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Common Sense NantucketMECEIVED Form CPF M 102: Campaign Finance Report Municipal Form Office of Campaign and Political Finance File with: Citvor Town Clerk or Election Commission F "rli7 PflMdyffe4 Beginning Date: January 15, 2012 Ending Date: (March 28, 2012 TN l6 &E1T (M" (ftTt R K 8th day preceding preliminary pX 8th day preceding election 30 day after election year -end report dissolution Candidate Full Name (ifapplicable) Office Sought and District Telephone Number (optional): Common Sense Nantucket Committee Name Dan Knise Name ofCommittee Treasurer Telephone Number (optional): (202) 236 -2909 SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report 0 Line 2: Total receipts this period (page 3, line 1 l) 54,215 Line 3: Subtotal (line I plus line 2) 54,215 Line 4: Total expenditures this period (page 5, line 14) 45,620.13 Line 5: Ending Balance (line 3 minus line 4) 8,594.87 Line 6: Total in -kind contributions this period (page 6) 1,647.f Line 7: Total (all) outstanding liabilities (page 7) Line 8: Name of bank(s) used: Chain Bridge Bank certify that I have examined this report includingattached schedules and d is, to bes ofmy knowledge and belief, a true and complete statement of all campaign finance ictivity, including all contributions, loans, r nditures, disbursements, ' -k' ontributions and liabilities forthis reporting period and represents the campaign finance activityof all persons acting under the a rity o behalfofthis i to ce with the requirements ofM.G.L. c. 55. Signed under the penalties of perjury: ffreasurees signature) Date: 4 -1 -12 DATE FILINGS ONJ&:'Xffidavit of Candidate: (cheek 1 box only) Candidate with Committee and no activity independent of the committee 1 certify that 1 have examined this report includingattached schedules and it is, to the best of my knowledge and belief, a true and complete statement ofall campaign finance activity, ofall persons acting under the authority oron behalfofthis committee in accordancewith the requirements of M.G.L. a 55. 1 have not received any contributions, incurred any liabilities normade airy expenditures on my behalf during this reporting period. Candidate without Committee Q)3 Candidate with Independent activity filing separate report 1 certify that 1 have examined this report including attached schedules and it is, to the best ofmy knowledge and belief, a true and complete statement ofall campaign finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign finance activity ofall persons acting under the authority or on behalf ofthis committee in accordance with the requirements ofM.G.L. c. 55. under the penalties of perjury: Candidate's signature) Date: SCHEDULE A: RECEIPTS M.G.L. c. 55 requires that the name andresidential address be reported in alphabetical order, for all receipts over $50 in a calendar year. Committees must keep detailed accounts andrecords ofall receipts, but need only itemize those receipts over $50. In addition, the occupation andemployer must be reportedfor allpersons who contribute $200 or more in a calendaryear. A "Schedule A: Receipts" attachment is available to complete, print and attach to this report, ifadditional pages are required to report all receipts. Please include your committee name and a page number on each page.) Date Received Name and Residential Address alphabetical listing required) Amount Occupation & Employer for contributions of $200 or more) see attached Line 9: Total Receipts over $50 (or listed above) 54,200 f- Enter on page 1, line 2 Line 10: Total Receipts $50 and under* (not listed above) is Line 11: TOTAL RECEIPTS IN THE PERIOD 54.215 Ifyou have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above. Page 2 SCHEDULE A: RECEIPTS (continued) Date Received Name and Residential Address alpha etical listing required) Amount Occupation & Employer for contributions of $200 or more) Line 9: Total Receipts over $50 (or listed above) Line 10: Total Receipts $50 (not listed above) and under* E- Enter on page 1, line 2Line11: TOTAL RECEIPTS IN THE PERIOD Ifyou have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized aWve. Page 3 SCHEDULE B: EXPENDITURES M.G.L. c. 55 requires committees to list, in alphabetical order, all expenditures over $50 In a reportingperiod. Committees must keep _ detailedaccounts and records ofall expenditures, but need only itemize those over $50. Expenditures 850 and under may be added together, from committee records, and reported on line 13. o A "Schedule B: Expenditures" attachment is available to complete, print and attach to this report, ifadditional pages are required to _ report all expenditures. Please include your committee name and a page number on each page.) Date Paid To Whom Paid alphabetical listing) Address Purpose of Expenditure Amount see attached Enter on page 1, line 4 - Line 12: Total Expenditures over $50 (or listed above) 45,620.13 Line 13: Total Expenditures $50 and under* (not listed above) Line 14: TOTAL EXPENDITURES IN THE PERIOD 45,620.13 Ifyou have itemized expenditures of $50 and under, include them in line 12. Line 13 should include only those expenditures not itemized above. Page 4 rr SCHEDULE C: "IN- KIND" CONTRIBUTIONS Please itemize contributors who have made in -kind contributions ofmore than $50. In -kind contributions $50 and under may be added together from the committee's records and included in line 16 on page 1. Date Received From Whom Received* Residential Address Description of Contribution Value see attached Line 15: In -Kind Contributions over $50 (or listed above) 1,647.64 Line 16: In -Kind Contributions $50 & under (not listed above) E=1 Enter on page I, line 6 - Line 17: TOTAL IN -KIND CONTRIBUTIONS 1,647.64 Ifan in -kind contribution is received from a person who contributes more than $50 in a calendar year, you must report the name and address ofthe contributor; in addition, ifthe contribution is $200 or more, you must also report the contributor's occupation and employer. page 6 SCHEDULED: LIABILITIES M.G.L. c. SS requires committees to reportALL liabilities which have been reportedpreviously and are still outstanding, as well as those liabilities incurred during this reporting period. Date Incurred To Whom Due Address Purpose Amount None Enter on page 1, line 7 Line 18: TOTAL OUTSTANDING LIABILITIES (ALL) Page 7 Catherine Stover From: Dan Knise [DKnise@amesgough.com] Sent: Monday, April 02, 2012 10:02 AM To: Catherine Stover Cc: Arthur Reade Subject: Common Sense Nantucket CPF M 102 Scanned Report with Signature Attachments: D00040212. pdf Ms. Stover - -Still sending the hard copy, but in the meantime, here is a color scan with a signature.. Thanks much.. Dan Dan Knise 1 Z !V D ° Z ^ C CD > CO C C CD co 0 c Q° (/r 7 ' N CD N. 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