Free orgreceiptandexpenditurest10.indd - Wyoming

ORGANIZATION STATEMENT OF RECEIPTS AND EXPENDITURES W.S. 22-25-106(b)
Any organization supporting or opposing a ballot proposition or an initiative or referendum petition drive shall file a fully itemized campaign report within the filing deadlines outlined below. (Organizations are prohibited from contributing to candidates and political parties, but may support or oppose ballot propositions or initiative or referendum petition drives). Organizations may receive contributions from corporations, partnerships, etcetera. The general rule is that an organization should note and keep track of all campaign contributions no matter how small. The law only requires you to itemize on this form contributions (receipts) totaling $25.00 or more. However, please keep in mind that if you receive $5.00 from a contributor who then later gives you $20.00, you must report the total $25.00 contribution on this form. Any organization violating the campaign reporting provisions of the Wyoming Election Code is guilty of a misdemeanor and punishable by not more than six (6) months imprisonment in the county jail, a fine of not more than $1000, or both.

FILING DEADLINES If supporting or opposing a ballot proposition: If the ballot proposition appears on the General Election ballot: Receipts only before General Election - October 26, 2010 (at least 7 days before General Election) If supporting or opposing a ballot proposition at any other election: Receipts only at least seven (7) days before the election If supporting or opposing an initiative or referendum petition drive Receipts only before General Election - October 26, 2010 (at least 7 days before General Election) FILING OFFICES County Clerk - Supporting or opposing a local ballot proposition. Mail to: the local County Clerk's Office. Contact information may be accessed at: http://soswy.state.wy.us Secretary of State - Supporting or opposing a statewide ballot initiative or referendum petition drive. Mail to: Secretary of State, 200 W. 24th St., Cheyenne, WY 82002

4/2009 orgreceiptandexpenditures10

RECEIPT AND EXPENDITURE REPORT
For Office Use Only

Statement covers period: From: To:

Type of Report: (Check One)
General Amendment Petition Drive Other Organization Name Address City State Zip Phone

Supporting or opposing the following ballot proposition, or initiative or referendum petition drive:

Summary for this filing period: A. Receipts 1. 2. 3. 4. 5. 6. 7. 8. B. C. Total individual contributions (page 2) Total contributions from PACs (page 3) Total contributions from Political Parties (page 3) Total contributions from corporations, organizations, associations, etc. (page 4) Total Anonymous Contributions (page 4) Total Loans/Obligations (page 5) Total In-Kind Contributions (page 5) Total unitemized receipts (page 5) (Unitemized receipts are defined as contributions less than $25) $ $ $ $ $ $ $ $ $ $

Total Receipts for this Filing Period (Sum A1 - A8) Total Expenditures for this Filing Period (page 6)

I certify that I have examined this statement, and to the best of my knowledge and belief, it is true, correct and complete. Signature of Chairman (Required) Chairman E-mail Address Signature of Treasurer (Required) Treasurer E-mail Address

Date 1

Date

Itemization of Receipts and Expenditures
(Use Additional Sheets as Necessary)

Contributions from Individuals
Name Address
(City, State & Zip)

Date

Amount

2

Contributions from Political Action Committees
Name (Identify by full name) Address
(City, State & Zip)

Date

Amount

Contributions from Political Parties
Name Address
(City, State & Zip)

Date

Description of Contribution

Amount

3

Contributions from Corporations, Organizations, Associations, etc.
These groups are prohibited from making contributions to candidates and political parties. However, these groups may make contributions to support or oppose a ballot proposition or an initiative or referendum petition drive. Name Address
(City, State & Zip)

Date

Description of Contribution

Value or Amount

Anonymous Contributions
Anonymous contributions are those contributions whose orgins cannot be determined, i.e., "pass the hat" contributions. An anonymous contribution does not mean a contributor may donate to the candidate or PAC with the understanding the contributor's name will not be reported. Event Date Amount

I do not know, nor can I ascertain, the origin of the above anonymous contributions.

Chairman or Treasurer 4

In-Kind Contributions
Name Address
(City, State & Zip)

Date

Description of Contribution

Value or Amount

Loans/Obligations

Date

Amount

Unitemized Receipts
(Receipts under $25.00. For example, you have a chili dinner. Tickets are $10.00 each and you sell 500 tickets. You may report these in aggregate here by reporting $5,000.00.) Event (if applicable) Date Amount

5

Expenditures
Name Address
(City, State & Zip)

Purpose

Date

Amount

Total Expenditures $ 6