48
ACCEPTED Elections Divis ion Department of State Space Below For Office Use Only 1700 Broadway, Ste. 270 OCT 12 2009 Denver, CO 80290 Ph: (303) 894-2200 x3 Fax: (303) 869-4861 THORNTON CITY CLERK WWW.sos.state.co.us REPORT OF CONTRIBUTIONS AND EXPENDITURES (C.R.S. 1-45-108) Full Name of CommitteelPerson: Committee to Elect Lynne Fox As Shown on Registration Address of CommitteelPerson: 4262 E. 130th Drive City, State & Zip Code: Thornton, CO 80241 Committee Type: Candidate Name of Financial Institution: 1st Bank Address of Financial Institution: 3390 E 104th Ave, Thornton, CO 80233 SOS In NUMBER (state committees ONLY): N/A Type of Report: [X] Regularly Scheduled Filing. 00 October 13,2009 (21 days prior to the November 3,2009 Municipal Election) D October 30, 2009 (Friday prior to the November 3, 2009 Municipal Election) D December 3,2009 (30 days after the November 3,2009 Municipal Election) D Annual- candidates from prior election held on ------------------ D Amended Filing. This amends previous report filed on (date) Submit changes or new information ONLY D Termination Report (Termination Reports MUST have a Monetary Balance of Zero in Line 5) Reporting Period Covered: 2/1/09 Through 10/8/09 date date Declared Total Spending (if applicable): [Art. N/A xxvm, Sect. 4 (I)] Totals Detailed Summary Page 1 Funds on Hand at Beginning of Reporting Period (monetary only) $0.00 2 Total Monetary Contributions (line II) $7,369.77 3 Total of Monetary Contributions & Beginning Amount (line 1+ line 2) $7,369;77 4 Total Monetary Expenditures (line 19) $7,369.77 5 Funds on Hand at End of Reporting Period (monetary) (line 3 -line 4) $0.00 The appropriate officer shall impose a penalty of $50 per day for each day that a report is filed late. [Art. XXVIII Sect. 10 (2) (a)] Authorization (Must be completed by either the Registered Agent OR the Candidate) I hearby certify and declare, under penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period, including any contributions received in the form of membership dues transferred by a membership organization, are from permissible sources. Print Registered Agent's (Treasurer's) Name: Richard Delaney Registered Agent's (Treasurer's) Signature: _ Print Candidate Name: Lynne Fox Lj --=::_" .... -------,,--------------------------.,..-------- I .,..-; /OL q j/."\ 0 J Candidate's Signature: ;:......;...YJ..:....:0_ .:.-' _ Date: _-J----:-_u......:.I d

Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

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Campaign contributions to Lynne Fox for the 2009 Thornton City Council elections.

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Page 1: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

~OOlOOAU.Y ACCEPTEDElections Division Department of State Space Below For Office Use Only 1700 Broadway, Ste. 270 OCT 12 2009Denver, CO 80290 Ph: (303) 894-2200 x3 Fax: (303) 869-4861 THORNTON CITY CLERK WWW.sos.state.co.us

REPORT OF CONTRIBUTIONS AND EXPENDITURES (C.R.S. 1-45-108)

Full Name of CommitteelPerson: Committee to Elect Lynne Fox As Shown on Registration

Address of CommitteelPerson: 4262 E. 130th Drive

City, State & Zip Code: Thornton, CO 80241

Committee Type: Candidate

Name of Financial Institution: 1st Bank

Address of Financial Institution: 3390 E 104th Ave, Thornton, CO 80233

SOS In NUMBER (state committees ONLY): N/A

Type of Report:

[X] Regularly Scheduled Filing.00 October 13,2009 (21 days prior to the November 3,2009 Municipal Election)

D October 30, 2009 (Friday prior to the November 3, 2009 Municipal Election)

D December 3,2009 (30 days after the November 3,2009 Municipal Election)

D Annual- candidates from prior election held on ----------------- ­

D Amended Filing. This amends previous report filed on (date)

Submit changes or new information ONLY

D Termination Report (Termination Reports MUST have a Monetary Balance ofZero in Line 5)

Reporting Period Covered: 2/1/09 Through 10/8/09 date date

Declared Total Spending (if applicable): [Art. N/Axxvm, Sect. 4 (I)]

Totals Detailed Summary Page

1 Funds on Hand at Beginning of Reporting Period (monetary only) $0.00 2 Total Monetary Contributions (line II) $7,369.77 3 Total of Monetary Contributions & Beginning Amount (line 1+ line 2) $7,369;77 4 Total Monetary Expenditures (line 19) $7,369.77 5 Funds on Hand at End of Reporting Period (monetary) (line 3 -line 4) $0.00

The appropriate officer shall impose a penalty of $50 per day for each day that a report is filed late. [Art. XXVIII Sect. 10 (2) (a)]

Authorization (Must be completed by either the Registered Agent OR the Candidate) I hearby certify and declare, under penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period, including any contributions received in the form of membership dues transferred by a membership organization, are from permissible sources.

Print Registered Agent's (Treasurer's) Name: Richard Delaney

Registered Agent's (Treasurer's) Signature: _--6l~ ~~ate:_/_·_O..,Lt--L.Z-f/~_O....::;....__iIt.....-Print Candidate Name: Lynne Fox Lj--=::_"....-------,,--------------------------.,..------- ­

~(J C· I .,..-; /OL q j/."\ 0JCandidate's Signature: ---:c;;:...../lA-..I--:F-VJ:VYt!--:~=1.';:......;...YJ..:....:0_ .:.-' _-....lo,'h2Y£~. Date: _-J----:-_u......:.I d

Page 2: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

DETAILED SUMMARY

Full Name of CommitteelPerson: ICommittee to Elect Lynne Fox

Current Reporting Period: 12/1/09 Through 110/8/09

Funds on hand at the beginning of reporting period (Monetary Only): $0.00

6 Itemized Contributions $20 or More [CRS 1-45-108(l)(a)]

(Please list on Schedule "A") $4,794.98

7 Total of Non-Itemized Contributions

(Contributions of $19.99 and Less) $92.17

8 Loans Received

(Please list on Schedule "C") $2,482.62

9 Total of Other Receipts (Interest, Dividends, etc.)

$0.00

10

11

Returned Expenditures (from recipient) (Please list on Schedule "D")

Total Monetary Contributions (Total of lines 6 through 10)

, $0.00

$7,369;77

12 Total Non-Monetary Contributions

(From Statement of Non-Monetary Contributions) $220.00

13 Total Contributions

(Line II + line 12) .... $7,589.77

14 Itemized Expenditures $20 or More [CRS 1-45-108(1)(a)]

(Please list on Schedule "B") $7,202.83

15 Total of Non-Itemized Expenditures

(Expenditures of$19.99 and less) $166.94

16 Loan Repayments Made

(Please list on Schedule "C") $0.00

17 Returned Contributions (To Donor)

(Please list on Schedule "D") $0.00

18 Total Coordinated Non-Monetary Expenditures

(Candidate/Candidate Committee & Political Parties only) $0.00

19 Total Monetary Expenditures

(Total of lines 14 through 17) $7,369.77

20 Total Monetary Expenditures

(Line 18 + Line 19) $7,369.77

Page 3: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) [C.R.S. 1-45-108 (1) (a)]

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: 1'- 2~/1-/0-9---IThrOUgh 1'-__10_/_8/_0_9_---l date date

WARNING: Please read the instruction page for Schedule "A" before completing!

Total Itemized Contributions: 1,....$-·......:=:.---4-,7-9-4-.9-8-'

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Aponte, Mercedes

61712009 5 Address: 1028 Rudi Ln

2 Contribution Amount 6 City/State/Zip: Golden, CO 80403

$ 100.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): State of Colorado

$ 9 Occupation (if applicable, mandatory): Legal Aid worker

1 Date Accepted 4 Name (Last, First): Appel, Merylee

8/10/2009 5 Address: 10957 Clermont Court

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80233

$ 30.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Aragoni, David

812012009 5 Address: 7556 Chase St

2 Contribution Amount 6 City/StatelZip: Westminster, CO 80003

$ 40.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Baumgartner Jr., William

512812009 5 Address: 5256 S Fraser St

2 Contribution Amount 6 City/State/Zip: Aurora, CO 80015

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a conunittee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVlll, Sec. 2(6); Political Party Art. XXVlll, Sec. 3(3); Political Conunittee Art. XXVlll, Sec 3(5); Small Donor Conunittee Art. xxvm, Sec. 2(14).

