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DEC-15-2011 15:11 FromiMPRK SIMMONS 30386559S2 To:lE0EEig0174 P a g e : 1-^6
FEC FORM 924 HOUR NOTICE OF DISBURSEMENTS/OBLIGATIONS FORELECTIONEERING COMMUNICATIONS1. P e r a o n M a k i n g t h e D i s b u r s e m e n t s / O b l i g a t i o n s
(a) Name / c r / )(b) Address (number and street) Q check if diflerent than previously rep orte dl lo\ f^t^t^ctj /v^ioia Ai^nL/g KM, So,yg l o o(c) City, State and ZIP Code
2 . F E C Identi f ication N u m b e r
(d) Name of Employer or'^Principal Place of Business (e) OccupationhJ/A3 . I s T h i s S t a t e m e n t
N e w
A m e n d e d4 . C o v e r i n g P e r i o d through1-214 f-z- ^ / "a
5 . (a) Date of Public D[stribution(s) 11 ' 2 .1 I C s t I ' Z . o | I i (b) Communicat ion T it le6 . Th e f i le r is a(n ) : (a) Q Individual (b) Q Unincorporated Orga nizat ion (c) [^iOualified Nonprofit Corporation (11 C FR 114.10)
(d)^ ^ C o r p o r a t i o n , Labor Orga nizat ion or Qual i f ied Nonprofi t C orporat ion making communicat ions unde r 11 C F R 114.15(e) |[^J Othe r, spe cify :
7 . If t h e f i l e r i s a n i n d i v i d u a l , u n i n c o r p o r a t e d o r g a n i z a t i o n o r q u a l i f i e d nonprofi t c o r p or a t io n , p ' l 0 |w e r e t h e d i s b u r s e m e n t s m a d e e x c l u s i v e l y f rom d o n a t i o n s to a s e g r e g a t e d b a n k a c c o u n t ? -^^Ss.8 . C u s t o d i a n o f R e c o r d s
(a) Name(b) Address (number and street) ^(c) City. Slate and ZIP Code(d) Name of Employer or Prindpai Place ot Business
IV M(e) Occupation
9 . T o t a l D o n a t i o n s T h i s S t a t e m e n t JL 7 1 ^ V 5 1 C 5 ^ 10 . T o t a l D i s b u r s e m e n t s / O b l i g a t i o n s T h i s S t a t e m e n t
Under penalty of perjury, I certify that this statement is true, correct and complete.TYPE OR PRINT NAME OF PERSON COMPLETING FORM j [ A ^ ^ 1^ * S t v^>v1o ^
S I G N A T U R E D A T E
NOTE: Subm ission of falsa, erroneou s or incomplete inlorm aiion may subject the person sign ing tiiis statement to tlie penalties ot 2 U.S.C. 437g.
FEC FORM 9 (REV. 12/2007)
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List of Person(s) Sharing/Exercising Control(use additional page s as necessary) P A G E OFi11. Person(s) Sharing/Exercising Control
a) Name
b) Address (number and s l re e t L|IO( reni5uj/>rn>ti.^ Avenwe, KJU/ , Si .Ve. T O Oc) City, state and ZIP Coded) Name of Employer or Principiyer or Principar P l ace of Business (e) Occupation
a) Nameb) Add ress (number and street) A>>L , S>u4;c) City, State a nd ZIP C ode;d) Name of Employer cr Principal Piace of Business (e) Occupation
a) Name
b) Address (number a nd street)||0[ V^^^S^L^KA^IC^ A- e,viut KJ ^ , Sc .T e "7 !30c) City, State and ZIP Code!d) Name of Employer or Pr incipalPrincipal Plac of Business (e) Occupation
a) Nameb) Address (number and street)
c) City, State and ZIP Code
:d) Name of Employer or Principal Place of Business (e) Occupation
E. a) Nameb) Address (number and street)
;c) City, State and ZIP Cod e
d) Name of Employer or Pr indpa i P lace of Business (e) Occupation
FE3AN038.PDF FEC FORM 9 (REV. 12/2007)
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S C H E D U L E 9 - ADonation(s) Received P A G E O F
A . Ful l Name of Donor3. Tee ^oke^Hs
Mailing Address of DonorT o ISc.^ ' ^ Z O , 6 0 7 Uv^^r- / 4 > U c ^ t o a j
City state Zi p
Date o f Re ce ip t
Amount
iiLiiuffiummil . fr>.'"Ti"fiaBafl
B . Ful l Name of Donor
Mai l ing Addre ss of Donor
City State Zip
Date of Receipt
C . Ful l Name of Donor
Mai l ing Ad dre ss of Donor
City State Zi p
Date o f Rece ip t
D. Ful l Nam e of Donor
Mai l ing Addre ss of Donor
City Sta te Zi p
Date o f Rece ip t
8rriirBrrriw-fl K m r r l h - r B S S s s a i S a a m f iAmount
