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Electronic Filing

SEEC FORM 20
Itemized Campaign Finance Disclosure Statement
CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2015

Do Not Mark in This Space For Official Use Only

Page 1 of 40

COVER PAGE
1. NAME OF COMMITTEE
Ansonia Democratic Town Committee

2. TREASURER NAME
First
James

MI

Last

D.

Hubbard

Suffix

3. TREASURER ADDRESS
Street Address

City

State

Zip Code

10 Harris Rd

Ansonia

CT

06401

4. ELECTION/REFERENDUM DATE

5. OFFICE SOUGHT (Complete only if Candidate Committee)

6. DISTRICT NUMBER (if applicable)

7. CANDIDATE NAME (Complete only if Candidate or Exploratory Committee)


First

MI

Last

Suffix

8. TYPE OF REPORT
October 10 Filing - Original

9. PERIOD COVERED

Beginning Date

07/01/2015

Ending Date

thru

09/30/2015

10. CERTIFICATION

I hereby certify and state, under penalties of false statement, that all of the information set forth on this
Itemized Campaign Finance Disclosure Statement for the period covered is true, accurate and
complete.

Electronic Filing

James Hubbard

10/03/2015 12:56:28PM

SIGNATURE

PRINT NAME OF THE SIGNER

DATE CERTIFIED

A Person who is found to have knowingly and willfully violated any provisions of the campaign finance statutes faces a civil
penalty or imprisonment or both.

Page 2 of 40

SEEC FORM 20
Itemized Campaign Finance Disclosure Statement
CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2015

SUMMARY PAGE TOTALS


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)
Ansonia Democratic Town Committee

TYPE OF REPORT
October 10 Filing - Original

COLUMN A

COLUMN B

This Period

Aggregate

11. Balance on hand January 1 of current year for Ongoing and Party Committees OR
Balance on hand from day Committee was formed for all other Committees

$4,110.48

12. Balance on hand at the beginning of Reporting Period

$4,970.48

13. Contributions received from Individuals (Section A and B)

$2,070.00

$2,515.00

14. Receipts from Other Committees (Sections C1 and C2)

$0.00

$0.00

15. Other Monetary Receipts (Section D through K)

$0.00

$400.00

16a. Total Proceeds from Small Puchases (Section L1 Subpart 1 + Subpart 3)

$0.00

$523.00

16b. Per Public Act 11-48, effective January 1,2012 Section L2 removed
16c. Total Purchases of Advertising - Program Book or Sign (Section L3)

$0.00

$0.00

17. Total Monetary Receipts (add totals for lines 13 through 16c)

$2,070.00

$3,438.00

18. Subtotals (add totals in Line 12 + 17 in Column A and in Line 11 + 17 in Column B)

$7,040.48

$7,548.48

19. Expenses Paid by Committee (Section P)


20. Balance on hand at close of Reporting Period (Subtract line 19 from line 18 in both colum
21. In-Kind Donations not Considered Contributions Received (Section L4)
22. In-Kind Donations not Considered Contributions - House Party (Section L5)
23. In-Kind Contributions Received (Section M)
24. Refundable Deposit to Telephone Company (Section N)
25. Loan Balance

$3,868.06
$3,172.42
$0.00
$0.00

$4,376.06
$3,172.42
$0.00
$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

25a. + Loans Received (Section D)

$0.00

$0.00

25b. + Interest and Penalties on Loan(s)

$0.00

$0.00

25c. - Payments on Loan

$0.00

$0.00

25d. Total Outstanding Loan Amount

$0.00

26. Campaign Expenses Paid By Candidate (Section Q)

$0.00

$0.00

$0.00

$0.00

27. Expenses Incurred on Committee Credit Card (Section R)


28. Expenses Incurred by Committee During this Period but Not Paid (Section S)
28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)

$0.00
$0.00

Page 3 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

A. Total Contributions from Small Contributors-Received this Period ONLY


(See instructions for definition of Small Contributor)

