HomeMy WebLinkAboutCCDR: Richard MohrigNo
r
SEC FORM CCDR
State of Georgia RECE1ED
Campaien Contribution Disclosure Report
1. Report Type 2. Filoitis being made on behalf of (Sel9pt One): ii2g jri my
(Select One) andidate or Public Official p(S fG� 9� 0 �u1N
Office Sought or Held: CCOO( I L �G%�t?/t%. ��I � J C�vU t
riginal Report (Include cou ry, municipadistrict, post orjudicial circuit) CLERK
�`( OF 11 MTON
Committee Name: i�'t C> 5 lity eLS$'
❑ Amended Report�r Use Earlier of Post
v" C6 � Mark or Hand
Amendment # ❑ Report of Organization or Person Other than Candidate's Campaign Committee
Delivered Date
3. Id
(1)
ng and Contact Information
GC,, krk :J-4 nla c /1(,i
Full Name of Candidate or Non -Candidate Campaign Comi>?hvKe
(3) j3goy Bkj%'re`s pr,., Al
GA
(2) 67
Today's Date
3o491(
Mailing Address / p �^ /City State Zip Code
(4) �78) 7Z3 gb30 and/ or (7� 663 'b� G
Contact Phone Number (We will understand the release of this information as permission to call your office if necessary)
(5) If a Candidate or Public Official, is there a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the
campaign, or file the reports? ❑ Yes (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes
(7) If so, complete the following:
Name of Chairperson and/or Treasurer of Committee
4. Period for which you are Reporting
You Must Check Only One Box
My Non Election Year
My Election Year
Run -Offs
(Report required only if you are in a Run -Off
Election)
Special Elections
(Report required only if you are in a Special
Election)
❑ June 30, (year)
❑March 31, (year)
❑6 days before Primary
❑ 15 days before
Run -Off, (year)
Special Primary,
Dec. 31, (year)
June 30, (year)
❑6 days before General
(year)
Run -Off, (year)
*Persons elected to office in each year following
❑ September 30, (year)
❑6 days before Special
15 days before
the year in which the election occurs
Primary Run -Off,
Special, (year)
Per ons leaving office with excess funds until
such funds are expended as provided in the Act
❑ October 25, (year)
(year)
*Unsuccessful candidates with excess funds, or
❑6 days before Special
[:]Dec. 31, (year)
who receive contributions to retire debt incurred,
until such funds are expended, or such unpaid
015ecember 31, year)
Run -Off, (year)
debts are satisfied (December 31 filing only)
Verification by Oath or Affirmation
State of C9 J,6 � 1A County of
<j u rw r I r 1 y being duly sworn (affirm), depose and say
that the information in this report form is complete, true, and correct. Further, I affirm that the contents in this report
are the same as t e ^ontents in the electronic filing submitted, if also electronically filed.
MaLk".1—A—k 20
Sworn to and subscribed before n ,i
f�Jj
!!Signa e of Notary Public a. Signature ofCandidat
JEANETTE R MARCHIAFAVA b. Organization/Chairpe reasurer
Nota Public Fulton Co GA
IMy Commission expires
who
My Commis 'on Expires August 29, 2009
fails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor.
SEC FORM CI:DR
nni
State of Georgia
Campaign Contribution Disclosure Report
Summary Report
CONTRIBUTIONS RECEIVED
1
I e:
co butions
In -Kind
Value
Cash Amount
The following contributions, including Common Source, to report:
A. If this is the first time to file a disclosure report for the current office sought,
ENTER 0 in both columns (one time only); or
B. If this is the first report of this Reporting Cycle*, ENTER 0 in the in-kind column
and list any net balance on hand brought forward from the previous reporting cycle
2
in the cash amount column (Line 13 of previous report, or total funds left over at
year end of previous cycle); or
C. If this filing is the second or subsequent filing or this Reporting Cycle, list totals
from Line 6 of previous report in both the in-kind and cash amount columns.
Total amount of all contributions of $101.00 or more received in this reporting period.
3
Each such contribution must be listed on the "Listed Contributions Received" page.
3a
All loans received this period.
3b
Interest earned on campaign account this period.
Total amount of all separate contributions of less than $101.00 each that were
4
reported in this reporting period. "Common Source" contributions must be aggregated
on the "Listed Contributions Received" page.
Total contributions reported this period.
5
Line 3 +3a+3b+4)
Total contributions to date. Total to be carried forward to next report of this reporting cycle*.
