REPORT OF CONTRIBUTIONS AND EXPENDITURES

Transcription

1 City Clerk's Office Lakewood Civic Center 480 S Allison Parkway Lakewood, CO Phone: Fax: TDD: REPORT OF CONTRIBUTIONS AND EXPENDITURES Full Name of Committee Address of Committee City, State & Zip Code Dan Smith for Lakewood 1000 S Marshall st Committee Type Name and Address of Financial Institution foothills credit union 7990 W Alameda Ave Type of Report Regularly Scheduled Filing Amended Filing This amends previous report filed on (date) Submit changes or new information ONLY Termination Report (Termination Reports MUST have a monetary balance of zero in Line E) Report Period Covered from 011/01/2016 through 011/05/2017 Page 1

2 Full Name of Committee Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) TOTAL CONTRIBUTIONS (total amount is calculated based on the entries below) Amount Name Address City/State/Zip Employer Page 1

3 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 2

4 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 3

5 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 4

6 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 5

7 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 6

8 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 7

9 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 8

10 STATEMENT OF NONMONETARY CONTRIBUTIONS Full Name of Committee Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 TOTAL CONTRIBUTIONS (total value is calculated based on the entries below) Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) 1 1/0/ Page 1

11 STATEMENT OF NONMONETARY CONTRIBUTIONS Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) Page 2

12 STATEMENT OF NONMONETARY CONTRIBUTIONS Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) Page 3

13 Full Name of Committee Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 ITEMIZED EXPENDITURES STATEMENT (more than 20.00) TOTAL EXPENDITURES (total amount is calculated based on the entries below) of Expense Amount Name Address City/State/Zip Purpose of Expenditure 1 1/0/ Page 1

14 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 2

15 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 3

16 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 4

17 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 5

18 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 6

19 Full Name of Committee LOANS Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 TOTAL OUTSTANDING LOANS (total amount is calculated based on the entries below) LOAN SOURCE Name Address City/State/Zip Loan amount at the beginning of the reporting period Amount received this reporting period LOAN AMOUNT Amount repaid this reporting period Loan balance at the end of the reporting period Page 1

20 CANDIDATE COMMITTEE FUNDS TRANSFER FORM This form is used by candidate committees established by the same committee for a different public office intending to transfer existing funds from an existing committee as defined by the Lakewood Municipal Code. Full Name of Committee Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer Page 1

21 DETAILED SUMMARY Full Name of Committee Dan Smith for Lakewood Reporting Period 011/01/2016 through 011/05/2017 Loans Outstanding Balance, 0.00 Funds on hand at the beginning of reporting period (Includes Candidate Contribution Funds Transferred) Itemized Contributions more than Total of NonItemized Contributions (Contributions of or less) 3 Total Monetary Contributions (Total of lines 1 & 2) 4 Total NonMonetary Contributions 5 Itemized Expenditures more than Total of NonItemized Expenditures (Expenditures of or less) 7 Total Expenditures (Total of lines 7 & 8) TOTALS DETAILED SUMMARY A Funds on Hand at the Beginning of Reporting Period (Includes Committee Funds Transferred) B Total Monetary Contributions (line 3) C Total Contributions & Beginning Amount (line A + line B) D Total Expenditures (line 7) E Funds on Hand at the End of Reporting Period (line C line D) Print Registered Agent's Name OR Print Candidate's Name Dan Smith I understand that campaign finance activities are governed by Chapter 2.54 Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and the Lakewood City Clerk Rules and Regulations regarding campaign finance. I further certify that I have read and understand the provisions of Chapter 2.54 Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and the Lakewood City Clerk Rules and Regulations regarding campaign finance. The City Clerk shall impose a penalty for each day a report is filed late per Chapter (C) Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and Rule 13 of the City Clerk Rules and Regulations. By submitting this form, you are signing this Contributions and Expenditures electronically and certifying the above information to be true and correct, to the best of your knowledge. Page 1