Kentucky Laborers - Contractors Deposits

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1 Kentucky Laborers Contractors Deposits PAGE 1 3/3/2017 # Local Contractor H & W Training KY LECET Regl LECET / Trifunds Local 576 Working Dues Assessment: District Coun ADVANCED VETERNARY SVC 3, HNKLE CONSTRUCTON SVC 2, PCL CVL PCL CVL PCL CVL PCL CVL ASSOCATED RALROAD NO WORK Total Daily Deposits 6,

2 Kentucky Laborers Contractors Deposits # Contractor Local 576 Add'l Working Dues: Total ADVANCED VETERNARY SVC 3,17100 HNKLE CONSTRUCTON SVC ,12803 PCL CVL PCL CVL PCL CVL PCL CVL ASSOCATED RALROAD Total Daily Deposits ,11459 District Coun KY LPL 189 Drug & Safety 1445 Drug & Safety 1445 BTD & Cap 576 Const Drug Test OTHER

KENTUCKY LABORERS CONTRACTORS DEPOSTS CONTRACTOR: ADVANCED VETERNARY SVC DEPOST DATE: 3/3/2017 LOCAL# 1445 REPORT DATE: CHECK AMOUNT: Mar17 3171 HOURS REPrD: Federal Tax D#: 61 1185349 CHECK NUMBER:

3 KENTUCKY LABORERS CONTRACTORS DEPOSTS CONTRACTOR: ADVANCED VETERNARY SVC DEPOST DATE: 3/3/2017 LOCAL# 1445 REPORT DATE: CHECK AMOUNT: Mar HOURS REPrD: Federal Tax D#: CHECK NUMBER: GROSS WAGES: PREPARED BY: RHONDA HOOVER ANDERSON RECEVED DATE: 3/1/2017 DATE PREPARED: 3/2/2017 RATE AMT ON REPT DFFERENCE REMARKS Health & Welfare 3, Training KY LECET Reg' LECET TriFunds 'i Working Dues: 4% LocaV1% KLDC of Gross Wages Local 576 District Council Add'/ Working Dues: 20 Loca/110 KLDC xhrsworked Local576 ; District Council KY LPL 189 Drug & Safety 1445 Drug & Safety 1445 STD & Cap 1"1' Const Drug Test PACAF nd' = 'TOTALS: 53,111ool soool

$Due date is the (10th) day of the month following the work month FEDERAL TAX D: (ul J _53yq EMPLOYERS NAME; Ad'lltl:wi Jcnl\4ik\ JU J EMPLOYERS ADDRESS: 3101, laul J '4 H :i 2 J EM::PLOYERS PHONE #:$ $JS7 CONTRBUTONS OWED: = W1_1KK G DUES: o of Grnss Wages= CERTFED BY: WORK PERFORMED N THE JURSDCilON OF: (Circle One) (l\ 1 Q '2) 576 (3)1214 (4) 1392 (5) 1445\') EMPLOYEES Ni\ME Va HW1 U ty"" u An$

4 ::>ep ur 16 10:14a Jackson Brothers p1 KENTUCKY LABORERS' DSTRCT COUNCL PENSON & WORK DUES MONTHLY EMPLOYER REMTTANCE REPORT (Stationary Units Only) REPORT FOR THE MONTH OF:,_ m+, tjjrt L Due date is the (10th) day of the month following the work month FEDERAL TAX D: (ul J _53yq EMPLOYERS NAME; Ad'lltl:wi Jcnl\4ik\ JU J EMPLOYERS ADDRESS: 3101, laul J '4 H :i 2 J EM::PLOYERS PHONE #: &Q 3Jt 7Wo EMJ>LOYEES # SOCAL SECURTY NUMBER l 1gq_ 2 (o'/ G7 2Ji ' f 4o' 1';J D?JS7 CONTRBUTONS OWED: = W1_1KK G DUES: o of Grnss Wages= CERTFED BY: WORK PERFORMED N THE JURSDCilON OF: (Circle One) (l\ 1 Q '2) 576 (3)1214 (4) 1392 (5) 1445\') EMPLOYEES Ni\ME Va HW1 U ty"" u An Da µ WtdW 1rf} Rnx LJ } FOR AUDT ONLY: SEND PENSON TO: Laborers' National Pension Fund PO Box Dallas, Texas SEND WORKNG D\J""ES TO: Laborers' Local Union i having jurisdiction where work is perfonned MO HOURS WORKED loo l D J o GROSS WAGES /3)tS:W 1"3 1 c::;,lp 2 Uu O 4 CfJW 5 ' 0 ) 6 ' 7 i/j "' ro v lf1 3 N A ve<, il1u<lo 8 3 qo thrl( (i1 (1 TOTALS : jq l8'3 r?

