CAMPAIGN FUND REPORT TITLE PAGE

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr

Name of Treasurer Sarah Raminhos

Name as Appears on Account

Checking Account Sandy Spring Bank Citizens for Julie Palakovich Carr

Other Accounts

•eNOTE: All pages of the Campaign Fund Report must be submitted when filinge

Bank Name

Due Date

Please Check Report: ,--, 10/03/2013 • Initial Pre-Election Report , __ J

All transactions through 09/30/2013 MUST BE HAND DELIVERED BY 5:00 PM

,- - ., I I 10/28/2013 • Second Pre-Election Report

All transactions from 10/01/2013 to 10/27/2013 MUST BE HAND DELIVERED BY 5:00 PM

I XI 12/05/2013 • Initial Post Election Reporte, __ ... All transactions from 10/28/2013 MAY BE MAILED (Must be Post-Marked by 12/05/2013)

IF HAND DELIVERED MUST BE RECEIVED BY 5:00 PMe

I I 11/08/2014 • Annual Report* , __ .J MAY BE MAILED (Must be Post-Marked by 11/10/2014)

IF HAND DELIVERED MUST BE RECEIVED BY 5:00 PM

Reports Are Mailed or Hand Delivered to:

Office of the City Clerk ,, -, · City Hall

City of Rockville

111 Maryland Avenue

Rockville MD 20850

Status of Report (please check one):

The report is:

�the current due date.

01 and the account has been/will be terminated.

Omendment to a previous report filed on (Date)

*Any deadline that falls on a day that City Hall i s closed (e.g, weekend, holiday, inclement weather) will be extended to thee

next City business day.e

12/3/1312:02 PM

Amended Report: 0 Yes 0 No

CAMPAIGN FUND REPORT SUMMARY SHEET

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr

CONTRIBUTIONS A I Contribution Receipts B.0 I Campaign Committees0C.0 Transfers in from Other Treasurers0D.0 Other0E.0 In-Kind Contributions0F. TOTAL RECEIPTS (A through E) EXPENDITURES G. Salaries and other Compensation0H. Office Rent, Supplies, other Expenses0I.0 Campaign Materials0J.0 Direct Mail0K. : Postage/Shipping0L. Fund-raising0M.0 Equipment Purchase0N. Transfers to Another Treasurer00. Transfers to petty cash0P.0 Media Advertising0Q. Interest payment0R. Other0S.0 In-Kind Contributions (Same as E) Note: Non Add Line T. I TOTAL EXPENDITURES (Add Lines G through RJ LOANS U.0 I Loans Received0V.0 I Loan Principal Repayment0SUMMARY

Current Period 275.00

0.00 0.00 0.00

20.00 295.00

Current Period 0.00

20.00 101.76 283.72 833.95

0.00 0.00 0.00 0.00

250.00 0.00 8.15

20.00 1,497.58

Current Period 0.00 0.00

Current Period

Initial Post Election Report

Prior Period(s) 7,790.00

0.00 0.00 0.00

110.68 7,900.68

Prior Period(s) 250

186.94 2842.47

262.99 895.3

0 0

2000 0 0 0

85.56 110.68

6,523.26 Prior Period{s)

ol 0

Prior Period(s)

Page 2 of 10

Total 8,065.00

0.00 0.00 0.00

130.68 8,195.68

Total 250.00 206.94

2,944.23 546.71

1,729.25 0.00 0.00

2,000.00 0.00

250.00 0.00

93.71 224.39

8,020.84i Total

0.00 0.00

Total W.0X. Y. Z. AA.

! Balance Forward (From last report Current Period line EE)0jAdd total receipts (Same as line F)0Add Loans (Same as line U)0Less total expenditures (Same as Line T)0Less loan principal repayment {line V)

1,377.42 295.00

0.00 1,497.58

7,900.68 0.00

6,523.26

8,195.68 0.00

8,020.84 0.00

174.84 174.84

0.00

174.84

0.00 0.00 BB. cc. DD.0EE.

