REPORT OF CONTRIBUTIONS AND EXPENDITURES ( , C.R.S.)

Transcription

1 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: 303) ext Fax: 303) REPORT OF CONTRIBUTIONS AND EXPENDITURES , C.R.S.) Space Below For Office Use Only i \ I Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial Institution SOS ID NUMBER state and county committees): Type of Report ' Regularly Scheduled Filing. D Amended Filing. This amends previous report filed on date) Submit changes or new information ONLY D Termination Report. Termination Reports MUST Have a Monetary Balance of Zero in Line 5) D Check this box if this Report Contains Electioneering s Information Reporting Period Covered: ~I _7_/_~~Z+-J_.<1~---~I Through I t 9 g Jts- Date ~~~~~~,,._-D=-a-te. Declared Total Spending if applicable) I I [Art. xxvm, Sec. 41)].. ' \ Totals Detailed Summ 1 Funds on Hand at the Be innin of Re ortin Period monetary only) 2 Total Monet Contributions line 11) I The appropriate officer shall impose a penalty of 50 per day for each day that a report is filed late. [Art. XXVIII Sec. 102)a)l Authorization Must be completed by either the Registered Agent OR the Candidate): I hereby certify and declare, under penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period, including any contributions received in the form of membership dues transferred by a membership organization, are from permissible sources. Print Registered Age~t's Name ft=} ~~) Registered Agent's Signature: J. l!z:;:::/jif./,i~ Print Candidate Name: ~ 1 Ee / k Candidates Signature: ~ J.. ~ Date: 1 l.z1 l s= ' Date: '1h '-... _

2 I DETAILED SUMMARY l Full Name of Committee/Person: C:JA /_ )), 0&1n J)~ A.26 /,.{c; r, Current Reporting Period: I 7 /.J. z S:: I Through I 9 / / ~ // S: Funds on hand at the beginning of reporting period Monetary Only) 1:J ct;.e.-/ 6 Itemized Contributions 20 or More [C.R.S. l l)a)] Jrg5 Q9 '1/19 Ii' Please list on Schedule "A") 7 Total of Non-Itemized Contributions Contributions of19.99 and Less) G~h 15-1 It<? 15' 8 Loans Received Please list on Schedule "C") I ;}-5D l oij 9 Total of Other Receipts Interest, Dividends, etc.) ;r 10 Returned Expenditures from recipient) if Please list on Schedule "D") 11 Total Monetary Contributions Total of lines 6 through 10) 12 Total Non-Monetary Contributions From Statement of Non-Monetary Contributions) / 050.@ 13 Total Contributions {050.);> Line 11 + line 12) 14 Itemized Expenditures 20 or More [C.R.S. l l)a)] Please list on Schedule "B") 15 Total of Non-Itemized Expenditures Expenditures of19.99 or Less) 1.5 ot. ;..JCJ 16 Loan Repayments Made Please list on Schedule "C") p 17 Returned Contributions To donor) Please list on Schedule "D") 18 Total Coordinated Non-Monetary Expenditures Candidate/Candidate Committee & Political Parties only),{)- J>- 19 Total Monetary Expenditures Total oflines 14 through 17) /Bot Total Spending Line 18 + line 19) I JtJ/., 1c; Colorado Secretary of State Fonn Rev. 12/09

3 Schedule A-Itemized Contributions Statement 20 or more) [C.R.S )a)] Full Name of Committee/Person:.,.~~""""'="""'A_~L..,;;;;..=~~=- _c2=="""4"""m~~i2'-"l'fl~. ;...itt/~ -.""=di""="-~=======- 1 ' WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINT/TYPE I. Date Accepted 2. 'c!:~ij{ 4. Name Last, First):.f;>.L.-"'o,_A)""--L><lv'---1 '---'/ F_,'-----, p_f:.?'--"'-...l.=--, r,_e---'-'~= Amt. 5. Address: / & ;<I'/ L" w to/!.. t/r111. boll!)_ D. > < 6. City/State/Zip: 12 12okr A;a s J 0 At C--o,J er 711 s: 3. Aggregate Amt. * C d // /J 7. Description: H UK - L-o tj/ & l J/-r:o tj 3_{' q_o. f--==-""'------"'----, 8. Employer if applicable, mandatoiy): '3~00/uJtr.S D Check box if Electioneering Sc_., hool. 9. Occupation if applicable, mandatoiy): ---+-/--46.""'-L/l_,_ _.&-~h_,.,./3.-l"""-'"" I. Date Accepted /) / / _ / J 4. Name Last, First): Y) A A. t Hut/; L/ c,!:""'tr.2=ibu~tiµ~~._,_c;am_t.-j 5. Address: o 7 o o Cl i.at:u. \ St l--~>j_3--=-.5'-""- n _ 6 _---l 6. City/State/Zip: Arv a J \ I ~ D 'loo 0 y 3. Aggregate Amt. * / J // /J ~/l "'//) --c 7. Description: C du ~ - c_-!!2 A) 1 flkd U /: 0 t..j j 8. Employer if applicable, mandatoiy):,i<,.,_... e---'+l-!-i _. i/_,e...,d"'--' Check box if Electioneering 9. Occupation if applicable, mandatoiy): I ' ' ' I. Date Accepted 4. Name Last, First): Contribution Amt. 5. Address: r j 6. City/State/Zip: 3. Aggregate Amt. * 7. Description: D Check box if Electioneering 8. Employer if applicable, mandatoiy): Occupation if applicable, mandatoiy): I. Date Accepted 2. Contribution Amt. 4. Name Last, First): Address: f i 6. City/State/Zip: Aggregate Amt. * 7. Description: , ~ Employer if applicable, mandatoiy): Check box if Electioneering 9. Occupation if applicable, mandatoiy): *For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate ". Committee Art. :XXVIII, Sec. 26); Political Party Art. XXVIII, Sec. 33); Political Committee Art. XXVIII, Sec 35); Small Donor Committee Art. XXVIII, Sec. 214).