$Sep07_1610:14a Jackson Brothers VVVVYVV"'T:r KEl'lTUCKY LABORERS, DSTUCt COUNCL PENSON & WORKDUES FEDERAL TAX D: Jlf5349 E\fPW):"'"ERS NAME; MONTlLY El\fPLOYER REMTTANCE REPORT (Stattonru Units Only)$

5 Sep07_1610:14a Jackson Brothers VVVVYVV"'T:r KEl'lTUCKY LABORERS, DSTUCt COUNCL PENSON & WORKDUES FEDERAL TAX D: Jlf5349 E\fPW):"'"ERS NAME; MONTlLY El\fPLOYER REMTTANCE REPORT (Stattonru Units Only) t> u _A J v ll t'll1!! \} (JJ<,:,, r\/j"\ vlu J EMPLOYERS ADDRESS: 3 1ut3 JU r:\la ::> \l \ 2 REPORT FOR TBE MONTH OF: «) Due date is the (10tli) day of tbe month following tbe wotk montb CONUUBUTONS OWED:, ' SlON: W J t< K rnig DUES: :ryo ofgfoss Wages= CERTFED BY: 61,j cy' FOR ATDT ONLY: SEND PENSON TO: Laborers' N ()nal Pension Fund PO Box Dallas, Texas EMJ>LOYERS PHONE#: 'VORK PERFORMED N THE SEND WORKNG DUES JURSDCTON OF: TO: Laborers' Local Union tlfu 3'1Y2JJ'O (Circle One) 1 having jurisdiction where woik EMPLOYEES " # soci;al SECURTY l'iljmber 1 1gq_ 2 lti Ji & 7 {,,, 1Uq3 (1\ 1Q 576 (3)1214 (4) 1392 ( ) 1445 EMPLOYEES NAME Vtdie(!{ b iy" u /hi D{wiµ 1\ttA is performed_ BO URS WORKED Mo GROSS WAGES 1o o J311s\w r&v l'3 is, io! 3, 402'1'/J, D'OS/ rfh:aj ijn Rn k s4j j f) 1 Z,(p CJ J'O 4 '"U 4 q 1 "tp o ro "Nu A av 3 ::,qo PJtZ /,o l,, l/1 x3 t 110 oo t ( (7:1 l1 1 TOT S: jo,(o18'3' J

$"flTTANCE REPORT (Stationruy Uruts Only) ;y\v REPORT FOR '1lE J\fONTH OF: {() taf1l 6(J Due date is the (10tli) day of tbc month followjog the work month FEDERAL TAX D: CONTRBUTONS OWED: FOR ATDT$

6 Sep071610:14a Jackson Brothers vvvvvvvr:r KENTUCKY LABORERS, DSTRlCt COUNCL PENSJON & WORKDUES MONTHLY EMPLOYER RE!"flTTANCE REPORT (Stationruy Uruts Only) ;y\v REPORT FOR '1lE J\fONTH OF: {() taf1l 6(J Due date is the (10tli) day of tbc month followjog the work month FEDERAL TAX D: CONTRBUTONS OWED: FOR ATDT ONLY: ( 1 J f53'icf E\fPWYERS NAME: _Adv1lt'lw1 \/eknmta\ "'' ) ) ::::::: SlON: Wt111' u NG DUES: of Gross Wages = 3 i3 J CERTFED BY: SEND PENSON TO: EMPLOYERS ADDRESS: rc1 =7 \ l EMPLOYERS PHONE#: {2fur 3'1 r 251 : WORK PERFORMED N THE JUlUSDCilON OF: (Circle One) (T\ (3)1214 (4) 1392 (5) EMPLOYEES ' # socl;al SECURTY l'iljmber EMPLOYEES NAME 1 1J?l1 <J; {nij6} Va lie D iy T, l 2JJ'13? W:, j)t'wiaj! 3 f 4 5 4a2'b ocos 7 ""' }iirtakt/ ''" J Laborers' National Pension Fund PO BOh S Dallas, Texas SEND WORKNG D13ES TO: Laborers Local Uruon 1 having jurisdiction wheno work is perfonncd RO URS WORKED Mo GROSS WAGES J lo 0 i3jl':;,io r v l "3 c:;?,o rfh:aj Jl1<A Rn ks }14) 0 1 7A,; c'j J'O 7 u q C,JW 4' a ' " 0 " ),, 6, CJl V :i_ 7 1 TOTAL: NbAtlli j (10 oo 8 3 :,qo P fh ( (z1 (1 jo_&1 3

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

REPORT OF CONTRIBUTIONS AND EXPENDITURES ( , C.R.S.) Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO 80290 Ph: 303) 894-2200 ext. 6383 Fax: 303) 869-4861 Email: cpfhelp@sos.state.co.us www.sos.state.co.us REPORT OF CONTRIBUTIONS