x~~uc W.LJ.5wo r+h Blva. ..I Through I ~ - 07, d}o1 ep

Transcription

1 Space Below For Office Use Only / P "":' "" r:. ' " ~ a.. '. ~' ~- J REPORT of contrbutions AND EXPEND1Twr-c _ A : (C. R.S , Code 7) Full Name of Committee/Person:.::5-tr\KC... 1'h (-ee._ Griru..{2 L 1 Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial nstitution As Shown On- on 4~ f\e, jtl.l t 5+ lnh~_-r R ctc;~ Co eoo39' x~~uc... hrs+~ 4350 W.LJ.5wo r+h Blva. Wr 1eLL-t e,- \'.:. & ~Q:?3 3 Tvpe of Report D Regularly Schednled Filing. D Amended Filing. This amends previous report filed on (date) Submit changes or new information ONLY ~ TennJnation Report (Termination Reports MUST Have a Monetary Balance of Zero in Line 5) D Check this box if this Report Contains Electioneering Communications nformation Reporting Period Covered:. 0_ <9_G?_ a. Date 0 _1 <.p.. Through ~ - 07, d}o1 ep Date 1 Funds on Hand at the B The City Clerk shau impose a penalty of 10 per day for each day that a report is filed late. [Code, 7-4) Authorization CMust 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: Registered Agent's Signature: _J.~flt Print Candidate Name: - be. be...:+-. JV'lc.Ro~ ~~~~==;0=:=d==(B=======::;-----Date: DETALED SUMMARY 1.:t_/ 7 /; (; Candidates Signature: D. ate:

2 Current Reporting Period: Through d CJQ/&;; Funds on band at the beginning of reporting period (Monetary Only) 587. D 0 6 temized Contributions 20 or More (Muni. Code 7-5] (Please list on Schedule u A") ~Q() ) 0 7 Total of Non-temized Contributions (Contributions ofs19.99 and Less) ~o Loans Received (Please list on Schedu.lc "Cj 9 Total of Other Receipts.. -. _, ' - 10 Returned Expenditures (from recipient) (Please list on Schedule "Dj 11 Total Monetary Contributions (Total oflines 6 through 10) 807 v 0 12 Total Non-Monetary Contributions (From Statement of Non-Monetary Contributions) 13 Total Contnoutions 80/. t) 0 (L.ine 11 +line 12) 14 temized Expenditures 20 or More [C.RS. l-45-lob(lxa)] (Please list on Schedule "Bj 15 Total of Non-temized Expenditures (Expenditures ofs19.99 or Less) Loan Repayments Made (Please list on Schedule "C") Returned Contributions (To donor) (Plca8e list on Schedule "Dj 18 Total Coordinated Non-Monetary Expenditures (Candidate/Candidate Committee & Political Parties only) 18. lfo 788. roo 19 Total Monetary Expenditures 507, oo (Total of lines 14 through 17) 20 Total Spending 8D7 oo (Line 18 + line 19)

3 Schedule A-temized Contrlbutions Statement (20 or more) [C.R.S. l-4s-108(l)(a), Muni. Code 7-6) PLEASE PRNTll'YPE t. Date As,:s,:mted // / //, /~ 2. Con!!:ihuti2n Amt. f){) /DO 3. Agmo~ Aon. JOO ()>. O!!t!: 6s.s.e12ti:d /l J.q C2nttt"2uli2n Amt /DO. oo 3. AgmgDt~ Amt, / Name (Last First): ~Vt,l!! - '/os (oq/)b L< 2. Lr1~~,Pl Nh~at fr5_,:1_q~ ~ goo55 f_j Hie :51-skr5 ol -H~ ~o r - ~l15fodu1;v 'r1i11t HecK-~ ( LJqq ~L (pw A~l)J_, 1 Arv J..,. J.. L~ <gooo.3 M(t'.t.~... fv1ct.h.~c.a.j.. 5rie- - A~ e;& v. Qa~ As,:~e12ted 2. C2ntribyt:ion Amt 3. Aggre~ Amt.. Qa~ A ~!:12ted 2. C2ntri!:rnti2n Amt. 3. A~m&:At~ Am!. l. Date Acoe12teg 2. ~nm"quriq!l Am!. 3. 6gmate Amr, 4. Name (last. First):

4 Schedule B - temized Expenditures Statement (20 or more) [C.R.S (1Xn), Muni. Code 7-6) :5t ri J-., e Th.r-e c (7yo1.. cp Full Name of Committee/Person: PLEASE PRNT/TYPE. l. Date :ex12ended. ( 2. AmOunt S. Address: "' u:r- 3.Recipienl is (optional): D Check box ifelectioneerin~ Communication i. Dat~ E1u2m~ed ' 2. Amount 3.Recipient is (optional): D Check box ifelcctioneerin~ Communication l. D te E!.~en~ed 2. Amount 3.Rccipienl is (optional): D Check box if Electioneering Communication 1. Q!lte Ex~enged 2. Amount 3.Recipient is (optional}: 0 Check box if Electioneering Communication. Qate E~~nded 2. Amount 3.Recipient is (optional): 0 Check box if Electioneering Communication

