﻿<?xml version="1.0" encoding="utf-8"?>
<Report xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.sbe.virginia.gov ContributionReport.xsd" xmlns="http://www.sbe.virginia.gov">
  <ReportHeader>
    <CommitteeCode>CC-19-00414</CommitteeCode>
    <CommitteeName>Sam Kroiz for Catoctin Supervisor</CommitteeName>
    <ReportYear>2019</ReportYear>
    <Address>
      <Line1>11861 Georges Mill Rd</Line1>
      <City>Lovettsville</City>
      <State>VA</State>
      <ZipCode>20180</ZipCode>
    </Address>
    <FilingDate>2019-10-29</FilingDate>
    <StartDate>2019-10-01</StartDate>
    <EndDate>2019-10-24</EndDate>
    <SubmitterEmail>Samkroizforsupervisor@gmail.com</SubmitterEmail>
    <FilingType>Report</FilingType>
    <IsFinalReport>false</IsFinalReport>
    <IsAmendment>true</IsAmendment>
    <AmendedReportNumber>1</AmendedReportNumber>
    <NoActivity>false</NoActivity>
    <BalanceLastReportingPeriod>5695.69</BalanceLastReportingPeriod>
    <ElectionCycle>11/2019</ElectionCycle>
    <OfficeSought>Member Board of Supervisors</OfficeSought>
    <District>Election - CATOCTIN DISTRICT</District>
  </ReportHeader>
  <ScheduleA>
    <LiA>
      <Contributor IsIndividual="true">
        <FirstName>Uta</FirstName>
        <LastName>Brown</LastName>
        <Address>
          <Line1>37883 E Main St</Line1>
          <City>Purcellville</City>
          <State>VA</State>
          <ZipCode>20132</ZipCode>
        </Address>
        <NameOfEmployer>self-employed</NameOfEmployer>
        <OccupationOrTypeOfBusiness>Self-employed</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>self-employed</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-17</TransactionDate>
      <Amount>1000.00</Amount>
      <TotalToDate>1000.00</TotalToDate>
    </LiA>
    <LiA>
      <Contributor IsIndividual="true">
        <FirstName>Christian</FirstName>
        <LastName>Hoyt</LastName>
        <Address>
          <Line1>38097 Britain Rd</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
        <NameOfEmployer>self-employed</NameOfEmployer>
        <OccupationOrTypeOfBusiness>self-employed</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>self-employed</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-17</TransactionDate>
      <Amount>200.00</Amount>
      <TotalToDate>200.00</TotalToDate>
    </LiA>
    <LiA>
      <Contributor IsIndividual="true">
        <FirstName>Donna</FirstName>
        <LastName>Kroiz</LastName>
        <Address>
          <Line1>11802 Georges Mill Rd</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
        <NameOfEmployer>Retired</NameOfEmployer>
        <OccupationOrTypeOfBusiness>Retired</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>Retired</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-17</TransactionDate>
      <Amount>250.00</Amount>
      <TotalToDate>1250.00</TotalToDate>
    </LiA>
    <LiA>
      <Contributor IsIndividual="true">
        <FirstName>Paul</FirstName>
        <LastName>Lawrence</LastName>
        <Address>
          <Line1>20048 Shelburne Glebe Rd</Line1>
          <City>Purcellville</City>
          <State>VA</State>
          <ZipCode>20132</ZipCode>
        </Address>
        <NameOfEmployer>self-employed</NameOfEmployer>
        <OccupationOrTypeOfBusiness>self-employed</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>self-employed</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-23</TransactionDate>
      <Amount>500.00</Amount>
      <TotalToDate>500.00</TotalToDate>
    </LiA>
    <LiA>
      <Contributor IsIndividual="true">
        <FirstName>Sue</FirstName>
        <LastName>Moutoux</LastName>
        <Address>
          <Line1>15290 Purcellville Rd</Line1>
          <City>Purcellville</City>
          <State>VA</State>
          <ZipCode>21032</ZipCode>
        </Address>
        <NameOfEmployer>retired</NameOfEmployer>
        <OccupationOrTypeOfBusiness>retired</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>retired</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-20</TransactionDate>
      <Amount>300.00</Amount>
      <TotalToDate>300.00</TotalToDate>
    </LiA>
  </ScheduleA>
  <ScheduleB>
    <LiB>
      <Contributor IsIndividual="false">
        <LastName>Crooked Run Brewing</LastName>
        <Address>
          <Line1>22455 Davis Dr</Line1>
          <Line2>Suite 120</Line2>
          <City>Sterling</City>
          <State>VA</State>
          <ZipCode>20164</ZipCode>
        </Address>
        <OccupationOrTypeOfBusiness>Brewery</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>Sterling, VA</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-19</TransactionDate>
      <Amount>2000.00</Amount>
      <TotalToDate>2267.12</TotalToDate>
      <ValuationBasis>Actual Cost</ValuationBasis>
      <ProductOrService>Event venue, catering, advertisement on beer cans</ProductOrService>
    </LiB>
    <LiB>
      <Contributor IsIndividual="false">
        <LastName>Market Table Bistro</LastName>
