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M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
FE5AN018
FEC
FORM 3
1. NAME OF COMMITTEE (in full)
ADDRESS (number and street)
Check if different than previously reported. (ACC)
FEC FORM 3(Revised 02/2003)
Office
Use
Only
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g.
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete.
Type or Print Name of Treasurer
Signature of Treasurer Date
4. TYPE OF REPORT (Choose One)
(a) Quarterly Reports:
12-Day PRE-Election Report for the:
Primary (12P) General (12G) Runoff (12R)
Convention (12C) Special (12S)
30-Day POST-Election Report for the:
General (30G) Runoff (30R) Special (30S)
CITY STATE ZIP CODE2. FEC IDENTIFICATION NUMBER
3. IS THIS NEW AMENDED
REPORT (N) OR (A)
in the
Election on State of
TYPE OR PRINT
REPORT OF RECEIPTS
AND DISBURSEMENTSFor An Authorized Committee
5. Covering Period through
in the
Election on State of
STATE DISTRICT
Office Use Only
April 15 Quarterly Report (Q1)
July 15 Quarterly Report (Q2)
October 15 Quarterly Report (Q3)
January 31 Year-End Report (YE)
Termination Report (TER)
(b)
Example: If typing, type
over the lines.
(c)
12FE4M5
03
45056
00
2016
03
Jennifer Best
Jennifer Best
2016
[Electronically Filed]
C00589333
PAGE 1 / 69
201601
03 OH15
Oxford OH
Derickson for Congress
2700 Millville-Oxford Rd
03/03/2016 08 : 41Image# 201603039009636146
2016
01 2402
OH
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M M / D D / Y Y Y Y M M / D D / Y Y Y Y
FE5AN018
COLUMN B
Election Cycle-to-Date
COLUMN A
This Period
6. Net Contributions (other than loans)
(a) Total Contributions
(other than loans) (from Line 11(e)) ....
(b) Total Contribution Refunds
(from Line 20(d)) ..................................
(c) Net Contributions (other than loans)
(subtract Line 6(b) from Line 6(a)) ......
7. Net Operating Expenditures
(a) Total Operating Expenditures
(from Line 17) ......................................
(b) Total Offsets to Operating
Expenditures (from Line 14) ................
(c) Net Operating Expenditures
(subtract Line 7(b) from Line 7(a)) ......
8. Cash on Hand at Close of
Reporting Period (from Line 27) .................
9. Debts and Obligations Owed TO
the Committee (Itemize all on
Schedule C and/or Schedule D) ................
10. Debts and Obligations Owed BY
the Committee (Itemize all on
Schedule C and/or Schedule D) ................
For further information contact:
Federal Election Commission
999 E Street, NW
Washington, DC 20463
Toll Free 800-424-9530
Local 202-694-1100
FEC Form 3 (Revised 02/2003) Page 2
SUMMARY PAGEof Receipts and Disbursements
Report Covering the Period: From: To:
Write or Type Committee Name
82591.61
145465.52
75514.45
216030.42
PAGE 2 / 69
2016
215980.42
201601
160465.97
0.00
50.00 50.00
20000.00
82641.61
Derickson for Congress
400.00
Image# 201603039009636147
0.00
160865.97
01 2402
145465.52
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M M / D D / Y Y Y Y M M / D D / Y Y Y Y
, , .
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FE5AN018
COLUMN B
Election Cycle-to-Date
COLUMN A
Total This Period
11. CONTRIBUTIONS (other than loans) FROM:
(a) Individuals/Persons Other Than
Political Committees
(i) Itemized (use Schedule A) ...........
(ii) Unitemized ....................................
(iii) TOTAL of contributions
from individuals .......................
(b) Political Party Committees .................
(c) Other Political Committees
(such as PACs) ...................................
(d) The Candidate ....................................
(e) TOTAL CONTRIBUTIONS
(other than loans)
(add Lines 11(a)(iii), (b), (c), and (d)) ..
12. TRANSFERS FROM OTHER
AUTHORIZED COMMITTEES ....................
13. LOANS:
(a) Made or Guaranteed by the
Candidate ............................................
(b) All Other Loans ...................................
(c) TOTAL LOANS
(add Lines 13(a) and (b)) ....................
14. OFFSETS TO OPERATING
EXPENDITURES
(Refunds, Rebates, etc.) ............................
15. OTHER RECEIPTS
(Dividends, Interest, etc.) ...........................
16. TOTAL RECEIPTS (add Lines 11(e), 12, 13(c), 14, and 15) (Carry Total to Line 24, page 4) ............
DETAILED SUMMARY PAGEof Receipts
I. RECEIPTS
FEC Form 3 (Revised 12/2003) Page 3
Report Covering the Period: From: To:
Write or Type Committee Name
0.00
28758.81
0.00
0.00
5000.00
236430.42
67041.61
400.00
147550.61
0.00
0.00
PAGE 3 / 69
2016
12031.00
82641.61
2016
0.00
20000.00
01
0.00
0.00
82641.61
5000.00
0.00
0.00
Derickson for Congress
182271.61
20000.00
0.00
Image# 201603039009636148
216030.42
01
10600.00
2402
55010.61
34721.00
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FE5AN018
COLUMN B
Election Cycle-to-Date
COLUMN A
Total This Period
17. OPERATING EXPENDITURES .....................
18. TRANSFERS TO OTHER
AUTHORIZED COMMITTEES .....................
19. LOAN REPAYMENTS:
(a) Of Loans Made or Guaranteed
by the Candidate .................................
(b) Of All Other Loans ..............................
(c) TOTAL LOAN REPAYMENTS
(add Lines 19(a) and (b)) .....................
20. REFUNDS OF CONTRIBUTIONS TO:
(a) Individuals/Persons Other
Than Political Committees ..................
(b) Political Party Committees ..................
(c) Other Political Committees
(such as PACs) ....................................
(d) TOTAL CONTRIBUTION REFUNDS
(add Lines 20(a), (b), and (c)) ..............
