. Transfer total of all loans received this period to the Statement of Other ln,ome (Form No. 31-A-2). Transfer total of all payments made in this period to the Statement of Expenditures (Form No. 31-8). Transfer Outstanding 13alance to the Cover page (Form No. 30-A). 1 Total
prior amount $_ _ $_0_._0_0______
2 Total received this period 5_ __:. $_5_5_0._0_0_ _ _ __ (To Form No. 31-A-2) 3 Total 4
paymen'is this period$ _ _$_O _._O_O_ _ __ _ _ _ (To Form No. 31-8)
Total Outstanding Balance $ _ _S_5_5_o_ .O_O_ __ __ _ (To Form No. 30-A)
31-J-l Page 1
R.C. JSl7.10
In-Kind Contributions Received Pracribcd by Scacllry of Slale OJ/OS Nome of Committee on Full
Committee to Elect Kline Full Name of Contributor
Employer, Occupation, Labor urg111ization•
Registration Number, if PAC
David D Scott Street Address
~
Description of Item or Service
37215 Beech Hills Dr
Digital photography
City
:lh!IC
OH
Willoughby Hills
44094
Employ«, vca1pa11on, _
S,reet Address
Description of Item or Service Stajte
OH
...... _..1zat1on•
Sored Address
Description of Item or Service
SUI••
Staj le
OH S,reet Address
Description of llem or Service Stalte
IZip Code
Street Address
Description of Item or Service Stalte
fZip Code
Description of Item 01 Service
Employer, Oocupouon,
Stred Address
Description of Item 01 Service
~t•
OH
r'l yES r,, NO Registration Number, if PAC
r air Markd Value
tpCode
r"I YES NO Regostratoon Number, if PAC
1 11
r air Markd Value
Ii Received at Fundtaising Event?
'Zip Code
Full Name ol Contnbutor
CII)
r air Markd Value
n
Soreet Address
St~t•
r'l vES r"I NO Reg1stn111on Number, ii PAC
Received al Fundtaising Event?
Employer, vcc:upoloon, Labor urg1111zatoon•
OH
il"'I YES r'I NO Registration Number, 1f PAC
1 11 11
Full Name ol ux,tributor
City
r •ir Markd Value
Ii Received al Fundtaising Event?
tmptoyer, uccupa11on, Labor lJrlllllozatoon•
OH
r'i vES f"I NO Regostratoon Number, ii PAC
1 11
Full Name of Contributor
City
-
1 11 I1
Employer, UCCUpatton, _ ......... .,_, tzauon•
OH
l Fair Markd Value
Received at Fundtaising Event?
t p Code
Full Naone ofCon1nbu1or
City
r'l vES r.. NO Registration Number, if PAC
rair Markd Value
' Cit>
$25.00
Received at Fundtaising Event?
I Zip Code
Description of llem or Service
Stred Address
1
1 11 11
Employer, vcc:upat,on, Labor lJrlllllizatoon•
Full Naone ofContnbutor
r air~Md Value
Received al Fundraising Event?
'Zip Code
tmployer, vcc:upatoon, Labor vrpmzatoon•
OH
~
1 11 11
Full Name ofContnbutor
City
6\
Received at Fundtaising Event?
IZip Code
Full Name or Coninbutor
City
0
... 1zauon•
r,, NO t"'I YES Registra1ion Number, if PAC
1 11 11
r•ir Markd Value
Received al Fundtaising Event? O vEs
O NO
• Required ·for contributions from individuals over $100 to stalCwidc and gencllll assembly candidales. If contributor is self-employed, lhc occupalion and 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 organizalion of which the employees arc members, if any, must also appear. [R.C.3517.10(8)(4))
Pa11.e Total
$25.00
31-N RC 3517.10
Statement of Outstanding Debts Ptcscribcd by Sea-etary ofS111e 2/01 Full Name o Commillce
Committee to Elect Kline o Whom
ed
Prior Amount
Ami.
