0 0 0 0ethics.ks.gov/cfascanned/senate/2016eleccycle/201610/s06pp_amen… · $27,138.80 : 2. total...

30
KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT RECEIVED OF A CANDIDATE FOR STATE OFFICE "n K8 .:, ,V j ,J 2017 October 31,2016 Govemmentcn t:thi . . FILE WITH SECRETARY OF STATE csCommlSSion SEE REVERSE SIDE FOR INSTRUCTIONS A. Name of Candidate: _P_a_t_P_e_tt_e_y _ Address: 5316 Lakewood St. City and Zip Code: Kansas City, Kansas 66106 County: Wyandotte Office Sought: State Senator District: 6 ------- B. Check only if appropriate: Amended Filing __ Termination Report C. Summary (covering the period from July 22, 2016 through October 27,2016) 1. Cash on hand at beginning of period . $27,138.80 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 3. Cash available this period (Add Lines 1 and 2) . $42,273.80 4. Total Expenditures and Other Disbursements (Use Schedule C) . $12,117.43 5. Cash on hand at close of period (Subtract Line 4 from 3) . $30,156.37 6. In-Kind Contributions (Use Schedule B) $82.95 7. Other Transactions (Use Schedule D) $0.00 D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor." i1 00 " \l, 1a- Lb\l '\-- \ ............. Date Signature ofCandidate or \ Ii GEe Form Rev, 2016

Upload: others

Post on 18-Oct-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORT RECEIVEDOF A CANDIDATE FOR STATE OFFICE

~IOI' "nK8 .:, ,V j ,J 2017October 31,2016 Govemmentcn t:thi . .

FILE WITH SECRETARY OF STATE csCommlSSion SEE REVERSE SIDE FOR INSTRUCTIONS

A. Name of Candidate: _P_a_t_P_e_tt_e_y _

Address: 5316 Lakewood St.

City and Zip Code: Kansas City, Kansas 66106 County: Wyandotte

Office Sought: State Senator District: 6 ------ ­

B. Check only if appropriate: ~ Amended Filing __ Termination Report

C. Summary (covering the period from July 22, 2016 through October 27,2016)

1. Cash on hand at beginning of period . $27,138.80

2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00

3. Cash available this period (Add Lines 1 and 2) . $42,273.80

4. Total Expenditures and Other Disbursements (Use Schedule C) . $12,117.43

5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . $30,156.37

6. In-Kind Contributions (Use Schedule B) $82.95

7. Other Transactions (Use Schedule D) $0.00

D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best ofmy knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."

(~\'- i1 Q~ 00 "\l, 1a- Lb\l '\- ­\ ~~, .............

Date Signature ofCandidate or Treasu~~r \ Ii

GEe Form Rev, 2016

Page 2: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Name and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

10/17/2016

Alex Craddock 3009 S 53rd Kansas City, KS 66106 D 0 D D $50.00

10/20/2016

Tony Villegas 1728 Haas Dr Kansas City, KS 66106-2981 0 D D D $20.00

10/20/2016

Jerald Pelofsky 5301 W 96th Ter Overland Park, KS 66207-3216 D 0 D D $100.00

10/20/2016

Andrea Watson 5144 Stearns St Shawnee Mission, KS 66203-1869

D 0 D D $50.00

10/19/2016

Gerald Gentry 521 N Mesquite St Olathe, KS 66061-5928 D 0 D D $50.00

10/19/2016

Local 124 Voluntary Political Fund 301 ESt Terr Kansas City, MO 64114

D 0 D D $500.00

09/06/2016

Wade Thomason 9507 W 129th St Overland Park, KS 66213-3244

Financial Advisor

Finance D 0 D D $200.00

$970.00 I

Page 2 of 15

Page 3: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Narne of Candidate, Party Committee or Political Committee)

Check Amount of

Date Name and Address of Occupation & Industry of Individual Giving More

Appropriate Box Cash, Check, Loan or

Contributor Than $150 Cash Check Loan E funds Other Other Receipt

10/20/2016

Ann Stirling 4526 Gibbs Rd Kansas City, KS 66106-2546 0 0 0 0 $100.00

08/12/2016

UP Railroad Company 800 SW Jackson St Ste 914 Topeka, KS 66612-2214

0 ~ 0 0 $500.00

10/22/2016

David Duckers 610 N 28th St Kansas City, KS 66102-3934 0 ~ 0 0 $100.00

08/09/2016

KS Optometric PAC 1266 SW Topeka Blvd Topeka, KS 66612-1815 0 ~ 0 0 $500.00

07/27/2016

Anheuser Busch 1 Busch PI Saint Louis, MO 63118-1849 0 ~ 0 0 $250.00

10/20/2016

KS WSW PAC 212 SW 8th Ave Ste 202 Topeka, KS 66603-3939

0 ~ 0 0 $250.00

10/20/2016

Robert Anver 108 Viewcrest Dr Kansas City, KS 66101-1151 0 ~ 0 0 $100.00

$1,800.00 I

Page 3 of 15

Page 4: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Name and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