$390.00

Subtotal Section A

B. Itemized Contributions from Individuals


Last Name

First Name

Maffeo
Residential Street Address

City

7 Ford St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

90 N State St

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Merlone

MI

Carol

Residential Street Address

City

8 Shortell Dr

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

06401

Maureen

Residential Street Address

Zip Code

CT

First Name

Levine

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Elizabeth

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 4 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Luxenberg
Residential Street Address

Manchester

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

10 Rockwood Ave

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Edmonds

MI

Shain

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

505 Beaver St Apt 15

Cash

06042

Christopher

Residential Street Address

Zip Code

CT

First Name

Phipps

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

45 Chatham Dr

MI

Geoffrey

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 5 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Blake
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

158 Hodge Ave Apt 1

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Bottone

MI

Madeline

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

31 Webster Dr

Cash

06401

Linda

Residential Street Address

Zip Code

CT

First Name

Gentile

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

19 Birchwood Dr

MI

Kevin

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 6 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Knapp
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

56 Locke St

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

St Jacques
City

16 Myrtle Ave

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

Rita

Residential Street Address

Cash

06401

Diana

Residential Street Address

Zip Code

CT

First Name

Branch

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

3 Glen Dr

MI

David

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 7 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Hunt
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

10 S Westwood Rd

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Madigosky

City

43 Holbrook St

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

Howard

Residential Street Address

Cash

06401

Thomas III

Residential Street Address

Zip Code

CT

First Name

Clifford

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

6 Myrtle Ave

MI

Denice

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 8 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Delucia
Residential Street Address

City

Murray St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

City

6 Elliott Rd

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Poehailos

City

20 Lawton Ter

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

Donald

Residential Street Address

Cash

06401

Fran

Residential Street Address

Zip Code

CT

First Name

Digiorgi

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Anthony

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 9 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Hubbard
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$25.00

$25.00
MI

City

28 Pinecrest Ave

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$50.00

$50.00

First Name

Dellavolpe

City

198 1/2 Prospect St

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

James

Residential Street Address

Cash

06401

Jo Lynn

Residential Street Address

Zip Code

CT

First Name

Flaherty

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

10 Harris Rd

MI

James

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$30.00

$30.00

Page 10 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Kennedy
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$50.00

$50.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

159 Pulaski Hwy

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$50.00

$50.00

First Name

Macero

MI

Louis

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

55 Hubbell Ave

Cash

06401

Carmen

Residential Street Address

Zip Code

CT

First Name

Pitney

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

12 Jason Wright Dr

MI

Ilene

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$50.00

$50.00

Page 11 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Lynch
Residential Street Address

City

15 Birchwood Dr

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$30.00

$30.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

46 N Westwood Rd

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/07/2015

$25.00

$25.00

First Name

Kolakowski

City

14 Farrel Dr

State

Ansonia

Principal Occupation

Zip Code

CT

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

Tara

Residential Street Address

Cash

06401

Joan

Residential Street Address

Zip Code

CT

First Name

Lawlor

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Anne

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/07/2015

Aggregate Contributions

$25.00

$25.00

Page 12 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Lynch
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/07/2015

$50.00

$50.00
MI

City

7 Ford St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/10/2015

$10.00

$10.00

First Name

Caporale

MI

Ann

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
06252015A

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

26 Page St

Cash

06401

Elizabeth

Residential Street Address

Zip Code

CT

First Name

Maffo

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

15 Macntosh Ln

MI

Elizabeth

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/10/2015

Aggregate Contributions

$25.00

$25.00

Page 13 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Kolakowski
Residential Street Address

City

14 Farrel Dr

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

26 Page St

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Lynch

MI

Anne

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

15 Birchwood Dr

Cash

06401

Ann

Residential Street Address

Zip Code

CT

First Name

Caporale

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Tara

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 14 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Puro
Residential Street Address

City

28 Locke St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

City

163 O'Neils Ct

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Supp

MI

Lynda

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401-2018

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

6 Kimberly Ln

Cash

06401

Florence

Residential Street Address

Zip Code

CT

First Name

Camilleri

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Jamie

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$10.00

$10.00

Page 15 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Edmonds
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

