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

Candidate or Committee Name
Candidate or Committee's Treasurer
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
Office Sought (for Candidates)
Justice of the Supreme Court of Appeals
City, State, Zip Code
Daytime Phone #

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 2012 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  $8,562.00
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$8,562.00
In-Kind Contributions +$0.00
Total Contributions: =$8,562.00
Other Income  $0.00
Loans Received +$0.00
Total Other Income: =$0.00
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 +$8,562.00
Total Other Income +$0.00
Subtotal: a. =$360,317.29
Total Expenditures Paid  $193,350.00
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$193,350.00
Ending Balance:
(Subtotal a. - Subtotal b.)

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

$250.00 or LESS

9/10/2012Greenbrier County Republican Club$100.00
9/8/2012Ritchie County Republican Committee$200.00
9/16/2012Donald Gray$170.00
9/17/2012George Michael Milanovich$242.00
9/23/2012Tyler County Federation of Republican Women$200.00
9/12/2012Tyler County Republican Executive Committee$150.00
 Subtotal of contributions of $250.00 or less$1,062.00

More than $250.00

8/1/2012 Full Name:  WV Farm PAC
Address:  Resident
1 Red Rock Road
Buchannon, WV 26201

Contributor's Job: (individual contributor only)  n/a
Where Contributor Works: (individual contributor only)  n/a
Affiliation: (political committee only)  n/a
9/17/2012 Full Name:  Thomas Kleeh
Address:  Resident
104 McDavid Lane
Charleston, WV 25311

Contributor's Job: (individual contributor only)  Lawyer
Where Contributor Works: (individual contributor only)  Steptoe & Johnson
Affiliation: (political committee only) 
9/7/2012 Full Name:  Peter Chambers
Address:  Resident
406 Rock Holly Road
Charleston, WV 25314

Contributor's Job: (individual contributor only)  Lawyer
Where Contributor Works: (individual contributor only)  Peter Chambers, Esq
Affiliation: (political committee only) 
9/13/2012 Full Name:  Richard Kerr
Address:  Resident
483 Rebecca Street
Morgantown, WV 26505

Contributor's Job: (individual contributor only)  Retired
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
9/4/2012 Full Name:  Sarah Wade
Address:  Resident
340 Snowcrest Lane
Point Pleasant, WV 25550

Contributor's Job: (individual contributor only)  Homemaker
Where Contributor Works: (individual contributor only)  none
Affiliation: (political committee only)  none
9/23/2012 Full Name:  Austin Wallace
Address:  Resident
820 Middle Road
Charleston, WV 25314

Contributor's Job: (individual contributor only)  Physician
Where Contributor Works: (individual contributor only)  Self-employed
Affiliation: (political committee only) 
9/22/2012 Full Name:  Carol Miller
Address:  Resident
1316 12th Street
Huntington, WV 25701

Contributor's Job: (individual contributor only)  Property Manager
Where Contributor Works: (individual contributor only)  Swann Ridge Bison Farm
Affiliation: (political committee only) 
9/12/2012 Full Name:  John Adams Skaggs
Address:  Resident
325 Clinton Avenue
Brooklyn, NY 11205

Contributor's Job: (individual contributor only)  Attorney
Where Contributor Works: (individual contributor only)  Brennan Center for Justics
Affiliation: (political committee only) 
9/21/2012 Full Name:  West Virginia State Farm PAC
Address:  Resident
410 58th Street, SE
Charleston, WV 25304

Contributor's Job: (individual contributor only)  PAC
Where Contributor Works: (individual contributor only)  State Farm
Affiliation: (political committee only) 
 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
  Total Other Income: $0.00

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
9/18/2012 Orion Precision Market Research
50 Progress Circle
Unit 7A
Newington, CT 06111
Television Media Buy$193,200.00
9/4/2012 West Virginians for Life
15 Canyon Road
Morgantown, WV 26508
Magazine Advertisement$150.00
  Total Expenditures: $193,350.00

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, September 28, 2012 4:38:39 PM