09/26/2016

LRICo Services LLC 2416 E 37th St N Wichita, KS 67219-3538 D ~ D D $200.00

10/20/2016

Jim Shetlar 12727 Mohawk Cir Leawood, KS 66209-1718 D ~ D D $100.00

10/03/2016

KS Livestock Assoc. 6031 SW 37th St Topeka, KS 66614-5128 D ~ D D $250.00

10/17/2016

Jolene Pryor 3001 S 47th St Kansas City, KS 66106-3775 D ~ D D $30.00

10/17/2016

KS State Farm Insurance Agents 825 S Kansas Ave Ste 500 Topeka, KS 66612-1253

D ~ D D $500.00

09/26/2016

Allie Devine 534 S Kansas Ave Topeka, KS 66603-3406

Lobbyist

Governmental Relations

D ~ D D $250.00

10/20/2016

Imogean (Jeannie) Westfall 2108 Shearer Rd Kansas City, KS 66106-3037 D ~ D D $50.00

I "SUbfota...·~.: ..T~...·.....~..~. ~p.:..... a;~~., , ' , ' , "

:;;:;~ ,,,.~ .,,=.Y:'·.;::.. ... :;.;' ..•.. - ~ ..;" ;~j~-- ,,~~.' . -::,---.

... ,',:.;;? ,,': -

$1,380.00 I

Page 4 of 15

Page 5: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Narne of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Name and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

10/25/2016

ATT KS PAC 220 SE 6th Ave R500 Topeka, KS 66603-3507

D 0 D D $500.00

10/18/2016

KS Medical Society PAC 623 SW 10th Ave Topeka, KS 66612-1615 D 0 D D $500.00

10/20/2016

Tom Roberts 12803 Sloan Ave Kansas City, KS 66109-4344 D 0 D D $40.00

10/17/2016

Mary Ellen Conlee 232 N Parkwood Ln Wichita, KS 67208-4143 D 0 D D $100.00

10/20/2016

Liz Wade 330 N 17th St Kansas City, KS 66102-4915 D 0 D D $100.00

10/20/2016

Vicki Lascala 108 Algonquin Dr Lake Winnebago, MO 64034-9301

D 0 D D $40.00

10/03/2016

Amerigroup Corporation 9225 Indian Creek Pkwy Bldg 32 Overland Park, KS 66210-2009

D 0 D D $200.00

$1.480.00 I

Page 5 of 15

Page 6: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Narne of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Narne and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

10/05/2016

Linda Lewis 7204 W 84th Ter Overland Park, KS 66212-1944 D 0 D D $30.00

10/20/2016

James Kendall 3620 Gibbs Rd Kansas City, KS 66106-3840 D 0 D D $50.00

10/06/2016

KS Hospital Assoc PAC 215 SE 8th Ave Topeka, KS 66603-3906 D 0 D D $1,000.00

09/26/2016

KS Society of CPA's 100 SE 9th St Ste 502 Topeka, KS 66612-1213

D 0 D D $250.00

10/25/2016

KTLA Consumer/Civil Justice 719 SW Van Buren St Topeka, KS 66603-3740 D 0 D D $250.00

08/30/2016

3M Traffic Safety and Security Systems Division 3M Center Bldg 223-4N-014 Saint Paul, MN 55144-1000

D 0 D D $500.00

10/20/2016

Michael Calwell 5610 W 61st Ter Mission, KS 66202-3509 D 0 D D $100.00

$2,180.00

Page 6 of 15

Page 7: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Name and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

10/20/2016

Mary Gonzales 3721 Thompson Cir Kansas City, KS 66103-3173 D 0 D D $100.00

10/05/2016

Comcast Corp. 1701 John F Kennedy Blvd Philadelphia, PA 19103-2855 D 0 D D $250.00

10/20/2016

Jerilyn Huggins PO Box 6147 Kansas City, KS 66106-0147 D 0 D D $100.00

10/17/2016

Barbara Kill 5548 Pawnee Dr Kansas City, KS 66106-1540 D 0 D D $50.00

09/26/2016

Sprint Nextel PO Box 63670 Phoenix, AZ. 85082-3670 D 0 D D $200.00

10/20/2016

Security Benefit Life Insurance PAC 1 Security Benefit PI Topeka, KS 66636-1000

D 0 D D $500.00

10/06/2016

HCA 1100 Walnut St Ste 2950 Kansas City, MO 64106-2187

D 0 D D $500.00

$1.700.00 I,:;'-!. "-S--'·~ ,; "~j; - ~~.; .,;. :':0 .~<:>.:

"-t~:,~_;.i~:--';:·:'::· ;.(/ '~,.->' ;7"~;;,i:'-:;~'~'

. " .. ',,.,,, "-:.," ...', ~.,-,,> '" >

Page 7 of 15

Page 8: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of

Date Name and Address of Occupation & Industry of Individual Giving More

Appropriate Box Cash, Check, Loan or

Contributor Than $150 Cash Check Loan E funds Other Other Receipt

10/19/2016

Rogers Liquor 1717 N 38th St Kansas City, KS 66102-2121 0 !ZI 0 0 $100.00

10/20/2016

Kathryn Peters 3617 N 59th St Kansas City, KS 66104-1104 0 !ZI 0 0 $50.00

10/22/2016

Planned Parenthood 4401 W 109th St Ste 200 Overland Park, KS 66211-1303

0 !ZI 0 0 $500.00

10/17/2016

CWA-Cope PCC 501 3rd St NW Washington, DC 20001-2760 0 !ZI 0 0 $100.00

08/18/2016

Kansas Contractors Assoc. 800 SW Jackson St Ste 100 Topeka, KS 66612-1216

0 !ZI 0 0 $500.00

10/18/2016

Physicians Hospitals Kansas 1200 SW 10th Ave Topeka, KS 66604-1204 0 !ZI 0 0 $500.00

10/20/2016

Mary Roddy 4175 Cambridge St Kansas City, KS 66103-3318 0 0 0 0 $50.00

$1,800.00

Page 8 of 15

Page 9: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Name and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

09/19/2016

KS Auto Dealers PAC 731 S Kansas Ave Topeka, KS 66603-3807 D ~ D D $250.00

10/19/2016

Nick Tomasic 608 Splitlog Ave Kansas City, KS 66101-3332 D ~ D D $100.00

10/20/2016

Farmers Employee &Agent PAC ofKS 2345 SW Current Ct Lees Summit, MO 64082-4086

D ~ D D $500.00

10/20/2016

Inti Assoc of Fire Fighters 7540 Leavenworth Rd Kansas City, KS 66109-1215 D ~ D D $250.00

10/20/2016

Ramey and Kathryn Carey 5338 Douglas Ave Kansas City, KS 66106-2258 D ~ D D $25.00

10/20/2016

Nancy Shirley 3850 N 113th St Kansas City, KS 66109-3489 ~ D D D $50.00

10/20/2016

James and Betty Millhouse 2114 S 48th Ter Kansas City, KS 66106-2441 D ~ D D $50.00

$1,225.00

Page 9 of 15

Page 10: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of

Date Name and Address of Occupation & Industry of Individual Giving More

Appropriate Box Cash, Check, Loan or

Contributor Than $150 Cash Check Loan E funds Other Other Receipt

07/23/2016

Greater Kansas City Women's Political Caucus PAC PO Box 10095 Kansas City, MO 64171-0095

D 0 D D $100.00

10/20/2016

Marilyn Miller 6840 Mastin St Merriam, KS 66203-3913 D 0 D D $50.00

09/26/2016

KS Bankers Assoc PAC PO Box 4407 Topeka, KS 66604-0407 D 0 D D $250.00

10/06/2016

Altria Client Services Inc 1005 Congress Ave Ste 850 Austin, TX 78701-2465

D ~ D D $450.00

10/20/2016

Norman Scott 501 N 86th St Kansas City, KS 66112-1606 D 0 0 D $50.00

10/05/2016

KS Healthcare Assoc 1100 SW Gage Blvd Topeka, KS 66604-1761 0 ~ 0 0 $250.00

10/20/2016

Ollie Carroll 8509 Spring Ave Kansas City, KS 66109-1037 D 0 D D $100.00

$1,250.00 I

Page 10 of 15

Page 11: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Check Amount of Occupation & Industry of Appropriate Box Cash, Check,

Date Narne and Address of Individual Giving More Loan or Contributor Than $150 Cash Check Loan E funds Other

