State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2006 Election Year

Candidate or Committee Name
North Central West Virginia Democracy for America
Candidate or Committee's Treasurer
Wayne Worth
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
163 W. Pike Street, Apt. K 
Office Sought (for Candidates)
City, State, Zip Code
Clarksburg, WV 26301
Daytime Phone #

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 25-Mar 31, 2006
Pre-primary Report
Due Apr 22-Apr 29, 2006
Post-primary Report
Due Jun 03-Jun 09, 2006
General - First Report
Due Sep 02-Sep 08, 2006
Pre-general Report
Due Oct 21-Oct 28, 2006
Post-general Report
Due Dec 02-Dec 08, 2006

Check if Applicable:

Amended Report
You must also check box of appropriate reporting period
Final Report
Zero balance required.
PAC must also file Form F-6 Dissolution

Non-Election Cycle Reporting Period:

Annual Report 2006 Calendar Year
Due last Saturday in March or within 6 days thereafter

Report Totals

Fill in totals at the completion of the report.

RECEIPTS OF FUNDS: Totals for this Period
Contributions  $0.00
Monetary Contributions from all Fund-Raising Events +$5,280.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$5,280.00
In-Kind Contributions +$0.00
Total Contributions: =$5,280.00
Other Income  $114.72
Loans Received +$0.00
Total Other Income: =$114.72
Unpaid Bills  $0.00
Outstanding Loans +$0.00
Total Debts: =$0.00
(Add total contributions from all reports)
Beginning Balance
(ending balance from previous report)
Total Monetary Contributions +$5,280.00
Total Other Income +$114.72
Subtotal: a. =$6,285.71
Total Expenditures Paid  $2,029.75
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$2,029.75
Ending Balance:
(Subtotal a. - Subtotal b.)

*Cannot be negative balance
(Add total expenditures from all reports)

$250.00 or LESS

 Subtotal of contributions of $250.00 or less 

More than $250.00

 Subtotal of all contributions of more than $250.00
Subtotal of all contributions of $250 or less
Total Contributions:

Fund-Raising Events

All monetary contributions received at a fundraiser must be reported in the Event Summary below.
If contributor's name and amount are not listed, the contribution must be turned over to the West Virginia General Revenue Fund. The only exception to this rule may apply to political party executive committees. (WV Code 3-8-5a).

HCDFA Fundraising Dinner Event Summary

Date of Event: 5/5/2006 Total Monetary Contributions:  $5,280.00
Type of Event: Formal sit-down dinner Total Expenditures: -$1,749.79
Name of Place Held: Village Square Enterprises NET RECEIPTS: =$3,530.21
Address of Place Held: Rt. 19 S
Clarksburg, WV 26301
Total In-Kind Contributions Related to the Fundraiser  $0.00