Page 4: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

-----------------------------

Schedule A . Itemized Contributions Statement ($20 or more) Page 2

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2/_1I_0_9__...lIThrOugh 1 10_/8_/0_9__ date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Berg, Jennifer

6/812009 5 Address: 2141 Baseline Rd, Apt 20

2 Contribution Amount 6 City/State/Zip: Boulder, CO 80302

$ 30.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 80.00 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Berg, Jennifer

812012009 5 Address: 2141 Baseline Rd, Apt 20

2 Contribution Amount 6 City/State/Zip: Boulder, CO 80302

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 80.00 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Blankenship, Lisa

7/3/2009 5 Address: 3132 Blue Mtn Ct

2 Contribution Amount 6 City/State/Zip: Loveland, CO 80537

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$

1

9 Occupation (if applicable, mandatory):

Date Accepted 4 Name (Last, First): Bolt, Nancy

8/1612009 5 Address: 9018 Ute Drive

2 Contribution Amount 6 City/State/Zip: Golden, CO 80403

$ 100.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Self Employed

$ 9 Occupation (if applicable, mandatory): Consultant

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2( 14).

Page 5: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 3

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: L....-__ 2/_1_/O_ 9 IThrOUgh 1L....-__10~/_8/_0_9_......J date date

PLEASE PRINTITYPE

1 Date Accepted 4 Name (Last, First): Burnell, Steve

61712009 5 Address: 4455 W 115th Ave

2 Contribution Amount 6 City/State/Zip: Thornton,CO 80233

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Burroughs, Martha

8120/2009 5 Address: 7755 E Quincy A5-305

2 Contribution Amount 6 City/State/Zip: Denver, CO 80237

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Cavanaugh-Miller, Rebecca

811012009 5 Address: 11903 Monroe St

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80233

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Christner, Diane

7/1512009 5 Address: 4210 E 100th Ave Lot 532

2 Contribution Amount 6 City/State/Zip: Thornton,CO 80229

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14).

Page 6: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 4

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/~1/_09 IThrough 1 10-:-/8_/0_9 ___ mre mre

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Claman, Henry N.

5/31/2009 5 Address: 596 South Olive Way

2 Contribution Amount 6 City/State/Zip: Denver,CO 80224-1539

$ 100.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): University of Colorado

$ 9 Occupation (if applicable, mandatory): Physician

1 Date Accepted 4 Name (Last, First): Cohen, Kevin

5/2812009 5 Address: 2089 Krameria St

2 Contribution Amount 6 City/State/Zip: Denver,CO 80207

$ 100.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): University of Colorado

$ 9 Occupation (if applicable, mandatory): Researcher

1 Date Accepted 4 Name (Last, First): Colburn, Clarence

61712009 5 Address: 13088 Grape Ct

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$

1

70. 00 9 Occupation (if applicable, mandatory):

Date Accepted 4 Name (Last, First): Colburn, Clarence

7/15/2009 5 Address: 13088 Grape Ct

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ rot 0,00 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candimte Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14).

Page 7: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) PageS

Full Narne of Cornmittee/Person: Committee to Elect Lynne Fox

, Reporting Period Covered: ,---__2/_1_/0_9 •IThrough 1__l_0~/8_/0_9_.......... date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name {Last, First): Deines, Teri

811012009 5 Address: 4265 E 119th Place, Apt H

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80233

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Delaney, Barbara

8/312009 5 Address: 2149 Road 19

2 Contribution Amount 6 City/State/Zip: Wilmore, KS 67155

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Delaney, Thomas

617/2009 5 Address: 11180 Clermont Cir

2 Contribution Amount 6 City/State/Zip: Thornton,CO 80233

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): DeSantis, Melissa

7/1512009 5 Address: 9161 E Arizona PI

2 Contribution Amount 6 City/State/Zip: Denver, CO 80247

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVUI, Sec. 2(6); Political Party Art. XXVUI, Sec. 3(3); Political Committee Art. XXVUI, Sec 3(5); Small Donor Committee Art. XXVUI, Sec. 2(14).

Page 8: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 6

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/_1I_09 IThrough 1 10....,.../8_/0_9__ date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Dickersin, Kay

8/1712009 5 Address: 1402 Bolton St

2 Contribution Amount 6 City/State/Zip: Baltimore, MD 21217

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Elder, Kathleen

6n12009 5 Address: 1309 S Josephine St

2 Contribution Amount 6 City/StatelZip: Denver,CO 80210

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Ensrud, Karen

8/1012009 5 Address: 2018 10th St N

2 Contribution Amount 6 City/State/Zip: Fargo, ND 58102

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Fischer, Lanna

8/1012009 5 Address: 4070 E 129th Way

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 20.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVill, Sec. 2(6); Political Party Art. XXVill, Sec. 3(3); Political Committee Art. XXVill, Sec 3(5); Small Donor Committee Art. XXVill, Sec. 2(14).

Page 9: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 7

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: L--__2/7'"l/:-09 1Through 11.--__ 1_ 0/,....8/_0_9_---' dille dare

PLEASE PRINT/TYPE

1 Date Accepted 4 Name (Last, First): Fletcher, Adelaide

7/13/2009 5 Address: 216 N 3rd St

2 Contribution Amount 6 City/State/Zip: Saratoga, WY 82331

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Fletcher, Bob and Suzanne

8/3/2009 5 Address: 208 Boulder Bluff

2 Contribution Amount 6 City/State/Zip: Chappel Hill, NC 27516

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Fox, Lisa

5/18/2009 5 Address: 1872 Rogue River Circle

2 Contribution Amount 6 City/State/Zip: Ventura, CA 93004-3104

$ 250.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Tri-Counties Regional Center

$ 300.00 9 Occupation (if applicable, mandatory): Seryice Coordinator

1 Date Accepted 4 Name (Last, First): Fox, Lisa

9/25/2009 5 Address: 1872 Rogue River Circle

2 Contribution Amount 6 City/State/Zip: Ventura, CA 93004-3104

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Tri-Counties Regional Center

$ 300.00 9 Occupation (if applicable, mandatory): Service Coordinator

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art.

XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14).

Page 10: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) PageS

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: ___2/~1I_0_9__....JIThrOUgh 1,-__10-:-/8_/0_9__ date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Fox, Ronald

61712009 5 Address: 2710 E 125th Cr

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Retired

$ 150.00 9 Occupation (if applicable, mandatory): Retired

1 Date Accepted 4 Name (Last, First): Fox, Ronald

8/2612009 5 Address: 2710 E 125th Cr

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 100.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Retired

$ 150.00 9 Occupation (if applicable, mandatory): Retired

1 Date Accepted 4 Name (Last, First): Friedland, Janise

617/2009 5 Address: 13501 Columbine Circle

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Fulton, Stephanie

8/312009 5 Address: 823 Sledge St

2 Contribution Amount 6 City/State/Zip: Houston, TX 77009

$ 40.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvrn, Sec. 2(6); Political Party Art. xxvrn, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. xxvrn, Sec. 2(14).

Page 11: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 9

Full Narne of CornrnitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/,:","l/_09 IThrough 1,--_,;;.;10;.../8;.../0:...:.9__1

PLEASE PRINTffYPE

1 Date Accepted

912512009

2 Contribution Amount

$ 100.00

3 Aggregate Amount*

$

1 Date Accepted

61712009

2 Contribution Amount

$ 25.00

3 Aggregate Amount*

$

1 Date Accepted

5/31/2009

2 Contribution Amount

$ 50.00

3 Aggregate Amount*

$ 200.00

1 Date Accepted

61712009

2 Contribution Amount

$ 100.00

3 Aggregate Amount*

$ 200.00

date date

4

5

6

7

8

Name (Last, First): Gerrity, Martha

Address: 8620 SW 80th Ave

City/State/Zip: Portland, OR 97223

Description Check

Employer (if applicable, mandatory): Portland VA Hospital

9 Occupation (if applicable, mandatory): Physician

4

5

6

7

8

Name (Last, First): Goff, Katherine

Address: 9675 W. 23rd Ave

City/State/Zip: Lakewood, CO 80215

Description Cash

Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

4

5

6

7

8

Name (Last, First): Gormley, Mark

Address: 13650 Clermont Ct

City/State/Zip: Thornton, CO 80602-6964

Description Check

Employer (if applicable, mandatory): SHAW

9 Occupation (if applicable, mandatory): Business Systems Analyst

4

5

6

7

8

Name (Last, First): Gormley, Mark

Address: 13650 Clermont Ct

City/State/Zip: Thornton, CO 80602-6964

Description Check

Employer (if applicable, mandatory): SHAW

9 Occupation (if applicable, mandatory): Business Systems Analyst

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14).