21. OTHER DISBURSEMENTS .........................
22. TOTAL DISBURSEMENTS
(add Lines 17, 18, 19(c), 20(d), and 21)
II. DISBURSEMENTS
DETAILED SUMMARY PAGEof DisbursementsFEC Form 3 (Revised 02/2003) Page 4
III. CASH SUMMARY
23. CASH ON HAND AT BEGINNING OF REPORTING PERIOD ...............................................
24 TOTAL RECEIPTS THIS PERIOD (from Line 16, page 3) .....................................................
25. SUBTOTAL (add Line 23 and Line 24) ..................................................................................
26. TOTAL DISBURSEMENTS THIS PERIOD (from Line 22) ......................................................
27. CASH ON HAND AT CLOSE OF REPORTING PERIOD
(subtract Line 26 from Line 25)..............................................................................................
, , . , , .
75514.45
145515.52
0.00
0.00
145515.52
0.00
0.00
50.00
0.00
0.00
50.00
PAGE 4 / 69
160865.97
50.00
138388.36
0.00
0.00
0.00
0.00
221029.97
0.00
0.00
82641.61
0.00
0.00
Image# 201603039009636149
145465.52
50.00
160915.97
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
500.00
500.00
500.00
500.00
TX
OH
5196 Rolling Hills Dr.
1064 N University Blvd
500.00
69 Redbud Trace
Derickson for Congress
45056Transaction ID : 0000491
75034
OHMiddletown
Oxford
Frisco
2016 Special Primary
2016 Special Primary
2016 Special Primary
Nenni and Co.
None
Transaction ID : 000047045042-3300
Transaction ID : 0000473
Toyota USA
07
07
15
1500.00
2016
5
2016
2016
Image# 201603039009636150
01
01
01
69
Mr. Mark Derickson
2016
2016
Mr. William W Pulley
2016
Mr. Paul D. Nenni
CPA
Logistics
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
500.00
250.00
500.00
500.00
OH
OH
4720 Deer Run
600 Thorn Hill Ln
700.00
7819 Surrywood Dr
Derickson for Congress
45052Transaction ID : 0000502
45042
OHMiddletown
North Bend
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Premier Health
Transaction ID : 000049245042-3752
Transaction ID : 0000493
None
15
15
20
1250.00
2016
6
2016
2016
Image# 201603039009636151
01
01
01
69
Melanie Costine Moon
2016
2016
Mr. Michael D Stautberg
2016
Mr. John Thomas Nenni
Retired
Homemaker
Executive
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
400.00
500.00
400.00
500.00
1000.00
OH
OH
4345 Trails End Dr
400 E. State St
1000.00
4725 Wicklow Dr
Derickson for Congress
45042Transaction ID : 0000505
45429-1661
OHTrenton
Middletown
Kettering
2016 Special Primary
2016 Special Primary
2016 Special Primary
Magnode Corp.
Insurance Associates
Transaction ID : 000050345067
Transaction ID : 0000504
Miller Valentine Group
20
20
20
1900.00
2016
7
2016
2016
Image# 201603039009636152
01
01
01
69
William H Krul II
2016
2016
Gregg Lee Grimes
2016
Mr. Martin J Bidwell
Owner
Chief Executive Officer
Agent
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
2700.00
500.00
2700.00
2700.00
OH
OH
4203 Rosedale Rd
4203 Rosedale Rd
2700.00
25 Sycamore Ter
Derickson for Congress
45044Transaction ID : 0000509
45042
OHMiddletown
Middletown
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Akers Packaging
None
Transaction ID : 000050645042
Transaction ID : 0000507
None
20
20
20
5900.00
2016
8
2016
2016
Image# 201603039009636153
01
01
01
69
Deborah J Akers
2016
2016
Elizabeth W Brockman
2016
William C Akers II
President
Homemaker
Homemaker
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
1000.00
500.00
1000.00
1000.00
OH
OH
7952 Graves Rd
1920 Court Donegal
1000.00
424 Vincent Ct
Derickson for Congress
45042-4903Transaction ID : 0000515
45243
OHMiddletown
Middletown
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Bon Development Co.
Transaction ID : 000051045042
Transaction ID : 0000511
AK Steel
20
20
27
2500.00
2016
9
2016
2016
Image# 201603039009636154
01
01
01
69
Mr. James L Wainscott
2016
2016
Mr. Samuel Oliver Nelson
2016
Georgina Pennington
Homemaker
Board of Directors
Executive
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
500.00
1000.00
500.00
500.00
OH
OH
607 Tara Oaks Dr
1232 Aintree Ct
500.00
7615 French Park Pl
Derickson for Congress
45237-1735Transaction ID : 0000520
45042
OHMaineville
Cincinnati
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Pax, Inc.
Cohen Brothers, Inc.
Transaction ID : 000051645039-9158
Transaction ID : 0000517
Chase
27
27
27
2000.00
2016
10
2016
2016
Image# 201603039009636155
01
01
01
69
David Anthony Pearce
2016
2016
Mr. Kenneth I Cohen
2016
Mr. James E Cory II
Executive
Executive
President
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
IN-KIND: Event Beverages
500.00
250.00
500.00
60.00
500.00
OH
OH
150 Lawton Ave.
5800 Forest Ridge Dr
500.00
6191 Green Knoll Cricle
Derickson for Congress
45011Transaction ID : 0000522
45050
OHOxford
Indian Springs
Monroe
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
State Farm
Transaction ID : 000052145056
Transaction ID : 0000576
Ohio Eagle Distributing
27
28
29
1060.00
2016
11
2016
2016
Image# 201603039009636156
01
01
01
69
Devyn Dugger
2016
2016
Brent D Arter
2016
Russell Bruce Starkey Jr
Retired
President
Agent
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
1000.00
500.00
1000.00
500.00
OH
OH
7145 Willoughby Ct
4968 Timberline Dr
500.00
3101 Milton Rd
Derickson for Congress
45042-3656Transaction ID : 0000542
45069
OHMiddletown
Middletown
West Chester
2016 Special Primary
2016 Special Primary
2016 Special Primary
The Dupps Co.
