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1. DATE OF REPORT OFFICE USE ONLY Missouri Ethics Commission COMMITTEE DISCLOSURE REPORT COVER PAGE 12/27/2012 C121458 M.E.C. ID NO. ______________________________ INSTRUCTIONS ON REVERSE SIDE 2. FULL NAME OF COMMITTEE SUSAN "TOOTIE" BURNS FOR COUNCIL 3. COMMITTEE MAILING ADDRESS 4. COMMITTEE TELEPHONE NUMBER 1400 FORUM BLVD STE C1-443 (573) 449-7974 CITY / STATE / ZIP COLUMBIA MO 65203 5. TREASURER'S NAME JOHN OTT 6. TREASURER'S MAILING ADDRESS 7. TREASURER'S TELEPHONE NUMBER 212 BINGHAM RD HOME: (573) 489-5353 CITY / STATE / ZIP WORK: (573) 489-5353 COLUMBIA MO 65203 8. DEPUTY TREASURER'S NAME CHECK IF NO DEPUTY TREASURER VICKI HOBBS 9. DEPUTY TREASURER'S MAILING ADDRESS 10. DEPUTY TREASURER'S TELEPHONE NUMBER 4001 S COATS LN COLUMBIA MO 65203 HOME: (573) 445-4940 CITY / STATE / ZIP WORK: (573) 445-4940 11. DATE OF ELECTION 12. TYPE OF ELECTION ( CHECK ONE ) 2/5/2013 PRIMARY GENERAL SPECIAL 13. TIME PERIOD COVERED BY THIS STATEMENT FROM 10/16/2012 THROUGH 12/22/2012 14. CANDIDATE COMMITTEES ONLY: LIST CANDIDATE'S NAME, 15. TYPE OF REPORT ADDRESS, PHONE, OFFICE SOUGHT, POLITICAL SUBDIVISION AND 15 DAYS AFTER CAUCUS NOMINATION POLITICAL PARTY COMMITTEE QUARTERLY REPORT SUSAN G BURNS Jan 15 Apr 15 Jul 15 Oct 15 117 W BURNAM RD 8 DAYS BEFORE COLUMBIA MO 65203 30 DAYS AFTER ELECTION (573) 449-7974 TERMINATION (ATTACH FORM CO-3) COUNCIL PERSON SEMIANNUAL DEBT REPORT Jan 15 Jul 15 CITY OF COLUMBIA ANNUAL SUPPLEMENTAL, JAN 15 15 DAYS AFTER PETITION DEADLINE 4 CHECK IF INCUMBENT OTHER 40 Day Before Special Charter Election-2/5/ AMENDING PREVIOUS REPORT DATED 4 REPUBLICAN DEMOCRAT NON-PARTISAN _________________________ ____________, 20 _____ 16. COMMITTEE TREASURER'S SIGNATURE 17. CANDIDATE'S SIGNATURE ( CANDIDATE COMMITTEES ONLY ) I CERTIFY THAT THIS REPORT, COMPRISED OF THIS COVER I CERTIFY THAT THIS REPORT, COMPRISED OF THIS COVER PAGE AND ALL ATTACHED FORMS, IS COMPLETE, TRUE AND PAGE AND ALL ATTACHED FORMS, IS COMPLETE, TRUE AND ACCURATE. ACCURATE. ELECTRONICALLY FILED Dec 27 2012 4:54PM ELECTRONICALLY FILED Dec 27 2012 4:54PM TREASURER'S SIGNATURE CANDIDATE'S SIGNATURE MO 300-1310 (10-06) CD Cover Page Missouri Ethics Commission Name of Committee Date of Report Office Use Only REPORT SUMMARY SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 Instructions on Reverse Side B. This Calendar Yr Receipts A. This Period Statement of or Election Cycle Beginning and Ending 1. Total Receipts For This Election Previously Reported $ 0.00 Financial Condition 2. All Monetary Contributions Received This Period $ 11,365.00 Money On Hand 3. All Loans Received This Period + 0.00 4. 24. Money On Hand at the beginning of Miscellaneous Receipts This Period + 0.00 this reporting period (Including funds 0.00 $ 5. Subtotal Monetary Receipts This Period in depository, cash, savings accounts (Sum 2A + 3A + 4A) $ 11,365.00 and all other investments) 6. In-kind Contributions Received This 25. Period + 0.00 Monetary Receipts this Period + 11,365.00 7. Total All Receipts This Period (Sum 5A (From Item 5 - this page) + 6A) $ 11,365.00 8. Total All Receipts This Election (Sum 26. Monetary Disbursements Made This 1B + 7A) $ 11,365.00 Period (Sum 10 + 16A + 23 ) - 1,104.33 B. This Calendar Yr a) Disbursements By Check $___1_,_1_0_4_._3_3 Expenditures A. This Period or Election Cycle b) Disbursements By Cash $_______0_._0_0 9. Total Expenditures for this election 27. previously reported $ 0.00 Money On Hand at the close of this reporting period $ 10,260.67 10. Expenditures made by cash or check (SUM 24 + 25 - 26) this period $ 850.57 11. In-Kind Exppenditures made this pperiod ++ 0.00 12. Expenditures incurred this period (not