Page 12: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 10

Full Name of CommitteelPerson: Committee to Elect Lynne FoX;

Reporting Period Covered: '--__2/_11_0_9_._---lIThrough 1 IO~/8_/0_9__ ~re ~re

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Gormley, Mark

7/15/2009 5 Address: 13650 Clermont Ct

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80602-6964

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): SHAW

$ 200.00 9 Occupation (if applicable, mandatory): Business Systems Analyst

1 Date Accepted 4 Name (Last, First): Hampton, Ada

6/7/2009 5 Address: 7002 E Dry Creek PI

2 Contribution Amount 6 City/State/Zip: Centennial, CO 80112

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Hemy,Eva

6/7/2009 5 Address: 4455 E 115th Ave

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80233

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Hisamoto, Kenneth

7/20/2009 5 Address: 11905 W 18th Ave

2 Contribution Amount 6 City/State/Zip: Lakewood, CO 80215

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candi~te Conunittee Art. xxvm, Sec. 2(6); Political Party Art. XXVill, Sec. 3(3); Political Conunittee Art. XXVill, Sec 3(5); Small Donor Conunittee Art. XXVill, Sec. 2(14).

Page 13: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 11

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: '---_---'-2/~1_/0_9---IThrOngh 1L....-_..;;,1_0/..;;,8/....;.0.;..9_---I date date

PLEASE PRINTfTYPE

1 Date Accepted 4 Name (Last, First): Hoffecker, Lilian

512812009 5 Address: 7876 S Niagra Way

2 Contribution Amount 6 City/State/Zip: Englewood, CO 80112

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Holst, Theresa

812012009 5 Address: 325 GametSt

2 Contribution Amount 6 City/State/Zip: Broomfield, CO 80020

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Horan, Joy

912512009 5 Address: POBox 93

2 Contribution Amount 6 City/StatelZip: Eastlake, CO 80614

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Hunter, Lawrence

512812009 5 Address: 180 Glencoe St

2 Contribution Amount 6 City/State/Zip: Denver, CO 80220

$ 99.99 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14).

Page 14: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 12

Full Name of CommitteelPerson: Committee toElect Lynne Fox

Reporting Period Covered: ---,-__2_/_1/_09__;.....IThrough 1 10_/8_/0_9__ ~re ~re

PLEASE PRINTITYPE

1 Date Accepted 4 Name (Last, First): Johnson, Helen

512812009 5 Address: 812 Harrison 5t

2 Contribution Amount 6 City/State/Zip: Denver, CO 80206

$ 20.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Jones, Patrick

8/1/2009 5 Address: 6914 Pillsbury

2 Contribution Amount 6 City/State/Zip: Richfield, MN

$ 250.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Hennepin County Library

$ 9 Occupation (if applicable, mandatory): Librarian

1 Date Accepted 4 Name (Last, First): Jones Jr., John

7/312009 5 Address: 20812 E Princeton Place

2 Contribution Amount 6 City/State/Zip: Aurora, CO 80013

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Katsh, Sara

8/1/2009 5 Address: 8330 E Quincy Ave Apt A301

2 Contribution Amount 6 City/State/Zip: Denver, CO 80237

$ 20.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvrn, Sec. 2(6); Political Party Art. xxvrn, Sec. 3(3); Political Committee Art. xxvrn, Sec 3(5); Small Donor Committee Art. xxvrn, Sec. 2(14).

Page 15: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 13

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/:-l/_09 IThrOUgh 1_·__1_0-:-/8_/0_9_----J1 date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Kelly, John

6/712009 5 Address: 4252 E l30th Dr

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 102.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Retired

$ 9 Occupation (if applicable, mandatory): Retired

I Date Accepted 4 Name (Last, First): Lauer, Angela

6/712009 5 Address: 3168 W 100th

2 Contribution Amount 6 City/State/Zip: Westminster, CO 80031

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Lord, Sue

5/7/2009 5 Address: 560 YumaCir

2 Contribution Amount 6 City/State/Zip: Boulder, CO 80302

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Marquez, Karen

5/3012009 5 Address: 4746 E 129th Place

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 35.00 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14).

Page 16: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 14

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/:-1I_09 IThrough 1 10_/8_/0_9_""",,­mre mre

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Martin, Sharon

7/312009 5 Address: 2423 S Racine Wy

2 Contribution Amount 6 City/State/Zip: Aurora, CO 80014

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): McCutcheon, Richard and Rhonda

7/15/2009 5 Address: 11000 E 153rd Dr

2 Contribution Amount 6 City/State/Zip: Brighton, CO 80602

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Metro Housing Coalition

10/512009 5 Address: 9033E Easter PI Ste 200

2 Contribution Amount 6 City/State/Zip: Centennial, CO 80112

$ 250.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): NtA

$ 9 Occupation (if applicable, mandatory): N/A

1 Date Accepted 4 Name (Last, First): Minton, Sandra

6/7/2009 5 Address: 13088 Grape Ct

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241-2300

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candimte Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxym, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14).

Page 17: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A . Itemized Contributions Statement ($20 or more) Page 15

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/_1I-,-09 IThrough 1 1O~/8_/0_9__ date date

PLEASE PRINTffVPE

1 Date Accepted 4 Name (Last, First): Nadeau, Melissa

6/13/2009 5 Address: 11766 Coal Creek Heights Dr

2 Contribution Amount 6 City/State/Zip: Golden, CO 80403-8506

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Neuman, David

7/1312009 5 Address: 3212 E 136th Place

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80602-8745

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Nicastle, Mark

7/15/2009 5 Address: 15371 Perrytown St

2 Contribution Amount 6 City/State/Zip: Hudson,CO 80642

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Nicholaisen, Judy

6/7/2009 5 Address: 13160 Kearney

2 Contribution Amount 6 City/State/Zip: Thornton,CO 80602

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. xxvrn, Sec. 2(6); Political Party Art. xxvrn, Sec. 3(3); Political Committee Art. xxvrn, Sec 3(5); Small Donor Committee Art. xxvrn, Sec. 2(14).

Page 18: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 16

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/:-l/_09 IThrOUgh 1 10_/8_/0_9_. __ date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Powell, Sheila

7/13120ocr 5 Address: 12951 Lafayette St. #C

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Roeder, Chris

512812009 5 Address: 655 Trenton St

2 Contribution Amount 6 City/State/Zip: Denver, CO 80230

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Salazar, Gina

811012009 5 Address: 516 W 91st Cir

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80260

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Scallion, Michael

8/3/2009 5 Address: 2036 E 102nd Cir

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80229

$ 20.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14).

Page 19: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 17

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

PLEASE PRINTffYPE

1 Date Accepted

812012009

2 Contribution Amount

$ 20.00

3 Aggregate Amount*

$

1 Date Accepted

912612009

2 Contribution Amount

$ 48.00

3 Aggregate Amount*

$

1 Date Accepted

5123/2009

2 Contribution Amount

$ 200.00

3 Aggregate Amount*

$ 250.00

1 Date Accepted

6/7/2009

2 Contribution Amount

$ 25.00

3 Aggregate Amount*

$ 250.00

Reporting Period Covered: '--__2/_1_/0_9__....IThrOUgh 1 10_/8_/0_9__ ~re ~re

Schweppe, Sue 4 Name (Last, First):

5 Address: 4790 Old Post Ct

6 City/State/Zip: Boulder, CO 80301

7 Description Cash

8 Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

Soderberg, Pat 4 Name (Last, First):

5 Address: 1002 E 133rd Way

6 City/State/Zip: Thornton, CO 80241

7 Description Charge (Paid for PO Box renewal)

8 Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

Solano, Manuel and Judy 4 Name (Last, First):

5 Address: 14789 Harrison St

6 City/StatelZip: Brighton, CO 80602

7 Description Check

8 Employer (if applicable, mandatory): Solano Law Offices and State of Colorado

9 Occupation (if applicable, mandatory): Attorney and State Representative

Solano, Manuel and Judy 4 Name (Last, First):

5 Address: 14789 Harrison St

6 City/State/Zip: Brighton, CO 80602

7 Description Check

8 Employer (if applicable, mandatory): Solano Law Offices and State of Colorado

9 Occupation (if applicable, mandatory): Attorney and State Representative

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candi~te Committee Art. XXVill, Sec. 2(6); Political Party Art. XXVill, Sec. 3(3); Political Committee Art. XXVill, Sec 3(5); Small Donor Committee Art. XXVill, Sec. 2(14).