Other Receipt

10/18/2016

KS New Energy Economy PAC 610 Brazos St Ste 210 Austin, TX 78701-3287

D ~ D D $1,000.00

10/17/2016

Matthew Watkins 11130 Whispering Ln Kansas City, KS 66109-4265 D ~ D D $50.00

10/20/2016

Frank and George Ann Burris 8521 Darnell Lenexa, KS 66215-2451 D ~ D D $100.00

10/17/2016

Hallmark Cards, Inc. PO Box 419580 Kansas City, MO 64141-6580 D ~ D D $200.00

Complete if this is the last page of Schedule A

Total Itemized Receipts for Period $15,135.00

Total Unitemized Contributions $0.00

Sale ofPolitical Materials (Unitemized) $0.00

Total Contributions When Contributor Not Known $0.00

$15,135.00

$1,350.00

Page 11 of 15

Page 12: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULEB IN-KIND CONTRIBUTIONS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Narne and Address of Contributor

List Occupation & Industry for Those

Giving an In-Kind of More Than $150

Description of In-Kind Contribution

Value of In-Kind

Contribution

09/21/2016

KS Bankers Assoc PAC PO Box 4407 Topeka, KS 66604-0407 food/beverages

$82.95

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions $82.95 Total Unitemized ($100 or less) In-Kind Contributions

TOTAL IN-KIND CONTRIBUTIONS THIS PERIO]) (to line 6 ofSuDnnary), -, ,

$0.00

$82.95

Snbtotal This Page $82.95

Page.-lLof~

1

Page 13: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULEC EXPENDITURES AND OTHER DISBURSEl\1ENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

07/2212016 Sunflower Chapter - KNEA 715 SW 10th Ave Topeka, KS 66612-1617

dues - Miscellaneous $10.00

09/06/2016 Mainstream Education Foundation 5690 Dearborn #213 Mission, KS 66202-1961

contribution - Donation/Contrib $125.00

09/29/2016 Sam's Club 10510 Parallel Pkwy Kansas City, KS 66109-3643

supplies, food - Supplies $155.20

08/2212016 Lee's Printing 804 Central Ave Kansas City I KS 66101-3504

notecards - Printing $49.11

09/06/2016 League of Women Voters 1730 M St NW Ste 1000 Washington, DC 20036-4570

membership dues - Miscellaneous $25.00

08/2212016 Armourdale Renewal Association 730 Osage Ave Kansas City I KS 66105-2026

dues - Miscellaneous $20.00

10/20/2016 Amigos Grill and Cantina 2737 S 47th St Kansas City I KS 66106-3629

food - Fundraising Expenses $485.36

10/16/2016 Morris Neighborhood Group 7120 Gibbs Rd Kansas City, KS 66106-5146

contribution - Donation/Contrib $50.00

Subtotal This Page $919.67\

Page.Jl of -li­

Page 14: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULE C EXPENDITURES AND OTHER DISBURSEl\1ENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

07/25/2016 Kansas Contractors Assoc. 800 SW Jackson St Ste 100 Topeka, KS 66612-1216

donation - Donation/Contrib $100.00

10/07/2016 Lee's Printing 804 Central Ave Kansas City. KS 66101-3504

invitations - Printing $52.38

09/08/2016 NGPVan 11 01 15th St NW Ste 500 Washington, DC 20005-5006

Fundraising Software ­Electronics/Computers

$450.00

08/19/2016 Lee's Printing 804 Central Ave Kansas City, KS 66101-3504

notecards - Printing $49.11

10/17/2016 KS Democratic Party 501 SE Jefferson St Ste 30 Topeka, KS 66607-1173

contribution - Donation/Contrib $1,000.00

10/11/2016 Post Office 3400 Strong Ave Kansas City, KS 66106-7400

stamps - Postage/Shipping $34.00

09/19/2016 NGPVan 1101 15th St NW Ste 500 Washington, DC 20005-5006

Fundraising Software ­Electronics/Computers

$450.00

09/09/2016 Yoder Office Supply Acct 7325 W 79th St Overland Park, KS 66204-2908

flag - Miscellaneous $22.95

09/27/2016 Argentine Betterment Corporation PO Box 6613 Kansas City, KS 66106-0613

silver city parade - Donation/Contrib $50.00

Subtotal This Page $2,208.44

Page.l!... of ~

1

Page 15: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULEC EXPENDITURES AND OTHER DISBURSEl\lENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