City

6 Elliott Rd

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$50.00

$50.00

First Name

Flaherty

MI

Jo Lynn

Residential Street Address

City

28 Pinecrast Ave

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

06401

Fran

Residential Street Address

Zip Code

CT

First Name

Digiorgi

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

505 Beaver St Apt 15

MI

Shain

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 16 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Rios
Residential Street Address

City

121 Great Hill Rd

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

MI

City

48 Holbrook St

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Adamowski

City

19 Kathy Ln

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

MI

Edward

Residential Street Address

Cash

06401

Howard

Residential Street Address

Zip Code

CT

First Name

Madigosky

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Milagros

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 17 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Shortell
Residential Street Address

City

19 Kathy Ln

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

2 Gracie Ln

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Branch

MI

Diana

Residential Street Address

City

56 Locke St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

06401

Joseph

Residential Street Address

Zip Code

CT

First Name

Jeanette

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Brittany

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 18 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Sheehy
Residential Street Address

City

130 Wakelee Ave

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

City

11 Dempsey Ct

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Williams

MI

Kan

Residential Street Address

City

2 Dogwood Dr

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

06401

Sean

Residential Street Address

Zip Code

CT

First Name

Rowley

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

James

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 19 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Unno
Residential Street Address

City

13 Locke St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

City

240 Prospect St

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Chellana

MI

Terrell

Residential Street Address

City

240 Prospect St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
_

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

06401

Carlos

Residential Street Address

Zip Code

CT

First Name

Cosme

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
Cash

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

MI

Louis

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 20 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Gentile
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$25.00

$25.00
MI

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

12 Jason Wright Dr

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

07/23/2015

$25.00

$25.00

First Name

Knapp

MI

David

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401-2911

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

3 Glen Dr

Cash

06401

Jeremiah

Residential Street Address

Zip Code

CT

First Name

Kennedy

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

158 Hodge Ave Apt 1

MI

John

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

07/23/2015

Aggregate Contributions

$25.00

$25.00

Page 21 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Lynch
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

X
_

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

07/23/2015

$50.00

$50.00
MI

City

45 Morningside Dr

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #
07232015B

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401-1311

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

_
_

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Yes

Yes

Amount of Contribution

No

No

Legislative

Date Received

Last Name

Aggregate Contributions

08/14/2015

$25.00

$25.00

First Name

Macero

MI

Louis

Residential Street Address

Ansonia

Principal Occupation

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #

_
X

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

City

55 Hubbell Ave

Cash

06401

Ronald

Residential Street Address

Zip Code

CT

First Name

Greski

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

15 Macintosh Ln

MI

Elizabeth

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

Amount of Contribution

No

Legislative

Date Received
_

Yes

Yes

09/04/2015

Aggregate Contributions

$25.00

$25.00

Page 22 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals


Last Name

First Name

Benjamin
Residential Street Address

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #

_
X

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes
No

If yes, indicate which branch or branches of


government the contract is with:

Executive

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

Zip Code

CT

06401

Yes

Yes

Amount of Contribution

No

No

Legislative
Aggregate Contributions

09/04/2015

$50.00

$50.00

First Name

Puro

MI

Jamie

Residential Street Address

City

28 Locke St

Ansonia

Principal Occupation

Yes

No

Is this contribution associated with an


event reported in Section L1?
If yes, list Event #

If contribution is in excess of $400 to a candidate committee for a chief executive


officer of a municipality does contributor or business he/she associated with have
a contract with said municipality valued at more than $5000?

Yes

No

Personal Check

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Executive

Method of Contribution
X

State

Zip Code

CT

06401

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

_
_

Date Received

Last Name

Is contributor a principal of state contractor or prospective state contractor?

Method of Contribution
X

State

Name of Employer

Is contributor a lobbyist, spouse,


or dependent child of a lobbyist?

Cash

City

16 Birchwood Dr

MI

Mary

_
_

Credit/Debit Card

Payroll Deduction

Money Order

No

No

09/04/2015

Aggregate Contributions

$50.00

Total of Section B

TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS

(Sections A & B)

Amount of Contribution

Legislative

Date Received
_

Yes

Yes

(Total on Line 13 of Summary Page)

$50.00
$1,680.00
$2,070.00

Page 23 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

C1. Contributions from Other Committees


Name of Treasurer

Name of Committee

Address

Is this contribution associated with an


event reported in Section L1?