$250 or Less

5/5/2006Greg Cunningham$60.00
5/5/2006Chuck Walsh$30.00
5/5/2006Carl Loy$30.00
5/5/2006Cherry Moser$30.00
5/5/2006Susan Thomas$30.00
5/5/2006Duck Webster$30.00
5/5/2006Mark Gorby$30.00
5/5/2006Cheryl Romano$30.00
5/5/2006Keith Marple$30.00
5/5/2006Margaret Bailey$30.00
5/5/2006BK VanHorn$30.00
5/5/2006Dan Thompson$30.00
5/5/2006Tracy Cook$30.00
5/5/2006Sherry Haynes$30.00
5/5/2006Ron Haynes$30.00
5/5/2006Shauna Jones$30.00
5/5/2006Tammy Snowden$30.00
5/5/2006Tim Manchin$30.00
5/5/2006Gene Kennedy$30.00
5/5/2006Stephanie Kennedy$30.00
5/5/2006Beth Trunzo$30.00
5/5/2006Pat Brougham$30.00
5/5/2006Martin Shaffer$30.00
5/5/2006Sam Cann$60.00
5/5/2006Rebekah Gibson$30.00
5/5/2006Denise Binion$30.00
5/5/2006Tod Lewark$30.00
5/5/2006Al Powell$30.00
5/5/2006Jerry Reel$30.00
5/5/2006Lori Hostuttler$30.00
5/5/2006Nora Hostuttler$30.00
5/5/2006Mike Hostuttler$30.00
5/5/2006Matt Hostuttler$30.00
5/5/2006C Moodispaugh$30.00
5/5/2006Nathan Drain$30.00
5/5/2006Theondra Robinson$30.00
5/5/2006T. J. Shaffer$30.00
5/5/2006Jason Drain$30.00
5/5/2006Thomas Drain$30.00
5/5/2006Martha Hawkins$30.00
5/5/2006James Scott$30.00
5/5/2006Nina Bryan$30.00
5/5/2006Lilly Junkins$30.00
5/5/2006Jerry McKeen$30.00
5/5/2006Tim Bryan$30.00
5/5/2006Renee Book$30.00
5/5/2006Tim Bonnett$30.00
5/5/2006Tina Bonnett$30.00
5/5/2006Rocky Romano$30.00
5/5/2006Ashley Summers$30.00
5/5/2006Sarah Summers$30.00
5/5/2006Belinda Biafore$30.00
5/5/2006Belinda Biafore$30.00
5/5/2006Meg Cianfrocca$30.00
5/5/2006Barb Cianfrocca$30.00
5/5/2006Rocky Cianfrocca$30.00
5/5/2006Margaret Biafore$30.00
5/5/2006Dana Summers$30.00
5/5/2006Randy Belcastro$30.00
5/5/2006Ryan Nicewarner$30.00
5/5/2006Tim Brady$30.00
5/5/2006Chris Cleghorn$30.00
5/5/2006Anthony Mancuso$30.00
5/5/2006Greg Schillace$30.00
5/5/2006Rena Cutlip$30.00
5/5/2006George Fordham$30.00
5/5/2006Desiree Evans$30.00
5/5/2006Tim Ferrell$30.00
5/5/2006Elizabeth Keough$30.00
5/5/2006David Book$30.00
5/5/2006Mike Romano$60.00
5/5/2006David Romano$60.00
5/5/2006Mike Audia$30.00
5/5/2006Bill Renelli$30.00
5/5/2006Bernard Fazzini$90.00
5/5/2006Joe DeLong$30.00
5/5/2006Jim Reaser$30.00
5/5/2006Jim Smith$90.00
5/5/2006Louis Marks$30.00
5/5/2006Steve McDaniels$30.00
5/5/2006Donny Snyder$30.00
5/5/2006John Scott$30.00
5/5/2006Susan Wilcher$30.00
5/5/2006Bob Carey$30.00
5/5/2006Crystal McWhirt$30.00
5/5/2006Talley Sergent$30.00
5/5/2006Betty Cottrill$30.00
5/5/2006Charlotte Link$30.00
5/5/2006Jim Link$30.00
5/5/2006Robert Stemple$30.00
5/5/2006Ionia Stemple$30.00
5/5/2006Pam Wilson$30.00
5/5/2006David Cutlip$60.00
5/5/2006Lynn Cutlip$30.00
5/5/2006Lu Bush$30.00
5/5/2006Jim Bush$30.00
5/5/2006Joe Minard$60.00
5/5/2006Lemeul Muniz$30.00
5/5/2006M. Farnsworth$30.00
5/5/2006Frank Angotti$60.00
5/5/2006Paul Howe$30.00
5/5/2006Ron Fragale$60.00
5/5/2006Karen Bowers$60.00
5/5/2006Tim Miley$90.00
5/5/2006Ron Watson$60.00
5/5/2006Larry Watson$30.00
5/5/2006Delores Yoke$60.00
5/5/2006Richard Iaquinta$90.00
5/5/2006Andrew Banko$90.00
5/5/2006Julie Rea$60.00
5/5/2006Robert Miley$30.00
5/5/2006Sandra Miley$30.00
5/5/2006Sally Egan$60.00
5/5/2006Bob Fox$60.00
5/5/2006Anthony Barberio$60.00
5/5/2006Judy Hart$30.00
5/5/2006Terry Stamp$60.00
5/5/2006Martin McKeen$90.00
5/5/2006Jennifer Banko$30.00
5/5/2006Anna Smucker$60.00
5/5/2006Kristy Nelson$60.00
5/5/2006Robin Stultz$60.00
5/5/2006Jerry E. McKeen II$90.00
5/5/2006James Marino$90.00
5/5/2006Mike Wilt$60.00
5/5/2006Kirk Cistaro$30.00
5/5/2006Dee Corcoran$30.00
5/5/2006Nikki Henderson$30.00
5/5/2006Dorothy Underwood$30.00
5/5/2006Christa Shafer$60.00
5/5/2006Janet Scott$30.00
5/5/2006Greta Brannon$60.00
5/5/2006Beth Crowder$60.00
5/5/2006Mark Benincosa$30.00
5/5/2006Mary Ellen Sullivan$30.00
5/5/2006Travis Friel$60.00
 Subtotal of event contributions of less than $250.00 $5,280.00

More than $250

 Event contributions of $250 or more: 
Event contributions of less than $250: 
Total Contributions: 

Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
5/3/2006Membership DuesTen Dollars per member$60.00
5/3/2006Bumper StickersSold to members at meeting.$24.72
5/5/2006Membership duesTen Dollars per member$30.00
  Total Other Income: $114.72

In-Kind Contributions

DateName and Contributor InformationDescription of ContributionValue
  Total In-Kind Contributions: $0


West Virginia Code: §3-8-5f. Loans to candidates, organizations or persons for election purposes.

"Every candidate, financial agent, person or association of persons or organization advocating or opposing the nomination or election of any candidate or the passage or defeat of any issue or item to be voted upon may not receive any money or any other thing of value toward election expenses except from the candidate, his or her spouse or a lending institution. All loans shall be evidenced by a written agreement executed by the lender, whether the candidate, his or her spouse, or the lending institution. Such agreement shall state the date and amount of the loan, the terms, including interest and repayment schedule, and a description of the collateral, if any, and the full names and addresses of all parties to the agreement. A copy of the agreement shall be filed with the financial statement next required after the loan is executed."

The loan agreement must include all items asked for in the statute. (See above.) The loan agreement does not have to follow a certain format; generally, if all the required information is listed, any format is acceptable. Candidates or political committees that take out a loan for the campaign through a bank or other commercial lending institution must include a copy of the loan agreement executed with that bank or institution. Candidates should not take out loans which are partially for personal use and partially for the campaign. It is almost impossible to keep reporting straight in this case. Any money a candidate contributes to his or her campaign committee with the hope of repayment must be treated as a loan and reported in this section. When a candidate determines that no further repayment can be expected, the loan can be reported as repaid in this section by entering the amount left to repay in the repayments column and reporting the same amount as a contribution from the candidate on Page 2. These loans must be executed in writing. Caution: Candidates may not carry outstanding loans from one campaign to the next. Each campaign is separate. Funds from a current campaign cannot be used to repay a loan from a previous campaign.

How To Report Loans

  1. Each loan for your campaign should be listed on a separate line. (Each time you loan money to the campaign or get a loan, it is considered to be a separate loan.) Include the following information ont he form below.
    1. loans(s) from prior reporting periods and the balance of each loan (Col A.) If a payment was made on the loan, list that in Col. C. Any loan that was repaid in previous reporting periods does not need to be listed.
    2. new loans, the amount (Col. B), any repayments (Col. C), and the balance (Col. D.)
  2. Attach a copy of the loan agreement for each loan received during the reporting period.

Loans (Continued)

Bank Loans: List name & address or financial institution
Candidate or Candidate's Spouse Loans: List name, residence and mailing address of person(s) making or cosigning loan
Column A
Balance of previous loan at end of period
Column B
Amount of new loan received during period
Column C
Repayments during period
Column D
Balance outstanding at end of period
Amount Date Amount Date Amount Amount
Loans Received Repayment of Loans Outstanding Loans
Totals: $0.00 $0.00 $0.00

Itemized Expenditures

DateName of Person or Vendor And AddressPurposeAmount
4/30/2006 PDQ Printers
124 S. 3rd Street
Clarksburg, WV 26301
5/2/2006 MCM Print Shop
1315 Buckhannon Pike
Nutter Fort, WV 26301
5/2/2006 US Postal Service
West Pike Street
Clarksburg, WV 26301
5/3/2006 Justine Marino
700 Milford Street
Clarksburg, WV 26301
5/4/2006 Justine Marino
700 Milford Street
Clarksburg, WV 26301
5/5/2006 Village Enterprises
Rt. 19 South
Clarksburg, WV 26301
5/19/2006 Staples
504 Emily Drive
Clarksburg, WV 26301
5/24/2006 Lewis Co. Democrat Women
607 Center Ave.
Weston, WV 26452
  Total Expenditures: $2,029.75

Receipt of a Transfer of Excess Funds

DateCandidate Committee Name and YearAmount
 Total Receipts of Transfer of Excess Funds: $0.00

Disbursement of Excess Funds

DateName of candidate committee and election year disbursing excess fundsPurpose of DisbursementAmount
  Total Disbursement of Excess Funds: $0

Unpaid Bills

DateGroup or Firm AffiliationPurposeAmount
  Total Unpaid Bills: $0.00

Office Use Only
Filed With West Virginia Secretary of State
Friday, June 9, 2006 8:51:38 PM