KANSAS GOVERNMENTAL ETHICS COMMISSION
RECE~TSANDEXPENDITURESREPORT
OF A CANDIDATE FOR STATE OFFICE
October 29, 2012
FILE WITH SECRETARY OF STATE SEE REVERSE SIDE FOR INSTRUCTIONS
FILED
OCT 29 2012
KRIS W. KOBACH SECRETARY or: STATE
A. Name ofCandidate: _A_n_n_E_._M_a_h _
Address: 3351 SE Meadowview Dr
City and Zip Code:_To_p_e_k_a_6_6_6_0_5 _ County: Shawnee
Office Sought: State Representative District: 54 -----
B. Check only if appropriate: __ Amended Filing __ Termination Report
C. Summary (covering the period from July 27, 2012 through October 25,2012)
1. Cash on hand at beginning of period . $15,118.95
2. Total Contributions and Other Receipts (Use Schedule A) .. $19,655.00
3. Cash available this period (Add Lines 1 and 2) . $34,773.95
4. Total Expenditures and Other Disbursements (Use Schedule C) .. ($281446.62)
5. Cash on hand at close ofperiod (Subtract Line 4 from 3) . $6,327.33
6. In-Kind Contributions (Use Schedule B) $172.50
7. Other Transactions (Use Schedule D) $71789.75
D. "I declare that this report, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is true, correct and complete. 1 understand that the intentional failure to file this document or intentionally filing a false document is a class A misdemeanor."
10/29/12 Date Signature ofCandidate or Treasurer
GEe Form Rev, 2001
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Date
7I1.m.012
811.11.012
81311.012
8/611.012
8n11.012
811.311.012
811.311.012
811.411.012
811.811.012
9/411.012
9/511.012
9/611.012
9n11.012
9/1111.012
Oceupation & Industry Cbeek
Name aud Address A ro riate Box of Contributor
ofIndividual Giving EfundsMore Tban $150 Casb Cbeek Loan Otber
Little Government Relations LLC 800 SW Jaekson St Ste #914 0 181 0 0 Topeka, KS 66612-2214
Marjorye S Heeney 100 SE 9th St #708 0 181 0 0 Topeka, KS 66612-1219
Laborers Local Union #1290 PAC, 2600 Merriam Ln 0 181 0 0 Kansas City, KS 66106
Shawnee Co. Deemocratic Legislative Committee 0 181 0 0 PO Box 2571, Topeka, KS 66601
Anheuser Busch Companies One Busch Place 0 181 0 0 StLouis,MO 63118
Kansas National Education AssocPAC, 715 SW 10th 0 181 0 0 Topeka, KS 66612-1686
Duane Johnson 4142 SE29th St 0 181 0 0 Topeka, KS 66606
Michael Blumenfeld 2713 Westdale Cir 0 181 0 0 Lawrence, KS 66049
Micheline Z Burger 26622 W Greentree Ct 0 181 0 0 Olathe, KS 66061
Jack Strukel 5125 SE 10th St 0 181 0 0 Tecumseh, KS 66542-9427
Marjorye S Heeney 100 SE 9th St #708 181 0 0 0 Topeka, KS 66612-1219
DarreU Timken 3418 SE Buckeye St 0 181 0 0 Topeka, KS 66605
Robert S Maxwell 2333 SW Mayfair PI 0 181 0 0 Topeka, KS 66611
H Edward Quick, Jr 503 Arizona St Retired 0 181 0 0 Lawrence, KS 66049
Amonntof Casb, Cbeek,
Loan or Otber Reeeipt
$100.00
$100.00
$500.00
$500.00
$200.00
$500.00
$100.00
$100.00
$100.00
$100.00
$20.00
$100.00
$75.00
$250.00
$2,745.00
Page 1 of 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Check Name and Address ro riate Box
Date of Contributor E funds
Cbeck Loan Otber