None
Transaction ID : 000052345042
Transaction ID : 0000527
TradeGlobal
29
29
31
2000.00
2016
12
2016
2016
Image# 201603039009636157
01
01
01
69
David Harold Cook
2016
2016
Melinda Ann Dickerson
2016
John Avery Dupps Jr
Owner
Chairman
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
500.00
250.00
500.00
1000.00
OH
OH
5025 Oakview Dr
2151 Harris Rd
1100.00
520 Curryer Rd
Derickson for Congress
45042Transaction ID : 0000546
45042
OHHamilton
Middletown
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Pedro's Angus
None
Transaction ID : 000054445013-9673
Transaction ID : 0000545
None
31
31
31
1750.00
2016
13
2016
2016
Image# 201603039009636158
01
01
01
69
Mr. Jerold Dan Pennington
2016
2016
Mr. Ronald Lee Williams
2016
William T Roe
Owner
Retired
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
250.00
250.00
250.00
250.00
OH
OH
1122 Herschel Ave.
6454 Centre Park Dr
250.00
7301 Contessa Way
Derickson for Congress
45068Transaction ID : 0000549
45208
OHWest Chester
Waynesville
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
RCF Group
SouthBrook Church
Transaction ID : 000052845069
Transaction ID : 0000547
Cincinnati Works Inc.
04
04
04
750.00
2016
14
2016
2016
Image# 201603039009636159
02
02
02
69
Ms. Peggy Zink
2016
2016
Mr. Gerald Ittel
2016
Mr. Scott Robertson
Chairman
Chief Executive Officer
Pastor
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
600.00
250.00
500.00
250.00
OH
OH
5984 Niederlander Ln
7806 Thomas Rd
500.00
2391 Morman Rd
Derickson for Congress
45013-9303Transaction ID : 0000557
45044
OHMiddletown
Hamilton
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Clark, Schaeffer, Hackett & Co.
McCullough-Hyde Hospital
Transaction ID : 000055445042
Transaction ID : 0000555
Self
07
07
07
1000.00
2016
15
2016
2016
Image# 201603039009636160
02
02
02
69
Ms. Lisa Marie Frye
2016
2016
Dr. Gregory Paul Calkins
2016
Mr. Thomas Dean Hazelbaker
Retired
IT
Physician
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
250.00
500.00
250.00
500.00
OH
OH
4812 Scarborough Ct
612 Da Vinci Dr
500.00
5917 Oak Ridge Rd
Derickson for Congress
45011Transaction ID : 0000565
45042-4909
OHMiddletown
Hamilton
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Magnode Corp.
