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

Transcription

1 Colorado Secretary of State Elections Divi sion 1700 Broadway, Ste. 200 Dcm cr, CO Ph: (303) ext fox: (303) Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial Institution Type of Report REPORT OF CONTRIBUTIONS AND EXPENDITURES ( , C.R.S.) SOS ID NUMBER (state and county committees): LIJ<.'gularly Scheduled Filing. D Amended Filing. This amends previous report filed on (date) Submit changes or new infon11ation ONLY D Tennination Report. (Termination Reports MUST Have a Monetary Balance of Zero in Line 5) D Check this box if this Report Contains s Information Space Below For Olfo:c U s~ Only Reporting Period Covered:... Qc.+/--'-l-=-3... / t_.1,i Through I 10/z q /tj Date Declared Total Spending or applicable) I [Art. XXVllT, Scc. 4(1)] ~ ~ Date Period (monetary only) Total Monetar Contributions (line 1 l) Amount (line 1 +line 2) Funds on Hand at the End of Re ortin Period (monetary) (line 3 - line 4) Totals Detailed Summar Pa e The appropriate officer shall impose a penally of 50 per day for each day that a report is filed late. f Art. XXVJJI Sec. 10(2)(a)l Authorization (Must be completed by either the Registered Agent OR the Candidate): I hereby certify and declare, 1111der penalty of perj111)', that to the best of my k11owledge or belief all contributions received during this reporting period, including any co11trihutio11s received in the form of 111e111bership dues transferred by a membership organization, are from permissible sources. Print Registered Agent's ~~t:j4.v I f L Registered Agent's Signa~#~!i:..?f:,AJ4..,l_. Print Candidate Name: I ~I.A Candidates Signature: Date: 1oho/tf! ---hr==--l""''-=-'~'f't'~=-1>< c-t->ll-,r-atlo-s-~ re'"".,r ''"":.,,,,. R". I~ ' ~

2 0l, ~II. Full Name of Committee/Person: 1,:,'...+~,--0'-X...<...L.-f-'-=.J.~-+----'--'-'+----,,_._.,'-+-~--?t_ ' {/\.._.../ Current Reporting Period:._I u_,_/_17.?""""-'/.,1._1-# ' _/ Through I to/zq (t7... Funds on hand at the beginning of reporting period (Monetary Only) </Jooo.JL/ 6 Itemized Contributions 20 or More [C.R.S (1)(a)J (Please list on Schedule "A") q6o. o-o 7 Total of Non-Itemized Contributions (Contributions of and Less) - 8 Loans Received - (Please list on Schedule "C") 9 Total of Other Receipts - (Interest, Dividends, etc.) 10 Returned Expenditures (from recipient) (Please list on Schedule "D") - 11 Total Monetary Contributions 150, (Total of lines 6 through I 0) 0() 12 Total Non-Monetary Contributions 75-oo (From Statement of Non-Monetary Contributions) - 13 Total Contributions lo~5. (Line 11 +line 12) ' oo 343:< (pq 14 Itemized Expenditures 20 or More [C.R.S. l (1)(a)] (Please list on Schedule "B") 15 Total of Non-Itemized Expenditures (Expenditures of or Less) Loan Repayments Made (Please list on Schedule "C") - 17 Returned Contributions (To donor) (Please list on Schedule "D") 18 Total Coordinated Non-Monetary Expenditures (Candidate/Candidate Committee & Political Parties only) Total Monetary Expenditures (Total of lines 14 through I 7) <t45j. t~ 20 Total spending (Line 18 +line 19)?: t/3.;2-. IPL( - Colorado Secretary of State Fonn Rev. 12/09

