LJ Amended Filing. This amends previous report filed on (date)

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1 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) j Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial Institution Space Below For Office Use Only OCT City Clerks Offic~ REPORT OF CONTRIBUTIONS AND EXPENDITURES - ( , C.R.S.) SOS ID NUMBER (state and county committees): Type of Report 51 Regularly Scheduled Filing. LJ Amended Filing. This amends previous report filed on (date) Submit changes or new information ONLY ~ ~~~ J ~ J D Termination Reoort. (fermination Reports MUST Have a Monetary Balance of Zero in Une 5) D Check this box if this Report Contains Electioneering s Information Reporting Period Covered: I f -/ 2- /...:J Date Declared Total Spending or applkable) 1 [Art. xxvm, Sec. 4(1)] L I Through!.,~./:...-.=..t/_...L.~-ti---;::--?~=S=--, Date Period (monetary onl ) The appropriate officer shall impose a penalty of 50 per day for each day that a report is filed late. [Art. XXVIll Sec. 10(2)(a)] 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 Agents Name: _..::::... _.::_:_. ---7=~::...L-:.,...;:;.~..u:::-~---=:.--.:: Registered Agents Signature: ~:::;.~~~~~~..;;;;;~=============--Date: ~...)_... ~ PrintCandidrteNrume: ~~~~~~~~~~~~~~~~~: Colorado Secretary of State Form Rev. 1m9

2 r ~==============~ , Full Name of Committee/Person: CurrentReportingPeriod: If-/?- /5 DETAILEDS~RY CC,??/U~ 2?/ ~Eq- I 1 Through! /0... /0 _. / J Funds on hand at the beginning of reporting period (Monetary Only),-0-6 Itemized Contributions 20 or More [C.R.S (l)(a)] / ()_ c. - (Please list on Schedule "A"),:J I 7 Total of Non-Itemized Contributions (Contributions of and Less) {) 8 Loans Received (Please list on Schedule "C) /u f/_:; 9 Total of Other Receipts 0 (Interest, Dividends, etc.) 10 Returned Expenditures (from recipient) {) (Please list on Schedule "D").. - (.. 11 Total Monetary Contributions (Total oflines 6 through 10) ~ la?a~ 12 Total Non-Monetary Contributions ~ 0 (From Statement of Non-Monetary Contributions) t Total Contributions. /LJ~~c-~ (Line 11 +line 12) 14 Itemized Expenditures 20 or More [C.R.S. l (1)(a)] /o~ g,~-., (Please list on Schedule "B") 15 Total of Non-Itemized Expenditures (Expenditures of or Less) Loan Repayments Made (Please list on Schedule "C) Returned Contributions (To donor) (Please list on Schedule "D) 18 Total Coordinated Non-Monetary Expenditures (Candidate/Candidate Couunittee & Political Parties only) (} c) cj 19 Total Monetary Expenditures (Total of lines 14 through 17) 20 Total Spending (Line 18 +line 19) LP~~ t:j.- /f!/d / c-~ Colorado Secretary of State fonn Rev. 12/09

3 Schedule A- Itemized Contributions Statement (20 or more) [C.R.S. I (l)(a)] Full Name of Committee/Person: C«dvYta=~- fo 8 <:::?: /~~ WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINT/TYPE I. Date Ag;ented /lf--77r 4. Name {Last, First):./ }4:JP S. ) tf/::oa,;tfvb2 2. Contribution Amt 5. Address: 57o.? /-/~L) >7 ~sc() 6. Cicy/Statemp: ~j~;!l ~ 1 U) S oa" Agmgl!.te Amt. *.. /~~~~~ 7. Descnptton: c ;:: ~ ~ 8. Employer (if applicable, ma~datorv; ~ ~/2 Electioneering 9. Occupation (if applicable, mandatory):,.--- ~~:; I. Oat~ Accented 4. Name {Last, First): 3. Agwgate Amt. * Electioneering Occupation (if applicable, mandatory): 1. Date Accented 4. Name (Last, First): 3. A&wgate Amt. * 0 Check box if.: Electioneering 9. Occupation (if applicable, mandatory): 1. Date Accented 4. Name {Last. First): 6. City/State/Zip: 3. Agwgate Amt. *. Electioneering 9. Occupation (if applicable, mandatory): * For contribution limits within a committees election cycle or contribution cycle, please refec to the following Colorado Constitutiooal cites: Candidate Committee Art. XXVIll, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIU, Sec 3(5); Small Donor Committee Art. XXVIU, Sec. 2(14). Colorado Secretary of State Form Rev

4 --.,~ Schedule B -Itemized Expenditures Statement (20 or more) [ (1 )(a), C.R.S.] Full Name of Committee/Person: Cd/11//t-~ /cj k6c;7 /~V~ PLEASE PRINTIIYPE 1. Date Ex~nded C d~-c/2!9-dcj C?J~~,4/-q.?~ / _/?? /:/2 3"~ t5 A,/o_ ~ 2-/d_ -:537;; 6. citytstaterzip: ~ #~ u; i cj It;; D Committee 7. Purpose of Expenditure: /1/J.t:::>./V / CJ ""..3_ --/_3 D Non-Committee 1. Date Exoended /{) r~/5 0 Check box if Electioneering c;,c).vp;fl/y/t; LL;J;l?1//Jt/VP7 5. Address: Y/ 5/ pl!./~-:~5 7, A2~JW 2. Amount ~~4_2_ ~Z-:/(/ 53!/)~ 6. City/State/Zip: //;!8~s ~~Co f?o/~r-) 7 D Committee 7. Purpose of Expenditure: /J:d 0~ / 1-/d -LJ D Non-Committee 1. Date Exnended 0 Check box if Electioneering 7 0 Committee 7. Purpose of Expenditure: 0 Check box if Electioneering 1. Date Exnended.. 0 Committee 7. Purpose of Expenditure: 0 Check box if Electioneering 1. Date Exoended ~ D Committee 6. City/State/Zip: 7. Purpose of Expenditure: 0 Check box if Electioneering - Colorado Secrewy of State Fonn Rev

5 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 infonnatioo copied from such reports shall be sold or used by any person for the purpose of soliciting connibutioos or for any commercial purpose. [Art. XXVIII, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidates candidate committee may receive a loan from a financial institution organized under state or federal law if the 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. 3(8)] LOAN SOURCE Name (Last, Frrstorlnstitution): fod?~.?#.,/( } G.r ~~~ Address: ~,Zs Q~ ~ City/State/Zip: ~ / C-.-;> ~ r"" L Original Amount of Loan:.)8/ Y - Interest Rate: --,_,L.~:.._- ~-4?~-- Loan Amount Received This Reporting Period: /t:;dj ~ "" l Principal Amount Paid This Reporting Period:. G)=--"---- Interest Amount Paid This Reporting Period:....C~) CJ Amount Repaid This Reporting Period:. (Amount Repaid is sum of Principal & Interest entered on Detail Summary) Outstanding Balance: TERMS OF LOAN: 6% ;?35 g-7_) -:a Date Loan Received Total of All Loans This Reporting Period: 4; {/ > 1 (Place online 8 ofoftailed Summary Report) Total Repayments Made: 0 (Sum of Schedule C pages, Place on line 16 of Detailed Summary) Due ofie for Final Payment _ LIST ALL ENDORSERS OR GUARANTORS OF TillS LOAN Full Name Address, City, State, Zip Amount Guaranteed Colorado Secretary of State Form Rev. 12/09