Page 20: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 18

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: ___2/_I_/0_9__...lIThrough 1 1O~/_8/_0_9__ date date

PLEASE PRINTffYPE

Solano, Manuel and Judy I Date Accepted 4 Name (Last, First):

8/1012009 5 Address: 14789 Harrison St

2 Contribution Amount 6 City/State/Zip: Brighton, CO 80602

$ 25.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): Solano Law Offices and State of Colorado

9 Occupation (if applicable, mandatory): Attorney and State Representative

Stoner, Tamara

$ 250.00

I Date Accepted 4 Name (Last, First):

8/312009 5 Address: 3349 Tejon St

2 Contribution Amount 6 City/StatelZip: Denver, CO 80211

$ 99.99 7 Description Cash

8 Employer (if applicable, mandatory): 3 Aggregate Amount*

9 Occupation (if applicable, mandatory):

Strauss, Hemy

$

I Date Accepted 4 Name (Last, First):

6/1312009 5 Address: 4060 S. Cherry

2 Contribution Amount 6 City/StatelZip: Cherry Hills Village, CO 80113

$ 50.00 7 Description Check

8 Employer (if applicable, mandatory): 3 Aggregate Amount*

9 Occupation (if applicable, mandatory):

Sun Enterprises (Ronald Lang)

$

I Date Accepted 4 Name (Last, First):

7/1312009 5 Address: 8877 N. Washington St

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80229

$ 500.00 7 Description Check

Employer (if applicable, mandatory): 3 Aggregate Amount* 8 ~/V>.

9 Occupation (if applicable, mandatory): $ -lll14 * For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14).

Page 21: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A . Itemized Contributions Statement ($20 or more) Page 19

Full Narne of Cornrnittee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/:-1/_09_·__IThrough 1_·_~10.;.,./8.;.,./0;.;.9_· __

PLEASE PRINTffYPE

1 Date Accepted

711512009

2 Contribution Amount

$ 50.00

3 Aggregate Amount*

$

1 Date Accepted

8/2012009

2 Contribution Amount

$ 25.00

3 Aggregate Amount*

$

1 Date Accepted

617/2009

2 Contribution Amount

$ 20.00

3 Aggregate Amount*

$ 40.00

1 Date Accepted

7/1512009

2 Contribution Amount

$ 20.00

3 Aggregate Amount*

$ 40.00

~re ~re

4

5

6

7

8

Name (Last, First): Tade, Eric

Address: 2404 E 145th Ct

City/State/Zip: Thornton,CO 80602-7310

Description Cash

Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

4

5

6

7

8

Name (Last, First): Talley, David

Address: 3048 W 24th Ave

City/State/Zip: Denver,CO 80211

Description Cash

Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

4

5

6

7

8

Name (Last, First): Tonsager, Dennis

Address: 2559 E 126th PI

City/State/Zip: Thornton,CO 80241

Description Check

Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

4

5

6

7

8

Name (Last, First): Tonsager, Dennis

Address: 2559 E 126th PI

City/State/Zip: Thornton, CO 80241

Description Check

Employer (if applicable, mandatory):

9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candi~te Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14).

Page 22: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 20

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: L..-__2/_1_/O_9 1Through 1L..-__l_0/~8/_0_9__. _ wre wre

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Traditi, Lisa

7/2/2009 5 Address: 485 Bexley Street

2 Contribution Amount 6 City/State/Zip: Highlands Ranch, CO 80126

$ 25.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): VanWert, Linda

6/7/2009 5 Address: 720 Field St

2 Contribution Amount 6 City/State/Zip: Lakewood, CO 80215-5400

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Verspoor, Cornelia

5/28/2009 5 Address: 9071 E 29th Pl

2 Contribution Amount 6 City/State/Zip: Denver, CO 80238

$ 40.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First): Weaver, Deb

8/1/2009 5 Address: 6701 W Linvale PI

2 Contribution Amount 6 City/State/Zip: Denver, CO 80227

$ 30.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candiwte Committee Art. xxvrn, Sec. 2(6); Political Party Art. xxvrn, Sec. 3(3); Political Committee Art. xxvrn, Sec 3(5); Small Donor Committee Art. xxvrn, Sec. 2(14).

Page 23: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A - Itemized Contributions Statement ($20 or more) Page 21*

Full Name of CommitteelPerson: -:C:....:o:..:IllIll1==::..:·t:.:.;te:..:e....:t..;;.o.;;;E:le:c::t::L::y::nn:::e:F::::o:x== --========~-

Reporting Period Covered: ___2/_11_09 1Through1__:....:10,;.;/8;;../0;.;..9_----, date date

PLEASE PRINTffYPE

1 Date Accepted 4 Name (Last, First): Vigil, Robert

6/7/2009 5 Address: 14707 Detroit Way

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80602

$ 20.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 45.00 9 Occupation (if applicable, mandatory):

Vigil, Robert 1 Date Accepted 4 Name (Last, First):

7/15/2009 5 Address: 14707 Detroit Way

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80602

$ 25.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 45.00 9 Occupation (if applicable, mandatory):

Williams, Jacob 1 Date Accepted 4 Name (Last, First):

8/112009 5 Address: 2746 Hedgrow Circle

2 Contribution Amount 6 City/State/Zip: Lafayette, CO 80026

$ 50.00 7 Description Paypal

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

Wiske, Dave and Sheri 1 Date Accepted 4 Name (Last, First):

6/7/2009 5 Address: 4272 E 130th Dr

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 50.00 7 Description Cash

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutionnal cites: Candidate Committee Art. xxvm, Sec. 2(6); Political Party Art. xxvm, Sec. 3(3); Political Committee Art. xxvm, Sec 3(5); Small Donor Committee Art. xxvm, Sec. 2(14)

Page 24: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

* Schedule A - Itemized Contributions Statement ($20 or more) Page 22

. . .

Full Name of CommitteelPerson: ....=....::..::=:.:::.:;.:.,:":....:.=...=:.:...:...:.:::::::.:t..:::::.:....::....:..:..:.--..,;".Committee to Elect Lynne Fox --..,;,,. _

Reporting Period Covered: date

PLEASE PRINTrrYPE

1 Date Accepted 4 Name (Last, First): Zimmerman, Paul

6/7/2009 5 Address: 12943 Columbine Circle

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 100.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory): UPS

$ 9 Occupation (if applicable, mandatory): Truck Driver

1 Date Accepted 4 Name (Last, First): Fox,Lynne

5/5/2009 5 Address: 4262 E 130!JJDrive

2 Contribution Amount 6 City/State/Zip: Thornton, CO 80241

$ 50.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First):

5 Address:

2 Contribution Amount 6 City/State/Zip:

$ 7 Description

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

1 Date Accepted 4 Name (Last, First):

5 Address:

2 Contribution Amount 6 City/State/Zip:

$ 7 Description

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

* For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutionnal cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14)

Page 25: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Statement of Non-Monetary Contributions [Art. XXVIII, Sect. 2, (5) (a) (II) (III), Sect. 5, (3)]

[C.R.S. 1-45-108 (1)]

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

~====~~----;::::::======~ Reporting Period Covered: I 2/1/09 Through 10/8/09

date date

Total Itemized Expenditures: I $220.00 I r-

PLEASE PRINTrrYPI

1 Date Provided 4 Name (Last, First): Delaney, Judy 5/23/09 5 Address: 11180 Clermont Cir

2 Fair Market Value 6 City/State/Zip: Thornton, CO 80233

$15.00 7 Description: T-shirt Transfers

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Party.*

1 Date Provided 4 Name (Last, First): Fox, Ronald 6/1/09 5 Address: 2710 E l25th Cir

2 Fair Market Value 6 City/State/Zip: Thornton, CO 80241

$25.00 7 Description: PhotOgraphy

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):IOn Check box if Coordinated with a Candidate/Candidate Committee or Political Party.*