Elliott Davis Decosimo
Transaction ID : 000056245042
Transaction ID : 0000563
The Kleingers Group
11
11
11
1250.00
2016
16
2016
2016
Image# 201603039009636161
02
02
02
69
Mr. James B Kleingers
2016
2016
Mr. Christopher Dennis Flaig
2016
Mr. Joseph M Bidwell
Vice President
President
CPA
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
1250.00
500.00
1000.00
250.00
OH
OH
8222 Lesourdesville-WC Rd
5530 Wather Rd
250.00
300 High St.
Derickson for Congress
45011Transaction ID : 0000569
45069
OHFairfield
Hamilton
West Chester
2016 Special Primary
2016 Special Primary
2016 Special Primary
Halo Branded Solutions
J. Gregory Howard Attorney At Law
Transaction ID : 000056745014
Transaction ID : 0000568
None
11
11
11
1750.00
2016
17
2016
2016
Image# 201603039009636162
02
02
02
69
Ste. 809
Ms. Patricia Alderson
2016
2016
J. Gregory Howard
2016
Mr. Mitchell L. Rhodus
Owner
Retired
Attorney
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
IN-KIND: Event Catering
500.00
1350.15
500.00
350.15
1500.00
OH
OH
700 Walnut St.
10 Lighthouse Point Dr.
2500.00
5281 Kruckberg Rd
Derickson for Congress
45331Transaction ID : 0000581
45202
FLLongboat Key
Greenville
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
Gold Coast Eagle Distributor
Fort Recovery Industries
Transaction ID : 000057034228
Transaction ID : 0000766
Government Strategies Group LLC
11
11
13
2350.15
2016
18
2016
2016
Image# 201603039009636163
02
02
02
69
Suite 450
Mr. Charles Gerhardt III
2016
2016
Mr. Wesley Jetter
2016
Denise Saputo
Administration
Partner
Executive
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
200.00
1500.00
100.00
500.00
OH
OH
34 Arden Rd.
17345 Road M
500.00
3775 Davidson Rd.
Derickson for Congress
43026Transaction ID : 0000590
43214
OHKalida
Hilliard
Columbus
2016 Special Primary
2016 Special Primary
2016 Special Primary
Superior Credit Union
Ohio Credit Union League
Transaction ID : 000058345853
Transaction ID : 0000586
Ohio Credit Union League
13
13
13
1600.00
2016
19
2016
2016
Image# 201603039009636164
02
02
02
69
Ms. Emily Leite
2016
2016
Mr. Paul Mercer
2016
Mr. Phillip Buell
Officer
Manager
Executive
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
300.00
250.00
800.00
250.00
250.00
OH
OH
55 Mount Pleasant Ave.
7910 Loneoak Ct.
250.00
11524 Applejack Ct.
Derickson for Congress
45249Transaction ID : 0000596
45215
OHCincinnati
Cincinnati
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
Focused Capitol Solutions LLC
Government Strategies Group, LLC
Transaction ID : 000059345243
Transaction ID : 0000595
Cincinnati Children's Hospital
14
14
14
800.00
2016
20
2016
2016
Image# 201603039009636165
02
02
02
69
Dr. Robert Kahn
2016
2016
Mr. James Benedict
2016
Mr. George Glover
Manager
Doctor
Consultant
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
2700.00
500.00
2700.00
500.00
OH
OH
700 Walnut St.
7357 Great Waters Ln
500.00
352 Rachel Ln
Derickson for Congress
45042Transaction ID : 0000625
45202
OHWest Chester
Middletown
Cincinnati
2016 Special Primary
2016 Special Primary
Ohio Court of Appeals
Clark Schaefer Hackett
Transaction ID : 000059745069-6318
Transaction ID : 0000598
Government Strategies Group LLC
14
14
15
3700.00
2016
21
2016
2016
Image# 201603039009636166
02
02
02
69
Suite 450
Mr. Charles Gerhardt III
2016
2016
John Joseph Venturella
2016
Honorable Stephen W. Powell
Judge
Partner
CPA
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
275.00
250.00
275.00
1000.00
OH
OH
1927 Hamilton New London Rd
PO Box 189
1250.00
7013 Treeridge Dr.
Derickson for Congress
45244Transaction ID : 0000615
45013
OHOxford
Cincinnati
Hamilton
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Procter & Gamble
Transaction ID : 000061045056-0189
Transaction ID : 0000612
Noah's Farms
17
17
17
1525.00
2016
22
2016
2016
Image# 201603039009636167
02
02
02
69
Mr. Noah F Woolum
2016
2016
Mr. Eric Wunsch
2016
Mr. Russell B Starkey Jr
Retired
Owner
Attorney
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
250.00
250.00
250.00
250.00
OH
OH
6846 Ken Arbre Dr.
9146 Cincinnati-Columbus Rd.
250.00
425 Walnut St.
Derickson for Congress
45202Transaction ID : 0000618
45236
OHWest Chester
Cincinnati
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
Dever Law Firm
Aronoff Rosen & Hunt, LPA
Transaction ID : 000061645069
Transaction ID : 0000617
Government Strategies Group
17
17
17
750.00
2016
23
2016
2016
Image# 201603039009636168
02
02
02
69
Suite 2200
Mr. J. Douglas Moormann
2016
2016
Mr. Stanley Aronoff
2016
Mr. Jonathan Dever
Attorney
Partner
Attorney
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
250.00
350.00
250.00
250.00
OH
OH
6136 Hummingbird Ln
1283 Sweetwater Dr.
250.00
1339 Cryer Ave.
Derickson for Congress
45208Transaction ID : 0000621
45040
OHCincinnati
Cincinnati
Mason
2016 Special Primary
2016 Special Primary
2016 Special Primary
Graydon, Head & Ritchey LLP
Taft Focused Capitol Solutions
Transaction ID : 000061945215
Transaction ID : 0000620
Squire Patton Boggs
17
17
17
750.00
2016
24
2016
2016
Image# 201603039009636169
02
02
02
69
Mr. Scott Kane
2016
2016
Ms. Nancy Cahall
2016
Mr. Steven Goodin
Attorney
Attorney
Director
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
200.00
500.00
400.00
500.00
100.00
OH
OH
2400 Schroff Dr
1104 Gage Dr.
250.00
605 White Oak Dr
Derickson for Congress
45056Transaction ID : 0000638
45042
OHMiddletown
Oxford
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Sibcy Cline Realtors
None
Transaction ID : 000062845042
Transaction ID : 0000637
Carpe Diem Learning Centers
18
18
18
800.00
2016
25
2016
2016
Image# 201603039009636170
02
02
02
69
Mr. Robert D Sommers
2016
2016
Mr. Philip Harmon Bowers
2016
Linda L. Wall
Realtor
Chief Executive Officer
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
IN-KIND: Postage
347.55
250.00
347.55
250.00
1000.00
OH
OH
408 Paxton Cir
122 Pinnacle Peak
1000.00
2933 Nichols Rd
Derickson for Congress
45013-9021Transaction ID : 0000767
45050
OHFairfield
Hamilton
Monroe
2016 Special Primary
2016 Special Primary
2016 Special Primary
Aveda Fredric's Institute
None
Transaction ID : 000064145014-8248
Transaction ID : 0000642
None
18
18
18
1597.55
2016
26
2016
2016
Image# 201603039009636171
02
02
02
69
Ms. Barbara K Chappell
2016
2016
Ms. Paula Rose Copeland Jr.
2016
Mr. Frederick J Holzberger
Founder
Retired
Homemaker
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
IN-KIND: Postage
IN-KIND: Postage
500.00
183.30
1500.00
83.30
133.00
OH
OH
718 David Dr.
9620 Windsor Club Circle
283.00
PO Box 273
Derickson for Congress
45056Transaction ID : 0000647
45056
OHFort Myers
Oxford
Oxford
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Dept of Zoology @ Miami Univer
Transaction ID : 000076833905
Transaction ID : 0000770
Northwest Local
18
18
19
716.30
2016
27
2016
2016
Image# 201603039009636172
02
02
02
69
Ms. Ruth Allyn Pettitt
2016
2016
Mr. Robert G. Sherman
2016
Ms. Marilyn Copeland
Retired
Educator
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
650.00
250.00
150.00
1000.00
OH
OH
5025 Oakview Dr
PO Box 189
2250.00
119 Dorset Dr
Derickson for Congress
45044Transaction ID : 0000660
45042
OHOxford
Middletown
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Insurance Agents of Ohio Inc.