Sarah M Casad 911112012 1130 Emery Rd III [J [J
Lawrence, KS 66044-2515
Randall Jay Roy 911112012 1561 SW Lakeside Dr III [J [J
Topeka,1CZS 66604-2529
Richard B Hanger 911112012 3575 Shoreline Dr III [J [J
Topeka, KS 66605
Frank C Sabatini Trust 911112012 2423 SE 37th St III [J [J
Topeka, KS 66605-2310
KS AFL-CIO - Cope Fund 9/1312012 2131 SW 36th St III [J [J
Topeka, KS 66611-2553
Kansas Sierra Club PAC 9/1312012 5240 Decatur Rd III [J [J
Meriden, KS 66512
Capital Area Federation of Women's 9/1412012 Democratic Club, 5131 SW 33rd Terr, III [J [J
Topeka, KS 66614
Dan Watkins 9/1412012 901 New Hampshire #200 III [J [J
Lawrencs,KS 66055
James M Gartner 9/1912012 928 SW Woodbridge Ct III [J [J
Topkea, KS 66606
DCP Midstream, LP 9/1912012 370 17th St, Ste#2500 III [J [J
Denver, CO 80101
Lynn Hellebust 9/1912012 1516 SW Boswell Ave III [J [J
Topeka, KS 66604
Rick Stein 911912012 963 N 1950Rd III [J [J
Lawrence, KS 66049
Marvin Hornbostel 9/1912012 3707 Hwy K244 III [J [J
Junction City, KS 66441
Teamsters 696 DRIVE for Kansas 912012012 3600 NE Sardou Ave Bldg #1 III [J [J
Topeka, KS 66616
Amount of Casb, Cbeck,
Loan or Otber Receipt
5100.00
5250.00
5100.00
5200.00
$300.00
$SOO.OO
5150.00
5100.00
5150.00
$300.00
5100.00
5100.00
5100.00
5500.00
52,950.00
Occupation & Industry of Individual Giving
More Tban 5150
Retired
Retired
Consultant 1 Telecommunications
Casb
[J
[J
[J
[J
[J
[J
[J
[J
[J
[J
[J
[J
[J
[J
A
Page 2 of 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Occupation & Industry Check Amouotof
Name and Address Ap ro riate Box Cash, Check, Date
of Contributor of Individual Giving
Efunds Loan orMore Than 5150 Cash Check Loan
Other Other Receipt
William R Brady 912012012 1235 Stone Creek Dr [J III [J [J $100.00
Lawrence, KS 66049-4788
NEA - Topeka PAC 912012012 715 SW 10th Ave [J III [J [J $100.00
Topeka, KS 66612-1617
Jolene C Miller Corporate Executive I
912012012 3309 SE Tomahawk Ct [J III [J [J $150.00
Topeka, KS 66609 Transportation
Nancy W Irwin 912012012 1540 SE 93rd St [J III [J [J $100.00
Wakarusa,KS 66546-9257
Mary M Thomas 912012012 3511 SE Tomahawk Ct [J 1m [J [J $100.00
Topeka, KS 66605
Zandra L Myrick 912012012 5831 SW 22nd Terr #1 [J III [J [J $100.00
Topeka, KS 66614
Kathleen A Selig Physical Therapist I
912012012 5601 SE Ratner Rd [J 1m [J [J $200.00 Berryton,KS 66409
Medical
Stephen N Six 912112012 1131West HiDs Pky [J 1m [J [J $100.00
Lawrence, KS 66044
United Steel Worken Local 307 912112012 Legislative Fund, 1603 NW Taylor [J 1m [J [J $250.00
Topeka, KS 66608-1556
Byron E Springer 912212012 POBox 666 [J 1m [J [J $100.00
Lawrence, KS 66044
Kansas Contractors Assoc 912212012 PAC, 316 SW 33rd St [J 1m [J [J $250.00
Topeka, KS 66605~061
United Transportation Union PAC 912212012 3741 SW Kings Forest Rd [J 1m [J [J $250.00
Topeka, KS 66610
Donald C Signor Retired I Spouse:
912512012 248N850Rd [J 1m [J [J $200.00 Overbrook, KS 66524
Retired
Marilyn H Tilghman 912512012 1602 Brandon Woods Ct [J 1m [J [J $100.00
Lawrence, KS 66047-1895
