KANSAS GOVERNMENTAL ETHICS COMMISSION RECEIPTS AND EXPENDITURES REPORT OF A POLITICAL OR PARTY COMMITTEE RECEIVED October 29,2012 OCT 252012 FILE WITH SECRETARY OF STATE

A. Name of Committee: Kansas Beverage Association Political Action Committee

Address: _5_84_5_S_W_2_9_t_h_S_t_re_e_t _

City and Zip Code: _T_o_p_e_k_a_6_6_6_14 _

This is a (check one): __ Party Committee v' Political Committee

B. Check only if appropriate: __Amended Filing __ Tennination Report

C. Summary (covering the period from July 27,2012 through October 25, 2012) 1. Cash on hand at beginn.ing ofperiod . 8150.49 2. Total Contributions and Other Receipts (Use Schedule A) . 412.00 3. Cash available this period (Add Lines I and 2) .. 8562.49 4. Total Expenditures and Other Disbursements (Use Schedule C) . 8000.00 5. Cash on hand at close of period (Subtract Line 4 from 3) .. 562.49 6. In-Kind Contributions (Use Schedule B) .. 7. Other Transactions (Use Schedule D) .

D. "1 declare that this report, including any accompanying schedules and statements, has been examined by me and to the best ofmy knowledge and belief is true, correct and complete. 1 understand that the intentional failure to file this document or intentionally filing a false do;ume~7lass A misdemeanor."

,(t?)?&1. / ~/ ~- ' Date Signature of Treasurer

GEe Form Rev, 2001 SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS

(Name of Party Committee or Political Committee)

Occupation & Industry of Check Amount of Name and Address Individual Giving More Appropriate Box Cash, Checl{, Date of Contributor Than $150 Loan or Other eMh Cheel< Lou" E fund. Olher Receipt

Pepsi-Cola Bottling Pittsburg 10/16/12 Box 1924 $412.00 Pittsburg KS 66762

$412.00

Complete if last page of Schedule A

Total Itemized Receipts for Period $412.00

Total Ullitemized Contributions ($50 or less) $0.00

Sale ofPolitical Materials (Unitemized) $0.00

Total Contributions When Contributor Not Known $0.00 $412.00

Page __ of__ SCHEDULEB IN-KIND CONTRIBUTIONS Kansas Beverage AssociatIon Political Action Commltee (Name of Party Committee or Political Committee)

List Occupation & Value of Date Name and Address Industry for Those Giving Description of In-Kind In-Kind of Contributor an In-Kind of More Than Contribution Contribution $150 None

- $0.00 Subtotal This Page

Complete if last page of Schedule B

Total Itemized (over $1 00) In-Kind Contributions

Total Unitemized ($100 or less) In-Kind Contributions

TOTAL IN-KIND CONTRIBUTIONS THIS PERIOD (to line 6 of Summary) $0.00

Page __ of__ SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Kansas Beverage Association Political Action Committee (Name of Party Committee or Political Committee)

Name and Address Purpose of Expenditure Date To Whom Expenditure Is Made Amount Ifindependent or in-kind expenditllre in excess of $300 is made for a candidate, list camlidate name & address

See Attachment to Schedule C 10/04/12 $8,000.00

" ~';I ' •. I Tj ;" " ... ;-' .. : ;lA .. .. I: " ' " , ,'::;, :f<" ". .. .J: . ~ "r . " $6,000.00 ,:~~:bt~til']':Ti)i~ ~!lg~,~' ~ :}t:,',;", ",,' J •• " '.' -,

Complete if last page of Schedule c

Total Itemized Expenditures This Period $6,000.00

Total Unitell1ized Expenditures of $50 or less $0.00 :,:" .~- :: $8,000.00

Page __ of__ Kansas Beverage Association~Political Action Committe SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS

Date Num Name Address Paid Amount Ju125· Dec 31, 12 10/4/2012 2754 Han. Tom Arpke Box 3003 Salina KS 67402-3003 500.00­ 10/4/2012 2755 Dick Barta 7949 NW Rochester Road Topeka KS 66617 500.00­ 10/4/2012 2756 Elaine Bowers 1326 N. 150th Road Concordia KS 66901 250.00­ 10/4/2012 2757 Marla Brems 8610 Mackey Street Overland Park, KS 66212 150.00­ 10/4/2012 2758 Rep. Ward Cassidy 420 E. 2nd Box 303 SL Francis, KS 677... 200.00­ 10/4/2012 2759 Mr. John Doll 2927 Cliff Place Garden City, KS 67846 150.00­ 10/4/2012 2760 Willie Dove 14715 Timber Lane Bonner Springs, KS 66012 150.00­ 10/4/2012 2761 Mr. Steve Fitzgerald 3100 Tonganoxie Road Leavenworth, KS ... 350.00­ 10/4/2012 2762 Dr. Shantl Gandhi 5802 Clarion Lakes Way Topeka, KS 66610 200.00­ 10/4/2012 2763 Mr. Daniel Hawkins 9406 Harvest Lane Wichita KS 67212 200.00­ 10/4/2012 2764 Rep. Gerald T. Henry 3515 Neosho Road Cummings, KS 66... 250.00­ 10/4/2012 2765 Mr. Larry Hibbard 858 EE75 Road Toronto KS 66777 150.00­ 10/4/2012 2766 Mr. 27487 Wells Creek Road Wamego, KS 66... 200.00­ 10/4/2012 2767 Rep. 1318 Avenue T Coldwater KS 67029 25D.00­ 10/4/2012 2768 Han. Mitch Holmes 211 SE 20th Avenue SL John, KS 67576 250.00· 10/4/2012 2769 Michelle Hucke 1914 S. Locust Pittsburg KS 66762 150.00­ 10/4/2012 2770 Mr. Russell Jennings 515 Pleasantview Box 295 Lakin KS 6... 200.00· 10/4/2012 2771 Han. Forrest Knox 17120 Udall Road Altoona, KS 66710-8560 250.00­ 10/4/2012 2772 Mr. Jacob LaTurner 204 E. Euclid Street Pittsburg, KS 66762 500.00­ 10/4/2012 2773 Sen. Jeff Longblne 2B01 Lakeridge Road Emporia KS 66801 250.00­ 10/4/2012 2774 Charles Macheers 21704 W. 57th Terrace Shawnee, KS 66218 150.00­ 10/4/2012 2775 Mr. Michael Houser 6891 SW 10th Street Columbus KS 667 ... 200.00­ 10/4/2012 2776 Janet Milchell1921 SW Damon COurt Topeka KS 66611 150.00­ 10/4/2012 2777 Mr. Reid Petty 818 N. Lincoln Liberal, KS 67901 150.00­ 10/4/2012 2778 Bob Reader P. O. Box 1841 Manhattan KS 66502 400.00­ 10/4/2012 2779 Rep. Sharon Schwartz 2051 20th Road Washington, KS 66968 250.00­ 10/4/2012 2780 Rep. Arlen Slegfreid 1403 W. Prairie Terrace Olathe, KS 660... 250.00­ 10/4/2012 2781 Han. Greg Smith 8605 Robinson Overland Park, KS 66212 400.00­ 10/4/2012 2782 Rep. Bill Sutton 301 W. Westhoff Place Gardner, KS 6603D 200.00­ 10/4/2012 2783 Mr. Jack Thlmesch 234 N. Henderson Cunningham, KS 670... 200.00­ 10/4/2012 2784 Mr. 112 N. Fairview Avenue Luray, I

Kansas Beverage Association Political Action Committee (Name of Party Committee or Political Committee)

Balance at Date Name and Address Nature of Account or Loan Payable Close of or Loan Receivable Period

None

$0.00 Subtotal This Page

Complete if last page of Schedule D

TOTAL OTHER TRANSACTIONS (to line 7 of Summary)

Page of__