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1 dc d 1).. 3t3 Coorado Secretary of State Eections Division 1700 Broadway. Ste. 200 Denver, CO Ph: (303)! ext F x: (303)!: Emai: cpfhep@sos.state.co.us 1 Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financia Institution REPORT OF CONTRIBUTIONS AND EXPENDITURES ( , C.R.S.) SOS ID NUMBER (state and county committees): Type of Report ~eguary Schedued Fiing. Space Beow For Offrce Use Ony ~ ~ 0 Amended Fiing. This amends previous report fied on (date) Submit changes or new information ONLY ' ' 0 Termination Report. (fermination Reports MUST Have a Monetary Baance of Zero in Line 5) 0 Check this box if this Report Contains Eectioneering s Information Reporting Period Covered: I / D /;).. 8 U.._?J Date Decared Tota Spending (icappiaahe) I n q <. J9 [Art. xxvm. Sec. 4(1)]. I 0 J J I Through ~~j-~- /~3():::::...;/ ;,_,J 3...,.---~ Date '5 Period (monetary ony) Amount (ine I +ine 2) The appropriate officer!dta impose a penaty of SO per day for each day that a report is fied ate. fart. XXVIII Sec. 10(2)(a)) Authorization <Mu~t be competed by either the Registered Agent OR the Candidate): I hereby certify and decare, under penaty of perjury, that to the best of my knowedge or beief a contributions received during this reporting period, incuding any contributions received in the form of membership dues transferred by a membership organizion. are from permijsibe sources. Prim Registered Agent's Name::::.,..:: ===J~e;.;a~n---"-e-c;-r_:)~()~e_=--_c/,,-h~/x=;JJ=r:..re.A_--'-~------::::---..,.--r-- Registered Agent's Signature: ---7<.:::::J=ti/-,~f<~-),..-.-}~:> ~,.L_--~---o;; 12) 1 b Print Candidate Name: Candidates Signature: V Date: Coorado Se=Wy of Stae Form Rev. 2A9

2 DETAILED SUMMARY Current Reporting Period: /0/ ;.,5 /;( j Through j Funds on hand at the beginning of reporting period (Monetary Ony) 6 Itemized Contributions 20 or More [C.R.S IOS()(a)] (Pease ist on Schedue "A") 17 Tota of Non-Itemized Contributions (Contributions of and Less) 0 t k."'e(12 0 v J!3a/;3 ) 1 Lfqo. D D 8 Loans Received (Pease ist on Schedue "C") 9 Tota of Other Receipts (Interest, Dividends, etc.) O Returned Expenditures (from recipient) (Pease ist on Schedue "D") Tota Monetary Contributions (Tota ofines 6 through 10) 12 Tota Non-Monetary Contributions (From Statement of Non-Monetary Contributions) 13 Tota Contributions (Line II +ine 12) 14 Itemized Expenditures 20 or MOR {C.R.S \0S()(a)\ (Pease ist on Schedue "B") 15 Tota of Non-Itemized Expenditures (Expenditures of19.99 or Less) Lf 9o. o a qj 16 Loan Repayments Made (Pease Jist on Schedue "C'') Coorado \ 17 Returned Contributions (To donor) (Pease ist on Schedue "D") 18 Tota Coordinated Non-Monetary Expenditures (Candidate/Candidate Committee&. Poitica Parties eny) 19 Tota Monetary Expenditures (Tota of ines 14 through 17) 20 Tota Spending (Une 18 +ine 19) I I '173.tf) 113.1/ Secretary of State Form Rev L.. j

3 ,.,.,. Schedue A- Itemized Contributions Statement (20 or more) [C.R.S ()(a)] WARNING: Pease read the instruction page for Schedue "A" before competing! 5. Address:...: =-~-..!..-"'~:::::,- :.::. ~ I-:----.!.-..C::::.>..::...-== ~-=--_; -=--=--r-~:::_:_--=g -=-O-=-d.:_::D:::._.:._I ( h,1 : J/ 7. Description:U{, -L - 1-== Empoyer (if appicabe, mandatorv): ---b-..t..l~~...,_j.'.ll..::..:::::.-w=-..l...l!:.:=...!~=.---l...l..k1o..::::!.l O Check box if 9. Occupation (if appicabe, mandatory): --1b:o-L!:O...:;._:_--=-..~!..._-L-_:_~:..._! Occupation (if appicabe, mandatory): :::,.. Date Accevted II/ ~~h3 2. Contribution Amt. 40.0{) 4. Name (Last. First>:...S'-o!W=--I_'-=e--f--- - ~------~ , 1 -~G-=~:::...:...:t-=-=.-_,_Cf-=-~ Address: Lf-~----~...:...= :::0:c._ ~(,e~/---=(}=--..:_( '----::o citytstatejzip: L(...::::()~sh:.-L: a~~---='-~--=-s::::...:~==-=-- 7 ~, C=-~~-C/-~_(R~'.:...]L--_ 7. De~ription: --~G~AA~f_L=J~k~t~=== /-;:::::; Empoyer (if appicabe, mandatory): Eectioneering 9. Occupation (if appicabe, mandatory): Date Accepted 4. Name(L~~Fmt): :---: :---:---i Description: ,-- /-;:::::; Empoyer (if appicabe, mandatory): Eectioneering 9. Occupation (if appicabe, mandatory): For contnbution irmts WJthm a committee s eecuon cyce or contnbuuon cyce, pease refer to the foowing Coorado Consutuuona ettes: Cand1date Committee Art. XXVI, Sec. 2(6); Poitica Party Art. XXVIII, Sec. 3(3); Poitica Committee Art. XXV, Sec 3(5); Sma Donor Committee Art. XXVIII, Sec. 2(14). Coorado Secretary of State Form Rev