Transaction ID : 000065545056-0189
Transaction ID : 0000659
None
20
21
21
1400.00
2016
28
2016
2016
Image# 201603039009636173
02
02
02
69
Mr. Jerold Dan Pennington
2016
2016
Mr. Scott Beckett Nein
2016
Mr. Russell B Starkey Jr
Retired
Retired
Vice President
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
500.00
250.00
500.00
250.00
OH
OH
5595 Boomer Rd.
1909 Antrim Ct
500.00
Key Bank Bldg Ste 311
Derickson for Congress
45011Transaction ID : 0000667
45247
OHMiddletown
Hamilton
Cincinnati
2016 Special Primary
2016 Special Primary
2016 Special Primary
Clark Schaefer
Richard A Hyde Attorney At Law
Transaction ID : 000066145042-2901
Transaction ID : 0000662
State of Ohio
21
21
21
1000.00
2016
29
2016
2016
Image# 201603039009636174
02
02
02
69
Mr. Louis Terhar
2016
2016
Mr. Richard A. Hyde
2016
Mr. William H Schaefer
Retired
State Representative
Attorney
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
600.00
1000.00
100.00
250.00
OH
OH
525 Thorn Hill Ln
6850 Sloebig Rd
500.00
605 Da Vinci Dr
Derickson for Congress
45042Transaction ID : 0000675
45042-3750
OHMiddletown
Middletown
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Premier Health Network
Huhtamaki
Transaction ID : 000066845042
Transaction ID : 0000673
Singer & McCausland Co., LPA
21
21
21
1350.00
2016
30
2016
2016
Image# 201603039009636175
02
02
02
69
Mr. Joseph H Mulligan
2016
2016
Mr. Robert L Fairchild Jr
2016
Mr. Paul Russell Jennewine
Doctor
Attorney
Vice President
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
300.00
2500.00
100.00
250.00
OH
OH
34 Arden Rd.
2054 Winding Brook Way
250.00
3775 Davidson Rd.
Derickson for Congress
43026Transaction ID : 0000682
43214
OHXenia
Hilliard
Columbus
2016 Special Primary
2016 Special Primary
2016 Special Primary
Wright-Patt Credit Union
Ohio Credit Union League
Transaction ID : 000067945385
Transaction ID : 0000680
Ohio Credit Union League
21
21
21
1350.00
2016
31
2016
2016
Image# 201603039009636176
02
02
02
69
Ms. Emily Leite
2016
2016
Mr. Paul Mercer
2016
Mr. Douglas Fecher
President
Manager
Executive
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
1000.00
2000.00
500.00
250.00
OH
OH
8245 Cherry Laurel Dr
7791 Joan Dr
250.00
11 Beechpoint Dr.
Derickson for Congress
45056Transaction ID : 0000694
45044-8347
OHWest Chester
Oxford
Liberty Township
2016 Special Primary
2016 Special Primary
2016 Special Primary
Todd Homes, LLC
None
Transaction ID : 000068945069-3682
Transaction ID : 0000691
Chetna Mital LLC
21
21
21
1750.00
2016
32
2016
2016
Image# 201603039009636177
02
02
02
69
Dr. Anubhav Mital
2016
2016
Norman R Bueche
2016
Todd T. Hall
Partner
Doctor
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
500.00
2000.00
250.00
500.00
OH
OH
37 Leah Ct.
36 Annie Lou Dr.
500.00
79 W. Central Ave.
Derickson for Congress
45311Transaction ID : 0000700
45013
OHHamilton
Camden
Hamilton
2016 Special Primary
2016 Special Primary
2016 Special Primary
Self
Dr. James Thomson, DO
Transaction ID : 000069845013
Transaction ID : 0000699
Butler County United Way
21
21
21
1750.00
2016
33
2016
2016
Image# 201603039009636178
02
02
02
69
PO Box 39
Ms. Margaret S Baker
2016
2016
Dr. James Thomson
2016
Robert L Weigel
Funeral Director
President & CEO
Doctor
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
50.00
500.00
250.00
250.00
200.00
OH
OH
6405 Contreras Rd.
4681 W. Elkton Rd.
400.00
945 Silvoor Ln
Derickson for Congress
45056Transaction ID : 0000707
45056
OHHamilton
Oxford
Oxford
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
None
Transaction ID : 000070245011
Transaction ID : 0000703
HDS, LLC
21
21
21
500.00
2016
34
2016
2016
Image# 201603039009636179
02
02
02
69
Mr. James M. Clawson
2016
2016
Ms. Mary Levering Evans
2016
Robert V Hoelle
Retired
Construction
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
250.00
750.00
250.00
100.00
OH
OH
625 Da Vinci Dr.
5025 Bonham Rd.
400.00
208 Beechpoint Dr
Derickson for Congress
45056Transaction ID : 0000713
45042
OHOxford
Oxford
Middletown
2016 Special Primary
2016 Special Primary
2016 Special Primary
Miami University
Miami University
Transaction ID : 000070845056
Transaction ID : 0000712
None
21
21
21
600.00
2016
35
2016
2016
Image# 201603039009636180
02
02
02
69
Ms. Tina Breitenbach
2016
2016
Mr. Robert Alan Applebaum
2016
Mr. Richard M Norman
Retired
Retired
Director
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
350.00
250.00
100.00
500.00
OH
OH
4340 Cherry St.
6195 Fairfield Rd. #18
750.00
PO Box 899
Derickson for Congress
45331-0899Transaction ID : 0000719
45056
OHOxford
Greenville
Oxford
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
State of Ohio
Transaction ID : 000071445056
Transaction ID : 0000716
Funeral Home Director
21
21
21
850.00
2016
36
2016
2016
Image# 201603039009636181
02
02
02
69
Harry W Ogle
2016
2016
Jim Buchy
2016
Kate E Wespiser
Retired
Retired
State Representative
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
IN-KIND: Postage and Office Expense
511.61
1000.00
711.61
500.00
150.00
OH
OH
3088 Millville Oxford Rd
95 Stone Creek Dr
300.00
2700 Oxford Millville Rd
Derickson for Congress
45056-9163Transaction ID : 0000784
45056
OHOxford
Oxford
Oxford
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Phi Delta Theta
Transaction ID : 000072045056-9774
Transaction ID : 0000722
Ned Hoelzer CPA, Inc.
21
21
22
1161.61
2016
37
2016
2016
Image# 201603039009636182
02
02
02
69
Mr. Ned C Hoelzer
2016
2016
Mrs. Kelly S Derickson
2016
John D Curry
Retired
CPA
Administration
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
250.00
500.00
250.00
100.00
OH
OH
PO Box 996
4578 Schollenbarger Rd
300.00
2241 Corinthian Ct.
Derickson for Congress
45244Transaction ID : 0000741
45504
OHOxford
Cincinnati
Springfield
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
DSD Advisors, LLC
Transaction ID : 000073345056-9110
Transaction ID : 0000737
Armoloy Ohio, Inc.