        <Address>
          <Line1>13 E Broad Way</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
        <OccupationOrTypeOfBusiness>Restaurant</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>Lovettsville. VA</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-17</TransactionDate>
      <Amount>1000.00</Amount>
      <TotalToDate>1000.00</TotalToDate>
      <ValuationBasis>Actual Cost</ValuationBasis>
      <ProductOrService>Catering</ProductOrService>
    </LiB>
    <LiB>
      <Contributor IsIndividual="false">
        <LastName>Wheatland Spring Farm and Brewery</LastName>
        <Address>
          <Line1>38506 John Wolford Rd</Line1>
          <City>Waterford</City>
          <State>VA</State>
          <ZipCode>20197</ZipCode>
        </Address>
        <OccupationOrTypeOfBusiness>Brewery</OccupationOrTypeOfBusiness>
        <PrimaryCityAndStateOfEmploymentOrBusiness>Waterford, VA</PrimaryCityAndStateOfEmploymentOrBusiness>
      </Contributor>
      <TransactionDate>2019-10-17</TransactionDate>
      <Amount>1000.00</Amount>
      <TotalToDate>1000.00</TotalToDate>
      <ValuationBasis>Actual Cost</ValuationBasis>
      <ProductOrService>Event Venue</ProductOrService>
    </LiB>
  </ScheduleB>
  <ScheduleC />
  <ScheduleD>
    <LiD>
      <Payee IsIndividual="true">
        <FirstName>Samuel</FirstName>
        <LastName>Kroiz</LastName>
        <Address>
          <Line1>11861 Georges Mill Rd</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
      </Payee>
      <TransactionDate>2019-10-22</TransactionDate>
      <Amount>760.00</Amount>
      <AuthorizingName>Sam Kroiz</AuthorizingName>
      <ItemOrService>Reimbursement for Facebook advertising</ItemOrService>
    </LiD>
    <LiD>
      <Payee IsIndividual="true">
        <FirstName>Samuel</FirstName>
        <LastName>Kroiz</LastName>
        <Address>
          <Line1>11861 Georges Mill Rd</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
      </Payee>
      <TransactionDate>2019-10-22</TransactionDate>
      <Amount>1462.21</Amount>
      <AuthorizingName>Sam Kroiz</AuthorizingName>
      <ItemOrService>Reimbursement for printed materials</ItemOrService>
    </LiD>
  </ScheduleD>
  <ScheduleE />
  <ScheduleF>
    <LiF>
      <Creditor IsIndividual="true">
        <FirstName>Samuel</FirstName>
        <LastName>Kroiz</LastName>
        <Address>
          <Line1>11861 Georges Mill Rd</Line1>
          <City>Lovettsville</City>
          <State>VA</State>
          <ZipCode>20180</ZipCode>
        </Address>
      </Creditor>
      <TransactionDate>2019-03-20</TransactionDate>
      <Amount>2000.00</Amount>
      <PurposeOfObligation>Left Empty</PurposeOfObligation>
    </LiF>
  </ScheduleF>
  <ScheduleG>
    <ScheduleACount>5</ScheduleACount>
    <ScheduleATotal>2250.00</ScheduleATotal>
    <ScheduleBCount>3</ScheduleBCount>
    <ScheduleBTotal>4000.00</ScheduleBTotal>
    <UnItemizedCount>15</UnItemizedCount>
    <UnItemizedTotal>661.00</UnItemizedTotal>
    <UnItemizedInKindCount>0</UnItemizedInKindCount>
    <UnItemizedInKindTotal>0.00</UnItemizedInKindTotal>
    <AllContributionsCount>23</AllContributionsCount>
    <AllContributionsTotal>6911.00</AllContributionsTotal>
    <ScheduleCTotal>0.00</ScheduleCTotal>
    <ScheduleBTotalRepeated>4000.00</ScheduleBTotalRepeated>
    <UnItemizedInKindTotalRepeated>0.00</UnItemizedInKindTotalRepeated>
    <ScheduleDTotal>2222.21</ScheduleDTotal>
    <TotalInKindAndExpenditures>6222.21</TotalInKindAndExpenditures>
    <BeginningLoanBalance>2000.00</BeginningLoanBalance>
    <LoansReceivedTotal>0.00</LoansReceivedTotal>
    <LoansReceivedAndExistingTotal>2000.00</LoansReceivedAndExistingTotal>
    <LoansPaidTotal>0.00</LoansPaidTotal>
    <NewLoanBalance>2000.00</NewLoanBalance>
  </ScheduleG>
  <ScheduleH>
    <BeginningBalance>5695.69</BeginningBalance>
    <ContributionsReceived>6911.00</ContributionsReceived>
    <ScheduleCTotal>0.00</ScheduleCTotal>
    <LoansReceivedTotal>0.00</LoansReceivedTotal>
    <ContributionsAndReceiptsReceived>6911.00</ContributionsAndReceiptsReceived>
    <TotalExpendableFunds>12606.69</TotalExpendableFunds>
    <TotalInKindAndExpenditures>6222.21</TotalInKindAndExpenditures>
    <LoansPaidTotal>0.00</LoansPaidTotal>
    <ScheduleITotal>0.00</ScheduleITotal>
    <TotalPaymentsMade>6222.21</TotalPaymentsMade>
    <ExpendableFundsBalance>6384.48</ExpendableFundsBalance>
    <TotalUnPaidDebts>2000.00</TotalUnPaidDebts>
    <BalanceAtStartOfElectionCycle>0.00</BalanceAtStartOfElectionCycle>
    <PreviousReceipts>18078.28</PreviousReceipts>
    <CurrentReceipts>6911.00</CurrentReceipts>
    <TotalReceiptsThisElectionCycle>24989.28</TotalReceiptsThisElectionCycle>
    <TotalFundsAvailable>24989.28</TotalFundsAvailable>
    <PreviousDisbursements>12382.59</PreviousDisbursements>
    <CurrentDisbursements>6222.21</CurrentDisbursements>
    <TotalDisbursements>18604.80</TotalDisbursements>
    <EndingBalance>6384.48</EndingBalance>
  </ScheduleH>
</Report>