Yes

No

Amount of Contribution

If yes, list Event #


City

State

Zip Code

Date Received

Aggregate Contributions

Total of Section C1

I. MONETARY RECEIPTS (Section A-K)


TYPE OF REPORT

NAME OF COMMITTEE

October 10 Filing - Original

Ansonia Democratic Town Committee


C2. Reimbursements or Surplus Distributions from other Committees
Name of Committee

Name of Treasurer

Address

Date Received

State

City

Zip Code

Amount of Receipt

Payment Type
Reimbursement for shared expense
Surplus Distribution

Expenditure # (if applicable)

Description

Total of Section C2

Page 24 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

D. Loans Received this Period


Name of Lender

Source of Loan:
Bank

Street Address

Date of Receipt
Candidate

City

Individual

Other

State

Zip Code

Is there a cosigner or
Guarantor of this loan?
Yes

Name of Cosigner/Guarantor (if applicable)

No

Amount Received

Street Address

City

State

Zip Code

Total of Section D

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLY)
Name of Entity

Street Address

Date Received

State

City

Zip Code

Amount Received

Aggregate Contributions

Total of Section E

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee

F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)
Date of Receipt

Is this transaction associated with an event


reported in Section L1?

Yes

No

Amount

If yes, list Event #

Total of Section F

Page 25 of 40

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee

G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)
Date of Receipt

Amount

Total of Section G

I. MONETARY RECEIPTS (Section A-K)


TYPE OF REPORT

NAME OF COMMITTEE

October 10 Filing - Original

Ansonia Democratic Town Committee


H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)
Date of Receipt

Method of Payment

Amount

Cash

Personal Check

Credit/Debit Card

Total of Section H

I. Monetary Receipts (Section A-K)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


J. Interest from Deposits in Authorized Accounts

Date Received

Name of Institution

Street Address

City

State

Amount

Zip Code

Total of Section J

Page 26 of 40

I. MONETARY RECEIPTS (Section A-K)


TYPE OF REPORT

NAME OF COMMITTEE

October 10 Filing - Original

Ansonia Democratic Town Committee


K. Miscellaneous Monetary Receipts not Considered Contributions
Name

Street Address

Date of Transaction

City

State

Zip Code

Description

Total of Section K

Amount
Received

Page 27 of 40

II. EVENT ACTIVITY (Sections L1 - L5)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

L1. Event Information


Event #
Date of Event

06/25/2015

Letter

Description

Was this a fundraising event?

Dinner Event

Yes

No

Location: Street Address

City

State

Zip Code

557 Wakelee Ave

Ansonia

CT

06401

Subpart 1: (All Committees)

Yes

No

Yes

No

Yes

No

Was this event hosted at a personal residence?

Did this fundraiser include goods or services donated by a business entity of


up to $200 or items donated by an individual of up to $100?

Was this fundraiser a tag sale, auction, or other sale of donated items with
puchases from an individual of up to $100?

(If yes, go to Section L5 In-Kind Donations not Considered


Contributions Associated with a House Party and complete required
information for any puchases made by host(s) for food, beverage and
invitations.)

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information.)

$0.00

(If yes, enter Total Receipts here.)

Subpart 2: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)
Were there purchases of advertising space in a program book or on a sign associated
with this fundraiser?
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass gathering held
within the state with this fundraiser?

Event #
Date of Event

07/23/2015

Letter

Yes

No

Yes

No

(If yes, go to Section L 3 Purchases of Advertising Space in a Program


Book or on a Sign and complete required information.)

$0.00

(If yes, enter Total Receipts here.)

Description

Was this a fundraising event?

Party Event

Yes

No

Location: Street Address

City

State

Zip Code

557 Wakelee Ave

Ansonia

CT

06401

Subpart 1: (All Committees)

Yes

No

Yes

No

Yes

No

Was this event hosted at a personal residence?

Did this fundraiser include goods or services donated by a business entity of


up to $200 or items donated by an individual of up to $100?