23
24
24
600.00
2016
38
2016
2016
Image# 201603039009636183
02
02
02
69
Mr. Stephen M Neely
2016
2016
Mr. Matthew Davis
2016
Mr. Jack B Cotter
Retired
Owner
President
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
250.00
1500.00
100.00
150.00
OH
OH
6195 Fairfield Rd. #22
2841 Oxford-Millville Rd.
400.00
95 White Tail Run
Derickson for Congress
45056Transaction ID : 0000746
45056
OHOxford
Oxford
Oxford
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
None
Transaction ID : 000074445056
Transaction ID : 0000745
None
24
24
24
750.00
2016
39
2016
2016
Image# 201603039009636184
02
02
02
69
M Barbara B Clawson
2016
2016
Frederick F Brower
2016
Ms. Patricia Rose Wiley
Retired
Retired
Retired
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
1000.00
1000.00
500.00
500.00
OH
OH
6020 Cincinnati Brookville Rd
3208 Sherman Ave
500.00
5372 Pinevalley Dr
Derickson for Congress
45069-1868Transaction ID : 0000749
45053
OHMiddletown
West Chester
Okeana
2016 Special Primary
2016 Special Primary
2016 Special Primary
State of Ohio
LNE Group
Transaction ID : 000074745044
Transaction ID : 0000748
Self
24
24
24
1500.00
2016
40
2016
2016
Image# 201603039009636185
02
02
02
69
Apt Y
Mr. Tim Hesselbrock
2016
2016
Mr. Scott Owens
2016
Mr. David Scott Schiavone
Manager
Farmer
Vice President
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
Partnership Share
SEE ATTRIBUTION BELOW
250.00
250.00
250.00
250.00
500.00
OH
OH
21 E. State St.
69 Redbud Trace
1000.00
21 E. State Street
Derickson for Congress
43215Transaction ID : 0000772-0001
43215
OHOxford
Columbus
Columbus
2016 Special Primary
2016 Special Primary
2016 Special Primary
None
Hicks Partners
Transaction ID : 000075145056
Transaction ID : 0000772
24
24
24
750.00
2016
41
2016
2016
Image# 201603039009636186
02
02
02
69
Suite 2200
Suite 2200
Hicks Partners, LLC
2016
2016
Mr. Brian Hicks
2016
Mr. William W Pulley
Retired
Partnership
Partner
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
8241 Julie Marie Dr
500.00
Derickson for Congress
55010.61
OHWest Chester
2016 Special Primary
Taft Stettinius & Hollister LLP
Transaction ID : 000077445069-2654
24
500.00
2016
42
Image# 201603039009636187
02
69
2016
Mr. Daniel R. Warncke
Attorney
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
5000.00
PO Box 242
5000.00
Derickson for Congress
5000.00
OHEaton
2016 Special Primary
Transaction ID : 000063145320
18
5000.00
2016
43
Image# 201603039009636188
02
69
2016
Preble County Republican Central Committee
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
1000.00
1000.00
1000.00
50.00
CA
OH
13500 Evening Creek Dr. North
9648 Burning Bush Ct
50.00
4505 Rosedale Rd
Derickson for Congress
45042Transaction ID : 0000490
92128
OHCincinnati
Middletown
San Diego
C00478404
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 000048445241
Transaction ID : 0000485
15
15
15
2050.00
2016
44
2016
2016
Image# 201603039009636189
01
01
01
69
Bridgepoint Education, Inc. PAC
2016
2016
Friends of Nancy Nix
2016
Friends to Elect Rob Lyons as Judge
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
1000.00
1000.00
1000.00
1000.00
750.00
OH
OH
5622 Walther Dr
6029 Winding Creek Blvd
750.00
63 Cedar St.
Derickson for Congress
45631Transaction ID : 0000571
45014-3951
OHHamilton
Gallipolis
Fairfield
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 000050045011
Transaction ID : 0000543
20
31
11
2750.00
2016
45
2016
2016
Image# 201603039009636190
02
01
01
69
Friends of Wilkins
2016
2016
Friends of Ryan Smith
2016
Friends of TC Rogers
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
250.00
100.00
250.00
100.00
1500.00
OH
OH
5324 Mosiman Rd.
1501 M St. NW #330
1500.00
3153 McGill Rd.
Derickson for Congress
45051Transaction ID : 0000622
45042
DCWashington
Mount St. Joseph
Middletown
C00457697
2016 Special Primary
2016 Special Primary
Transaction ID : 000057220005
Transaction ID : 0000580
11
13
17
1850.00
2016
46
2016
2016
Image# 201603039009636191
02
02
02
69
Friends of Mary Swain
2016
2016
Committee to Elect Louis Blessing
2016
Miller Coors LLC PAC
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
100.00
1000.00
200.00
1000.00
500.00
OH
OH
221 E. 4th St.
4454 Idea Center Blvd.
500.00
5324 Mosiman Rd.
Derickson for Congress
45042Transaction ID : 0000677
45201
OHDayton
Middletown
Cincinnati
C00087478
C00479899
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 000062345430
Transaction ID : 0000624
17
17
21
1600.00
2016
47
2016
2016
Image# 201603039009636192
02
02
02
69
PO Box 2301
Cincinnati Bell Federal PAC
2016
2016
Friends of Mary Swain
2016
Woolpert, Inc. PAC
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
100.00
1000.00
100.00
1000.00
250.00
OH
OH
201 E. 4th St.
633 Cambridge Dr.
350.00
9003 Cincinnati Dayton Rd.
Derickson for Congress
45069Transaction ID : 0000693
45202
OHMiddletown
West Chester
Cincinnati
C00350108
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 000068745042
Transaction ID : 0000688
21
21
21
1350.00
2016
48
2016
2016
Image# 201603039009636193
02
02
02
69
Convergys Corporation PAC
2016
2016
Friends of Barbara Carter
2016
Friends of Talbott Moon
SCHEDULE A (FEC Form 3)
ITEMIZED RECEIPTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
A.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
B.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
C.
Election Cycle-to-Date
Date of Receipt
Name of Employer Occupation
! ! !, , .
FEC ID number of contributing
federal political committee. C
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 11d
12 13b 13a 14 15
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
Amount of Each Receipt this Period
! ! !, , .
FEC Schedule A (Form 3) (Revised 12/2015)
500.00
500.00
500.00
OH
Rock Springs Dr
545 E. Town St.
500.00
Derickson for Congress
10600.00
45011
OHColumbus
Liberty Twp
C00554055
2016 Special Primary
2016 Special Primary
Transaction ID : 000073943215
Transaction ID : 0000752
24
24
1000.00
2016
49
2016
Image# 201603039009636194
02
02
69
Friends of Margy Conditt
2016
2016
Jobs America PAC
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
2 S. Main St.
8 Alameda Cir
15367 Lockbourne Eastern Rd.
1875.00
975.67
250.00
Derickson for Congress
Transaction ID : 0000482
OH
OH
OH
45044
43103
45044
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000478
Transaction ID : 0000480
01
01
Event Expenses
01
Catering
Consulting
2016
3100.67
Mr. Colton Henson
2016
Ms. Kathleen K Williams
2016
50
2016
The Windamere
2016
2016
Image# 201603039009636195
04
69
05
05
Middletown
Ashville
Middletown
007
001
007
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5555 Hilton Ave.
47 E. Gay St.
70 S. Fourth St.
603.39
78.60
51.23
Ste. 106
Derickson for Congress
Transaction ID : 0000474
LA
OH
OH
70808
43215
43215
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000479
Transaction ID : 0000481
01
01
Bank Fees
01
General Printing
General Printing
2016
733.22
E-Bee Printing
2016
Monks Copy Shop
2016
51
2016
Anedot
2016
2016
Image# 201603039009636196
05
69
05
07
Columbus
Columbus
Baton Rouge
001
004
004
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5145 Brown Rd.
15367 Lockbourne Eastern Rd.
2534 Commerce Blvd.
2731.18
1875.00
245.22
Derickson for Congress
Transaction ID : 0000529
OH
OH
OH
45056
45056
43103
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000483
Transaction ID : 0000477
01
01
Postage, Non-Bulk Mail
01
Consulting
Campaign Materials
2016
4851.40
PCS Marketing Group, LLC
2016
Mr. Colton Henson
2016
52
2016
US Post Office
2016
2016
Image# 201603039009636197
12
69
12
13
Ashville
Oxford
Oxford
006
006
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
1319 Classen Dr
5555 Hilton Ave.
5555 Hilton Ave.
Ste. 106
Ste. 106
8.70
1.27
29600.00
Derickson for Congress
Transaction ID : 0000534
OK
LA
LA
73103
70808
70808
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000496
Transaction ID : 0000513
01
01
Consulting
01
Bank Fees
Bank Fees
2016
29609.97
Anedot
2016
Anedot
2016
53
2016
Wilson Perkins Allen
2016
2016
Image# 201603039009636198
16
69
24
26
Baton Rouge
Baton Rouge
Oklahoma City
001
001
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
ITEMIZATION BELOW
295 E. Long St.
150 Lawton Ave.
(contributor) In-Kind Received
15367 Lockbourne Eastern Rd.
1875.00
60.00
399.36
Apt. 410
Derickson for Congress
Transaction ID : 0000536
OH
OH
OH
43215
43103
45050
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000535
Transaction ID : 0000576-IK
01
01
Reimbursements
01
IN-KIND: Event Beverages
Consulting
2016
2334.36
Mr. Colton Henson
2016
Devyn Dugger
2016
54
2016
Mr. Christopher Albanese
2016
2016
Image# 201603039009636199
27
69
28
28
Monroe
Ashville
Columbus
001
001
003
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
MEMO
5145 Brown Rd.
2700 Oxford Millville Rd
ITEMIZATION BELOW
5145 Brown Rd.
MEMO
245.00
2337.46
588.00
Derickson for Congress
Transaction ID : 0000537-0001
OH
OH
OH
45056
45056
45056-9163
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000536-0001
Transaction ID : 0000537
01
12
Postage, Non-Bulk Mail
01
Reimbursements
Postage, Non-Bulk Mail
2016
2337.46
US Post Office
2016
Timothy S Derickson
2015
55
2016
US Post Office
2016
2016
Image# 201603039009636200
28
69
28
02
Oxford
Oxford
Oxford
006
006
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
MEMO
PO Box 1326
5145 Brown Rd.
MEMO
5145 Brown Rd.
MEMO
5.75
25.75
500.75
Derickson for Congress
Transaction ID : 0000537-0011
NC
OH
OH
28201
45056
45056
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000537-0002
Transaction ID : 0000537-0003
12
01
Office Overhead
12
Postage, Non-Bulk Mail
Postage, Non-Bulk Mail
2015
0.00
US Post Office
2016
US Post Office
2016
56
2016
Duke Energy
2016
2015
Image# 201603039009636201
17
69
29
05
Oxford
Oxford
Charlotte
001
006
006
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
275 Wyman St.
5555 Hilton Ave.
2700 Oxford Millville Rd
MEMO
Ste. 106
773.90
45.75
93.75
Derickson for Congress
Transaction ID : 0000540
MA
LA
OH
02451
45056-9163
70808
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000537-0013
Transaction ID : 0000539
01
01
General Printing
12
Bank Fees
Travel expense reimbursement
2015
139.50
Timothy S Derickson
2016
Anedot
2016
57
2016
VistaPrint
2016
2016
Image# 201603039009636202
29
69
29
29
Baton Rouge
Oxford
Waltham
004
002
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
1806 N. Star Rd.
500 Staples Dr.
275 Wyman St.
199.22
147.98
2000.00
Derickson for Congress
Transaction ID : 0000559
OH
MA
MA
43212
02451
01702
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000541
Transaction ID : 0000604
02
02
Consulting
01
Campaign supplies
General Printing
2016
2347.20
VistaPrint
2016
Staples
2016
58
2016
Mr. Samuel Tyler Smith
2016
2016
Image# 201603039009636203
29
69
01
03
Framingham
Waltham
Columbus
001
004
006
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
7669 Strategy Group Company
7669 Stagers Loop
5555 Hilton Ave.Ste. 106
36.60
60000.00
3915.00
Derickson for Congress
Transaction ID : 0000601
OH
OH
LA
43015
70808
43015
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000550
Transaction ID : 0000551
02
02
Campaign Materials
02
TV Time
Bank Fees
2016
63951.60
Anedot
2016
Strategic Media
2016
59
2016
The Strategy Group
2016
2016
Image# 201603039009636204
04
69
05
09
Delaware
Baton Rouge
Delaware
006
001
004
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
15367 Lockbourne Eastern Rd.
1806 N. Star Rd.
PO Box 37046
1699.47
1000.00
1875.00
Derickson for Congress
Transaction ID : 0000600
OH
OH
MD
43103
21297
43212
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000602
Transaction ID : 0000599
02
02
Consulting
02
Consulting
Computer Software and Supplies
2016
4574.47
i360
2016
Mr. Samuel Tyler Smith
2016
60
2016
Mr. Colton Henson
2016
2016
Image# 201603039009636205
09
69
09
09
Columbus
Baltimore
Ashville
001
001
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
2534 Commerce Blvd.
700 Walnut St.
(contributor) In-Kind Received
5555 Hilton Ave.
Suite 450
Ste. 106
4.20
350.15
2000.00
Derickson for Congress
Transaction ID : 0000573
OH
OH
LA
45056
70808
45202
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000561
Transaction ID : 0000766-IK
02
02
Campaign Materials
02
IN-KIND: Event Catering
Bank Fees
2016
2354.35
Anedot
2016
Mr. Charles Gerhardt III
2016
61
2016
PCS Marketing Group, LLC
2016
2016
Image# 201603039009636206
10
69
11
11
Cincinnati
Baton Rouge
Oxford
006
001
003
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5145 Brown Rd.
