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

Candidate or Committee Name
CASEY MAYER
Candidate or Committee's Treasurer
BETH MAYER
Political Party (for candidates)
Republican
Treasurer's Mailing Address (Street, Route, or P.O. Box)
1010 E. BROOKSIDE AVENUE  
Office Sought (for Candidates)
State Senate
District/Division
13
City, State, Zip Code
FAIRMONT, WV 
Daytime Phone #
8433689341

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
 X 
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:

 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  $1,108.95
Monetary Contributions from all Fund-Raising Events +$2,175.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$3,283.95
In-Kind Contributions +$50.00
Total Contributions: =$3,333.95
 
Other Income  $0.00
Loans Received +$0.00
Total Other Income: =$0.00
 
OUTSTANDING LOANS & DEBTS:  
Unpaid Bills  $0.00
Outstanding Loans +$0.00
Total Debts: =$0.00
 
TOTAL CONTRIBUTIONS ELECTION YEAR-TO-DATE
(Add total contributions from all reports)
$3,383.95
 
CASH BALANCE SUMMARY
Beginning Balance
(ending balance from previous report)
 $0.00
Total Monetary Contributions +$3,283.95
Total Other Income +$0.00
Subtotal: a. =$3,283.95
 
Total Expenditures Paid  $1,668.12
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$1,668.12
 
Ending Balance:
(Subtotal a. - Subtotal b.)

*Cannot be negative balance
=$1,615.83
 
TOTAL EXPENDITURES ELECTION YEAR-TO-DATE
(Add total expenditures from all reports)
$1,668.12

Contributions
$250.00 or LESS

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
8/7/2012Ken Wright$50.00
8/7/2012Lorain Wright$50.00
8/3/2012Rebecca Polis$150.00
8/13/2012Craig Eckard$25.00
9/12/2012Chris Caldwell$25.00
9/18/2012Zella Keener$50.00
8/30/2012Adrian Nez$10.00
8/24/2012Kandi Nuzum$100.00
7/26/2012Beth Mayer$148.95
 Subtotal of contributions of $250.00 or less$608.95
 

Contributions
More than $250.00

DATECONTRIBUTOR'S FULL NAME OR COMMITTEE'S NAMEAMOUNT
8/7/2012 Full Name:  John Polis
Address:  Resident
11 Francis Marion Circle
Beaufort, SC 29905

Contributor's Job: (individual contributor only)  Self Employed/Pastor
Where Contributor Works: (individual contributor only)  John Polis Ministries
Affiliation: (political committee only) 
$500.00
 Subtotal of all contributions of more than $250.00
Subtotal of all contributions of $250 or less
Total Contributions:
$500.00
$608.95
$1,108.95

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).

Fundraiser Dinner Event Summary

Date of Event: 8/25/2012 Total Monetary Contributions:  $2,175.00
Type of Event: Buffet style dinner with two speakers and singing Total Expenditures: -$317.65
Name of Place Held: Faith Church International NET RECEIPTS: =$1,857.35
Address of Place Held: 600 The Drive
Fairmont, WV 26554
Total In-Kind Contributions Related to the Fundraiser  $0.00

$250 or Less

DATEFULL NAMEAMOUNT
8/25/2012Amber Nuzum$100.00
8/25/2012Sam Polis$100.00
8/25/2012Thresa Musgrave$200.00
8/25/2012Jim McNeill$100.00
8/25/2012Gary Gearde$100.00
8/25/2012Karen Ford$25.00
8/25/2012Amber Tennant$50.00
 Subtotal of event contributions of less than $250.00 $675.00

More than $250

DATE AMOUNT
8/25/2012 Full Name:  Roger Nuzum
Address:  Resident
1688 Fairmont Ave
Fairmont, WV 26554

Contributor's Job: (individual contributor only)  Owner
Where Contributor Works: (individual contributor only)  Nuzum Trucking
Affiliation: (political committee only) 
$1,000.00
8/25/2012 Full Name:  Bill Taylor
Address:  Resident
209 Fair Oaks Dr
Fairmont, WV 26554

Contributor's Job: (individual contributor only)  Manager
Where Contributor Works: (individual contributor only)  Frito-Lay
Affiliation: (political committee only) 
$500.00
 Event contributions of $250 or more: 
Event contributions of less than $250: 
Total Contributions: 
$1,500.00
$675.00
$2,175.00

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
7/28/2012Buck’s Inc.Website design$50.00
  Total In-Kind Contributions: $50.00

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
Loans Received Repayment of Loans Outstanding Loans
Totals: $0.00 $0.00 $0.00

Itemized Expenditures

DateName of Person or Vendor And AddressPurposeAmount
8/3/2012 Sams Club
200 Emily Dr
Clarksburg, WV 26301
Parade$37.19
8/4/2012 Walmart
32 Tygart Valley Mall
Fairmont, WV 26554
Parade$9.51
8/4/2012 Dollar General
1228 Country Club Rd.
Fairmont, WV 26554
Parade$3.18
8/4/2012 Everyday Day is A Party
3119 University Ave
Morgantown, WV 26505
Parade$25.26
8/6/2012 Shop N Save
9789 Mall Loop
Fairmont, WV 26554
Parade$21.18
7/26/2012 Vistaprint
95 Hayden Ave
Lexington, MA 02421
Parade$37.66
7/26/2012 Network Solutions
13861 Sunrise Valley Dr.
suite 300
Herndon, VA 20171
Parade$8.94
8/15/2012 Buck’s Inc
RR 19
Clarksburg, WV 26301
2 Banners for Parade$84.38
8/25/2012 Dollar General
1228 Country Club Rd.
Fairmont, WV 26554
labels/ice$4.95
8/25/2012 Dollar General
1228 Country Club Rd.
Fairmont, WV 26554
crayons/ ribbon/coloring books-kids table for fundraiser$6.72
8/24/2012 Party City
526 Emily Drive
Clarksburg, WV 26301
fundraiser$10.23
8/23/2012 Walmart
32 Tygart Valley Mall
Fairmont, WV 26554
food for fundraiser$26.09
8/14/2012 Walmart
32 Tygart Valley Mall
Fairmont, WV 26554
card stock, ink for donation envelopes$34.41
8/22/2012 Sam’s Club
200 Emily Dr
Clarksburg, WV 26301
food for fundraiser$179.68
8/27/2012 Faith Church International
600 The Drive
Fairmont, WV 26554
rental of Fellowship Hall$50.00
8/14/2012 Dollar General
1228 Country Club Rd.
Fairmont, WV 26554
fundraiser$5.57
8/31/2012 Capitol Promotions Inc.
PO Box 231
Glenside, PA 19038
Yard Signs/ Door hangers$1,109.89
9/27/2012 Piryx
144 2nd Street
1st floor
Fairmont, WV 26554
fees for using Piryx$13.28
  Total Expenditures: $1,668.12

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, October 12, 2012 10:55:11 AM