Item or Purpose of Debt
Outstanding Balance
Michael E Kline
$615.85
Address
38531 Dodds Landing Dr
$615.85
C1mp,11Qn suppies, INrts, weblilt:
St le
CII)
OH
Willoughby Hills Date Debt was orii:inally Incurred
Zip Code Payments This Period
44094
3
Amount
9
Rc:gis1ra1ion Number. if PAC
Item or Purpose of Debt
AJdress City
le
Outstanding Balance
Zip Code Payments This Period Amount
OH
s
Date Debt was orii:iaally Incurred Registration Numbe<, if PAC
D
I Item or Purpose of Debt
AJdr<SS le
City
OH
Outstanding Balance
Zip Code Payments This Period Amount
s Date Debt was orii:inally Incurred Registra1ion Number, if PAC
II' a Jcb1 is forgiven, write "Forgiven" in the ''Outstanding Balance" column. Transfer total of all payments made in this period lo the S1a1emen1 of Expenditures (Form No. 31-B). Total amount 1urg1vcn should be included in the In-Kind Contributions Received (Form No. 31 -J-1). Transfer total outstanding debt amount 10 the cover page. Total Payments this Period S _$_O_._ O_O______ (also record oo Form 31-8) Total Outstanding Balance S _$6 _ 15 _._8_5____
_
(also record oo cover page)
OFFICE OF THE
Ohio Secretay of State
l@ ;z er' ~
LAKE BOARD GF ELEC;IO ocT 23 20:s AM9:46
•
'f
/4 .,- G.vr,._,.,_c
Ohio Campaign Finance Report
,.
Form 30-A
ORC3511.10
Commillae Name
OfflceSol.lght
District
Neighbors for Responsible Government Slnlel Address
Sin
City
2929 Lamplight Lane Candidnl Name OR PAC Registlaliun Nwnber
Zip
oti
Willoughby Hlls
44094
Treasurer Name
Election Date (MMIDD'YYYY)
11 '°5/2019
Denise Neidermeyer Type of Report (choose one):
0
Annual
O
Semiannual
O
Pre-Primary
O
Post-Primary
[gJ
Pre-General
O
Post-General
Statewide Candidates Only:
0
July Monthly
Amended Report
0
Yes
O
August Monthly
D
September Monthly
Termination
D
Short Form Report (R.C. 3517.10(H))
Check this box if the committee wishes to terminate with this report
D
1. Amount brought torward from last report 2. Total monetary contributions (From Forms 31-A and 31-E)
Check this box if the comnittee is filing a short term report See attached instructions. $0.00 $1,675.00
3. Total other income (From Form 31-A-2) 4. Total funds available (sum of lines 1, 2, 3) 5 . Total monetary expenditures (From Forms 31-8 and 31-F)
6. Balance on hand (line 4 minus line 5)
$1 ,675.00
Iz
0.00
0
~
$1,675.00
7. Value of In-kind contributions received (From Form 31.J-1)
$0.00
8. Value of In-kind contributions made (From Form 31.J-2)
$0.00
9 . Outstanding loans owed by comrnltlee (From Form 31-C)
$0.00
10. Outstanding debls owed by comrnltllle (From Form 31-N)
$0.00
11. Outstanding loans owed to committee (From Form 31-K)
$0.00
12. Value of Independent expendlturn made (From Form 31-U)
$0.00
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THIS STATEMENT IS MADE UNDER PENALTY OF ELECTION FALSIFICATION. WHOEVER COMMITS ELECTION FALSIFICATION IS GUILTY OF A FELONY OF THE FIFTH DEGREE.
110/20/2019 O..(VM/00/'(YYY)
r;-'Pages I
Last Updated 09/2017
IPogt_LI
omCEOFTHE
Statement of Contributions Received
Ohio Secretory of State
Form 31-A
ORC3517.10
Full Name of Committee Neighbors for Responsible Government Registnllion Number, f PAC
FulNlmeofConlriluor
Denise Neidermeyer SlrNI Address
Form (Cash, Cl-.ck, ate.)
