m
{
r
-
;:::
Address
of
Committee/Person:
Committee
T
e:
Name
of
Financial Institution:
Address
of
Financial Institution:
REPORT
OF
CONTRIBUTIONS AND EXPENDITURES
(C.R.S. 1-45-108)
Full
Name
of
CommittccfPerson:SOS ID NUMBER (state committees ONLY):
N/A
Type
of
Report:
[RJ
R e g U I a I I ~
jhedUled
Filiug D
••
dli
••••
October 13, 2009 (21 days prior to the November 3, 2009 Municipal Election)
D
October 30, 2009 (Friday prior to the November 3, 2009 Municipal Election
D
December
3,2009
(30 days after the November 3, 2009 Municipal Election)
D
~ I
================================
nnual -candidates from prior election held on
o
Amended Filing.
This amends previous report filed on (date)
I
Submit changes or new infom1ation
ONLY
o
Termination Report
(Tennination Reports MUST have a Monetary Balance
of
Zero
in
Line 5)
Reporting
Period Covered:
110
-org
--
09
Through
/0
datedate
Declared
Total
Spending
(if
applicable):
N/A
[Art XXVIII
Sect 4 (I)]Totals Detailed
Summary
Page
1
Funds
on Hand
at
Beginning
of
Reporting Period
(monetary only)
()
$0.00
2
Total
Monetary
Contributions
(line
II)
a ~ ( ) { ) , ( j ( )
$0.00
3
Total
of
Monetary Contributions
&
Beginning
Amount
(line I
+
line 2)
:=?
~
/)
I)
-
()
lJ
$0.00
4
Total
Monetary Expenditures
(line 19)
3
3
()
9,
(n
9
$0.00
5
Funds
on Hand
at
End
of
Reporting
Period
(monetary) (line 3 • line 4)
I
Qn,
<q/
$0.00
The
appropriate
officer shall impose a penalty
of
$50
per
day for each
day
that
a
report
is filed late.
.
[Art.
XXVIII Sect. 10 (2) (a)]
Authorization
(Must be completed by either the Registered Agent
OR
the Candidate) I hearby certifY and declare, under penalty
ofpeJjury,
that to the best
of
my knowledge
or
belief all contributionsreceived during this reporting period, including any contributions received
in
the fonn
of
membership dues transferred
by
a membership organization, are from pennissible sources.
Colorado Secretary
of
StateElections Division1700 Broadway, Ste. 270Denver. CO 80290Ph: (303) 894-2200
x3
Fax: (303) 869-4861
www.sos.state.co.us
CONDITIONALLY
ACCEPTED
Space Below For Office Use Only
OCT
13
2009
THORNTON
CITY
CLERK
Print Registered Agent's (Treasurer's) Name:
S f l 1 = ~
p....
If
Era
0
D
ILIA--J-J
R.gist.red
Ag
••
'"
(Treosurer.) Sig"ture,
~
~
d d ~
Da'"
j{)
-/3
..
PI""
9
Print Canrodate'.
Nam"
H
A,
C
1<...
soc
~ ~ A
JCJ
Candidate's Signature:
_ ~
~ ~ - = = - u e - e _
Date:
A ? ~ . 3 . b 9
/'
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