$2,100.00
Page 3 of 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann EMah (Name of Candidate, Party Committee or Political Committee)
Occupation & Industry Cbeck Amount of
Name and Address A ro riate Box Casb, Cbeck,Date of Contributor
of Individual Giving Efunds Loan or
More Tban $150 Casb Cbeck Loan Otber Otber Receipt
Harry G. MiUer 912612012 345 Mississippi [] 1m [] [] $100.00
Lawrence, KS 66044
Jean F Shepherd 912612012 3416 Riverview Rd [] 1m [] [] $100.00
Lawrence, KS 66049-2132
Kansas Optometric PAC 912612012 1266 SW Topeka Blvd [] 1m [] [] $250.00
Topeka, KS 66612
Carolyn J Crawford 912612012 834 Hwy40 [] 1m [] [] $100.00
Lawrence,KS 66049-4173
Abbie P Hodgson 912612012 2028 New Hampshire St [] 1m [] [] $100.00
Lawrence, KS 66046-2948
Tess Banion 912612012 505 Rockledge 1m [] [] [] $60.00
Lawrence, KS 66044
Kansas Funeral Directors Assoc 912812012 PAC, 1200 Kansas, Topeka, KS [] 1m [] [] $150.00
66612
Herman Page 912812012 POBox 5167 [] 1m [] [] $100.00
Topeka, KS 66605-0167
Local 1445 Carpenters PAC 912812012 212 NW Norris St [] 1m [] [] $500.00
Topeka, KS 66608-1355
Betty M Tudor 912812012 900 SW 31st St #239 Retired [] 1m [] [] $100.00
Topeka, KS 66611
Robert R Resnik 912912012 3641 SE 27th St [] 1m [] [] $100.00
Topeka, KS 66605-1960
GKCWPC Separate Segregated 10/112012 Fnnd, PO Box 10095 [] 1m [] [] $100.00
Kansas City, MO 64171
Plumbers & Pipefitters Local 101312012 Union #441, 1330 E 1st #115 [] 1m [] [] $500.00
Wichita, KS 67214
Kansas State Troopers PAC 101312012 1200 SW 10tb Ave [] 1m [] [] $250.00
Topeka, KS 66604
$2,510.00
Page 4 of 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Occupation & Industry Check Amount of
Name and Address A ro nate Box Cash, Check. Date
of Contributor of Individual Giving
Efunds Loan orMore Than $150 Cash Cbeck Loan
Other Other Receipt
Micbael W Goodwin 1013/l012 3819 SE 31st St [] 1m [] [] $100.00
Topeka, KS 66605-2109
KS State Farm Insurance Agents 1013/l012 & Employees PAC 825 S Kansas [] 1m [] [] $100.00
Ave #SOO, Topeka, KS 66612
International Assoc of Fire 10/4/l012 Fighten #83, 318 SE Jeffenon [] 1m [] [] $500.00
Topeka, KS 66607
Howard A Duncan Corporate Executive /
10/4/l012 3320 SE 37th St [] 1m [] [] $150.00 Topeka, KS 66605
Recreation Industry
Pat Laugblin 10/6/l012 3100 SE Burton [] 1m [] [] $100.00
Topeka, KS 66605
Kansas Dental PAC 10/6/l012 5200 SW Huntoon St [] 1m [] [] $250.00
Topeka, KS 66604
Justin A Hoover Pbysical Tberapist /
10/6/l012 604 N Spring Valley Rd [] 1m [] [] $500.00 Junction City, KS 66441
Medical
KTLA Consumer/Civil Justice 1018/l012 PAC, 719 SW Van Buren [] 1m [] [] $500.00
Topeka, KS 66603
Elizabeth H Scott 10/13/l012 3435 SW Alameda Dr [] 1m [] [] $100.00
Topeka, KS 66614
Glass House Liquor 10/13/l012 2301 Wakarusa Ste C [] 1m [] [] $125.00
Lawrence, KS 66047
Western MO & KS Laborers' Dist 10/13/l012 Council PAC, 1101 E 87th #100 [] 1m [] [] $500.00
Kansas City, MO 64131
District #70 MNPL, PA 10/13/l012 3830 S Meridian [] 1m [] [] $500.00