Indebtedness including loans) including payments made by credit card (line 17 CD3) + 753.76 13. Total All expenditures made this period 28. (Sum 10A + 11A + 12A) Including Outstanding Indebtedness at the 0.00 $ payments made by Credit Card (line 17 beginning of this period 1,604.33 CD3) $ 14. Total Expenditures This Election 29. (Sum 9B + 13A) $ 1,604.33 Loans Received This Period + 0.00 B. This Calendar Yr Contributions Made A. This Period or Election Cycle 15. Total Contributions Made For This 30. A. New Expenditures Incurred This Election Previously Reported $ 0.00 Period (include payments by Credit + 753.76 Card (Line 17 CD3) 16. All Contributions Made This Period AA 0.00 CCaasshh//CChheecckk (25A or 25B of CD3) BB 0.00 B. New Contributions Made by Credit + 0.00 CCrreeddiitt CCaarrdd Card (Line 25B CD3) 17. All In-Kind Contributions Made This 31. Period + 0.00 Payments Made on Loans This Period - 253.76 18. Total Contributions Made This Period (Sum 16A + 17A) $ 0.00 19. Total All Contributions Made This 32. 0.00 Election (Sum 15B + 18A) $ Debt Forgiven on Loans This Period - 0.00 B. This Calendar Yr Other Disbursements A. This Period or Election Cycle 20. Funds Used For Paying Loans This 33. Payments Made This Period on Period Including Credit Card Payments + 253.76 Expenditures Incurred in Previous - 0.00 21. Payments This Period on Prev Reported Period (Paid by Cash/Check Only) Expend Incurred (Paid by Cash/Check Only) + 0.00 (Line 21 this page) 22. Any Miscellaneous Disbursement Not 34. Reported Elsewhere + 0.00 Total Indebtedness at the Close of 500.00 This Reporting Period (Sum 28 + 29 + $ 23. Total Other Disbursements This Period 253.76 30A + 30B - 31 - 32 - 33) ((SSuumm 2200AA + 2211AA + 2222AA)) $$ MO 300-1311 (1-11) CD Summary MISSOURI ETHICS COMMISSION OFFICE USE ONLY CONTRIBUTIONS AND LOANS RECEIVED INSTRUCTIONS ON REVERSE SIDE 1. NAME OF COMMITTEE 2. REPORT DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING (CHECK IF MORE THAN $100 TO A COMMITTEE. AGGREGATE TO MONETARY 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE OR IN-KIND) NAME: ADDRESS: $ CITY / STATE: View Supplemental Form(s) EMPLOYER: MONETARY $ COMMITTEE: IN-KIND NAME: ADDRESS: $ CITY / STATE: EMPLOYER: MONETARY $ COMMITTEE: IN-KIND NAME: ADDRESS: $ CITY / STATE: EMPLOYER: MONETARY $ COMMITTEE: IN-KIND NAME: ADDRESS: $ CITY / STATE: EMPLOYER: MONETARY $ COMMITTEE: IN-KIND NAME: ADDRESS: $ CITY / STATE: EMPLOYER: MONETARY $ COMMITTEE: IN-KIND 6. SUBTOTAL: ITEMIZED CONTRIBUTIONS THIS PAGE (SUM COLUMN 5) $ 0.00 7. SUBTOTAL: ITEMIZED CONTRIBUTIONS ANY ATTACHED PAGES + $ 11,265.00 8. TOTAL: ITEMIZED CONTRIBUTIONS THIS PERIOD (SUM 6 + 7) $ 11,265.00 9. AMOUNT OF ITEM 8 THAT WAS RECEIVED AS MONETARY CONTRIBUTIONS $ 11,265.00 10. AMOUNT OF ITEM 8 THAT WAS RECEIVED AS IN-KIND CONTRIBUTIONS $ 0.00 B. NON-ITEMIZED CONTRIBUTIONS RECEIVED AMOUNT (LIST BY CATEGORY, NOT BY INDIVIDUAL CONTRIBUTIONS) RECEIVED 11. TOTAL CONTRIBUTIONS RECEIVED AT FUND-RAISERS AS REPORTED INLINE 8 ON FORM CD1A $ 0.00 12. TOTAL ANONYMOUS CONTRIBUTIONS RECEIVED FROM PERSON GIVING $25 OR LESS $ 0.00 13. TOTAL MONETARY CONTRIBUTIONS RECEIVED FROM PERSONS GIVING $100 OR LESS $ 100.00 14. TOTAL IN-KIND CONTRIBUTIONS RECEIVED FROM PERSONS (NOT COMMITTEES) GIVING $100 OR LESS $ 0.00 C. LOANS RECEIVED 16. DATE 17. AMOUNT OF LOAN 15. NAME AND ADDRESS OF LENDER RECEIVED (IF MORE THAN $100 ATTACH CD-1B) NAME: ADDRESS: CITY / STATE: $ NAME: ADDRESS: CITY / STATE: $ 18. SUBTOTAL: LOANS THIS PAGE (SUM COLUMN 17) $ 0.00 19. SUBTOTAL: LOANS FROM ANY ATTACHED PAGES $ 0.00 20. TOTAL: LOANS THIS PERIOD (SUM 18 + 19) $ 0.00 21. TOTAL: ALL IN-KIND CONTRIBUTIONS (SUM 10 + 14) $ 0.00 22. TOTAL: ALL MONETARY CONTRIBUTIONS (SUM 9, 11, 12 & 13) $ 11,365.00 23. MONETARY CONTRIBUTIONS & LOANS RECEIVED REQUIRING A RECORD OF NAME & ADDRESS (SUM 9, 13 & 20) $ 11,365.00 FORM CD1 OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Tootie Burns $ 1,000.00 10/16/2012 CITY / STATE: 117 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Self-employed -- Artist $ 1,000.