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:

Cauthen Forbes & Williams

Identification Numbers

House Registrant ID:

36886

Senate Registrant ID:

284551

Reporting Period

Year:

2011

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:

12/06/2011

Payee:

Perlmutter for Congress

Honoree:

Ed Perlmutter

#2.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/06/2011

Payee:

Bill Nelson for US Senate

Honoree:

Bill Nelson

#3.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/06/2011

Payee:

McCaskill for Missouri

Honoree:

Claire McCaskill

#4.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/08/2011

Payee:

Friends of Mazie Hirono

Honoree:

Mazie Hirono

#5.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$500.00

Date:

12/08/2011

Payee:

Donnelly for Indiana

Honoree:

Joe Donnelly

#6.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

07/22/2011

Payee:

Glacier PAC

Honoree:

Max Baucus

#7.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/06/2011

Payee:

Blue Hen PAC

Honoree:

Chris Coons

#8.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/08/2011

Payee:

Forward Together PAC

Honoree:

Mark Warner

#9.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$3,000.00

Date:

12/19/2011

Payee:

Moderate Senate PAC

Honoree:

Moderate Senate Democrats

#10.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$1,000.00

Date:

12/15/2011

Payee:

DSCC

Honoree:

DSCC

#11.

Contribution Type:

FECA

Contributor Name:

Self

Amount:

$5,000.00

Date:

09/15/2011

Payee:

Moderate Democrats PAC

Honoree:

Moderate Democrats PAC

#12.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$4,650.00

Date:

09/29/2011

Payee:

Bob Casey for Senate

Honoree:

Bob Casey

#13.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

09/29/2011

Payee:

Kaine for Virginia

Honoree:

Tim Kaine

#14.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

09/29/2011

Payee:

Gillibrand for Senate

Honoree:

Kirsten Gillibrand

#15.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

09/29/2011

Payee:

Manchin for West Virginia

Honoree:

Joe Manchin

#16.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$4,650.00

Date:

09/29/2011

Payee:

Donnelly for Indiana

Honoree:

Joe Donnelly

#17.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Carper for Senate

Honoree:

Tom Carper

#18.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$350.00

Date:

12/19/2011

Payee:

Bob Casey for Senate

Honoree:

Bob Casey

#19.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Montanans for Tester

Honoree:

Jon Tester

#20.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Bill Nelson for US Senate

Honoree:

Bill Nelson

#21.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Manchin for West Virginia

Honoree:

Joe Manchin

#22.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Gillibrand for Senate

Honoree:

Kirsten Gillibrand

#23.

Contribution Type:

FECA

Contributor Name:

ModSquad PAC

Amount:

$2,500.00

Date:

12/19/2011

Payee:

Martin Heinrich for Sneate

Honoree:

Martin Heinrich

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, 1/30/2012 6:10:48 PM