5555 Hilton Ave.
275 Wyman St.
Ste. 106
128.22
189.90
39.53
Derickson for Congress
Transaction ID : 0000763
OH
LA
MA
45056
02451
70808
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000761
Transaction ID : 0000626
02
02
Postage, Non-Bulk Mail
02
Bank Fees
General Printing
2016
357.65
VistaPrint
2016
Anedot
2016
62
2016
US Post Office
2016
2016
Image# 201603039009636207
11
69
15
16
Baton Rouge
Waltham
Oxford
006
004
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
275 Wyman St.
275 Wyman St.
5145 Brown Rd.
351.85
292.97
88.22
Derickson for Congress
Transaction ID : 0000764
MA
MA
OH
02451
45056
02451
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000765
Transaction ID : 0000754
02
02
General Printing
02
General Printing
Postage, Non-Bulk Mail
2016
733.04
US Post Office
2016
VistaPrint
2016
63
2016
VistaPrint
2016
2016
Image# 201603039009636208
16
69
16
16
Waltham
Oxford
Waltham
004
006
004
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
(contributor) In-Kind Received
718 David Dr.
9620 Windsor Club Circle
(contributor) In-Kind Received
2933 Nichols Rd
(contributor) In-Kind Received
347.55
133.00
83.30
Derickson for Congress
Transaction ID : 0000770-IK
OH
OH
OH
45056
45013-9021
33905
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000767-IK
Transaction ID : 0000768-IK
02
02
IN-KIND: Postage
02
IN-KIND: Postage
IN-KIND: Postage
2016
563.85
Ms. Paula Rose Copeland Jr.
2016
Ms. Marilyn Copeland
2016
64
2016
Ms. Ruth Allyn Pettitt
2016
2016
Image# 201603039009636209
18
69
18
18
Fort Myers
Hamilton
Oxford
001
001
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5555 Hilton Ave.
5555 Hilton Ave.
750 Cross Pointe Blvd.
Ste. 106
Suite N
25196.58
40.81
44.97
Ste. 106
Derickson for Congress
Transaction ID : 0000654
LA
LA
OH
70808
43230
70808
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000760
Transaction ID : 0000653
02
02
Bank Fees
02
Bank Fees
Direct Mail
2016
25282.36
King Strategic Communications, Inc.
2016
Anedot
2016
65
2016
Anedot
2016
2016
Image# 201603039009636210
18
69
19
20
Baton Rouge
Gahanna
Baton Rouge
001
004
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5145 Brown Rd.
5555 Hilton Ave.
2700 Oxford Millville Rd
(contributor) In-Kind Received
Ste. 106
511.61
12.60
245.00
Derickson for Congress
Transaction ID : 0000758
OH
LA
OH
45056
45056-9163
70808
2016 Special Primary
2016 Special Primary
2016 Special Primary
Transaction ID : 0000784-IK
Transaction ID : 0000729
02
02
Postage, Non-Bulk Mail
02
Bank Fees
IN-KIND: Postage and Office Expense
2016
769.21
Mrs. Kelly S Derickson
2016
Anedot
2016
66
2016
US Post Office
2016
2016
Image# 201603039009636211
22
69
22
22
Baton Rouge
Oxford
Oxford
006
001
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
5555 Hilton Ave.
500 Staples Dr.
Ste. 106
478.62
16.12
Derickson for Congress
144535.05
LA
MA 01702
70808
2016 Special Primary
2016 Special Primary
Transaction ID : 0000759
Transaction ID : 0000735
02
02
Bank Fees
Campaign supplies
2016
494.74
Staples
2016
Anedot
67
2016
2016
Image# 201603039009636212
22
69
23
Baton Rouge
Framingham
006
001
FE5AN018
SCHEDULE B (FEC Form 3)
ITEMIZED DISBURSEMENTS
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
! ! !, , .
! ! !, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3) (Revised 12/2015)
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code Amount of Each Disbursement this Period
! ! !, , .
C.Date of Disbursement
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
PAGE OFFOR LINE NUMBER: (check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page
Category/Type
17 18 19a 19b
20a 20b 20c 21
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
463 Elsmere St.
50.00
Derickson for Congress
50.00
OH 43206
2016 Special Primary
Transaction ID : 0000771
02
Refund Of Contribution
2016
50.00
Ms. Lisa Griffin
2016
68
Image# 201603039009636213
10
69
Columbus
010
FE5AN018
SCHEDULE C (FEC Form 3)
LOANS
PAGE OF
Use separate schedule(s)
for each category of the
Detailed Summary Page
NAME OF COMMITTEE (In Full)
SUBTOTALS This Period This Page (optional) .................................................................
TOTALS This Period (last page in this line only) .............................................................
FEC Schedule C (Form 3) (Revised 12/2015)
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
Name of Employer
Occupation
List All Endorsers or Guarantors (if any) to Loan Source
, , .
, , .
, , . , , . , , .
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
Date Incurred Date Due Interest Rate Secured:
Yes No . % (apr)
Election:
Primary
General
Other (specify)
LOAN SOURCE Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code
1. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
2. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
3. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
4. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
TERMS
FOR LINE NUMBER:
(check only one) 13a
13b
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
0.00
Transaction ID : 388-5
[PERSONAL FUNDS]
Timothy S Derickson
OH
Derickson for Congress
2015
20000.00
29
2700 Oxford Millville Rd
None12
Oxford
20000.00
2016
20000.00
69
20000.00
Image# 201603039009636214
69
On Demand
45056-9163