Was this fundraiser a tag sale, auction, or other sale of donated items with
puchases from an individual of up to $100?

(If yes, go to Section L5 In-Kind Donations not Considered


Contributions Associated with a House Party and complete required
information for any puchases made by host(s) for food, beverage and
invitations.)

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information.)

(If yes, enter Total Receipts here.)

$0.00

Subpart 2: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)
Were there purchases of advertising space in a program book or on a sign associated
with this fundraiser?
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass gathering held
within the state with this fundraiser?

Yes

No

Yes

No

(If yes, go to Section L 3 Purchases of Advertising Space in a Program


Book or on a Sign and complete required information.)

(If yes, enter Total Receipts here.)

$0.00

Page 28 of 40
$0.00

Total of Section L1

II. EVENT ACTIVITY (Sections L1 - L5)


TYPE OF REPORT

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

October 10 Filing - Original

Ansonia Democratic Town Committee


L3. Purchases of Advertising in a Program Book or on a Sign
Name of Purchaser

Purchase Made By:


Business Entity

Other

Individual/Sole Proprietorship
Street Address

Date Received

City

Event #

Aggregate Purchases for All Events

Zip Code

State

Amount of Program Ad Purchase

Amount of Sign Purchase

Total of Section L3

II. EVENT ACTIVITY (Sections L1 - L5)


TYPE OF REPORT

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

October 10 Filing - Original

Ansonia Democratic Town Committee


L4. In-Kind Donations Not Considered Contributions
Name of the Donor

City

Street Address

Donation Given by:

State

Description of Donation

Fair Market Value of


Donation

Business Entity
Individual

Date Received

Zip Code

Event #

Aggregate value for this event

Sole Proprietorship

Total of Section L4

Page 29 of 40

II.EVENT ACTIVITY (Sections L1 - L5)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee

L5. In-Kind Donations Not Considered Contributions Associated with a House Party
Is this event supporting more than one candidate or committee?

Name of the Host

Yes

No

If yes, complete Itemization in


Addendum L5

City

Street Address

State

Description of Donation

Zip Code

Fair Market Value of


Donation

Event #

Aggregate value of this Event - all hosts

Aggregate value of all Events - this host/candidate

Total of Section L5

III. NONMONETARY RECEIPTS (Sections M - O)


TYPE OF REPORT

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

October 10 Filing - Original

Ansonia Democratic Town Committee


M. In-Kind Contributions
Name

City

Street Address

Type of Contributor:

Committee

Individual / Sole Proprietorship


Is Contributor a lobbyist, spouse, or
dependent child of a lobbyist?

Is this contribution associated with an


event reported in Section L1?
If yes, list Event#

Date Received

Aggregate contributions

State

Zip Code

Description of In-Kind Contribution

Other
Yes
No

If contribution is in excess of $400 to a candidate committee for a chief


executive officer of a municipality does contributor or business he/she is
associated with have a contract with said municipality valued at more
than $5000?
Yes
No

Yes
No

Is contributor a principal of state contractor or prospective state contractor?


If yes, indicate which branch or branches of
government the contract is with:

Fair Market Value of this


Contribution

Yes
No

Executive

Legislative

Total of Section M

Page 30 of 40

III. Non Monetary Receipts (Sections M - O)


NAME OF COMMITTEE

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

N. Refundable Deposit to Telephone Company


Last Name of Individual

Residential Street Address

First Name

City

MI

State

Date Deposit Made

Zip Code

Name of Telephone company

Street Address

City

State

Zip Code

Total of Section N

Amount of
Deposit

Page 31 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Molto Bene Resturant

07/01/2015

Street Address

City

557 Wakelee Ave

Ansonia

Purpose of Expenditure
(by code)

Method of Payment
X

Check #

Debit Card

1247

State

CT

Description

EFT

06401
Amount

Event #

FNDR *

Zip Code

06252015A

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$450.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Eliabeth Lynch