E . Ful l Nam e of Donor
Mai i ing Addre ss of Donor
City State Zip
S UBTO TA L of Donations This P a g e (optional)
TO TA L This Per iod (last page this l ine number only) (carry total from last page to L ine 9)
FE3AN03S.PDF FEC FORM 9 (REV. 12^007)
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S C H E D U L E 9-BDisbursement(s) Made or Obilgation(s) P A G E O F
A . Ful l Name (LasL First, Middle Initial) of Payee
Ma i i ing Address o f Payee
City State Z ip Code
Name of EmployerIM . OccupationKJfA
Date of Disbursement or Obligation"oTTB"
Communication Date1 " ^ o I I
Purpose of Disbursement (Including title(s) of communication(s))-rv - Q t ^ ' i l i e . \ r a A ScW i
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Schedule 9-BDisbursem ent(s) Made or Obligation(s) Page 2 of 3
A. (continued)
Name of Federal Candidate Office So ug ht : 0 House State:Q Senate District:Gary Johnson [If President
Disbursement/Obligation For:Pr imary Q GeneralOther (specify)
Name of Federal Candidate Office So ug htiQ House State: Se nate District:
Ron PaulDisbursement/Obligation For:
B^Pr imary Q Genera lOther (specify)
Name of Federa l CandidateRick Perry
Office Sought: House State:I Sena te District:j3P''65ident
Disbursement/Obligation For:CS^Primary Q Genera l
Other (specify)
Name of Federal CandidateMitt Romney
Office So ug ht : p House State:Q Senate District:JjE^President
Disbursement/Obligation For:tS^u ma ry Genera lOther (specify)
Name of Federal Candidate Office So ug ht: Q House State:O Senate District:
R i c k S a n t o r u m { ^ P r e s i d e n tDisbursement/Obligation For:
l3 [Pr imary O Genera lOther (specify)
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Schedule 9-BDisbursement(s) Made or Obligation(s)
Page 3 of 3
B. (continued)
Name of Fede ral Candidate Office So ug ht: Q House State: Se nate District:Gary Johnson (president
Disbursement/Obligation For:Pr imary Ge neralOther (specify)
Name of Federal Candidate Office S ou g ht Q House State:Q Senate District:
R o n P a u l j g P r e s i d e n t
Disbursement/Obligation For:ISK^Primary G ene ral
Other (specify)
Name of Federal Candidate Office Sou g ht :Q House State:O Senate District:Rick P erry CSlPresident
Disbursement/Obligation For:ISLPrimary Ge neral
Other (specify)
Name of Fede ral Candidate Office So ug ht: Q House State:Q Senate District:Mitt R o m n e y E lP r e sid e nt
Disbursement/Obligation For:H^^rimary Q Genera lOther (specify)
Name of Federal Candidate Office So ug ht :Q House State:Q Senate District:
R i c k S a n t o r u m P r e s i d e n tDisbursement/Obligation For:
^ ^P r imary Q Genera lOther (specify)
T O T A L This Pe riod (last page this line number only): 357,545.00
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Federal Election CommissionENVELOPE RE PLACEME NT PAGE
FO R INCOMING DOCUMENTSThe FEC added this page to the end of this filing to indicate how it w as rece ived.Hand Delivered Date of R eceipt
PostmarkedUSPS First Class Mail
USPS Registered/Certified Postmarked (R /C)
USPS Priority Mail PostmarkedDelivery Confirmation Label f
PostmarkedUSPS Express Mail
Postmark Illegible
No Postmark
Overnight Delivery Service (Specify): Shipping Date
Received from House Records & R eg istration Office Date of R eceipt
Received from Senate Public Records Office Date of R eceipt
Received from Electronic Filing Office Date of R eceipt
Other (Specify): Date of R ece ipt or PostmarkedThe document preceding this page w as received by FAX at the FEC. The receivingFAX machine has printed at the bottom of each page the date and time of receipt, thephone number of the transmittingmachine and the sequential page numbe rs.
N/APREPARER(5/2004)N/ADATE P RE P A RE D
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