1. DATE OF REPORT
OFFICE USE ONLY
Missouri Ethics Commission
COMMITTEE DISCLOSURE REPORT COVER PAGE
M.E.C. ID NO. ______________________________
INSTRUCTIONS ON REVERSE SIDE
2. FULL NAME OF COMMITTEE
3. COMMITTEE MAILING ADDRESS
4. COMMITTEE TELEPHONE NUMBER
CITY / STATE / ZIP
5. TREASURER'S NAME
6. TREASURER'S MAILING ADDRESS
7. TREASURER'S TELEPHONE NUMBER
HOME:
CITY / STATE / ZIP
WORK:
8. DEPUTY TREASURER'S NAME
CHECK IF NO DEPUTY TREASURER
9. DEPUTY TREASURER'S MAILING ADDRESS
10. DEPUTY TREASURER'S TELEPHONE NUMBER
HOME:
CITY / STATE / ZIP
WORK:
11. DATE OF ELECTION
12. TYPE OF ELECTION ( CHECK ONE )
PRIMARY
GENERAL
SPECIAL
13. TIME PERIOD COVERED BY THIS STATEMENT
FROM
THROUGH
14. CANDIDATE COMMITTEES ONLY: LIST CANDIDATE'S NAME,
15. TYPE OF REPORT
ADDRESS, PHONE, OFFICE SOUGHT, POLITICAL SUBDIVISION AND
15 DAYS AFTER CAUCUS NOMINATION
POLITICAL PARTY
COMMITTEE QUARTERLY REPORT
Jan 15
Apr 15
Jul 15
Oct 15
8 DAYS BEFORE
30 DAYS AFTER ELECTION
TERMINATION
(ATTACH FORM CO-3)
SEMIANNUAL DEBT REPORT
Jan 15
Jul 15
ANNUAL SUPPLEMENTAL, JAN 15
15 DAYS AFTER PETITION DEADLINE
CHECK IF INCUMBENT
OTHER
AMENDING PREVIOUS REPORT DATED
REPUBLICAN
DEMOCRAT
,
20
_________________________
___________
_
____
_
16. COMMITTEE TREASURER'S SIGNATURE
17. CANDIDATE'S SIGNATURE ( CANDIDATE COMMITTEES ONLY )
I CERTIFY THAT THIS REPORT, COMPRISED OF THIS COVER
I CERTIFY THAT THIS REPORT, COMPRISED OF THIS COVER
PAGE AND ALL ATTACHED FORMS, IS COMPLETE, TRUE AND
PAGE AND ALL ATTACHED FORMS, IS COMPLETE, TRUE AND
ACCURATE.
ACCURATE.
TREASURER'S SIGNATURE
CANDIDATE'S SIGNATURE
MO 300-1310 (10-06)
CD Cover Page