6
(Line 2 + 5)
EXPENDITURES MADE
7
N expgnditures to report.
In -Kind
Value
Cash Amount
e o ow ex en itures to report:
Total expenditures made and reported prior to this reporting period. If this is the
8
first report of this Reporting Cycle*, ENTER 0.
(Line 12 of previous report)
9
Total amount of all expenditures of $101.00 or more made in this reporting period.
Total amount of all separate expenditures of less than $101.00 each that were made
10
in this reporting eriod.
Total expenditures reported this period.
I I
(Line 9 + 10)
Total expenditures to date. Total to be carried forward to next report of this reporting cyclet
12
(Line 8 + 11)
Net balance on hand.
UIA
13
Line 6 - Line 12)
.. :;
* O.C.G.A. 21-5-34(b)(1)(D)(ii) A reporting cycle shall commence on January I ofthe year in which an election is to be held for the public office to which a candidate
seeks election and shall conclude:
(1) At the expiration of the term of office if such candidate is elected and does not seek reelection or election to some other office;
(11) On December 31 of the year in which such election was held if such candidate is unsuccessrul; or
(III) If such candidate is successful and seeks reelection or seeks election to some other office the current reporting cycle shall end when the reporting cycle for
reelection or for some other office begins
Public Officer/Candidate/Non-Candidate Committee Name
a
SEC FORM CCDR
State of Georgia
Campaign Contribution Disclosure Report
Outstanding Indebtedness
1
Outstanding indebtedness at the beginning of this period.
2
Loans received this period.
3
Deferred payment of expenses this period
4
Payments made on loans this period.
5
Credits received on loans this period.
6
Payments this period on previously deferred expenses.
Total indebtedness at the close of this reporting period.
f�
2
(Line 1+2+3-4-5-6)
1 Outstanding indebtedness at the beginning of this period.
2 Loans received this period.
3 Deferred payment of expenses this period
4 Payments made on loans this period.
5 Credits received on loans this period.
6 Payments this period on previously deferred expenses.
7 Total indebtedness at the close of this reporting period.
(Line 1+2+3-4-5-6)
1 I Outstanding indebtedness at the beginning of this period.
2 Loans received this period.
3 Deferred payment of expenses this period
4 Payments made on loans this period.
5 Credits received on loans this period.
6 Payments this period on previously deferred expenses.
7 Total indebtedness at the close of this reporting period.
(Line 1+2+3-4-5-6)
* Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special,
Run -Off Special Primary)
Public Officer/Candidate/Non-Candidate Committee Name V ""
SEC FORM CCDR
State of Georgia
Campaign Contribution Disclosure Report
Listed Contributions Received of $101.00 or More
Full Name of Contributor
Mailing Address
(PAC Affiliation if applies)
Contributor
Election
Cycle**
Cash
Amount
In -Kind Contributions
Received Date
Contribution Type*
a. Occupation
b. Employer
Estimated Value
Description
Page Total
The Act requires all public officers, candidates, and campaign committees to list contributions received and expenditures made which are
individually $101.00 or more and to disclose the total amount of all contributions received and expenditures made which are individually
less than $101.00.
* Contribution Type (Monetary, In -Kind, Loan, Common Source, Credit Received on Loan)
"Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special,
Run -Off Special Primary)
Public Officer/Candidate/Non-Candidate Committee Name V`�"" ^ �� Page of
SEC FORM CCDR
REV OW2006
State of Georgia
Campaign Contribution Disclosure Report
Listed Expenditures Made of $101.00 or More
List Name and Mailing Address
of Recipient
Expenditure Date
Expenditure Type*
Occupation and Place
of Employment
Expenditure Purpose
Amount Paid
Page Total $'10
The Act requires all public officers, candidates, and campaign committees to list contributions received and expenditures made which are
individually $101.00 or more and to disclose the total amount of all contributions received and expenditures made which are individually
less than $101.00.
* Expenditure Type (Expenditure, In -Kind, Loan Repayment, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment,
Payment on Deferred Expense)
c
Public Officer/Candidate/Non-Candidate Committee Name Page of
yr.1-
JEC FORM CCDR
—, n, nm
State of Georgia
Campaign Contribution Disclosure Report
Addendum Statement
I The Addendum Statement should be used for explanation of any addiponal information needed to complete an accurate filing of this report.
Public Officer/Candidate/Non-Candidate Committee Name Page of