10/05/2016 BNV Printing 800 N Market St Wichita, KS 67214-3520

mailers - Printing $2,800.00

10/21/2016 Lee's Printing 804 Central Ave Kansas City, KS 66101-3504

thank you cards - Printing $60.02

09/19/2016 Our Lady of Unity 2646 S 34th St Kansas City, KS 66106-4260

donation - Donation/Contrib $75.00

10/07/2016 KS Democratic Party 501 SE Jefferson St Ste 30 Topeka, KS 66607-1173

Services - Miscellaneous $6,000.00

09/06/2016 Post Office 3400 Strong Ave Kansas City, KS 66106-7400

stamps, shipping - Postage/Shipping $49.30

Complete if last pa2e of Schedule C Total Itemized Exoenditures This Period $12,112.43

Total Unitemized Exnenditures $50 or less $5.00

TOTAL EXPENDITURES & OTHER DISBURSE1\fENTS THIS PERIOD (to line 4 of Summary)

$12,117.43

Subtotal This Page $8,984.32 1

Page.l.i.- of .l.i.­

Page 16: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

KANSAS GOVERNMENTAL ETHICS COMMISSION

RECEIPTS AND EXPENDITURES REPORT OF A CANDIDATE FOR STATE OFFICE

October 31, 2016

FILE WITH SECREfARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS

FILED

JAN l 0 dolt KRIS W KOBACH

SECRETARY OF STATE

A. Name of Candidate Pat Pettey Address -5-31-6~La_k_e_w_o_o_d~S-t~~~~~~~~~~~~~~~~~~~~~~~~~~

City and Zip Code Kansas City, KS 66106 Office Sought State Senate

County Wyandotte District No. 6

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

B. Check only if appropriate: 0 Amended Filing D Termination Report

C. Summary (covering the period from 07/22/2016 through 10/27/2016

1. Cash on hand at beginning of period $27,938.80

2. Total Contributions and Other Receipts (Use Schedule A) $15, 135.00 ~~~~~~~~~~~~~~~~~~~

3. Cash available this period (Add Lines 1 and 2) $43,073.80

4. Total Expenditures and Other Disbursements (Use Schedule C) $12,217.43

5. Cash on hand at close of period (Subtract Line 4 from 3) $30,856.37

6. In-Kind Contributions (Use Schedule B) $82.95

7. Other Transactions (Use Schedule D) $0.00

D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete. I understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."

l--lo-iv17 Date Signature of Candidate or Treasurer

GEC Form Rev 2016

Page 17: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than$150 Cash Check Loan

Alex Craddock 3009 S 53rd

10/17/2016 Kansas City, KS 66106 D 0 D

Tony Villegas 1728 Haas Dr

10/20/2016 Kansas City, KS 66106-2981 0 D D

Jerald Pelofsky 5301W96th Ter

10/20/2016 Overland Park, KS 66207-3216 D 0 D

Andrea Watson 5144 Stearns St

10/20/2016 Shawnee Mission, KS D 0 D 66203-1869

Gerald Gentry 521 N Mesquite St

10/19/2016 Olathe, KS 66061-5928 D 0 D

Local 124 Voluntary Political Fund

10/19/2016 301 E St Terr D 0 D Kansas City, MO 64114

Wade Thomason 9507 W 129th St Financial Advisor

09/06/2016 Overland Park, KS 66213-3244 D 0 D Finance

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $50.00

D $20.00

D $100.00

D $50.00

D $50.00

D $500.00

D $200.00

$970.00

Page 2 of 15

Page 18: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than$150 Cash Check Loan

Ann Stirling 4526 Gibbs Rd

10/20/2016 Kansas City, KS 66106-2546 D 0 D

UP Railroad Company 800 SW Jackson St

08/12/2016 Ste 914 D 0 D Topeka, KS 66612-2214

David Duckers 610 N 28th St

10/22/2016 Kansas City, KS 66102-3934 D 0 D

Y • •

KS Optometric PAC 1266 SW Topeka Blvd

08/09/2016 Topeka, KS 66612-1815 D 0 D

Anheuser Busch 1 Busch Pl

07/27/2016 Saint Louis, MO 63118-1849 D 0 D

KS WSW PAC 212 SW 8th Ave

10/20/2016 Ste 202 D 0 D Topeka, KS 66603-3939

Robert Anver 108 Viewcrest Dr

10/20/2016 Kansas City, KS 66101-1151 D 0 D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $100.00

D $500.00

D $100.00

D $500.00

D $250.00

D $250.00

D $100.00

$1,800.00

Page 3 of 15

Page 19: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than $150 Cash Check Loan