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Marjo Price 10/20/2012 $ 500.00 CITY / STATE: 107 Bingham Rd Columbia MO 65203 4 EMPLOYER: Retired $ 500.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Elizabeth Gill $ 20.00 10/21/2012 CITY / STATE: 500 Westmount Ave Columbia MO 65203 4 EMPLOYER: Retired $ 20.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Mary Lee Grone 11/11/2012 $ 500.00 CITY / STATE: 611 Villa Gardens Dr Kirkwood MO 63112 4 EMPLOYER: Retired $ 500.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: James Baugher & Jacqueline Verdun $ 300.00 211 Bingham Rd 11/7/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 300.00 COMMITTEE: IN-KIND NAME: ADDRESS: Sally Silvers $ 100.00 11/3/2012 CITY / STATE: 310 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Retired $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Don & Katherine Duello $ 250.00 203 Bingham Rd 11/2/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 250.00 COMMITTEE: IN-KIND NAME: ADDRESS: Chris Teeter $ 100.00 11/12/2012 107 East Ridgeley Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Self-employed -- Artist MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Patricia Butera $ 25.00 11/13/2012 CITY / STATE: 1605 Dunhill Way Columbia MO 65203 4 EMPLOYER: Muscular Dystrophy Assn -- Exec Dir $ 25.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Martina Parker 11/13/2012 $ 300.00 CITY / STATE: 208 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Not employed $ 300.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Michael & Roxanne Alden $ 200.00 11/14/2012 CITY / STATE: 111 East Ridgeley Rd Columbia MO 65203 4 EMPLOYER: Univ of MO -- Athletic Dir $ 200.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: David & Jean Goldstein 11/14/2012 $ 100.00 CITY / STATE: 206 East Ridgeley Rd Columbia MO 65203 4 EMPLOYER: Hindman & Goldstein LLC -- Attorney $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Ellen Rippeto $ 100.00 PO Box 1405 11/14/2012 CITY / STATE: Columbia MO 65205 4 EMPLOYER: Not employed MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Alicia Price $ 300.00 11/14/2012 CITY / STATE: 111 East Brandon Rd Columbia MO 65203 4 EMPLOYER: Stephens College -- Instructor $ 300.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Yoga Sol LLC $ 50.00 11/14/2012 CITY / STATE: 902 Wayne Rd 4 EMPLOYER: Columbia MO 65203 MONETARY $ 50.00 COMMITTEE: IN-KIND NAME: ADDRESS: Stacey & Wyatt Thompson $ 100.00 11/15/2012 2011 Wynfield Dr CITY / STATE: Columbia MO 65203 4 EMPLOYER: Self-employed -- Business Owner MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Nancy Schultz $ 25.00 11/16/2012 CITY / STATE: 7100 Madison Creek Dr Columbia MO 65203 4 EMPLOYER: Univ of MO -- Development Officer $ 25.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Jennifer Perlow 11/16/2012 $ 100.00 CITY / STATE: 1008 Sunset Dr Columbia MO 65203 4 EMPLOYER: Self-employed -- Retail store owner $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Tallulah's-Mary Stauffer Enterprises LLC $ 100.00 11/19/2012 CITY / STATE: 6521 S Scott Blvd 4 EMPLOYER: Columbia MO 65203 $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: James & Melissa Alabach 11/19/2012 $ 100.00 CITY / STATE: 1221 Tartan Place Columbia MO 65203 4 EMPLOYER: Self-employed -- Retail store owner $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Cande Iveson $ 100.00 205 E Ridgeley Rd 11/19/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Univ of MO -- Instructor MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Fred Schmidt & Cathy Rosenholtz $ 50.00 11/20/2012 CITY / STATE: 110 Andersen Columbia MO 65203 4 EMPLOYER: Self-employed -- Accountant $ 50.