State of West Virginia Campaign Financial Statement
(Long Form) in Relation to the 2004 Election Year

Candidate or Committee Name
West Virginia Community Action Program PAC
Candidate or Committee's Treasurer
Mary Chipps
Political Party (for candidates)
Treasurer's Mailing Address (Street, Route, or P.O. Box)
2 Hale Street, Suite 100 
Office Sought (for Candidates)
City, State, Zip Code
Charleston, WV 25301
Daytime Phone #

Election Cycle Reporting Period (check one):

Primary - First Report
Due Mar 27-Apr 02, 2004
Pre-primary Report
Due Apr 24-May 03, 2004
Post-primary Report
Due Jun 05-Jun 11, 2004
General - First Report
Due Sep 04-Sep 10, 2004
Pre-general Report
Due Oct 16-Oct 25, 2004
Post-general Report
Due Nov 27-Dec 03, 2004

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 2004 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  $2,913.05
Monetary Contributions from all Fund-Raising Events +$0.00
Receipt of a Transfer of Excess Funds +$0.00
Total Monetary Contributions: =$2,913.05
In-Kind Contributions +$0.00
Total Contributions: =$2,913.05
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 +$2,913.05
Total Other Income +$0.00
Subtotal: a. =$2,913.05
Total Expenditures Paid  $119.43
Total Disbursements of Excess Funds +$0.00
Repayment of Loans +$0.00
Subtotal: b. =$119.43
Ending Balance:
(Subtotal a. - Subtotal b.)

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

$250.00 or LESS

1/3/2004David Jarroll$20.00
1/3/2004Vicki Geary$20.00
5/3/2003Bruce Miller$27.00
5/3/2003Mary Turner$40.00
5/3/2003Kenneth Straub$34.00
5/3/2003Nettie Harper$20.00
5/3/2003Helen Estep$14.00
5/3/2003Regina White$10.50
5/3/2003Vonda Berry$60.00
5/3/2003Steve Poling$35.00
5/3/2003Darleta Chambers$12.00
5/3/2003Della Lyons$55.00
5/3/2003Cheryl Walkley$12.00
5/3/2003Glenda Helman$42.00
5/3/2003Barbara Hultin$11.00
5/3/2003Rebecca Malone$25.00
7/1/2003Bobbi Thomas-Bailey$200.00
7/28/2003Teresa Ward$20.00
7/28/2003David Jarroll$20.00
7/28/2003Kenny Dean$20.00
7/28/2003Mary Chipps$40.00
7/28/2003Jodi Morrison$45.00
7/28/2003Vicki Geary$25.00
7/28/2003Judy Raveaux$35.00
8/14/2003Kenny Dean$20.00
8/14/2003Judy Raveaux$20.00
8/14/2003Tim Crum$20.00
8/14/2003Loyd Casto$20.00
8/14/2003David Treharne$20.00
9/29/2003Charlotte Henline$50.00
2/19/2004Loyd Casto$60.00
9/29/2003Mary Chipps$200.00
9/29/2003Bobbi Thomas-Bailey$200.00
5/3/2003Cherie Jenkins$7.50
5/3/2003Mary Chipps$50.00
5/3/2003David Jarroll$27.00
5/3/2003Diane Allen$16.00
5/5/2003Barbara Painter$42.00
5/5/2003Doris Staton$105.00
5/16/2003Vicki Geary$54.00
6/5/2003David Treharne$50.00
1/3/2004Jodi Morrison$20.00
1/3/2004Bobbi Thomas-Bailey$40.00
1/3/2004Loyd Casto$20.00
1/3/2004David Treharne$50.00
1/3/2004Kenny Dean$50.00
1/3/2004Mary Chipps$20.00
1/3/2004Charlotte Henline$25.00
1/3/2004Dan Pauley$18.00
1/3/2004Steve Haid$50.00
1/15/2004David Treharne$30.00
1/28/2004Judy Raveaux$50.00
4/7/2003David Treharne$50.00
5/2/2003Jodi Morrison$18.00
5/2/2003Kenny Dean$103.00
5/2/2003Bonnie Samu$38.05
5/2/2003Judie Williams$64.00
5/3/2003Tim Crum$42.50
5/3/2003Connie Sherrill$16.00
5/3/2003Angela McElwain$12.00
5/3/2003Erica Neal$25.00
5/3/2003Patty Barnett$27.00
5/3/2003Connie Rollins$10.00
5/3/2003Larry Glenn$23.50
5/3/2003Josephine Murray$7.00
 Subtotal of contributions of $250.00 or less$2,613.05

More than $250.00

9/29/2003 Full Name:  Kenny Dean
Address:  Resident
213 Jackson Street
Fairmont, WV 26554

Contributor's Job: (individual contributor only)  Executive Director
Where Contributor Works: (individual contributor only)  North Central WV CAA
Affiliation: (political committee only)  WV Community Action
 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
1/26/2004 United Bank
Parkersburg, WV 26104
Checkbook One Time Fee$1.00
2/9/2004 US Post Office
Parkersburg, WV 26104
Postage for candidate questionnaires$18.43
3/11/2004 Clif Moore
PO Box 67
Thorpe, WV 24888
Campaign Contribution$100.00
  Total Expenditures: $119.43

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
Tuesday, October 28, 2008 10:56:49 AM