4 /0/ }S- t/:;,o 7-t/3 Schedue A- Itemized Contributions Statement (20 or more) [C.R.S ( I )(a)] WARNING: Pease read the instruction page for Schedue "A" before competing! 1. Date AcceQted 7. Description: 8. Empoyer (if appicabe, mandatory): Eectioneering 9. Occupation (if appicabe, mandatory): 1. Date AcceQted 3. Aggrngate Amt. * 7. Description: Eectioneering 8. Empoyer (if appicabe, mandatory): 9. Occupation (if appicabe, mandatorv): 1. Date AcceQted 7. Description: 8. Empoyer (if appicabe, mandatory): Eectioneering 9. Occupation (if appicabe, mandatory): For contnbut10n hmi~ Withm a committee s eection cyce or contnbunon cyce, pease refer to the foowing Coorado Constitutiona cttes: Candidate Committee Art. XXVIII, Sec. 2(6); Poitica Party Art. XXVIII, Sec. 3(3); Poitica Committee Art. XXVIII, Sec 3(5); Sma Donor Committee Art. XXVIII, Sec. 2(1 4 ). Coorado Secretary of State Fonn Rev. 12/09

5 ( Schedue B -Itemized Expenditures Statement (20 or more) [ ()(a), C.R.S.] I _ PLEASE PRINTffYPE I. Date E~en<ed, h_.v'---'1'-'=e"-'' t-~:.v:::_... s~---'-"d'-f--_l..as...!.,. C_::e~-n~zoco..o~ Name: /I)/I} J3 JtLk Kro/;ct, 2. Amount 5. Address:_ /OfCJ:J fdyrtdgtor'. I--::-=-.R-eci:-':-1-2--=-~~-~-~- 7. Purpose of Expenditure: U U J tej 12 CO,-d;n 7 O Check box if Eectioneering 3.Recipient is (optiona): I. Date Exoended 1t/;A1/B 2. Amount J...OO. cf) 3.Recipient is (optiona): I. o~~~j;g][3_ : 3j4_.oD }.Recipient is (optiona): 1 0n-a)-: fj I~ / 0-~ KtL-10 {G. ft!j? 4. Name:,.Jio.j.Je~e~n~n~~~~Jid-=-..;;::...-~...:... ~a;;..;;;.vj_'~t:..-:y!j~--.l ' 5. Address: J~(e30 L!). {pfr-1-a PJ. ~ 1 ;.' IJtv ag {d. 1 ~ f? c:oo 3 > ) I 7. Purpose of Expenditu~===~(}...,b't...,.,:r.,;1~r"'=~~LJ,.'6'~~"""-~' a!!!!jftte;;r/-...,. =' """/=..,._."""""""?"""""=,.,!;1_ Eectioneering 4. Name: --L-><4..!...:<r._,_,... 7 ~~C{"-"-t1--'-ff...:...=_f!_S.5_--=-----~-- Q~fJ----'--. h-'--. -=--U, b""-"'e_~y'-----=-~- h ' CtJ.. eu 4 {)3 5. Address: _---J_j J.-->ooo{ /H 7. Purpose of Expenditure: :1-fUT'--! Eectioneering 4. Name: Eectioneering I. Date Exoended 4. Name:. f{;d/;r L/ n Lva II /f 2 Aiwtej )/Jf /(3 -- ( u -2-. A-'-m-ouc...:.nt-'-' Address: J'L/ 7 J Cha 5e JY-r t J f7 DO ].Recipient is (optiona): 6. city/state/zip:!rv oci~_ e_o_::_o--={)_3_: 7. Purpose of Expenditure: B 0 bo r ~- ((:::.:,, Eectioneering Coorado Secmary of S1.a1e Form Rev. 12.K9 L \