4 Schedule C - Loans LOANS - Loans Owed by the Committee Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.) [No infonnation copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial purpose. [Art. XXVIII, Sec. 9{e)] Notwithstanding any other section of this article to the contrary, a candidate's candidate committee may receive a loan from a financial institution organized under state or federal law ifthe loan bears the usual and customary interest rate, is made on a basis that assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 38)] LOAN SOURCE Name Last, First or Institution): '- Address: 9/ 1~ ID t!f ~ j:.) t~d City/State/Zip: 4vt?b/l. t!!_&? lti Mhi o 1 oo Original Amount of Loan: /.,:;, blj - Interest Rate: CJ io I oo Loan Amount Received This Reporting Period: / ::2.57) - Principal Amount Paid This Reporting Period: 0~~-- Interest Amount Paid This Reporting Period: f) Amount Repaid This Reporting Period: t2 Amount Repaid is sum of Principal & Interest entered on Detail Summary) Total of All Loans This Reporting Period: Place on line 8 of Detailed Summary Report) Total Repayments Made: Sum of Schedule C pages, Place on line 16 of Detailed Summary) { ' Outstanding Balance: TERMS OF LOAN: A,4J~f7>A/Jll / Date Loan Received Due Date for Final Payment LIST ALL ENDORSERS OR GUARANTORS OF TIDS LOAN Full Name Address, City, State, Zip Amount Guaranteed l Colorado Secretary of State Fonn Rev. 12/09

5 Schedule B-Itemized Expenditures Statement 20 or more) [I l)a), C.R.S.] Full Name of Committee/Person: _,{2=-_.._AL...d,_ ~L- '--.-b..._ll,_a_,,_wr_,_,_+{j,,_,,_/l,_jj--=--..:::;_~~-'-~,. /l. I PLEASE PRINT/TYPE 1. Date Exgended 7 l /;_c;- 4. Name: ).5. 1Jr!t 2. Amount 5. Address: C),t[9{) lt }. ~<L 8 ijll A}!lE ;J_ 7, /.l5 6. City/State/Zip: 1/11/ll h /l. <2'9/D. <i' ' t'c CJ -3 / 7. Purpose of Expenditure: {} 14. c=- I:: 1. Date Exgended 7 f:z.;z,,/; c; 4. Name: FI~f, e fcf & {_ ~);-; jc. ll~.. stau a s 1. rr 2. Amount 5. Address:SSLS: DLAe. t11a-~tz CJ a~ 1H. --YiJ. ~s kvd fd ll, C2o / o rq. fl b 0 6. City/State/Zip: q t:j«> 3 7. Purpose of Expenditure: //ic_'k 0~ ~uuaj~ L 4. Name: /JE IL)/; ill 2. Amount 5. Address: /.212/.5 tr/!:: Lo b / ba. t)o "'"" City/State/Zip: i J~srmirusTt/. Co '6 0~31 7. Purpose of Expenditure: ~tl_b~l~<j~aj~t~f~, ~/~_1~8~8.~t _.k~h~A~'CJ,, 4. Name: d F" r:: I _ E Vlclt 5. Address: -S~] ~ 0 Lht._ WA l)s ~ L tlo. "--_l----""--"-----'--<-).._--= City/State/Zip: f/a Vil f) ~ Co/ C 1o ao 3 1. Date Exgended 7. Purpose of Expenditure: _l,_t~f~~=-~,_, D Check box ifelectioneerin 4. Name: J. s. B,q,.,1t 8 /, /, s 2. Amount 5. Address: 1' 51C /JJ. ~8 AU... ll-~tt._._1~b.e~~ jl- 6. City/State/Zip: /112u/l hll tlalo CZ 0003 ~ ) 7. Purpose of Expenditure: f'j Uis!L D ;2..1_{}_ -r T Fl:,,

6 Schedule B -Itemized Expenditures Statement 20 or more) [ )a), C.R.S.] Full Name of Committee/Person:...i.d-~ %:..Ltt~L,, b~.!... -'a=..lfim~"-'--l'{)-'-'a...,,._,_tu=-l!e,,_.c"'-..lilu=l PLEASE PRINT/TYPE 1. Date F.xnended 4. Name: A B.v.4 [)A HAR t'est F'e.hUAL 91~ le: 2. Amount 5. Address: G 73_l LJ. 29- II tj t.,3 bo Cb - 6. City/State/Zip: Jl_ll_1L {}_ fjij, }_D lo )SJ 000~ - 7. Purpose of Expenditure: ~I<. I) It> ~ -!1)/R-v 2. Amount 4. Name: UrHL~. ll1ij;l 5. Address:...S-.J-75: JtA ~ ~ W o&..f ft B U D ~_3=--...L~-1.L City/State/Zip: IJ f<. 1/ll b II, Co /I"?. ~60 3 / /JAA-ll DE 7. Purpose of Expenditure: -'-L=---,,,_L=..cT:_e,_.<,..,_/l._,,,, ffti.,_,_.._..1'-'le_..._~ Non-Committee 1. Date Exriended 4. Name: 2. Amount 5. Address: 1. Date Exriended 6. City/State/Zip: 7. Purpose of Expenditure: 4. Name: 2. Amount 5. Address: 1. Date Exriended 6. City/State/Zip: 7. Purpose of Expenditure: 4. Name: 2. Amount 5. Address: " City/State/Zip: 7. Purpose of Expenditure: