I Through I IC/ u~ / d-0 II

Transcription

1 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) REPORT OF CONTRIBUTIONS AND EXPENDITU ( , C.R.S.) OCT 1 O ZOll CITY CLERK'S S OFFICE Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: A s Sh own 0 n R eg1strat1on (SS5 AiL--tSON CT Ai::.-JADA Co ~ooos c'andidatt: COL Vl!'\'\ ITT E:. Name and Address of Financial TC~ Nr-:\ 1 Ot~ Al- BJ.\. N~ '. Ci,~ Et:: N,\j Ch?> e:. Institution G: '-ft'.> 0 '.' FtDDLei0 <; c1'keen c.e :. lf/uat:;f: ('v"60111 Type of Report I SOS ID NUMBER (state and county committees): l. N_'+-(-f\ ~ lzj. 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 Communications Information Reporting Period Covered: I <f ltcj J :Xo /{ Declared Total Spending (if applicable) I [Art. XXVlll, Sec. 4(1)] ~ ~ ~ Date I Through I IC/ u~ / d-0 II Date Period (monetar only) mnm Amount (line I +line 2) Period (monetary) (line 3 - line 4) The appropriate officer shall impose a penalty of 50 per day for each day that a report is filed late. IArt. XXVIII Sec. 10(2)(a)I 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. Pri~~~~~A~m'sNwM:_r~1~l~~~<~K~~~~~~-G~~~~~~ Registered Agent's Signature: /fl~ /"t7 '-,~ Date:/~ - /d -/ / Print Candidate Name: VV\.ct.,\ ~ m c: G('I f+- Candidates Signature:,/"?-7~ /11,'-~ Date: I 6 -/ 2J - / J

2 Full Name of Committee/Person: -1../1~.' c::_' Current Reporting Period: I ~1/t~ / DETAILED SUMMARY '~11'\C..:JtL!\1~1 T!._1.:._:-8::::::;;...!::e-==--_!W~":. c~l::-"')c...:e::....!::'.e-:...!:l~g=-c=-~--'.! M~A..::1_.:.?..~(c.._/_,~_,_,,U=' :).i) / \ L--+-1~~~~~~~~~~--' Funds on hand at the beginning of reporting period (Monetary Only) Through I /8 /It) J d...() / ( I I ~).l}20. Jl7 6 Itemized Contributions 20 or More [C.R.S (l)(a)] if 56.()0 (Please list on Schedule "A") ==-ifr-=-o-'-r,_r-_ 7 Total of Non-Itemized Contributions (Contributions of19.99 and Less) 8 Loans Received (Please list on Schedule "C") 9 Total of Other Receipts (Interest, Dividends, etc.) c 00 0,00 10 Returned Expenditures (from recipient) 0.06 (Please list on Schedule "D") 11 Total Monetary Contributions /f 55,co (Total oflines 6 through I 0) 12 Total Non-Monetary Contributions (From Statement of Non-Monetary Contributions) 13 Total Contributions (Line 11 + line 12) o. {) 0 //S Itemized Expenditures 20 or More [C.R.S (l)(a)] I t50f. 11 (Please list on Schedule "B") 15 Total of Non-Itemized Expenditures (Expenditures of19.99 or Less) 30, Loan Repayments Made {).OD (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) (),do JV/A 19 Total Monetary Expenditures /':i}8i l/1 (Total of lines 14 through 17) 20 Total Spending i 5 (}8/-1 t (Line 18 + line 19) Colorado Secretary of Stale Form Rev. 12/09

3 , Schedule A- Itemized Contributions Statement (20 or more) [C.R.S ( I )(a)] Full Name of Committee/Person: ~.&rn!vi 1rree TO Rt? l (JT /Vl A /C. lc fyltyo F WARNING: Please read the instruction page for Schedule "A" before completing! PLEASE PRINT/TYPE I. Date Acce[)ted 4. Name (Last, First): ~ ~ ~v st=~ ~.). 7. Description: Aggregate Amt. * ~/~ I 6f Electioneering Communication 9. Occupation (if applicable, mandatory): v\ l. Date Acce[)ted 4. Name (Last, First): 3. Aggregate Arnt. * 7. Description: Electioneering 1 Communication 9. Occupation (if applicable, mandatory): l. Date Acce12ted 4. Name (Last, First): 3. Aggregate Amt. * 7. Description: Electioneering Communication I. Date Accegted 9. Occupation (if applicable, mandatory): 4. Name (Last, First): ~.), Aggregate Amt. * 7. Description:. ' Electioneering 9. Occupation (if applicable, mandatory): :ommunication 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 Art. XXVlll, Sec. 2(14).