3 Schedule A - Itemized Contributions Statement (20 or more) [C.R.S (l)(a)] WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINT/fYPE '55L f!.j1~vi 5. Address: f 3b.f41 ljj 6_q11... D~ 6. City/State/Zip:Ar\.bf-04-. LO ioo:: '-ag-"'gr-e-ga-te_a_m_t_. *--l ~ I ~s:-j _.U1~ '.wl"""'."""f~ =-0KJ,_,,""-"'(" l / _. / -'-J2=l'.o._:,_'li_,_l_.Y2'-'~-""" ""'~" l -~4=.r:./:;;~~.!:..J.~L!!.:.YJ---"U...!LJ~ Address: 7?://1 ()non 6. City/State/Zip: _..,,.,;!ln'---'--'--'lo<-11!>+= -'-"". ~--'~'---o =- _... <3:X/..6.. ~ -~<_..2J~ Aggregate Amt. * /'J J h I. --=C.'-"' -Vl..._.,et.:?-"""""= == ~ _,~. =...J>tJ:b...'"-+... L_'L;,...,~.,._,,. '-"",_,tm'-"'-'-_u~l--1-.tk-l='::..:~===-;-' r 1-=,,, l --~---t-' l.].,_yt_e:::..... T'-'-1 Vl'-"'C:""q' _ >L_f-_=/- L Address: 11./-33 Qu X..\ LI City/State/Zip: A-vial:u.>f. eo ~ l ~ 7!lj 3. Aggregate Amt. * fy f,.. j,., L.J// CCiL f Z {!_ ~ H / hkji/-ja =Wd: /fl.~ ~ _,O=-.,l-1..~2.,_Jl)-f-'.{-"/'-ly'L-- For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: C:111didalc T Commillec Art. XXVlll, Sec. 2(6); Political Party Art. XXVlll, Sec. 3(3); Political Commillee Art. XXVlll, Sec 3(5): Small Donor Cornrnitlce Art. XXVllI, Sec. 2(14). Colorado Secretary of Stale Fann Rev

4 Schedule A - Itemized Contributions Statement (20 or more) [C.R.S (1 )(a)] Full Name of Committee/Person: WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINT/fYPE f-.,, Address: 41"/~SD;J.:S-f _ City/State/Zip: ~J!,O 'Jooot/ 3. Aggregate Amt. * /1 J Wft,_,, --=L'-~~ ;::._L:>.-<< >-== i Date Accegted ID /;itp/j7 2. Conthbutidn Amt. 5. Address: L~<6 [") i1!'/jer f_ A~A-'ll ;, /~ ~.sf-. c-0-tj- 6. City/State/Zip: &U-LJ::>GR_ ~ &536b 3. Aggregate Amt. * t#ge&: T For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVlll, Sec. 2(6); Political Party Art. XXVlll, Sec. 3(3); Political Committee Art. XXVlll, Sec 3(5); Small Donor Committee An. XXVlll, Sec. 2(14). Colorado Secretary of Stale Form Rev. 12/09

5 r Full Name of Committee/Person: Schedule A - Itemized Contributions Statement (20 or more) [C.R.S. l (1)(a)] WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINTffYPE 1. Date Acce1:1ted.J\-i&\Ji l l-1, ~. :, id/i</1 fi.t ' J 2. Con(ribution Amt 5. Adchess h1/o~l- Sf- f)o-- Co -:good/ 6. City/State/Zip:,.. t 3. Aggregate Amt * # D V\ LGVL.t I. Date Acce1:1ted Contribution Amt 5. Address: City/State/Zip: Aggregate Amt * Date Acce1:1ted 2. Contribution Amt. 5. Address: 6. City/State/Zip: 3. Aggregate Amt. * 1. Date Acce1:1ted 2. Contribution Amt. 5. Address: 6. City/State/Zip: 3. Aggregate Amt. * For T contnbullon lnruts w1thm a comrmttee's elecuon cycle or contnbut1on cycle, please refer to the following Colorado Consutullonal cites: C:111d1da1c Committee Art. XXVlll, Sec. 2(6); Political Party Art. XXVlll, Sec. 3(3); Political Committee Art. XXVlll, Sec 3(5): Small Donor Committee Art. XXVlll, Sec. 2(14). Colorado Secretary of Slate Form Rev