LRICo Services LLC 241'6 E 37th St N

09/26/2016 Wichita, KS 67219-3538 D 0 D

Jim Shetlar 12727 Mohawk Cir

10/20/2016 Leawood, KS 66209-1718 D 0 D

KS Livestock Assoc. 6031 SW37th St

10/03/2016 Topeka, KS 66614-5128 D 0 D

Jolene Pryor 3001 S 47th St

10/17/2016 Kansas City, KS 66106-3775 D 0 D

KS State Farm Insurance Agents

10/17/2016 825 S Kansas Ave D 0 D Ste 500 Topeka, KS 66612-1253

Allie Devine 534 S Kansas Ave Lobbyist

09/26/2016 Topeka, KS 66603-3406 D 0 D Governmental Relations

lmogean (Jeannie) Westfall 2108 Shearer Rd

10/20/2016 Kansas City, KS 66106-3037 D 0 D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $200.00

D $100.00

D $250.00

D $30.00

D $500.00

D $250.00

D $50.00

$1,380.00

Page 4 of 15

Page 20: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than$150 Cash Check Loan

ATT KS PAC 220 SE 6th Ave

10/25/2016 R500 D 0 D Topeka, KS 66603-3507

KS Medical Society PAC 623 SW 10th Ave

10/18/2016 Topeka, KS 66612-1615 D 0 D

Tom Roberts 12803 Sloan Ave

10/20/2016 Kansas City, KS 66109-4344 D 0 D

Mary Ellen Conlee 232 N Parkwood Ln

10/17/2016 Wichita, KS 67208-4143 D 0 D

Liz Wade 330 N 17th St

10/20/2016 Kansas City, KS 66102-4915 D 0 D

Vicki Lascala 108 Algonquin Dr

10/20/2016 Lake Winnebago, MO D 0 D 64034-9301

Amerigroup Corporation 9225 Indian Creek Pkwy

10/03/2016 Bldg 32 D 0 D Overland Park, KS 66210-2009

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $500.0.0

D $500.00

D $40.00

D $100.00

D $100.00

D $40.00

D $200.00

$1,480.00

Page 5 of 15

Page 21: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check . Occupation & Industry of Appropriate Box Date Name and Address of Individual Giving More

Contributor Than $150 Cash Check Loan

Linda Lewis 7204 W 84th Ter

10/05/2016 Over1and Park, KS 66212-1944 D 0 D

James Kendall 3620 Gibbs Rd

10/20/2016 Kansas City, KS 66106-3840 D 0 D

KS Hospital Assoc PAC 215 SE 8th Ave

10/06/2016 Topeka, KS 66603-3906 D 0 D

KS Society of CPA's 100 SE 9th St

09/26/2016 Ste 502 D 0 D Topeka, KS 66612-1213

KTLA Consumer/Civil Justice 719 SW Van Buren St

10/25/2016 Topeka, KS 66603-3740 D 0 D

3M Traffic Safety and Security Systems Division

08/30/2016 3M Center D 0 D Bldg 223-4N-014 Saint Paul, MN 55144-1000

Michael Calwell 5610 W61stTer

10/20/2016 Mission, KS 66202-3509 D 0 D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $30.00

D $50.00

D $1 ,000.00

D $250.00

D $250.00

D $500.00

D $100.00

$2,180.00

Page 6 of 15

Page 22: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than $150 Cash Check Loan

Mary Gonzales 3721 Thompson Cir

10/20/2016 Kansas City, KS 66103-3173 D 0 D

Comcast Corp. 1701 John F Kennedy Blvd

10/05/2016 Philadelphia, PA 19103-2855 D 0 D

Jerilyn Huggins PO Box 6147

10/20/2016 Kansas City, KS 66106-0147 D 0 D

Barbara Kill 5548 Pawnee Dr

10/17/2016 Kansas City, KS 66106-1540 D 0 D

Sprint Nextel PO Box63670

09/26/2016 Phoenix, AZ 85082-3670 D 0 D

Security Benefit Life Insurance PAC

10/20/2016 1 Security Benefit Pl D 0 D Topeka, KS 66636-1000

HCA 1100 Walnut St

10/06/2016 Ste 2950 D 0 D Kansas City, MO 64106-2187

Amount of Cash, Check,

Loan or E funds Other Other Receipt

D $100.00

D $250.00

D $100.00

D $50.00

D $200.00

D $500.00

D $500.00

;

$1,700.00

Page 7 of 15

Page 23: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More

Contributor Than $150 Cash Check Loan

Rogers Liquor 1717 N 38th St

10/19/2016 Kansas City, KS 66102-2121 D 0 D

Kathryn Peters 3617 N 59th St

10/20/2016 Kansas City, KS 66104-1104 D 0 D

Planned Parenthood 4401 W 109th St

10/22/2016 Ste 200 D 0 D Over1and Park, KS 66211-1303

CWA-Cope PCC 501 3rd St NW

10/17/2016 Washington, DC 20001-2760 D 0 D

Kansas Contractors Assoc. 800 SW Jackson St

08/18/2016 Ste 100 D 0 D Topeka, KS 66612-1216

Physicians Hospitals Kansas 1200SW10th Ave

10/18/2016 Topeka, KS 66604-1204 D 0 D

Mary Roddy 4175 Cambridge St

10/20/2016 Kansas City, KS 66103-3318 D 0 D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $100.00

D $50.00

D $500.00

D $100.00

D $500.00

D $500.00

D $50.00

$1,800.00

Page 8 of 15

Page 24: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than $150 Cash Check Loan

KS Auto Dealers PAC 731 S Kansas Ave

09/19/2016 Topeka, KS 66603-3807 D 0 D

Nick Tomasic 608 Splitlog Ave

10/19/2016 Kansas City, KS 66101 -3332 D 0 D

Fanners Employee & Agent PAC of KS

10/20/2016 2345 SW Current Ct D 0 D Lees Summit, MO 64082-4086

Intl Assoc of Fire Fighters 7540 Leavenworth Rd

10/20/2016 Kansas City, KS 66109-1215 D 0 D

Ramey and Kathryn Carey 5338 Douglas Ave

10/20/2016 Kansas City, KS 66106-2258 D 0 D

Nancy Shirley 3850 N 113th St

10/20/2016 Kansas City, KS 66109-3489 0 D D

James and Betty Millhouse 2114 S 48th Ter

10/20/2016 Kansas City, KS 66106-2441 D 0 D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $250.00

D $100.00

D $500.00

D $250.00

D $25.00

D $50.00

D $50.00

$1,225.00

Page 9 of 15

Page 25: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than $150 Cash Check Loan

Greater Kansas City Women's Political Caucus PAC

07/23/2016 PO Box 10095 D IZI D Kansas City, MO 64171-0095

Marilyn Miller 6840 Mastin St

10/20/2016 Merriam, KS 66203-3913 D IZI D

KS Bankers Assoc PAC PO Box4407

09/26/2016 Topeka, KS 66604-0407 D IZI D

Altria Client Services Inc 1005 Congress Ave

10/06/2016 Ste 850 D IZI D Austin, TX 78701-2465

Norman Scott 501 N 86th St

10/20/2016 Kansas City, KS 66112-1606 D IZI D

KS Healthcare Assoc 1100 SW Gage Blvd

10/05/2016 Topeka, KS 66604-1761 D IZI D

Ollie Carroll 8509 Spring Ave

10/20/2016 Kansas City, KS 66109-1037 D IZI D

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $100.00

D $50.00

D $250.00

D $450.00

D $50.00

D $250.00

D $100.00

$1,250.00

Page 10 of 15

Page 26: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Candidate, Party Committee or Political Committee)

Check Occupation & Industry of Appropriate Box

Date Name and Address of Individual Giving More Contributor Than$150 Cash Check Loan

KS New Energy Economy PAC 610 Brazos St

10/18/2016 Ste 210 D ~ D Austin, TX 78701-3287

Matthew Watkins 11130 Whispering Ln

10/17/2016 Kansas City, KS 66109-4265 D ~ D

Frank and George Ann Burris 8521 Darnell

10/20/2016 Lenexa, KS 66215-2451 D ~ D

Hallmark Cards, Inc. PO Box 419580

10/17/2016 Kansas City, MO 64141-6580 D ~ D

Complete if this is the last page of Schedule A

Total Itemized Receipts for Period

Total Unitemized Contributions

Sale of Political Materials (Unitemized)

Total Contributions When Contributor Not Known

Amount of Cash, Check,

Loan or Efunds Other Other Receipt

D $1,000.00

D $50.00

D $100.00

D $200.00

$15,135.00

$0.00

$0.00

$0.00

$15,135.00

$1,350.00

Page 11 of 15

Page 27: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

Pat Pettey

SCHEDULEB IN-KIND CONTRIBUTIONS

(Name of Candidate, Party Committee or Political Committee)

Date Name and Address of List Occupation & Contributor Industry for Those

Giving an In-Kind of More Than $150

KS Bankers Assoc PAC

09/21/2016 PO Box4407 Topeka, KS 66604-0407

Complete if last page of Schedule B

Total Itemized (over $100) In-Kind Contributions

Total Unitemized ($100 or less) In-Kind Contributions

Description of In-Kind Value of Contribution In-Kind

Contribution

food/beverages $82.95

$82.95 $0.00

TOTAiflN-~ C.ONT.RIBUTIONS.'TffiS PERIOD (to' line 6 of Suminary) ' ,'(··:•''. ·:.·~:;;;\ :, :!,' ' ~51 ·, ,., $82.95 .,