ITOTAL (!N-AA) Balance in Checking Account0Balance in Savings0TOTAL BALANCE (CC-DD)

CERTIFICATIONS: WE SWEAR THAT THE INFORMATION PROVIDED IS TRUE AND COMPLETE TO THE BEST OF OUR KNOWLEDGE AND BELIEF.

� �v4__ /)_-?, -a.o1,3 12/J'/is CAi?DIDATE DATE TRJ�f:� DATE

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Amended Report: DYes &No Initial Post Election Report

CAMPAIGN FUND REPORT - SCHEDULE 1 CONTRIBUTION RECEIPTS

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 3 of 10 ... , . , ,., •. _':,'.° ·. . . .·•·. ·':, _;, ·- \.'""', .: -.

Contributor Information Payment Type Source

Date Name

' i

i Address Check Cash Non-Campaign

Committee Campaign Committee

10/28/13 Jeffrey Watters !2802 Albemarle Dr. Alexandria, VA 22303 X 100.00 10/29/13 Stephen Edwards 1391 Kersey Lane Rockville, MD 20854 X 100.00 10/31/13 Nancy Breen 713 Ivy League Lane Rockville, MD 20850 X 25.00 11/06/13 Kate Osten 128 Calvert Rd, Rockville, MD 20850 ------ X 50.00

--------------i

-------------------------- ------·

.

$275.00 $0.00

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Amen�mi�: !Jo Initial Post Election Report

CAMPAIGN FUND REPORT - SCHEDULE 1A TRANSFERS FROM ONE TREASURER TO ANOTHER

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 4 of 10

N/A N/A N/A

$0.00

Amended Report: 0Yes Cs] No Initial Post Election Report

CAMPAIGN FUND REPORT -SCHEDULE 1B

OTHER RECEIPTS AND IN-KIND CONTRIBUTIONS

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr

""-.,-,: _ "', -�----lil! _ 2i��� _cJE1'ifls[@;:;{:

": '" 0' <.. ' . y�- •."\ H jll'J!�

·"• •·• .-.c ;,.-,-£,,:

Date Contributor Information Received Name Address

10/31/13 Eric & Julie Palakovich Carr 107 Charles St. Rockville MD 20850

11/30/13 Eric & Julie Palakovich Carr 107 Charles St. Rockville MD 20850

_____ JL, .. Loans

Received

Page 5 of 10

..-.__ �-: _ I13-l : '""· � Other In-Kind -- - --(Misc) Contributions (value in dollars per item)

10.00 Hosting Website on Server

10.00 Hosting_Website on Server

.

........ ·•··············· ····-···

.

.

--------- ------······

$0.00 $0.00 $20.00

[15]

Ame0ed RepoO 0Yes [] No Initial Post Election Report CAMPAIGN FUND REPORT - SCHEDULE 2

SCHEDULES Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 6 of 10

EXPENDITURE CLASSIFICATION 1161 [171 1181 [19] [20] [21]

t'(enT/UTC To Whom Paid/Received From (In-Kind) Check#/ In Total Salaries/ Su pis/Other Campaign Date Name Address Kind (!Kl Amount Comp. Supls Materials

10/30/13 PaypalFee 1 221 N. First St. San Jose,CA 3.20 I UL ' ,�arrows Lane0

2 11/01/13 Direct Mail Express Silver Spring, MD 20906 95 1,117.67

11/04/13 Paypal Fee 3 221 N. First St. San Jose.CA 3.20 IV,J I n.Ovr..vlue r-lr..v

4 11/04/13 Staples Rockville, MD 20852 101.76 101.76 1vv I vvluvvw 1,Y. tv181110

5 11/04/13 Facebook Advertising Park, CA 94025 50.00 I 1vv, vvluvvw ,,u.. ,v,en,o

6 11/04/13 Facebook Advertising i Park, CA 94025 50.00 1vv, vvluvW '''-'-· ,v,e1110

11/05/13 Facebook Advertising Park, CA 94025 7 50.00 1vv I vvlllOW '''-'· ,v,e,,.o

8 11/07/13 Facebook Advertising Park, CA 94025 50.00 1601 Willow Rd. Menlo

9 ' 11/08/13 Facebook Advertising Park, CA 94025 50.00

10 11/08/13 PaypalFee 221 N. First St. San Jose,CA 1.75 , , u 1 1..,m,r,"" v,.