07/07/2015

Street Address

City

15 Macintosh Ln

Ansonia

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

D
Method of Payment
X

Check #

Debit Card

1248

State

EFT

Zip Code

CT

Description

POST

06401

Event #

Amount

Stamps envelpoes

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$93.67

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

DSCC

07/07/2015

Street Address

City

30 Arbor St Ste 404

Hartford

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

State

CT
Event #

Description

Misc *

1249
_

EFT

Zip Code

06106
Amount

Voter File Access

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

Expenditure #
(if applicable)
X

$442.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Page 32 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Elizabeth Lynch

07/07/2015

Street Address

City

15 Macintosh Ln

Ansonia

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

Check #

Debit Card

1250

State

EFT

Zip Code

CT

Description

A-NEWS

Method of Payment

06401
Amount

Event #

Caucus meeting

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$139.51

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Bank of America

07/13/2015

Street Address

City

Main St

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
_

Check #

Debit Card

State

EFT

Zip Code

CT

Description

Event #

Amount

BNK

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$3.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Molto Bene

07/23/2015

Street Address

City

557 Wakelee Ave

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

State

CT
Event #

Description

FNDR *

Pizza Party

1251
_

EFT

Zip Code

06401
Amount

07232015B

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

Expenditure #
(if applicable)
X

$600.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Page 33 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Elizabeth Lynch

07/25/2015

Street Address

City

15 Macintosh Ln

Ansonia

Purpose of Expenditure
(by code)

Method of Payment
X

Check #

Debit Card

1252

State

CT

Description

EFT

Zip Code

06401
Amount

Event #

POST

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$29.40

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Elizabeth Lynch

07/25/2015

Street Address

City

15 Macintosh Ln

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

1253

State

EFT

Zip Code

CT

Description

Event #

Amount

OFFICE

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$25.07

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Hong Tran

08/04/2015

Street Address

City

East Main St

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

State

CT
Event #

Description

OVHD

1254
_

EFT

Zip Code

06401
Amount

Campaign Headquaters

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

Expenditure #
(if applicable)
X

$600.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Page 34 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Olderman& Hallihan

08/05/2015

Street Address

City

400 Main St Ansonia

Ansonia

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

Check #

Debit Card

1255

State

EFT

Zip Code

CT

Description

Misc *

Method of Payment

06401
Amount

Event #

Liability Insurance

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$877.84

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Alzheimer's Assoc

08/10/2015

Street Address

City

200 Executive Blvd # 4B

Southington

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

D
Method of Payment
X

Check #

Debit Card

1256

State

EFT

Zip Code

CT

Description

Misc *

06489

Event #

Amount

Memory of Pauline Sampieri

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$25.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

James D. Hubbard

08/10/2015

Street Address

City

10 Harris Rd

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

State

CT
Event #

Description

Misc *

1257
_

EFT

Zip Code

06401
Amount

Flowers to Madeline Botton

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

Expenditure #
(if applicable)
X

$26.57

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Page 35 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Bank of America

08/11/2015

Street Address

City

Main St

Ansonia

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

Check #

Debit Card

State

EFT

Zip Code

CT

Description

BNK

Method of Payment

06401
Amount

Event #

check Service

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$3.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

The Vinci Group

08/31/2015

Street Address

City

54 Robert Rd

Manchester

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

1259

State

EFT

Zip Code

CT

Description

06040

Event #

Amount

CNSLT

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$500.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Name of Payee

Date of Payment

Ansonia Cultural Comm

09/02/2015

Street Address

City

253 Main St

Ansonia

Purpose of Expenditure
(by code)

D
Method of Payment
X

Check #

Debit Card

State

CT
Event #

Description

FNDR *

1260
_

EFT

Zip Code

06401
Amount

basket sale

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

Expenditure #
(if applicable)
X

$50.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Page 36 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT
October 10 Filing - Original

Ansonia Democratic Town Committee


P. Expenses Paid By Committee
Name of Payee

Date of Payment

Bank America

09/10/2015

Street Address

City

Main St

Ansonia

Purpose of Expenditure
(by code)

Method of Payment
_

Check #

Debit Card

State

CT

Description

EFT

Zip Code

06401
Amount

Event #

BNK

Expenditure #
(if applicable)