5 ScheduJe C - Loans LOANS - Loans Owed by the Committee (Use a separate schedule for each loan. This form is for line item 8 and 16 oftbc Detailed Summary Report.) [No mformation copied from such reports shall be sold or used by any J>CSOn ror lhc purpose of soliciting contnliutioos or for any commcrcia1 purpose. [An.. XXVln, Sec. 9(e)] Notwithstanding any other sec&ion of bis article 10 the conlj1lry, a candidaie's candidate comminee may iudve a loan from a fidancial instirutioo organized under Slale or federal law if the loan bears the usual and customary inlc:rt:sl raie, is made oo a basis that ass\l1ts repayment, is evidenced by a written instrument, and is subject O a due date or amortrntion schcdulc [An. xxvm. Sec. 3(8)) LOANSOVRCE Name (Last, First or nstitution): N (_+q- City/State/Zip: Original Amount of Loan: nterest Rate: ~ Loan Amount Received Th.is Reporting Period: Totlll of All Loans This Reporting Period: (Place on line 8 of Detailed Summary Report) Principal Amount Paid This Reporting Period: nterest Amount Paid This Reporting Period: _ Amount Repaid Th.is Reporting Period: (Amount Repaid is 5um of Principal & nterest entered on Detail Summary) Total Repayments Made: (Sum of Schedule C pages, Pla_l%_on lin_e_l_6_of Detailed Summary) Outstanding Balance: TERMS OF LOAN: Date Loan Received Due Date for Final Payment LST ALL ENDORSERS OR GUARANTORS OF THS LOAN Full Name Address. City. State. Zip Amount Guaranteed

6 Schedule D-Returned Contributions & Erpenctimn ( Returned Contributions (Previously reported on Schedule A - Contributions accepted and then returned to donors 1 PLEASE PRNTffYPE l. ~!!~ A~1t~12ted 100'5./(p v~1be1-,- /:'""' l/ rxro f<er,d l.d f 1 ( K'.obc.rT5 2. Pate Returned s-r J{) vd.. (/; Whi:a,-r e,cu~. Co 806 = ~ 3. AmOUDt - ~L- ;-t3~. ~o 7. Purpose: :5~>LS 1. Date Acce~ted 2. Date Returned 3. Affiount s 7. Purpose: Returned Emenditures (Previously reported on Schedule B - Expenditures returned or refunded to the committee) PLEASE PRNT/TYPE. ~~l~ E~12~m;leg 2. Date Rcrumcd 3. Amounr s 7. Comment (Optional): l. Qiu~ ~x12endcd 2. Date Returned 3. AmOUOt 6. Cicy. 1 State/Zip: s 7. Comment (Optional):

7 Full Name of Committee/Person: _...;:,;Sfy Statement of Non-Monetary Contributions [Art. XXVll, Sec. 2(S)(a)(J)(Jil) & Sec. 5(3) & C.R.S (1)) i ~ JM _J e_e PLEASE PRNTfl'YPE 1. Date Provided 1'J. ~ 2. Fair Market Value 3. Agm;gat~ Amt. 1. Description; 6Yl}c{? D Check box if Coordinated with a Candidate/Candidate Committee or Political Party. * 9. 0 Check box if Electioneering Communication 1. Dat~ PrnY:ided 2. Fair Market Value 3.,Aggi:~~~ Amt. 8. D Check box if Coordinated with a Candidate/Candidate Committee or Political Party. 9. D Check box if Electioneering Communication 1. Date Pr2vided 2. Fair M!!!ket Yfilue 3. Aggre~te Amt Check box if Coordinated with a Candidate/Candidate Committee or Political Party. * 9. 0 Check box ifelectioneerinji: Communication 1. Qate PrO\'ided 2. fair: Mm:ke Yalu~ 3. Aggre~te Amt. 4. Name (Las1., First): 6. CityiState/Zip: 8. 0 Check box if Coordinated with a Candidate/Candidate Committee or Political Party Check box if Electioneerin2 Communication Note: f coordinared, then cootributioo must also be reponed as a non-monetary cxpendirurc: on Derailed Summlll)'. An. XXVTll, Sec. 2(9) states: ~.. Expenditures that are conirolled by or coordinated with a candidate or candida1e' s agenl are deemed co be both contributions by the maker of the cxpendirures, and cxpc:odi~ by the candidate committee."