I Full Name of Committee/Person:

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1 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial nstitution Space Below For Office Use Only OCT REPORT OF CONTRBUTONS AND EXPENDTWierk's Office (l , C.R.S.) Type of Report SOS D NUMBER (state and county committees): ~ ~ ~Regularly Scheduled Filing. D Amended Filing. This amends previous repon filed on (date) Submit changes or new information ONLY ~ ~ D Termination Report. (fennination Reports MUST Have a Monetary Balance of Zero in Line 5) D Check this box if this Report Contains Electioneering s nformation Reporting Period Covered: Sl?(lt J/ie 2tJ i2 Declared Total Spending (f applicable)! c,-o [Art. XXVlll, Sec. 4(1)] L-. ---=-'...:...:..::..=.. Through CJd ic). :2-o/:3 Date Totals Detailed Summary Page Funds on Hand at the Beginning of Reporting Period (monetary only) -:0 ~ Total Monetary Contributions (line 11) 31>6::1. &t Total of Monetary Contributions & Beginning Amount (line 1 +line 2) ~o.oo _oo Total Monetary Expenditures Oine 19) '7?-Q, (,0 Funds on Hand at the End of Reporting Period (monetary) (line 3 -line 4) '2. 7 ~. OC) The appropriate officer shall impose a penalty of 50 per day for each day that a report is filed late. [Art. XXV Sec. 10(2)(a)] Authorization (Must be completed by either the Registered Agent OR the Candidate): 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 Agent's Name: _...:;J)=i.L!o~N,L L_t)...L.!...jLf.:::c.::...JtL.ed=-. Registered Agent's Signature: An -/b!tbul Print Candidate Name: :no /'{ A lk. r d Date: ojl 7 Candidates Signature: fut tftfax cl Date: ltjt /13 Colorado Secretary of State Form Rev. 12/09

2 ~ DETALED SUMMARY Full Name of Committee/Person: ---=C.~r,LJ.? Y~h1~/+-/kL...Jo.o......!.-f.~a ;,e::...!l~e=-!ooc...,_f: J),~~'...L.t./L...LA...L...LL.:...!:'/ tz.~-'.:...d~- Current Reporting Period: S.ett- 1 '\ 2rJ 13 Through &cf /<:), Zo/3 ) Funds on hand at the beginning of reporting period (Monetary Only) -{)-- 6 temized Contributions 20 or More [C.R.S. l-45-jos(l)(a)] 7!3- c;~ (Please list on Schedule "A") 7 Total of Non-temized Contributions (Contributions of and Less) -() - 8 Loans Received (Please Jist on Schedule "C'') 2C;'75" 9 Total of Other Receipts (nterest, Dividends, etc.) Returned Expenditures (from recipient) - -~ (Please Jist on Schedule "D") -o - 11 Total Monetary Contributions (Total of lines 6 through 10) 3ooo ~- 12 Total Non-Monetary Contributions (From Statement of Non-Monetary Contributions) -c-- 13 Total Contributions 3 (?C (Line ll +line 12) OOu - 14 temized Expenditures 20 or More [C.R.S. l-45-los(l)(a)j (Please Jist on Schedule "B") /7ZE 16 Loan Repayments Made (Please list on Schedule "C'') 15 Total of Non-temized Expenditures (Expenditures of or Less) C)- 17 Returned Contributions (To donor) (Please Jist on Schedule "D") 18 Total Coordinated Non-Monetary Expenditures (Candidatc:/Candidate Committee & Political Parties only) ~o- -o- 19 Total Monetary Expenditures (Total of lines 14 through 17) Total Spending (Line 18 + line 19) 1728 Colorado Secretary of State Form Rev