11 10/31/13 Eric & Julie Palakovich Carr Rockville, MD 20850 In-Kind 10.00 10.00 1u, vr11::1.nes .... �.

12 11/30/21: Eric & Julie Palakovich Carr Rockville, MD 20850 In-Kind 10.00 10.00

13 0.00

14 0.00

15 0.00

' 16: 0.00

$1,497.58 $0.00 $20.00 $101.76

[22)

Direct Mail

[231

Postage/ Shippina

283.72 833.95

$283.72 $833.95

Amended Report: D Yes 0 No Initial Post Election Report

CAMPAIGN FUND REPORT - SCHEDULE 2 EXPENDITURES

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 7 of 10

EXPENDITURE CLASSIFICATION [24} [25] [26) [271 ; [28] [29}

'

[30) [31} [32] Purchase of Transfer to another Media Interest

FundraisinQ Equipment Treasurer Pettv Cash i Advertising Payment Loan Principal Savings/Interest

Other Repayment Bearing Account

1 3.20

2

3 3.20

4

5 50.00

6 50.00

7 50.00

8 50.00

91 50.00

101 1.75

11

12

13

$0.00 $0.00 $0.00: $0.00 $250.00 $0.00 $8.15 $0.00 $0.00

14

15

16

Amended Report: 0Yes IS] No Initial Post Election Report

CAMPAIGN FUND REPORT - SCHEDULE 2A

PETTY CASH REPORTING FORM

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 8 of 10

N/A N/A N/A N/A

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. / -,';;:".;.:, __ -,-�- :_·-,,;

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� ;i'!Jiif' 1:1:35]

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Written Consent

DYes [8J No Amended Report: Initial Post Election Report

OUTSTANDING OBLIGATIONS

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 9 of 10

,: .. - 13Pl .. ' .· -•-•-[33] : " -

Name & Address of Date Obligation Balance of Creditor Incurred Previously Filed Filed Herewith Loan Balance Due Description

NIA NIA NIA NIA NIA NIA NIA

i

'

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Chapter 8 of the Rockville City Code provides that no loan may be made to a candidate, or accepted on behalf of the candidate, without written consent of the candidate. A copy of the written consent shall be furnished to the lender at the time of the loan. This consent is given on Schedule 4 of the Campaign Fund Reporiing forms for the transacuon period for which the load is made.

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Amended Report: Oves � No Initial Post Election Report

CAMPAIGN FUND REPORT: Schedule 4 REPORT ON LOAN TO CAMPAIGN FUND ACCOUNT

Name of Campaign Fund Account: Citizens for Julie Palakovich Carr Page 10 of 10

This schedule must be attached to the Campaign Fund Report for the transaction period in which the loan was made. A copy should also be given to the lender.

I. CONSENT OF RECIPIENT Please print

in the amount of

N/A

NIA

, hereby acknowledge receipt of a loan on

made payable to N/A

NIA

(Date)

from NIA A copy of this consent has been supplied to the lender.

(Signature of Candidate) NIA

(Date)

II. TERMS OF LOAN Please print

Name of Lender: --'--'N:..:./A-'-------'---------------------------------------

Address of Lender: N/A

Are the terms of the loan stated in writing? N/A Yes N/A No

Schedule for repayment: N/A

Interest rate: N��/A�------------------------------------------------

N/A (Signature of Lender) (Date)