1 Date Provided 4 Name (Last, First): Holst, Theresa 6/1/09 5 Address: 325 Gamet St

2 Fair Market Value 6 City/State/Zip: Broomfield, CO 80020

$90.00 7 Description: Campaign Portraits

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Party.*

1 Date Provided 4 Name (Last, First): Lauer, Angela 6/1/09 5 Address: 3168 W 100th

2 Fair Market Value 6 City/State/Zip: Westminster, CO 80031

$90.00 7 Description: Design Thank-you Notes

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

IOn Check box if Coordinated with a Candidate/Candidate Committee or Political Party.*

1 Date Provided 4 Name (Last, First):

5 Address:

2 Fair Market Value 6 City/State/Zip:

7 Description:

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

IOn Check box if Coordinated with a Candidate/Candidate Committee or Political Partv.* * Note: If coordinated, then contribution must also be reported as a non-monetary expenditure on Detailed Summary. Art. xxvrn, Sec. 2(9) states: " ...Expendltures that are controlled by or coordinated with a candidate or candidate's agent are deemed to be both contributions by the maker of the expenditures, and expenditures by the candidate committee."

Page 26: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B • Itemized Expenditures Statement ($20 or more) [C.R.S. 1-45-108-(1) (a)]

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: '---__2_/_11_09-'.-,.",------,I Through 1"'--__1O~/8-/0-9---

PLEASE PRINTffYPE

1 Date Expended

4/19/09 2 Amount

$ 25.09

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

4121109 2 Amount

$ 50.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

5/6/09 2 Amount

$ 899.99

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

5/8/09 2 Amount

$ 27.00

3 Recipient is (optional):

D Committee

D Non-Committee

illre

Total Itemized Expenditures: 1

illre

--'-_7_'...2_0_2__.8_3_

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Staples

14458 Delaware St Suite 600

Westminster, CO 80020

7 Purpose of Expenditure: Office supplies

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Thornton Festivals and Events

11151 Colorado Blvd

Thornton, CO 80233

7 Purpose of Expenditure: Booth rental at Thorntonfest

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Gamino Printing

1090 S Raritan St

Denver, CO 80233

7 Purpose of Expenditure: Campaign Cards and Remittance Envelopes

4

5

6

Name (Last, First):

Address:

City/State/Zip:

City of Thornton

9500 Civic Center Drive

Thornton, CO 80229

7 Purpose of Expenditure: Copies of candidate reports

Page 27: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B - Itemized Expenditures Statement ($20 or more) Page 2

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: L.....-__2;.../l_/0_9 1 Through [ 10~/8_/0_9_.__

PLEASE PRINTffYPE

1 Date Expended

5/13/09 2 Amount

$ 226.07

3 Recipient is (optional):

D Committee

D Non-Committee

date date

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Fun Services Inc

12345 Huron St

Westminster, CO 80234

7 Purpose of Expenditure: Promotional items balloons

1 Date Expended 4 Name (Last, First): Fun Services Inc

2 5/15/09 Amount 5 Address: 12345 Huron St

$ 141.31 6 City/State/Zip: Westminster, CO 80234

3 Recipient is (optional):

D Committee

D Non-Committee

7 Purpose of Expenditure: Helium tank rental

1 Date Expended 4 Name (Last, First): United Chinese Restaurant

2 6/7/09 Amount 5 Address: 4150 E 128th Ave

$ 539.60 6 City/State/Zip: Thornton, CO 80241

3 Recipient is (optional):

D Committee

D Non-Committee

7 Purpose of Expenditure: Campaign kickoff event

1 Date Expended

6/13/09 2 Amount

$ 38.09

3 Recipient is (optional):

D Committee

D Non-Committee

4

5

6

7

OfficeMaxName (Last, First):

Address: 801 E I 20th Ave

City/State/Zip: Thornton, CO 80233

Purpose of Expenditure: office supplies

Page 28: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B -Itemized Expenditures Statement ($20 or more) Page 3

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: 1_· 2_/1.../0.....9--'---'-_1 Through 1 10_/8_/0_9 _

PLEASE PRINTffYPE

1 Date Expended

6/13/09 2 Amount

$ 114.21

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

6/14/09 2 Amount

$ 30.49

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

6/16/09 2 Amount

$ 121.90

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

6/23/09 2 Amount

$ 72.00

3 Recipient is (optional):

D Committee

D Non-Committee

date date

Costeo4 Name (Last, First):

5 Address:

6 City/State/Zip: Thornton, CO

7 Purpose of Expenditure: office supplies, postage

OffieeMax4 Name (Last, First):

5 Address: 801 E 120th Ave

6 City/State/Zip: Thornton, CO 80233

7 Purpose of Expenditure: copies, office supplies

Candy Creek Inc4 Name (Last, First):

5 Address: Three Osage Road

6 City/State/Zip: Canton, MA 02021

7 Purpose of Expenditure: promotional item, candy

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Aurora, CO 80010

postage stamps

Page 29: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B -Itemized Expenditures Statement ($20 or more) Page 4

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: L....-,--_2_/_1I_09 1 Through 1L....-__1_0/~8/_0_9

PLEASE PRINTffYPE

1 Date Expended

6/25/09 2 Amount

$ 194.11

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

6/25/09 2 Amount

$ 100.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

7/1109 2 Amount

$ 786.36

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

7/2/09 2 Amount

$ 28.00

3 Recipient is (optional):

D Committee

D Non-Committee

date date

_

4

5

6

Name (Last, First):

Address:

City/State/Zip:

KSE Imprints-M

1000 Chopper Circle

Denver, CO 80204

7 Purpose of Expenditure: promotional items, t-shirts

4

5

6

Name (Last, First):

Address:

City/State/Zip:

American Cancer Society

7 Purpose of Expenditure: campaign event, relay for life

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Gamino Printing

1090 S Raritan St

Denver, CO 80223

7 Purpose of Expenditure: Brochures

4

5

6

Name (Last, First):

Address:

City/State/Zip:

USPS

Aurora, CO 80010

7 Purpose of Expenditure: Postage

Page 30: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B -Itemized Expenditures Statement ($20 or more) Page 5

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: ___2/-:-1_/0....;.9 1 Through 1'---__10_/8_/0_9 _

PLEASE PRINTffYPE

1 Date Expended

7/8/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

7120/09 2 Amount

$ 23.98

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

7122/09 2 Amount

$ 28.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

4/9/09 2 Amount

$ 49.00

3 Recipient is (optional):

D Committee

D Non-Committee

~re ~re

USPS4 Name (Last, First):

5 Address:

6 City/State/Zip: Aurora, CO 80010

7 Purpose of Expenditure: Postage

FedEX Kinko's4 Name (Last, First):

5 Address: 13700 Colfac Ave Suite F

6 City/State/Zip: Aurora, CO 80011

7 Purpose of Expenditure: Copies

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Aurora, CO 80010

postage

4

5

6

7

Name (Last, First): USPS

Address:

City/State/Zip: Northglenn, CO 80233 9998

Purpose of Expenditure: Post box rental (6 months)

Page 31: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B -Itemized Expenditures Statement ($20 or more) Page 6

Full Narne of CornrnitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: ___2_/1_/0_9 1 Through 1 1O~/8_/0_9__-",

PLEASE PRINTffYPE

1 Date Expended

8/8/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

8/9/09 2 Amount

$ 31.15

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

8/9/09 2 Amount

$ 68.96

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

8/13/09 2 Amount

$ 991.02

3 Recipient is (optional):

D Committee

D Non-Committee

date date

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Aurora, CO 80010 7238

Stamps

Office Max4 Name (Last, First):

5 Address: 801 E 120th Ave

6 City/State/Zip: Thornton, CO 80233

7 Purpose of Expenditure: office supplies

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

Costco

Thornton, CO

office supplies

4

5

6

7

Name (Last, First): Color Graphix

Address: 33 S Fox

City/State/Zip: Denver, CO 80223

Purpose of Expenditure: campaign signs

Page 32: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

1

Schedule B - Itemized Expenditures Statement ($20 or more) Page 7

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: 2/-:-1_/0_9__---'1 Through 1 10-:-/8_/0_9

