State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2012 Election Year

Candidate or Committee Name
Greenbrier Co. Republican Club
Candidate or Committee's Treasurer
Michael S. Rose
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
PO Box 1300 
Office Sought (for Candidates)
City, State, Zip Code
Lewisburg, WV 24901
Daytime Phone #
(304) 497-4319

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 31-Apr 06, 2012Mar 31-Apr 06, 2012
Pre-primary Report
Due Apr 23-Apr 27, 2012Apr 23-Apr 27, 2012
Post-primary Report
Due May 21-Jun 19, 2012May 21-Jun 19, 2012
General - First Report
Due Sep 24-Sep 28, 2012Sep 24-Sep 28, 2012
Pre-general Report
Due Oct 22-Oct 26, 2012Oct 22-Oct 26, 2012
Post-general Report
Due Nov 19-Dec 19, 2012Nov 19-Dec 19, 2012

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 2013 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  $830.00
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$830.00
In-Kind Contributions +$0.00
Total Contributions: =$830.00
Other Income  $5.66
Loans Received +$0.00
Total Other Income: =$5.66
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 +$830.00
Total Other Income +$5.66
Subtotal: a. =$2,021.81
Total Expenditures Paid  $377.55
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$377.55
Ending Balance:
(Subtotal a. - Subtotal b.)

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

$250.00 or LESS

1/3/2013Lowell Rose$30.00
1/3/2013Charles & Shirley Elmore$30.00
1/3/2013Sam & Tate Hudson$30.00
1/3/2013Russell & Berniece Siegal$30.00
1/3/2013Shirley Ratliff$20.00
1/3/2013Bill Higginbotham$20.00
1/3/2013Michael Rose$20.00
2/7/2013Gayle Mason$50.00
2/7/2013Nina Emmerling$30.00
2/7/2013William Horne$30.00
2/7/2013R Marshall Musser$30.00
2/7/2013Charles Blackman$20.00
2/7/2013Wilma McMillion$20.00
2/7/2013Mina Wheatley$20.00
2/7/2013Ray & Denny Caterburyy$30.00
2/7/2013Roger & Melanie Patterson$30.00
2/7/2013Joan & Eddie Shafer$30.00
2/7/2013John Wyatt$20.00
2/7/2013Michael McClung$30.00
2/7/2013Donald & Gaye Keech$30.00
2/7/2013Jim Childers & Lisa King$30.00
2/7/2013Steve & Jeni Baker$30.00
2/7/2013George & Vicki Ambler$30.00
2/7/2013Kevin Nutter$20.00
2/7/2013Eleanor & Wayne Herkness$30.00
2/7/2013Welton & Lois Shipe$30.00
2/7/2013Samuel & Pixote McClung$30.00
3/7/2013Patrick & Jeri Via$30.00
2/7/2013Ronald & Suzanne Snyder$30.00
3/7/2013Sue Spicer$20.00
 Subtotal of contributions of $250.00 or less$830.00

More than $250.00

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

Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
2/6/2013SuddenlinkRefund on Campaign HQ TV Service$5.16
2/28/2013Bank Account InterestInterest on Club Checking Acct.$0.10
1/31/2013Interest on Bank AcctInterest on Club Checking Acct.$0.10
12/31/2012Interest on Bank Acct.Interest on Club Checking Acct.$0.09
11/30/2012Interest on Bank AcctInterest on Club Checking Acct.$0.21
  Total Other Income: $5.66

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
12/5/2012 Suddenlink
P.O. Box 130489
Tyler, TX 75713
Suddenlink Cable TV Service for Campaign HW$165.50
2/4/2013 USPS
Main Post Office
Lewisburg, WV 24901
Annual Renewal of Republican Club Post Office Box$54.00
2/7/2013 William Horne
106 N Lee St
Lewisburg, WV 24901
Reimbursement for Flag Purchase for Lewisburg Library$64.95
2/7/2013 Shirley Elmore
Rt 1 Box 264A
Ronceverte, WV 24970
Reimbursement for Stamps$13.50
2/7/2013 Nola Gaye Keech
463 McClung St
Drawer J
Rupert, WV 25984
Reimbursement for Stamps$37.20
3/7/2013 Lowell Rose
Rt 1 Box 268
Ronceverte, WV 24970
Reimbursement for Printing of Reagan Day Dinner Tickets$42.40
  Total Expenditures: $377.55

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
Sunday, March 31, 2013 5:51:00 PM