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

Candidate or Committee Name
ELLIOT SIMON
Candidate or Committee's Treasurer
RANDY DAVIS
Political Party (for candidates)
Republican
Treasurer's Mailing Address (Street, Route, or P.O. Box)
24 SYDNEY CIRCLE  
Office Sought (for Candidates)
House of Delegates
District/Division
67
City, State, Zip Code
HARPERS FERRY, WV 
Daytime Phone #
7034062400

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
 X 
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:

 X 
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  $11,070.00
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$11,070.00
In-Kind Contributions +$0.00
Total Contributions: =$11,070.00
 
Other Income  $75.00
Loans Received +$0.00
Total Other Income: =$75.00
 
OUTSTANDING LOANS & DEBTS:  
Unpaid Bills  $0.00
Outstanding Loans +$5,000.00
Total Debts: =$5,000.00
 
TOTAL CONTRIBUTIONS ELECTION YEAR-TO-DATE
(Add total contributions from all reports)
$28,056.34
 
CASH BALANCE SUMMARY
Beginning Balance
(ending balance from previous report)
 $14,837.46
Total Monetary Contributions +$11,070.00
Total Other Income +$75.00
Subtotal: a. =$25,982.46
 
Total Expenditures Paid  $12,235.83
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$12,235.83
 
Ending Balance:
(Subtotal a. - Subtotal b.)

*Cannot be negative balance
=$13,746.63
 
TOTAL EXPENDITURES ELECTION YEAR-TO-DATE
(Add total expenditures from all reports)
$17,634.71

Contributions
$250.00 or LESS

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
9/24/2012Henry K. Willard$200.00
10/1/2012Richard Burke$100.00
10/3/2012Selina Meehleib$75.00
10/4/2012Jean Rousek$100.00
10/3/2012Jonathon Trivett$100.00
10/4/2012Juanita Burns$20.00
10/9/2012Linda Winicki$150.00
10/11/2012Paul Ormond$245.00
10/11/2012Don Orser$100.00
10/11/2012John Shank$100.00
10/11/2012Robert Morris$25.00
10/11/2012American Electric Power$250.00
10/11/2012Larry Wright$250.00
10/11/2012Ernest C. Lico$100.00
10/11/2012Nancy Strine$100.00
10/12/2012Brian Bellman$50.00
10/12/2012Melodie Williams$40.00
10/14/2012Jerry Yates$40.00
10/14/2012Pepsico Concerned Citizens Fund$250.00
10/14/2012Todd Metzger$100.00
10/14/2012Robert Murto$75.00
10/14/2012Anne Turner$50.00
10/14/2012Bonnie Dorman$25.00
10/14/2012Brenda Robinette$75.00
10/14/2012Walter C. Pellish$15.00
10/14/2012Todd Metzger$100.00
10/14/2012Anne DeVere Ditto$50.00
10/14/2012Ira Hale$25.00
10/14/2012Mary Ann Hammann$200.00
10/14/2012David Staton$50.00
10/14/2012Raymond Bielicki$50.00
10/14/2012Randolph S. Davis$250.00
10/14/2012Michael Folk$50.00
10/14/2012Jean Kingsbury Jacobs$50.00
10/14/2012John Overington$200.00
10/14/2012Stefan Leeb$150.00
10/14/2012John Younis$250.00
10/14/2012Paul Espinosa$75.00
10/14/2012Henry A. Willard, III$75.00
10/14/2012Eric Householder$250.00
10/14/2012John Bresland$150.00
10/14/2012Joseph A. Siler$100.00
10/14/2012Robert C. Smith CPA$250.00
10/15/2012Marchel Pitcher$10.00
10/15/2012Gail Greenisen$50.00
10/20/2012J & K State Legislative PAC$100.00
10/20/2012The Coca-Cola Company$250.00
10/20/2012Coke Consol Comm For Govt$250.00
10/20/2012WV Oil Makers & Grocers Association$100.00
10/20/2012WV Trucking Association PAC$100.00
10/20/2012HUB-PAC$250.00
10/20/2012Republican Executive Committee$200.00
 Subtotal of contributions of $250.00 or less$6,270.00
 

Contributions
More than $250.00

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
9/25/2012 Full Name:  Charles Adkins
Address:  Resident
5405 Champagne
Sarasota, FL 34235

