Clerk of the House of Representatives • Legislative Resource Center • B-106 Cannon Building • Washington, DC 20515

Secretary of the Senate • Office of Public Records • 232 Hart Building • Washington, DC 20510

Filer Type and Name

Type:

OrganizationLobbyist

Lobbyist Name:

Mr. JEFFREY FORBES

Employer Name:

Forbes-Tate

Identification Numbers

House Registrant ID:

42131

Senate Registrant ID:

400976792

Reporting Period

Year:

2012

Mid-Year (January 1 - June 30)

Year-End (July 1 - December 31)

Amendment

Political Action Committee Names

Contributions

No Contributions

#1.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

7-11-12

Payee:

Democratic Senatorial Campaign Committee

Honoree:

Democratic Senatorial Campaign Committee

#2.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$2,500.00

Date:

8-26-12

Payee:

Long Leaf Pine PAC

Honoree:

Kay Hagan

#3.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

9-20-12

Payee:

Impact

Honoree:

Charles Schumer

#4.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$500.00

Date:

9-28-12

Payee:

Peak PAC

Honoree:

Mark Udall

#5.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

9-27-12

Payee:

Friends of Mark Warner

Honoree:

Mark Warner

#6.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$3,000.00

Date:

10-17-12

Payee:

Forward Together PAC

Honoree:

Mark Warner

#7.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$2,500.00

Date:

10-31-12

Payee:

Common Sense Colorado

Honoree:

Michael Bennet

#8.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

11-5-12

Payee:

Long Leaf Pine PAC

Honoree:

Kay Hagan

#9.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

9-28-12

Payee:

Impact

Honoree:

Chuck Schumer

#10.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$2,500.00

Date:

9-24-12

Payee:

Indiana Democratic Party - Federal Account

Honoree:

Indiana Democratic Party

#11.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$2,500.00

Date:

7-27-12

Payee:

Cantwell Victory 2012

Honoree:

Maria Cantwell

#12.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

10-16-12

Payee:

Democratic Senatorial Campaign Committee

Honoree:

Democratic Senatorial Campaign Committee

#13.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Alaskans for Begich 2014

Honoree:

Mark Begich

#14.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Chris Coons for Delware

Honoree:

Chris Coons

#15.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Hagan Senate Committee

Honoree:

Kay Hagan

#16.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Friends of Mary Landrieu

Honoree:

Mary Landrieu

#17.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Mark Pryor for US Senate

Honoree:

Mark Pryor

#18.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Friends of Jeanne Shaheen

Honoree:

Jeanne Shaheen

#19.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Udall for Colorado

Honoree:

Mark Udall

#20.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Udall for Us All

Honoree:

Tom Udall

#21.

Contribution Type:

FECA

Contributor Name:

Mod Squad

Amount:

$5,000.00

Date:

12-11-12

Payee:

Tim Johnson for South Dakota

Honoree:

Tim Johnson

#22.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

12-11-12

Payee:

Friends of Mark Warner

Honoree:

Mark Warner

Comments

Certification and Signature

I certify that I have read and am familiar with the provisions of the Standing Rules of the Senate and the Standing rules of the House of Representatives relating to the provision of gifts and travel. I have not provided, requested or directed a gift, including travel, to a Member of Congress or an officer or employee of either House of Congress with knowledge that receipt of the gift would violate rule XXXV of the Standing Rules of the Senate or rule XXV of the Rules of the House of Representatives during this filing period.

Digitally Signed By:

JEFFREY FORBES, 2/1/2013 2:36:05 PM