6 Schedule B - Itemized Expenditures Statement (20 or more) [ (1)(a), C.R.S.] Full Name of Committee/Person: J_..:...\ ~\U._=-=: ~ }u----.:. ' f~...:..._ !!_j...l.!...il.l j.=..:~~l!_... ljl ~ PLEASE PRINTffYPE I. Date Expended D l~ "'--=.... -"--'-,.< City/State!Zip: -+-.,L...1~.l.L.+-'--.i...-i~.=...c~~,...-,.A"'-'-----==::..=-=~=-= _Recipient is (opti nal): 0 Committee 0 Non-Committee 3.Recipient is (optional): 0 Committee 0 Non-Committee I. Date Expended 2. Amount,, 6. City/State/Zip: Recipient is (optional): 0 Committee 0 Non-Committee I. Date Expended 7. Purpose of Expenditure: Electioneerin 2. Amount 5. Address: ,, 6. City/State/Zip: Recipient is (optional): 0 Committee 0 Non-Committee 7. Purpose of Expenditure: Electioneerin Colorado Secretary of State Forni Rev. 12/09

7 Statement of Non-Monetary Contributions [Art. XXVIII, Sec. 2(5)(a)(Il)(III) & Sec. 5(3) & (1), C.R.S.] PLEASE PRINTffYPE 2. Fair Market Value 16r 3. Aggregate Amt Address: ,L.-~~=--_,,D,:::::: -=lrj:..!...!..i\/...:.iu~ JIL..lL.1.::::C~-L...J...:.~~_.e.~C/--1.~./..S:;l.'.1..,,)._ 6. City/State/Zip: iakuajbffd} [{) ('o bb lm { Coordinated with a Candidate/Candidate Committee or Political Part *,..,. I. Date Provided 2. Fair Market Value 3. Aggregate Amt. 5. Address: 6. City/State/Zip: 10. Coordinated with a Candidate/Candidate Committee or Political Party.* I. Date Provided 2. Fair Market Value 3. Aggregate Amt. 5. Address: 6. City/State/Zip: 10. Coordinated with a Candidate/Candidate Committee or Political Party.* Nole: If coordinated, lhen contribution musl also be reponcd as a non-monetary expenditure on Detailed Summary. An. XXVIII, Sec. 2(9) slates: "... Expenditures that are controlled by or coordinated with a candidate or candidate's agent are deemed lo be both contributions by lhe maker of lhe expenditures, and expenditures by lhe candidate comm1tlee. Colorado Sccrela.ry of State Forni Rev. 12/09

8 Schedule C - Loans Full Name of Committee/Person: 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 information 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 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, First or Institution): Original Amount of Loan: Loan Amount Received This Reporting Period: Total of All Loans This Reporting Period: (Place on line 8 of Detailed Summary Report) ) Principal Amount Paid This Reporting Period: Interest Amount Paid This Reporting Period: Amount Repaid This Reporting Period: (Amount Repaid is sum of Principal & Interest entered on Total Repayments Made: (Sum of Schedule C pages, Place on line 16 of Detailed Summary) Date Loan Received Due Date for Final Payment TALL ENDORSERS OR GUARANTORS OF Tms LOAN 'Full Name Address, City, State, Zip Amount Guaranteed Colorado Secretary of State Form Rev. 12/09

9 Schedule D - Returned Contributions & Expenditures Returned Contributions (Previously reported on Schedule A- Contributions accepted and then returned to donors) PLEASE PRJNT/fYPE 1. Date AcceQted 2. Date Returned 5. Address: ~ 3. Amount 6. City/State/Zip: 7. Purpose: / / / 1. Date AcceQted / 2. Date Returned 5. Address: I 3. Amount 6. City/State/Zip: I 7. Purpose: / I ~ ]'-- PLEASE PRINT/fYPE 1. Date Exgended Ret (Previously reported on Schedule B (l.uf: 4. Name 2. Date Returned 5. Address: 3. Amount ~ire/np 7. C ent {Optional): 1. Date Exgended / ed Expenditures Expenditures returned or refu.nded to the committee) 2. Date Returned 5. Address: 3. Amount 6. City/State/Zip: 7. Comment {Optional): Colorado Secretary of State Form Rev. 12/09