Wicbita, KS 67217-3704
Heavy Constructon Assn PAC 10/13/l012 3101 Broadway Ste #780 [] 1m [] [] $200.00
Kansas City, MO 64111
Kansas Health Care Assn PAC 10/13/l012 117 SW 6th Ave Ste #200 [] 1m [] [] $250.00
Topeka, KS 66603-3840
$3,875.00
Page 5 of 12
SCHEDULE A CONTRIBUTIONS AND OTHER RECEIPTS
Ann EMah (Name of Candidate, Party Committee or Political Committee)
Occupation & Industry Check Amount of
Name and Address A ro riate Box Cash, Check, Date
of Contributor oflndividual Giving
Efunds Loan orMore Than $150 Cash Check Loan
Other Other Receipt
AT&T Kansas PAC 10/1612012 220 E 6th Rm ##500 [] 181 [] [] $500.00
Topeka, KS 66603
American Family Insurance 10/1612012 Kansas PAC, 1300 SW [] 181 [] [] $100.00
Arrowhead, Topeka, KS 66604
Phil Ruffin Investor /
10/1712012 POBox 17087 [] 181 [] [] $200.00 Wichita, KS 67217
Real Estate
By-Vee Inc 10/1712012 5820 Westown Parkway [] 181 [] [] $250.00
West Des Moines, IA 50266
IBEW PAC Educational Fund 10/1712012 900 Seventh St NW [] 181 [] [] $500.00
Washington, DC 20001
Betty M Tudor 1011912012 900 SW 31st St #239 Retired [] 181 [] [] $100.00
Topeka,KS 66611
Summit Strategies Group, LLC 1012012012 POBox 1342 [] 181 [] [] $100.00
Topeka, KS 66601
Steven R Magee 1012012012 454 E 137th St [] 181 [] [] $100.00
Carbondale, KS 666414
Operating Engineen Local 101 PAC 1012012012 6601 Wmchester Ste 280 [] 181 [] [] $200.00
Kansas City, MO 64133
Kansas State Industrial Union 1012512012 Council, 1603 NW Taylor [] 181 [] [] $200.00
Topeka,1CS 66608
$2,250.00
Total Unitemized Contributions ($50 or less)
Total Unitemized Contributions ($50 or less)
Sale of Political Materials (Unitemized)
Total Contributions When Contributor Not Known
TOTAL RECEIPTS THIS PERIOD (to line 2 of Summary)
$16,430.00
$3,225.00
$0.00
$0.00
$19,655.00
Page 6 of 12
SCHEDULE C EXPENDITURES AND OTHER DISBURSEMENTS
Ann EMah (Name of Candidate, Party Committee or Political Committee)
Date Name and Address Purpose of Expenditure
Amount or Disbursement
AnnMah Reimbursement to candidate for
713012012 3351 SE Meadowview Dr postage $90.00
Topeka, KS 66605
AnnMah Reimbursement to candidate for
81312012 3351 SE Meadowview Dr office supplies $89.84
Topeka,KS 66606
Econ-O-Print 8/14/2012 4140 SW Martin Dr Postcard printing $247.32
Topeka,KS 66609
AnnMah Reimbursement to candidate for
8/15/2012 3351 SE Meadowview Dr postage $90.00 Topeka, KS 66606
Neal Resources 8/1712012 17520 Nature Walk Trail #106 Website design $295.20
Parker, CO 80134-5264
AnnMah 8120/012 3351 SE Meadowview Dr
Reimbursement to candidate for $116.91
Topeka,KS 66606 postage & office supplies
AnnMah Reimbursement to candidate for 8/20/012 3351 SE Meadowview Dr office supply donation to Washburn $14.17
Topeka,KS 66606 Auburn Schools
AnnMah Reimbursement to candidate for 8/20/012 3351 SE Meadowview Dr Topeka Aids Projetct Auction! $48.10
Fundraiser
Econ-Q-Print 8124/2012 4140 SW Martin Dr Yard signs & wires $2,586.47
Topeka,KS 66609