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Laura Kreisman $ 100.00 322 W Burnam Rd 12/3/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Self-employed -- Corporate Identi-T's Inc MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Vicki & John Ott $ 100.00 12/4/2012 212 Bingham Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Self-employed -- Developer MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Gilmore & Tamara Stone $ 100.00 12/6/2012 CITY / STATE: 200 W Brandon Rd Columbia MO 65203 4 EMPLOYER: Airpath -- Business Owner $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Joshua Nunez 12/6/2012 $ 50.00 CITY / STATE: 1706 Rainwood Pl Columbia MO 65203 4 EMPLOYER: Self-employed -- Sales $ 50.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: James & Dilek Sowers $ 200.00 12/6/2012 CITY / STATE: 212 W Ridgeley Rd Columbia MO 65203 4 EMPLOYER: Univ of MO -- Professor $ 200.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Michael & Emy Friedman 12/6/2012 $ 100.00 CITY / STATE: 1209 Larail Columbia MO 65203 4 EMPLOYER: Boone Anesthesia -- Physician $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: John & Evelyn Tanner $ 100.00 111 W Brandon 12/6/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Univ of MO -- Professor MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Dennis & Ruth Wright $ 50.00 12/6/2012 CITY / STATE: 504 Cumberland Columbia MO 65203 4 EMPLOYER: Retired $ 50.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Marilyn Holm $ 50.00 106 W Ridgeley Rd 12/7/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 50.00 COMMITTEE: IN-KIND NAME: ADDRESS: James & Susan Reynolds $ 250.00 12/7/2012 1301 Stonehaven Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Unilever -- Engineer MONETARY $ 250.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Sharon Cornelison $ 100.00 12/7/2012 CITY / STATE: 2704 Vistaview Terr Columbia MO 65203 4 EMPLOYER: Retired $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Linda Keown 12/7/2012 $ 100.00 CITY / STATE: 106 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Univ of MO -- Asst Professor $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Margaret & Robert Bavasi $ 150.00 12/6/2012 CITY / STATE: 4904 Harbor Ln Everett WA 98203 4 EMPLOYER: Bavasi Sports Partners -- Attorney $ 150.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Wayne & Carolyn Hawks 12/6/2012 $ 100.00 CITY / STATE: 3212 Westcreek Cir Columbia MO 65203 4 EMPLOYER: Self-employed -- Dentist $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Ian & Ellen Thomas $ 100.00 2616 Hillshire Dr 12/7/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Tiger Pediatrics -- Pediatrician MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Grace Elder $ 100.00 12/8/2012 CITY / STATE: 4312 Glen Eagle Columbia MO 65203 4 EMPLOYER: Tallulah's -- Sales $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Mark & Kristin Hahn-Cover $ 200.00 5501 Saddle Ridge Dr 12/8/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Univ of MO -- Professor MONETARY $ 200.00 COMMITTEE: IN-KIND NAME: ADDRESS: Wayne Fields $ 100.00 12/8/2012 18 E Burnam Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Bonnie Trickey $ 100.00 12/8/2012 CITY / STATE: 708 Silverton Ct Columbia MO 65203 4 EMPLOYER: Flat Branch Mortgage -- Vice-President $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Glee Rollins 12/8/2012 $ 50.00 CITY / STATE: 3410 Woodrail Terr Columbia MO 65203 4 EMPLOYER: Retired $ 50.