4 as of 10/10/2011 Committee to Re-Elect Mark McGoff Reporting Period Schedule A - Itemized Contributions Statement 9/20/ /10/2011 DATE... CONTRIBUTION AGGREGATE... EMPLOYER& RECEIVED or NAME ADDRESS CITY ZIP AMOUNT AMOUNT.,, ~ OCCUPATION CHECK DATE 1 09/19/ Spears, Gary E. Dr W 64th Ave Arvada co /19/ Melba J McDanal 6148 Iris Way Arvada co /20/ Ferdinandsen, Richard 8023 W 78th Pl Arvada co /20/ Thornton, W E Bayard Ave Denver co I /20/ Jackson, Bob & Shirley 6467 Ammons St Arvada co City of Arvada Director, Economic 6 09/23/ Hartbarger, Hazel V Quail St Arvada CO Development 7 09/23/ Buller, Laurel J Quartz Way Arvada CO '80007 retired ' 8 09/25/ Larsen, Dennis L 6714 Field St Arvada ico /28/11; Dahlkemper, Lesley W Harvard Ave -- Lakewood co, /29/ Kiljan, John P 6185 Field St 1 Arvada CO : retired 11 10/02/ Heller, H. N Ammons St -- -,--- Arvada co Realtor Candidate Political Action Realtor Candidate Political 12 10/06/ Committee 309 Inverness Way South Englewood,CO 'Action Committee TOTAL 1, page 1of1

5 Schedule B - Itemized Expenditures Statement (20 or more) [1-45-IOS(l)(a), C.R.S.] Full Name of Committee/Person: ( 61V! MI TL e TD Re Ei Ci lm A<CI< Mee{ off' PLEASE PRINT/TYPE I. Date Exnended ct I JJ._ I;}, o Amount e tt7 /1V ADVEf?TL 51 vuq ~ 5. Address: 5S'io C>L])E WAOSw D ~Th Bi\f J) ( A/2-VltDA Co Recipient is (optional): l:z! Non-Committee I. Date Ex1;1ended q / :J 8/ ;)o A-,;:;ount' lll/3!),.t>o 3.Recipient is (optional): ~ Non-Committee 1. Date ExQended PK/NTIN(j 7. Purpose of Expenditure: kud 1 L PR1rJ-U1\J<j L fv) At LLIDf'.j COSTS Electioneering Communication f'vl1ll3!+1qh Ne:wsPptPEJ?S 5. Address: I or N!2. us tj t D12, yolden cid <toqo3 7. Purpose of Expenditure: A't> 1./ e1<-tt ~ VV'l e-.\yt's Electioneering Communication 2. Amount 5. Address: l 3.Recipient is (optional): D Non-Committee I. Date ExQended 7. Purpose of Expenditure: Electioneering Communication 2. Amount 5. Address: 3. Recipient is (optional): D Non-Committee 1. Date Ex1:1ended 7. Purpose of Expenditure: Electioneering Communication 2. Amount 5. Address: 3.Recipient is (optional): 0 Committee 7. Purpose of Expenditure: 0 Non-Committee Electioneering Communication I

6 Schedule C - Loans Full Name of Committee/Person: L.1 Otl1/1Vi111t:[ TD Reeu;cr fvlatl/l t11c 4orF 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. XXYIII, 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 dat: or amortization schedule [Art. XXVIll, Sec. 3(8)] LOAN SOURCE Name (Last, First or Institution): Address: ft'} C ~ 0 f FI {Vl~IC.. IC, 1--'8 5S ftll \SO f\.) C_,- City/State/Zip: Af2..VA-J>A CO 8D00'6 Original Amount of Loan: /, / Interest Rate: tj/a ' Loan Amount Received This Reporting Period:._{)..._,_D'---0 Principal Amount Paid This Reporting Period: _~0~ ~0_0 Interest Amount Paid This Reporting Period: 0 l2 0 Amount Repaid This Reporting Period: (2 (J 0 (Amount Repaid is sum of Principal & Interest entered on Detail Summary) Total of All Loans This Reporting Period: /, ( (){) c CJO (Place on line 8 of Defailed Summary Report) Total Repayments Made: 0,(JQ (Sum of Schedule C pages, Place on line 16 of Detailed Summary) Outstanding Balance: TERMS OF LOAN: /l I /to. 0-0 ~{:i"l/).c/i 5-j~O 1{,~/20/t t.ij.!j '3" J r D{e Loan Received LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN Full Name Address, City, State, Zip Amount Guaranteed