PLEASE PRINTffYPE

1 Date Expended

8/14/09 2 Amount

$ 894.03

3 Recipient is (optional):

D Committee

D Non-Committee

___date date

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Gamino Printing

1090 S. Raritan St

Denver, CO 80223

7 Purpose of Expenditure: brochures

1 Date Expended

8/11/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Aurora, CO 80010 7238

stamps

1 Date Expended

8/17/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

8/17/09 2 Amount

$ 31.33

3 Recipient is (optional):

D Committee

D Non-Committee

USPS4 Name (Last, First):

5 Address:

6 City/State/Zip: Aurora, CO 80010 7238

7 Purpose of Expenditure: stamps

FedExKinko's4 Name (Last, First):

5 Address: 13700 E Colfax Ave Suite F

6 City/State/Zip: Aurora, CO 80011

7 Purpose of Expenditure: printing

Page 33: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B - Itemized Expenditures Statement ($20 or more) PageS

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

PLEASE PRINTffYPE

1 Date Expended

8/25/09 2 Amount

$ 121.39

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

8/13/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

9/11109 2 Amount

$ 20.60

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

9/29/09 2 Amount

$ 56.00

3 Recipient is (optional):

D Committee

D Non-Committee

Reporting Period Covered: '--__2_/1_/09 1 Through 1__......:..:10;;;.;/8::.../09:::..::......"'--_ date date

4 Name (Last, First): Robodial.org LLC

admin @ robodial.org

campaign calls

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Aurora, CO 80010

postage stamps

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

Ace Hardware

3851 E 120th Ave

Thornton, CO 80233

campaign sign supplies

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

Eastlake, CO 80614

postage stamps

Page 34: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B - Itemized Expenditures Statement ($20 or more) Page 9

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

PLEASE PRINTffYPE

1 Date Expended

10/3/09 2 Amount

$ 70.46

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

9/28/09 2 Amount

$ 269.30

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

9/26/09 2 Amount

$ 48.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/6/09 2 Amount

$ 358.39

3 Recipient is (optional):

D Committee

D Non-Committee

Reporting Period Covered: 1_··__·....;;;2;.,;/1;.,;/09~__1 Through 1__--.,;;;..1O;;.;,./.;;.;.8/..;;.;09~__ date date

4 Name (Last, First): Costeo

16375 N Washington

Thornton, CO 80023

office supplies

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

Color Graphix

33 S Fox St

Denver, CO 80223

campaign signs

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

USPS

280 E First Ave

Broomfield, CO 80020

post box rental

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

Offiee Max

801 E 120tM.ve

Thornton, CO 80233

copies

Page 35: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B - Itemized Expenditures Statement ($20 or more) Page 10

Full Name of Committee/Person: Committee to Elect Lynne Fox

PLEASE PRINTffYPE

1 Date Expended

10/7/09 2 Amount

$ 21.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/6/09 2 Amount

$ 136.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/8/09 2 Amount

$ 310.00

3 Recipient is (optional):

D Committee

D Non-Committee

Reporting Period Covered: __""-~2/;..;;1;..;/09;.;..... 1 ...... __... __1 Through __........;;.1O_/...;.;8/09~date date

4 Name (Last, First): University of Colorado HSC Library

12950 E Montview Blvd

Aurora, CO 80045

copies

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

Robodial.org

admin @ robodial.org

telephone calling service

4 Name (Last, First):

5 Address:

6 City/State/Zip:

7 Purpose of Expenditure:

MetroNorth Newspapers

PO Box 350070

Westminster, CO 80035

newspaper advertisement

I Date Expended 4 Name (Last, First):

5 Address: 2 Amount

$ 6 City/State/Zip:

3 Recipient is (optional):

7 Purpose of Expenditure:D Committee

D Non-Committee

Page 36: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule C - Loans

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

Reporting Period Covered: 1 2/~1_/0_9 date

_ Through 10/8/09 date

LOANS - Loans Owed by the Committee

(Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.) [No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial

purpose. [Art. XXVllI, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidate's candidate committee may receive a loan from a fmancial institution organized under state or federal law if the loan bears the usual and customary interest rate, is made on a basis that

assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 3(8)]

LOAN SOURCE

Name (Last, First or Institution): _F_o_x-'-,_L....y_nn_e _

Address: 4262 E. BOth Drive

City/State/Zip: Thornton, CO 80241

Original Amount of Loan: $ 2,482.62 Interest Rate: -%--'---"'---"--------------- ---------- ­Total of All Loans This Reporting

Loan Amount Received This Reporting Period: $2,482.62

Period: $2,482.62 (Place on line 8 of Detailed Summary Report)

Principal Amount Paid This Reporting Period: $0.00

Interest Amount Paid This Reporting Period: $0.00

Amount Repaid This Reporting Period: (Amount Repaid is sum of Principal & Interest entered on Detail Summary)

$0.00·· Total Repayments Made: $0.00 .. (Sum of Schedule C pages, Place on line 16 of Detailed Summary)

Outstanding Balance: $2,482.62

TERMS OF LOAN: 10/8/09 Date Loan Received Due Date for Final Payment

LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN

Full Name Address, City, St., Zip Amount Guaranteed

Page 37: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Elections Division Department of State 1700 Broadway, Ste. 270 Denver, CO 80290 Ph: (303) 894-2200 x3 Fax: (303) 869-4861 www.sos.state.co.us

,ONDITIONALLY ACCEPTED

OCT 30 2009

THORNTON CITY CLERK

REPORT OF CONTRIBUTIONS AND EXPENDITURES (C.R.S. 1-45-108)

Space Below For Office Use Only

Full Name of CommitteelPerson: Committee to Elect Lynne Fox As Sho\\n on Registration

Address of Committee/Person: 4262 E. 130th Drive

City, State & Zip Code: Thornton, CO 80241

Committee Type: Candidate

Name of Financial Institution: 1st Bank

Address of Financial Institution: 3390 E 104th Ave, Thornton, CO 80233

SOS ID NUMBER (state committees ONLY): N/A

Type of Report:

[i] RegUlallYsrhedUled Filing. October 13,2009 (21 days prior to the November 3,2009 Municipal Election)

[i] October 30,2009 (Friday prior to the November 3,2009 Municipal Election)

D December 3,2009 (30 days after the November 3,2009 Municipal Election)

D Annual - candidates from prior election held on -------------------,

D Amended Filing. This amends previous report filed on (date)

Submit changes or new information ONLY

D Termination Report (Termination Reports MUST have a Monetary Balance ofZero in Line 5)

Reporting Period Covered: 10/9/09 Through 10/25/09I---;-:---- ­date date Declared Total Spending (if applicable): [Art.

N/AXXVlll, Sect. 4 (I)]

Totals Detailed Summary Page

1 Funds on Hand at Beginning of Reporting Period (monetary only) $0.00 2 Total Monetary Contributions (line II) $5,100.00 3 Total of Monetary Contributions & Beginning Amount (line 1+ line 2) $5,100.00 4 Total Monetary Expenditures (line 19) $3,114.32 5 Funds on Hand at End of Reporting Period (monetary) (line 3-line 4) $1,985.68

The appropriate officer shall impose a penalty of $50 per day for each day that a report is filed late. [Art. XXVIII Sect. 10 (2) (a)]

Authorization (Must be completed by either the Registered Agent OR the Candidate) I hearby certify and declare, under penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period, including any contributions received in the form of membership dues transferred by a membership organization, are from permissible sources.