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

$3.00

None of the below

Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

$3,868.06

Total of Section P

IV. EXPENDITURES (Sections P - T)


TYPE OF REPORT

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

October 10 Filing - Original

Q. Campaign Expenses Paid By Candidate


Name of Payee (Name of vendor, Person or Entity who candidate paid directly)

Date of Payment

Is Reimbursement Claimed?
Yes

Purpose of Expenditure
(by code)

State

City

Street Address

Description

Event #

No

Zip Code

Amount

Total of Section Q

Page 37 of 40

IV. EXPENDITURES
TYPE OF REPORT

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

October 10 Filing - Original

Ansonia Democratic Town Committee


R. Expenses Incurred on Committee Credit Card
Type of Credit Card:

Name of Issuing Institution

Visa

Master Card

American Express

Discover

Other
Date of Transaction

Name of Vendor, Person or Entity

City

Street Address

Purpose of Expenditure
(by code)

Expenditure #
(if applicable)

State

Description

Zip Code

Event #

Amount

Type of Expenditure ( Itemization in Addendum R Required unless "None of the below" is checked)

None of the below


Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization

Total of Section R

IV. EXPENDITURES
NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

S. Expenses Incurred By Committee but Not Paid During this Period


Date Incurred

Name of Creditor

City

Street Address

Purpose of Expenditure
(by code)

Expenditure#
(if applicable)

Description

State

Amount Incurred
(Estimate or Actual)

Event #

Type of Expenditure (Itemization in Addendum S Required unless "None of the below" is checked)

None of the below


Coordinated with reimbursement sought (joint expenditure)

Independent

Coordinated without reimbursement sought (in-kind contribution

Organization :

Zip Code

Total of Section S

Page 38 of 40

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)

TYPE OF REPORT

Ansonia Democratic Town Committee

October 10 Filing - Original

T. Itemization of Reimbursements and Secondary Payees


Last Name of Worker/Consultant

First

MI

Date of Payment to Vendor, Person or Entity

Payment to Reimburse Committee Worker/Consultant as reported in Section P

Name of Vendor, Person or Entity Paid by Committee Worker/Consultant

Check #
Street Address of Vendor, Person or Entity Paid by Committee Worker/Consultant

Purpose of Expenditure
(by code)

Expenditure #

Debit Card

City

State

Event #

Description

None of the below


Independent

Coordinated without reimbursement sought (in-kind contribution)

Organization:

Total of Section T

Section L5. ADDENDUM


NAME OF COMMITTEE

TYPE OF REPORT

L5. In - Kind Donations Not Considered Contribution Associated with a House Party - Addendum

Event #
Name of Candidate or Committee

Zip Code

Amount

Type of Expenditure ( Itemization in Addendem T Required unless "None of the below" is checked)

Coordinated with reimbursement sought (joint expenditure)

EFT

Page 39 of 40

Section P. ADDENDUM
TYPE OF REPORT

NAME OF COMMITTEE

P. Expenses Paid By Committee - Addendum


Expenditure #

Name of Candidate or Committee

Supported

Amount of Expenditure

Opposed

Office Sought (if applicable)

Cost Allocated to Candidate or Committee

Section R. ADDENDUM
NAME OF COMMITTEE

TYPE OF REPORT

R. Expenses Incurred on Committee Credit Card - Addendum


Expenditure #

Name of Candidate or Committee

Supported

Amount of Expenditure

Opposed

Office Sought (if applicable)

Cost Allocated to Candidate or Committee

Section S. ADDENDUM
TYPE OF REPORT

NAME OF COMMITTEE

S. Expenses Incurred by Committee but Not Paid During this Period - Addendum
Expenditure #

Name of Candidate or Committee

Supported

Opposed

Office Sought (if applicable)

Amount of Expenditure

Cost Allocated to Candidate or Committee

Page 40 of 40

Section T. ADDENDUM
TYPE OF REPORT

NAME OF COMMITTEE

T. Itemization of Reimbursements and Secondary Payees - Addendum


Expenditure #

Name of Candidate or Committee

Supported

Opposed

Office Sought (if applicable)

Amount of Expenditure

Cost Allocated to Candidate or Committee