AnnMah 8/2712012 3351 SE Meadowview Dr
Reimbursement to candidate for $154.00
Topeka,KS 66606 postage
AnnMah 8129/2012 3351 SE Meadowview Dr
Reimbursement to candidate for $73.98
Topeka, KS 66607 office supplies
AnnMah Reimbursement to candidate for 8129/2012 3351 SE Meadowview Dr Life House Child Advocacy Center $40.00
Topeka, KS 66608 FundraiserlDonation
$3,845.99
Page 7 of 12
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Ann EMah (Name of Candidate, Party Committee or Political Committee)
Date Name and Address Purpose of Expenditure
Amount or Disbursement
Shawnee County Democrats 8/30/2012 1301 S Kansas Ave Donation $250.00
Topeka,1(S 66611
Neal Resources 813012012 17520 Nature Walk Trail #106 Website design $35.00
Parker, CO 80134-5264
Auburn Lions Club 8/3012012 9615 SW Auburn Rd Advertisement $225.00
Wakarusa, I(S 66546
AnnMah Reimbursement to candidate for 8/3112012 3351 SE Meadowview Dr NAACP banquet fundraiserl $73.00
Topeka,1(S 66606 donation, and advertisement
AnnMah Reimbursement to candidate for
9/4/2012 3351 SE Meadowview Dr postage and parade candy $142.13
Topeka, I(S 66607
AnnMah Reimbursement to candidate for
9/512012 3351 SE Meadowview Dr postage and office supplies $109.86 Topeka, I(S 66608
AnnMah Reimbursement to candidate for
917/2012 3351 SE Meadowview Dr office supplies $32.67 To ka, I(S 66609
AnnMah Reimbursement to candidate for
917/2012 3351 SE Meadowview Dr $25.92 To eka,1(S 66610
candy
Cumulus Broadcasting 917/2012 825 S Kansas Ave Radio advertising $50.00
Topeka,1(S 66612
AnnMah Reimbursement to candidate for
9/1312012 3351 SE Meadowview Dr office supplies $8.29
Topeka, I(S 66607
AnnMah Reimbursement to candidate for 9/1312012 3351 SE Meadowview Dr Combat Air Museum RunlWalk $50.00
WmWRadio 911312012 1210 SW Executive Dr Radio advertising $49.30
Topeka,1(S 66615
Osage Co Herald-Chronicle 9/18/2012 527 Market St Advertisement $147.50
Osage City, I(S 66523
SI,198.67
Page 8 of 12
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Date Name and Address Purpose of Expenditure
Amount or Disbunement
AnnMah Reimbursement to candidate for
9123/2012 3351 SE Meadowview Dr office supplies 5109.97
Topeka, KS 66607
AnnMah 9/23/2012 3351 SE Meadowview Dr Fundraiser refreshments 520.57
Topeka,KS 66607
Econ-O-Print 9/2412012 4140 SW Martin Dr Mailer printing & postage 52,961.27
Topeka,KS 66609
Osage Co Herald-Chronicle 9/26/2012 527 Market St Advertisement 5296.25
Osage City, KS 66523
Friends of the Topeka Zoo 9/2412012 635 SW Gage Blvd FundraiserlDonation 575.00
Topeka, KS 66606
Econ-O-Print 9128/2012 4140 SW Martin Dr Mailer printing & postage 53,508.50
Topeka,KS 66609
Econ-Q-Print 10/5/2012 4140 SW Martin Dr Mailer printing & postage 52,562.31
Topeka,KS 66609
Osage Co Herald-Chronicle 10/5/2012 527 Market St Advertisement 5296.25
Osage City, KS 66523
AnnMah 10/612012 3351 SE Meadowview Dr
Reimbursement to candidate for 5160.00
Topeka,KS 66606 postage
AnnMah 10/6/2012 3351 SE Meadowview Dr
Reimbursement to candidate for 539.95