Subtotal This Page $82.951

Page _11__ of __li_

Page 28: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

10/19/2016 Turner High School Donation - Donation/Contrib $100.00 2211 S 55th St Kansas City, KS 66106-2246

07/22/2016 Sunflower Chapter - KNEA dues - Miscellaneous $10.00 715SW10th Ave Topeka, KS 66612-1617

09/06/2016 Mainstream Education Foundation contribution - Donation/Contrib $125.00 5690 Dearborn #213 Mission, KS 66202-1961

09/29/2016 Sam's Club supplies, food - Supplies $155.20 10510 Parallel Pkwy Kansas City, KS 66109-3643

08/22/2016 Lee's Printing notecards - Printing $49.11 804 Central Ave Kansas City, KS 66101-3504

09/06/2016 League of Women Voters membership dues - Miscellaneous $25.00 1730 M St NW Ste 1000 Washington, DC 20036-4570

08/22/2016 Armourdale Renewal Association dues - Miscellaneous $20.00 730 Osage Ave Kansas City, KS 66105-2026

10/20/2016 Amigos Grill and Cantina food - Fundraising Expenses $485.36 2737 S 47th St Kansas City, KS 66106-3629

Subtotal This Page $969.671

Page_Q_of ~

Page 29: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCllEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

10/16/2016 Morris Neighborhood Group contribution - Donation/Contrib $50.00 7120 Gibbs Rd Kansas City, KS 66106-5146

07/25/2016 Kansas Contractors Assoc. donation - Donation/Contrib $100.00 800 SW Jackson St Ste 100 Topeka, KS 66612-1216

10/07/2016 Lee's Printing invitations - Printing $52.38 804 Central Ave Kansas City, KS 66101-3504

09/08/2016 NGPVan Fundraising Software - $450.00 110115th St NW Electronics/Computers Ste 500 Washington, DC 20005-5006

08/19/2016 Lee's Printing notecards - Printing $49.11 804 Central Ave Kansas City, KS 66101-3504

10/17/2016 Kansas Democratic Party contribution - Donation/Contrib $1 ,000.00 501 SE Jefferson St Ste 30 Topeka, KS 66607-1173

10/11/2016 Post Office stamps - Postage/Shipping $34.00 3400 Strong Ave Kansas City, KS 66106-7400

09/19/2016 NGPVan Fundraising Software - $450.00 1101 15th St NW Electronics/Computers Ste 500 Washington, DC 20005-5006

09/09/2016 Yoder Office Supply Acct flag - Miscellaneous $22.95 7325 W 79th St Overland Park, KS 66204-2908

... Subtotal This Page · 1 $2,208.441

Page _H_ of _Ji_

Page 30: 0 0 0 0ethics.ks.gov/CFAScanned/Senate/2016ElecCycle/201610/S06PP_amen… · $27,138.80 : 2. Total Contributions and Other Receipts (Use Schedule A) . $15,135.00 : 3. Cash available

SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS

Pat Pettey (Name of Candidate, Party Committee or Political Committee)

Date Name and Address Purpose of Expenditure or Disbursement Amount

09/27/2016 Argentine Betterment Corporation silver city parade - Donation/Contrib $50.00 PO Box6613 Kansas City, KS 66106-0613

10/05/2016 BNV Printing mailers - Printing $2,800.00 800 N Market St Wichita, KS 67214-3520

10/21/2016 Lee's Printing thank you cards - Printing $60.02 804 Central Ave Kansas City, KS 66101-3504

09/19/2016 Our Lady of Unity donation - Donation/Contrib $75.00 2646 S 34th St Kansas City, KS 66106-4260

10/07/2016 Kansas Democratic Party Services - Miscellaneous $6,000.00 501 SE Jefferson St Ste 30 Topeka, KS 66607-1173

09/06/2016 Post Office stamps, shipping - Postage/Shipping $49.30 3400 Strong Ave Kansas City, KS 66106-7400

Complete if last pae:e of Schedule C Total Itemized Exnenditures This Period $12,212.43

Total Unitemized Exnenditures $50 or less $5.00

TOT AL EXPENDITURES & OTHER DISBURSEMENTS $12,217.43

TIDS PERIOD (to line 4 of Summary)

Subtotal This Page . I $9.034.32 I Page~of~