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Laurie & Charlie Digges $ 100.00 12/8/2012 CITY / STATE: 5101 Forum Blvd Columbia MO 65203 4 EMPLOYER: The Insurance Group -- President $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Andy & Sarah Hill 12/10/2012 $ 100.00 CITY / STATE: 3005 Greenbriar Columbia MO 65203 4 EMPLOYER: MU Athletic Dept -- Coach $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Dorothy Harrison $ 20.00 3808 Hallbrook Ct 12/10/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 20.00 COMMITTEE: IN-KIND NAME: ADDRESS: Jane West $ 100.00 12/10/2012 CITY / STATE: 305 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Columbia Public Schools -- Educator $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Anne Edwards $ 50.00 1113 Vintage Dr 12/10/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 50.00 COMMITTEE: IN-KIND NAME: ADDRESS: Dorothy Warrick $ 100.00 12/10/2012 207 W Ridgeley Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL OFFICE USE ONLY MISSOURI ETHICS COMMISSION CONTRIBUTIONS RECEIVED - SUPPLEMENTAL NAME OF COMMITTEE DATE SUSAN "TOOTIE" BURNS FOR COUNCIL 12/27/2012 INSTRUCTIONS PURPOSE: The purpose of the Contributions Received supplement is to provide a printed outline for attaching additional pages to Form CD1 (Contributions Received). This form should be used as additional space for reporting persons contributing more than $100 and for committee contributions. This form may be reproduced as needed. Total all itemized contributions at the bottom of the page and carry to item 7 (Subtotal: Itemized Contributions From Any Attached Pages) on Form CD-1. If further information is needed concerning reporting itemized expenditures, see Form CD-1 Instructions. A. ITEMIZED CONTRIBUTIONS RECEIVED 4. DATE RECEIVED 5. AMOUNT RECEIVED FROM COMMITTEES REGARDLESS OF THE AMOUNT, OR FROM PERSONS GIVING MORE THAN $100 TO A COMMITTEE. AGGREGATE TO (CHECK IF MONETARY OR IN-KIND) 3. NAME, ADDRESS AND OCCUPATION (LIST COMMITTEES FIRST) DATE NAME: ADDRESS: Wayne & Jo Behymer $ 25.00 12/10/2012 CITY / STATE: 3201 S Rolling Hills Rd Columbia MO 65201 4 EMPLOYER: Retired $ 25.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Jan & Chuck Swaney 12/11/2012 $ 250.00 CITY / STATE: 2709 Westbrook Way Columbia MO 65203 4 EMPLOYER: Radiology Consultants Inc -- Physician $ 250.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Timothy Olson $ 25.00 12/11/2012 CITY / STATE: 116 W Burnam Rd Columbia MO 65203 4 EMPLOYER: Self-employed -- Sales $ 25.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Diane Orton 12/11/2012 $ 100.00 CITY / STATE: 3624 Augusta Dr Columbia MO 65203 4 EMPLOYER: Univ of MO -- Educator $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: Tex & Nancy Badger $ 50.00 1203 Sedona Villa Dr 12/11/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Retired MONETARY $ 50.00 COMMITTEE: IN-KIND NAME: ADDRESS: Wade Welshons & Susan Nagel $ 100.00 12/11/2012 CITY / STATE: 910 Wayne Rd Columbia MO 65203 4 EMPLOYER: Univ of MO -- Professor $ 100.00 MONETARY COMMITTEE: IN-KIND NAME: ADDRESS: James & Elizabeth Cogswell $ 100.00 112 W Burnam Rd 12/11/2012 CITY / STATE: Columbia MO 65203 4 EMPLOYER: Univ of MO -- Development Officer MONETARY $ 100.00 COMMITTEE: IN-KIND NAME: ADDRESS: Eric & Kathy Karl $ 100.00 12/11/2012 107 W Ridgeley Rd CITY / STATE: Columbia MO 65203 4 EMPLOYER: Truman VA Hospital -- Social Worker MONETARY $ 100.00 COMMITTEE: IN-KIND TOTAL: ITEMIZED CONTRIBUTIONS -- (CARRY TO ITEM 7 "SUBTOTAL: ITEMIZED CONTRIBUTIONS FROM ANY ATTACHED PAGES" ON FORM CD-1) FORM CD-1 SUPPLEMENTAL