Contributor's Job: (individual contributor only)  Retired
Where Contributor Works: (individual contributor only)  Retired
Affiliation: (political committee only)  Retired
$500.00
10/11/2012 Full Name:  Lawrence Pack
Address:  Resident
300 Summers St., Suite 1450
Charleston, WV 25301

Contributor's Job: (individual contributor only)  self employed
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
$500.00
10/11/2012 Full Name:  Wild & Wonderful PAC
Address:  Resident
PO Box 651374
Potomoc Falls, VA 20165

Contributor's Job: (individual contributor only)  PAC
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
$500.00
10/11/2012 Full Name:  HOSPAC
Address:  Resident
100 Association Dr.
Charleston, WV 25311

Contributor's Job: (individual contributor only)  PAC
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
$300.00
10/11/2012 Full Name:  Leonard Frenkil, Sr.
Address:  Resident
6909 A Moravia Park Dr.
Baltimore, MD 21237

Contributor's Job: (individual contributor only)  Retired
Where Contributor Works: (individual contributor only)  Retired
Affiliation: (political committee only)  Retired
$600.00
10/11/2012 Full Name:  Patrick Morrisey
Address:  Resident
126 Rebels Roost Ct.
Harpers Ferry, WV 25425

Contributor's Job: (individual contributor only)  self employed
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
$500.00
10/14/2012 Full Name:  Matthew Knott
Address:  Resident
200 River Rock Run
Harpers Ferry, WV 25425

Contributor's Job: (individual contributor only)  President
Where Contributor Works: (individual contributor only)  River Riders
Affiliation: (political committee only)  President
$500.00
10/14/2012 Full Name:  Leonard Frenkil, Sr.
Address:  Resident
6909 A Moravia Park Dr.
Baltimore, MD 21237

Contributor's Job: (individual contributor only)  Retired
Where Contributor Works: (individual contributor only)  Retired
Affiliation: (political committee only)  Retired
$400.00
10/20/2012 Full Name:  WV Farm PAC
Address:  Resident
1 Red Rock Rd.
Buckhannon, WV 26201

Contributor's Job: (individual contributor only)  PAC
Where Contributor Works: (individual contributor only) 
Affiliation: (political committee only) 
$1,000.00
 Subtotal of all contributions of more than $250.00
Subtotal of all contributions of $250 or less
Total Contributions:
$4,800.00
$6,270.00
$11,070.00


Other Income: Interest, Refunds, Miscellaneous Receipts

DateSource of IncomeType of ReceiptAmount
10/14/2012Walter DukeExcess funds from Walter Duke--2010 campaign account$75.00
  Total Other Income: $75.00

In-Kind Contributions

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

Loans

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
1. Elliot Simon
21 Chestnut Lane
Harpers Ferry, WV 25425
$5,000.00 $5,000.00
Loans Received Repayment of Loans Outstanding Loans
Totals: $0.00 $0.00 $5,000.00

Itemized Expenditures

DateName of Person or Vendor And AddressPurposeAmount
9/24/2012 The Journal
PO Box 807
Martinsburg, WV 25402
Newspaper ads$1,260.00
9/26/2012 Valpak
1829 Howell Road, Ste. 1
Hagerstown, WV 21740
Post card mailings$5,744.12
9/28/2012 Spirit of Jefferson County
210 N. George St.
Charles Town, WV 25414
Newspaper ads$625.00
9/28/2012 Valpak
1829 Howell Road, Ste. 1
Hagerstown, MD 21740
Post card mailings$615.36
9/28/2012 Bavarian Inn
164 Shepherd Grade Road
Shepherdstown, WV 25443
Meet & Greet$649.06
9/28/2012 Spirit of Jefferson County
210 N. George St.
Charles Town, WV 25414
Newspaper ad$75.00
9/28/2012 Printing Productios, Inc.
1333-E Shepard Dr.
Sterling, VA 20164
Printing$373.00
10/2/2012 Alliant Merchant Services
8133 Leesburg Pike
Vienna, VA 22182
Website collection fees$55.09
9/24/2012 Printing Productions, Inc.
1333-E Shpeard Drive
Sterling, VA 20164
Printing$2,756.60
9/24/2012 WVFL
25 Canyon Road
Morgantown, WV 26508
Mailing list$82.60
  Total Expenditures: $12,235.83

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
Thursday, October 25, 2012 12:22:37 PM