3 Schedule A- temized Contributions Statement (20 or more) [C.R.S lOS(l)(a)] Full Name of Committee/Person: WARNNG: Please read the instruction page for Schedule "A" before completing! PLEASE PRNT'YPE ttjf,,3 fyl i {/t. t 2. Cdntribution Amt. 5. Address: &11[ '::f L_,u) ea. ~f.. 5 at' f-4 JtA} g,_ J.a c: J (! (JL} 1J. z.- 6. City/StatefZip: a 3.,Aggrngate Amt. Electioneering 1. Date AccenY:d J v 8. Employer (if applicable, mandatory): ~e..j.i t:.~d 9. Occupation (if applicable, mandatory): w!a "' " 6. City/StatefZip: 3. Aggregate Amt. * 8. Employer (if applicable, mandatory): 6. City/State/Zip: 3. Aggregate Amt. * 8. Employer (if applicable, mandatorv>: 6. City/State/Zip: 3. Aggregate Amt. 8. Employer (if applicable, mandatory): Por conttibutionlimits within a committee's election cycle or conttibution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVD, Sec. 2(6); Political Party Art. XXVU, Sec. 3(3); Political Committee Art. XXV, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14). Colorado Secretary of State Ponn Rev

4 \ Full Name~ CommltteeiPenoa: PLEASE PRNT'YPE 1. Date Rgpm:W /0/~1 13 Schedule B-temiHd Expeadl~ Statement (20 or more) [l-4s-108(1xa), C.R.S.] &; tj:1 tr1 i 1/ e /c e /e-e.i AN ll!l.::ll-d Cb/oyc:.eb C!urzm ani /ly med{cl. 2. Anioggt s. Address: tj/3'7 &/dyej,/ve Blvd, #2-10 J ::_ 6. City/State/Zip: ll.irh 14tlcls!? a. tt:. c b.. C_tr ;!O2'l.. 3.Rccipient ia (opdoul):.. D Committee liz..p.la. fie/ ill Alt..lk1'dfl. E!.te.q_s D Non-Coauaiaa: 0 Cleek box if Blectioneerintr Communicadon 1. Dale 8Jnmk;d 2. Amount s. Address: - 6. Oty/StatefZ.ip:... 3.Rcc:ipient ia (opdoul):. 0Committee 7. Purpose of Expeuditure: 0 Noo-Commitb:e 0 Cllcck box if Elcctioneerintr 1. Date 8Jnmk;d ' 2. Amount S. Address: 3.Recipient ia (opdoaal): Deommittee 0 Non-Committee 1. Date Rmended 6. Oty/Statei'Zip: Blectionec:rintr 2. Amount S. Address: 3.R.cc:ipient ia (optiodal): 0Committee 0 Non-Committee. Date &pmkd 6. Oty/StatefZ.ip: Electioneerintr 2. Amouul s. Address: 3.R.cc:ipient is (optiodal): D Committee. 0 Non-Committee 6. Oty/StatefZ.ip: Elcc::tioneerintr Colondo Secretary ofs: PanD Rev. l:w9

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 information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial purpose. [An. XXV, Sec. 9(e)) Notwithstanding any other section of this anicle to the conttary, 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. XXV, Sec. 3(8)) LOAN SOURCE Name (Last, First or nstitution): ) Address: --"f-~'----jf~o"'--l.7_tu=- 1 -' =-g_z._j_:]j.:z=..l...::.~::...; City/State/Zip: ---,,,Lif.J,...h~V~CL::..~,i,j..t=ll~_..f.~:::>...Jc5.L......:::g::...:o::._:~::...:3= Original Amount of Loan: nterest Rate:... _CJ_- J DA A 't11~ Total of All Loa~ This Re._portingc<."", c. ~" Loan Amount Received This Reporting Period: ;lub Penod:.-.., (Place on line 8 of Detailed Summary Repon) Principal Amount Paid This Reporting Period:. -_c.=."'_-_- nterest Amount Paid This Reporting Period: - ~ - Amount Repaid This Reporting Period: - c - (Amount Repaid is sum of Principal & nterest entered on Detail Summary) Total Repayments Made:. (Sum of Schedule C pages, Place on line 16 of Detailed Summary) TERMS OF LOAN: LST ALL ENDORSERS OR GUARANTORS OF THS LOAN Full Name Address, City, State, Zip Amount Guaranteed.tb n1 A 1"-r ~ 64-"?A~h/- P;;;_d 7Jl lef_. a.. '()Lrd ~,(J?fl~ :2CJ75~s t:p A Colorado Secretary of State Form Rev. 12/09