Eff1Pk¥trl0c:c"'81ion/Labor Organization"
2929 Lamplight Lane Cly
Willoughby Hills
Cash Stale
OH
Zip Code
Amourt
Date (MMIDQ'YYYY)
09/19/2019
44094
$50.00
Regislration Number, r PAC
Ful Name of Conlriluor
Camille A. Schroeck SlrNI Address
Form (Cash, Cl-.ck, ate.)
Employerl0c:c"'8tion/labor Organization•
2873 Lamplight Lane Cly
Willoughby Hills
Check Stale
OH
Zip Code
Amourt
Date (MMIDD'YYYY)
10/03'2019
44094
$50.00
Regialration Number, r PAC
Ful Name of ConlrlllUlor
Edward McKenna Slraet Address
Form (Cash, Cl-.ck, ate.)
Ernployerl0c:c"'8tion/labor Organiz:ation"
2963 Lamplight Lane Cly
Willoughby Hills
Check Stl18
OH
Zip Code
Amounl
Date (MM/DDYYYY)
10/02/2019
44094
$100.00
Registnllion Number, f PAC
Ful Name of Conlriluor
Mary Cihula SlrNI Address
Form (Cash, Cl-.ck, ate.)
Ernployerl0c:c"'8tion/labor Organization"
Check
35060 Dixon Road City
Willoughby
Stata
OH
Zip Code
Amounl
Date (MMIDD'YYYY)
10/07/2019
44094
$50.00
Regislration Number, f PAC
Full Name of Conlriluor
Sharon Nichting SlrNI Address
Form (Cash, Cl-.ck, ate.)
Employer~bor Organiz:ation"
Check
35n1 Maplegrove Rd. Cly
Willoughby Hills
Stale
OH
ZipCode
44094
Amounl
Date (MM/00/YYYY)
10/01/2019
$125.00
*Required for contributions from individuals over $100 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 contribute via payroll deduction and exceed the aggregate of $100, the labor organization of which the employees are members, if any, must also appear. [RC. 3517.10(9)(4)]
I
Page Total $375.00
IPoge..:il
OFACEOFTHE
Statement of Contributions Received
Ohio Secretay of State
Form 31-A
ORC3517.10
Full Name of Committee Neighbors for Responsible Government Full Name of eor.ril:uor
Cuvier Lukat Street Address
6153 Pepperwood Ct. Cly
Mentor
Regisntion Number, f PAC
I
State
OH
Check Zip Code
Cly
10/17'2019
Cly
Employer/Occupation/Labor Organimtion•
Stele
Zip Code
Cly
Cly
Amouft
Registration Number, f PAC
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
State
Zip Code
Amount
Date (MM/OO'YYYY)
Regisntion Nunar, f PAC
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
Staa
Zip Code
Amount
Date (MM/OO'YYYY)
Ragislration Number, f PAC
Full Name of Conlribulor
Street Address
Form (Cash, Check, etc.)
Date (MM/OO'YYYY)
Ful Name of Conlribulor
Street Addnlss
$1,300.00
Ragislration Nurnt»r, f PAC
Ful Name of ConlritlUlof
Slnlel Address
Amount
Date (MM/OO'YYYY)
44060
Ful Name of Conlribulor
SlnlelAddress
Fonn (Cash, Check, etc.)
Employer/Occupation/Labor Organization•
Form (Cash, Check, etc.)
Employer/Occupation/Labor OrganiEation•
Stale
Zip Code
Amount
Date (MM/OO'YYYY)
*Required for contributions from individuals over $100 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 contribute via payroll deduction and exceed the aggregate of $100, the labor organization of which the employees are members, if any, must also appear. [R.C. 3517.10(6 )(4)]
I
Page Total $1 ,300.00