Print Registered Agent's (Treasurer's) Name:

Registered Agent's (Treasurer's) Signature:

Print Candidate Name: Lynne Fox---=:_--:------------------------------------ ­

Richard Delaney

Candidate's Signature: _~~............,.""""':~'F-F-'"V14A~g...... Date:j'111-1'-'-1'-'-,--'31~.1ZX.-.,,-,' t6)U. 3['):2.. OtJ9

Page 38: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

DETAILED SUMMARY

Full Name of CommitteelPerson: Icommittee to Elect Lynne Fox

Current Reporting Period: 110/9/09 Through 110/25/09

Funds on hand at the beginning of reporting period (Monetary Only):

6 Itemized Contributions $20 or More [CRS 1-45-108(l)(a)]

(Please list on Schedule "A") $5,100.00

7 Total of Non-Itemized Contributions

(Contributions of $19.99 and Less)

8 Loans Received

(Please list on Schedule "C") $0.00

9 Total of Other Receipts (Interest, Dividends, etc.)

10 Returned Expenditures (from recipient)

(Please list on Schedule "D") $0.00

11 Total Monetary Contributions

(Total of lines 6 through 10) $5,100.00

12 Total Non-Monetary Contributions

(From Statement ofNon-Monetary Contributions) $996.63

13 Total Contributions

(Line 11 + line 12) $6,096.63

14 Itemized Expenditures $20 or More [CRS 1-45-108(1 )(a)]

(Please list on Schedule "B") $3,083.07

15 Total of Non-Itemized Expenditures

(Expenditures of$19.99 and less) $31.25

16 Loan Repayments Made

(Please list on Schedule "C") $0.00

17 Returned Contributions (To Donor)

(Please list on Schedule "D") $0.00

18 Total Coordinated Non-Monetary Expenditures (Candidate/Candidate Committee & Political Parties only)

19 Total Monetary Expenditures (Total oflines 14 through 17) $3,114.32

20 Total Monetary Expenditures (Line 18 + Line 19) $3,114.32

Page 39: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) [C.R.S. 1-45-108 (1) (a)]

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: 1 1_0-:-/9_/_09__---'1 Through 1L....-__10~/2:-5_/0_9_----J d~ d~

WARNING: Please read the instruction page for Schedule "A" before completing!

Total Itemized Contributions: 1,..;$...;.......5:....--5-,-1-00-.-0-0-,1

PLEASE PRINTffVPE

1 Date Accepted 4

10/9/2009 5

2 Contribution Amount 6

$ 200.00 7

Name (Last, First): Brickmont Jr, Robert

Address: 136 S. Downing St

City/State/Zip: Denver, CO 80209-2431

Description Check

3 Aggregate Amount* 8

$ 9

1 Date Accepted 4

10/22/2009 5

2 Contribution Amount 6

$ 200.00 7

3 Aggregate Amount* 8

$ 9

1 Date Accepted 4

10/16/2009 5

2 Contribution Amount 6

$ 500.00 7

3 Aggregate Amount* 8

$ 9

1 Date Accepted 4

10/16/2009 5

2 Contribution Amount 6

$ 500.00 7

3 Aggregate Amount* 8

$ 9

Employer (if applicable, mandatory): Self employed

Occupation (if applicable, mandatory): Attorney

Polis, Jared Name (Last, First):

Address: PO Box 4659

City/State/Zip: Boulder, CO 80306

Description Check

Employer (if applicable, mandatory): US Congress

Occupation (if applicable, mandatory): Congressman

AFSCMEName (Last, First):

Address: 1625 L Street NW

City/State/Zip: Washington DC 20036

Description Check

Employer (if applicable, mandatory):

Occupation (if applicable, mandatory):

Plateau 470 LLC (Clarke Carlson) Name (Last, First):

Address: 1790 Platte St

City/State/Zip: Denver, CO 80202

Description Check

Employer (if applicable, mandatory):

Occupation (if applicable, mandatory):

• For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVlII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(l4).

Page 40: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule A -Itemized Contributions Statement ($20 or more) Page 2

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: L....­__I_0.,..../9_/0_9__IThrough 1__ 1_ 0...,../2_5/_0_9__ date date

PLEASE PRINTffYPE

I Date Accepted 4 Name (Last, First): CSCEW SMALL DONOR COMMITTEE

10/22/2009 5 Address: 5660 Logan St

2 Contribution Amount 6 City/State/Zip: Denver, CO 80216

$ 500.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

I Date Accepted 4 Name (Last, First): Denver Area Labor Federation

10/22/2009 5 Address: 140 Sheridan Blvd

2 Contribution Amount 6 City/State/Zip: Denver, CO 80226

$ 1200.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

I Date Accepted 4 Name (Last, First): S.E.LV. Local 105, Small Donation Committee

10/9/2009 5 Address: 2525 W. Alameda Ave

2 Contribution Amount 6 City/State/Zip: Denver, CO 80219

$ 2000.00 7 Description Check

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

I Date Accepted 4 Name (Last, First):

5 Address:

2 Contribution Amount 6 City/State/Zip:

$ 7 Description

3 Aggregate Amount* 8 Employer (if applicable, mandatory):

$ 9 Occupation (if applicable, mandatory):

• For contribution limits within a committee's election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIIl, Sec 3(5); Small Donor Committee Art. XXVIIl, Sec. 2(14).

Page 41: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B - Itemized Expenditures Statement ($20 or more) [C.R.S. 1-45-108-(1) (a)]

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: 10..,./9_/0_9__.....J1 Through 1 1_0/...,-2_5/_09

PLEASE PRINTffVPE

1 Date Expended

10/9/09 2 Amount

$ 76.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/11/09 2 Amount

$ 136.00

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/13/09 2 Amount

$ 2716.29

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

10/22/09 2 Amount

$ 154.78

3 Recipient is (optional):

D Committee

D Non-Committee

___dme

Total Itemized Expenditures: 1

_ dme

3-',~O_8_3•....;,O_7....J

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Cricket Communications

8414 Pearl Ave

Thornton, CO 80229

7 Purpose of Expenditure: phones for campaign

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Robodial.org LLC

[email protected]

7 Purpose of Expenditure: telephone call

4

5

6

Name (Last, First):

Address:

City/State/Zip:

C&D Printing

5351 Tennyson St Unit lC

Denver, CO 80212

7 Purpose of Expenditure: mailing

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Robodial.org

[email protected]

7 Purpose of Expenditure: telephone call

Page 42: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule C - Loans

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: 1 IO~/~9/_0_9 _ Through 10/25/09

date date

LOANS - Loans Owed by the Committee

(Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.) [No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial

purpose. [Art. XXVIII, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidate's candidate committee may receive a loan from a financial institution organized under state or federal law if the loan bears the usual and customary interest rate, is made on a basis that

assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 3(8)]

LOAN SOURCE

Name (Last, First or Institution):

Address:

City/State/Zip:

Original Amount of Loan: $ %......;:;...------------- Interest Rate: ------...;..:..--­Total of All Loans This Reporting

Period: $0.00 ---::::---~"':""""::-::-....:::-:-:..:::=-----:::----:--

(Place on line 8 of Detailed Summary Report)

Loan Amount Received This Reporting Period:

Principal Amount Paid This Reporting Period:

Interest Amount Paid This Reporting Period:

Amount Repaid This Reporting Period: $0.00 Total Repayments Made: $0.00 (Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16 of Detailed Summary)

Outstanding Balance:

TERMS OF LOAN: Date Loan Received Due Date for Final Payment

LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN

Full Name Address, City, St., Zip Amount Guaranteed

Page 43: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule D - Returned Expenditures & Contributions

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: 11....-_1_o/_9_/o_9__ Through 10/25/09 1

date date

Total Returned Contributions: I $

Total Returned Expenditures: I_$~ ====== _ Returned Contributions

(Previously reported on Schedule A - Contributions accepted and then returned to donors)

PLEASE PRINTrrYPE

1 Date Accepted 4

2 Date Returned 5

6

3 Amount 7

$

Name (Last, First):

Address:

City/State/Zip:

Purpose:

1 Date Accepted 4

2 Date Returned 5

6

3 Amount 7

Name (Last, First):

Address:

City/State/Zip:

Purpose:

$

Returned Expenditures (Previously reported on Schedule B - Expenditures returned or refunded to the committee)

PLEASE PRINTrrYPE

1 Date Expended 4 Name (Last, First):

Address:

City/State/Zip:

Comment (optional):

2 Date Returned 5

6

3 Amount 7

$

1 Date Expended 4

2 Date Returned 5

6

3 Amount 7

Name (Last, First):

Address:

City/State/Zip:

Comment (optional):

$

Page 44: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Statement of Non-Monetary Contributions [Art. XXVlll, Sect. 2, (5) (a) (II) (lll), Sect. 5, (3)]

[C.R.S. 1-45-108 (I)]

Full Name of CommitteelPerson: Committee to Elect Lynne Fox

;::::::::::::::::==~~------;:::::========~ Reporting Period Covered: I 10/9/09 Through 10/25/09

date date

Total Itemized Expenditures:IL... $~9_9_6_.6_3_ PLEASE PRINT/TYPI

I Date Provided 4 Name (Last, First): S.E.I.U. Local 105, Small Donation Committee