ToPeka, KS 66606 email service
Econ-O-Print 10/9/2012 4140 SW Martin Dr Postcard printing & postage 52,562.31
Topeka,KS 66609
Osage Co Herald-Cbronicle 10/912012 527 Market St Advertisement 5600.00
Osage City, KS 66523
513,192.38
Page 9 of 12
SCHEDULEC EXPENDITURES AND OTHER DISBURSEMENTS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
$74.69 $28,371.93
$10,134.89
Total Itemized Ex enditures This Period Total Unitemized Ex enditures of $50 or less
Date Name and Address Purpose of Expenditure
Amount or Disbursement
Econ-O-Print 10/15/2012 4140 SW Martin Dr Postcard printing & postage $2,638.94
Topeka, KS 66609
WmWRadio 10/1512012 1210 SW Executive Dr Radio advertising $847.88
Topeka, KS 66615
AnnMah Reimbursement to candidate for
10/15/2012 3351 SE Meadowview Dr postage $45.00 Topeka,KS 66606
Econ-O-Print 10/1712012 4140 SW Martin Dr Mailer printing & postage $1,568.13
Topeka,KS 66609
Postmaster 10/19/2012 Hicrest Station Postage $205.00
Topeka,KS 66605
Kansas Democratic Party 10/1912012 700 SW Jackson #706 Donation $2,500.00
Topeka, KS 66603
Econ-O-Print 101232012 4140 SW Martin Dr Postcard printing & postage $601.53
Topeka,KS 66609
Econ-O-Print 10123/2012 4140 SW Martin Dr Printing set-up $65.37
Topeka,KS 66609
AnnMah 1012412012 3351 SE Meadowview Dr
Reimbursement to candidate for $186.00
Topeka,KS 66606 postage
TeleRoots Technologies Inc 10/2412012 2232 Vermont St Roboc:aUs $137.76
Lawrence, KS 66046
Econ-O-Print 10/25/2012 4140 SW Martin Dr Postcard printing & postage $1,339.28
Topeka, KS 66609
TOTAL EXPENDITURES & OTHER DISBURSEMENT TillS PERIOD to line 2 of Summary) $28,446.62
Page 10 of 12
SCHEDULE B IN-KIND CONTRIBUTIONS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Value ofList Occupation & Industry Description of In-KindName and Address In-Kindfor Those Giving an In-Kind Date Contributionof Contributor Contributionof more than $150
Kansas' Wine & Spirits Wholesalers $172.50Beverages for Fundraiser 9/20/2012 PAC, 212 WS 8th Ave Ste
#202,Topeka,~ 66603
$172.50
Complete if last page of Schedule B
$172.50 $0.00
$172.50
Page 11 Of 12
SCHEDULE D OTHER TRANSACTIONS
Ann E Mah (Name of Candidate, Party Committee or Political Committee)
Balance atNature of Account or Loan Payable
Close ofName and AddressDate or Loan Receivable Period
AnnMah Account payable to candidate for campaign 10/23/2012 3351 SE Meadowview Dr payment to Osage Co. Herald-Chronicle for $693.75
Topeka, KS 66605 advertising
Econ-O-Print 10/2512012 4140 SW Martin Dr Account Payable for printing, mailing & postage $5,200.00
Topeka, KS 66609
Osage Co Herald-Chronicle 10/2512012 527 Market St Accounts payable for advertising $296.00
Osage City, KS 66523
Kansas Democratic Party 10/2512012 700 SW Jackson Ste #706 Accounts payable for campaign services $1,000.00
Topeka, KS 66603
KTPKRadio 10/2512012 1210 SW Executive Dr Accounts payable for advertising $600.00
Topeka, KS 66615
$7,789.75
Complete if last page of Schedule D
$7,789.75
Page 12 of 12