10/25/09 5 Address: 2525 W. Alameda Ave

2 Fair Market Value 6 City/State/Zip: Denver, CO 80219

$996.63 7 Description: stafftime (phone bank, literature drop oft)

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Partv.*

I Date Provided 4 Name (Last, First):

5 Address:

2 Fair Market Value 6 City/State/Zip:

7 Description:

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Partv.*

I Date Provided 4 Name (Last, First):

5 Address:

2 Fair Market Value 6 City/State/Zip:

7 Description:

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Party.*

I Date Provided 4 Name (Last, First):

5 Address:

2 Fair Market Value 6 City/State/Zip:

7 Description:

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Partv.*

I Date Provided 4 Name (Last, First):

5 Address:

2 Fair Market Value 6 City/State/Zip:

7 Description:

8 Employer (if applicable, mandatory):

3 Aggregate Amount 9 Occupation (if applicable, mandatory):

10 n Check box if Coordinated with a Candidate/Candidate Committee or Political Party.* • Note: Ifcoordmated, then contnbutlOn must also be reported as a non-monetary expendIture on DetaIled Summary. Art. XXVlll, Sec. 2(9) states: " ... Expendltures that are controlled by or coordinated with a candidate or candidate's agent are deemed to be both contributions by the maker of the expenditures, and expenditures by the candidate committee."

Page 45: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Elections Division .,()['!uiif:IONALLY ACCEPTED Space Below For Office Use Only

1700 Broadway, Ste. 270 Denver, CO 80290

Department of State

DEC 03 2009Ph: (303) 894-2200 x3 Fax: (303) 869-4861 www.sos.state.co.us THORNTON CITY CLERK

REPORT OF CONTRIBUTIONS AND EXPENDITURES (C.R.S.I-45-108)

Full Name of Committee/Person: Committee to Elect Lynne Fox As Shown on Registration

Address of Committee/Person: 4262 E. BOth Drive

City, State & Zip Code: Thornton, CO 80241

Candidate

1st Bank

3390 E 104th Ave, Thornton, CO 80233

Committee Type:

Name of Financial Institution:

Address of Financial Institution:

SOS ID NUMBER (state committees ONLY): N/A

Type of Report:

[i] Regularly Scheduled Filing.D October 13,2009 (21 days prior to the November 3,2009 Municipal Election)

D October 30, 2009 (Friday prior to the November 3, 2009 Municipal Election)

IX I December 3,2009 (30 days after the November 3,2009 Municipal Election)

D Annual - candidates from prior election held on -------------------,

D Amended Filing. This amends previous report filed on (date)

Submit changes or new information ONLY

00 Termination Report (Tennination Reports MUST have a Monetary Balance of Zero in Line 5)

Reporting Period Covered: 10/26/09 Through 11/28/09 date date

Declared Total Spending (if applicable): [Art. N/AXXVIII, Sect. 4 (I)]

Totals Detailed Summary Page

I Funds on Hand at Beginning of Reporting Period (monetary only) $1,985.68

2 Total Monetary Contributions (line II) $0.00

3 Total of Monetary Contributions & Beginning Amount (line 1+ line 2) $1,985.68 4 Total Monetary Expenditures (line 19) $1,985.68 5 Funds on Hand at End of Reporting Period (monetary) (line 3 - line 4) $0.00

The appropriate officer shall impose a penalty of$50 per day for each day that a report is filed late. [Art. XXVIII Sect. 10 (2) (an

Authorization (Must be completed by either the Registered Agent OR the Candidate) I hearby certify and declare, under penalty of perjury, that to the best of my knowledge or belief all contributions received during this reporting period, including any contributions received in the form of membership dues transferred by a membership organization, are from permissible sources.

Print Registered Agent's (Treasurer's) Name:

Registered Agent's (Treasurer's) Signature:

Print Candidate Name: Lynne Fox ---='-~----....,.....----------------------j""'------.,.-------

Candidate's Signature: LJ,,~P1. Sr4.

Page 46: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

DETAILED SUMMARY

Full Name of Committee/Person: Icommittee to Elect Lynne Fox

Current Reporting Period: 110/26/09 Through 111 /28/09

Funds on hand at the beginning of reporting period (Monetary Only): $1,985.68

6 Itemized Contributions $20 or More [CRS 1-45-108(1)(a)]

(Please list on Schedule "A") $0.00

7 Total of Non-Itemized Contributions

(Contributions of $19.99 and Less)

8 Loans Received

(Please list on Schedule "C") $0.00

9 Total of Other Receipts (Interest, Dividends, etc.)

10 Returned Expenditures (from recipient)

(Please list on Schedule "D") $0.00

11 Total Monetary Contributions

(Total oflines 6 through 10) $0.00

12 Total Non-Monetary Contributions

(From Statement ofNon-Monetary Contributions) $0.00

13 Total Contributions

(Line 11 + line 12) $0.00

14 Itemized Expenditures $20 or More [CRS 1-45-108(1)(a)]

(Please list on Schedule "B") $557.77

15 Total of Non-Itemized Expenditures

(Expenditures of $19.99 and less)

16 Loan Repayments Made

(Please list on Schedule "C") $0.00

17 Returned Contributions (To Donor)

(Please list on Schedule "D") $1,427.91

18 Total Coordinated Non-Monetary Expenditures

(Candidate/Candidate Committee & Political Parties only)

19 Total Monetary Expenditures

(Total oflines 14 through 17) $1,985.68

20 Total Monetary Expenditures

(Line 18 + Line 19) $1,985.68

Page 47: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule B -Itemized Expenditures Statement ($20 or more) [C.R.S. 1-45-108-(1) (a)]

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: '--__1_0_/2_6/_0_9__I Through 1 111....,..2_8/_09__....

PLEASE PRINTrrYPE

1 Date Expended

10/9/09 2 Amount

$ 495.45

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

11/2/09 2 Amount

$ 62.32

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

2 Amount

$

3 Recipient is (optional):

D Committee

D Non-Committee

1 Date Expended

2 Amount

$

3 Recipient is (optional):

D Committee

D Non-Committee

_ dale dale

Total Itemized Expenditures: 1'-- ..;.5_5_7_.7....;,7_

AT&T wireless 4 Name (Last, First):

5 Address: PO Box 30218

6 City/State/Zip: Los Angeles CA 90030-0218

7 Purpose of Expenditure: usage cahrges for phone

Robodial.org LLC 4 Name (Last, First):

5 Address: [email protected]

6 City/State/Zip:

7 Purpose of Expenditure: telephone call

4

5

6

Name (Last, First):

Address:

City/State/Zip:

Purpose of Expenditure:7

4

5

6

7

Name (Last, First):

Address:

City/State/Zip:

Purpose of Expenditure:

Page 48: Lynne Fox - 2009 City of Thornton City Council Campaign Contributions

Schedule D - Returned Expenditures & Contributions

Full Name of Committee/Person: Committee to Elect Lynne Fox

Reporting Period Covered: 1l....-_10_/2~6_/0_9__ Through 11/28/09 I date date

Total Returned Contributions: 1 $ 1,427.91

Total Returned Expenditures: 1_$:...-====== _

Returned Contributions (Previously reported on Schedule A - Contributions accepted and then returned to donors)

PLEASE PRINT/TYPE

1 Date Accepted 10/8/09 4 Name (Last, First):

2 Date Returned 5 Address:

11/20/09 6 City/State/Zip:

3 Amount 7 Purpose: $ 1427.91

Fox,Lynne

4262 E 130th Drive

Thornton, CO 80241

Reimbursement for payment of expenses

1 Date Accepted 4

2 Date Returned 5

6

3 Amount 7 $

Returned Expenditures (Previously reported on Schedule B - Expenditures returned or refunded to the committee)

PLEASE PRINT/TYPE

1 Date Expended 4

Name (Last, First):

Address:

City/State/Zip:

Purpose:

Name (Last, First):

Address:

City/State/Zip:

Comment (optional):

2 Date Returned 5

6

3 Amount 7 $

1 Date Expended 4

2 Date Returned 5

6

3 Amount 7

Name (Last, First):

Address:

City/State/Zip:

Comment (optional):

$