HomeMy WebLinkAboutTermination Report 5-1-2024I-Spave Belo", tor Office Use OnIv
FROISTONE TON� NXLERX
Q950 Park Avenue
Firestone. CO 80520
I ownClerk ( ,, FirestorteCO pov
Mr 003t 531-a2apt
Fax: (72017134 106
TOWN OF FIRESTM
To" Mrii's Offim
MAY - 12024
1
Time 431
FIRESTONE � � r- !!!_': �_ ? �'
,' v j, (5 it % q j'Y rXC W V
REPORT OF CONTRIBUTIONS AND EXPENDITURES
Article XXV111 of the Colorado (onStItLnion an(] Title 1, Anicle 45 1 )f the Colorado Re% ised StatUIC (.('.R.S,)
Full Name of Committee/Person:
I f, VJ2 UQ
I
Address of Committee/Person: __GAA 1,
U
City, State & Zip Code:
L/
Committee Tpe:
Name and Address of Financial
V
Institution
COMMITTEE ID NIJIMBER
Type of Report
0 Regularly Scheduled Filing.
Amended Filing. 'this amend, piekious report filed on Ware!
Submit chanpv� or new, informarron ONLA
Termination Report, (Tertnination Reports MUST Have a Monclary Balance of Zero in Line 5)
Check this box if this Report Contains Elect ioneed rig Communications Information
Reporting Period Covered: Through
Date Date
Declared Total Spending if appjicat)tt�t �� ���
fArt. XXV111, Sec 411 ll ES
F—Tot—ztl—s—De—t.i—il—ed—S—ui—ii—mar—y —P—ge-7
I Funds on Hand at the Beginning of Reporting Period inioncturyonlyt
S
Total Monetary Contributions (firic, 1 -0
3 Total of Monetary ContribUtions & Beginning Arnount (line 1 4 title 21 N
4 Total Monetary Expenditures (line 19l
5 Funds on Hand at the End of Reporting Period 0110riclarN) (line 3 - line 41 C> C
The appropriate officer shall impose a penalty of $50 per day fin- each day that a report is filed late.
tArt. XXV111 See. l0(2oa)J
Authorizatio, I here hY certth, and declare, under
pelfalor qfPerjjfj1N,' that to the hest of my knowledge oi- belit, 1'all contributhms receired during this repoohkq perio(1,
pennissible sources.
Print Registered Agent's, Narne:
Registered Agent's Signature-.
Date:
Print Candidate Name:
Candidates Signature;
Firesirwe'rokkn Clerk cm- fonir 12,'2023
DETAILED SUMMARY
Full Name of Committee/Person:
71zv-�
A,
Current Reporting Period:
Tbrougb
tom_
"j
Funds on hand at the beginning of reporting period Wonetan, Only)
$
6
Itemized Contributions $2.0 or More JC.R,S, 1-45-1080nail
(From SLI7et111le "A")
7
Total of Non -Itemized Contributions
Wontributions o1'$M99 and Less)
Loans Received
$
(From schedule "C-)
9
Total of Other Receipts
$
(Interest, Dividend,. etc,)
to
Returned Expenditures (from recipient)
$
&roni SclredUIC "D")
Total Monetary Contributions
$
(Total of fines 61irough 10)
12
Total Non -Monetary Contributions
$
(Trom Starenront of Non- monctary Coni rib ufions)----
13
Total Contributions
$
if-ine I I + line: 12)
14
Itemized Expenditures $20 or More ICKS, 1-45-1081 hail
$
(Flom schedule --B")
15
Total of Non -Itemized Expenditures
$
(Expcnditure,� uvfls 19,99 or Lcs.$)
16
Loan Repayments Made
$
(Frorn far hetlule -C"t
17
'T
Returned Contributions (o donor)
$
(Please fixt on Schedule D-)
18
Total Coordinated Non-Monetao, (in -kind) Expenditures
$
Coinvittee & NlifiCd PnTfic" Only)
19
Total Monetary Expenditures
$
(Towl of limns 14 through 17)
20
Total Spending
$
(Line 18'* line 19)
V
Hrc,Iowie Town Clerk CPF forim 1 2i2O23
Schedule A ., Itemized Contributions Statement 20 or inort
i
Full Name of Committee/Person:
3 ,w
'� LL
WARNING: Please read the instruction page for Schedule "A" before completing!
1. MattVttn
?. Conit.
5. Address,
iAtint.
r
Mtn C it /Sr sty.,,Zi E1�
Nzalle":Ite
*wt
7. e�, t iptttst�.
S. Employer ttt alplicLibl . 7i ii atatctra t. ,
Ch ck, flax It
ecti neering
, f�ccttpation it kttsp��cthlc.allatrt ttt r 1=:
Cone nnicatictn
3. Da c Accet, red
4. Name (Last, F%rbt1:
2, C° ntribmion Anit.
5, Address:
ss: wrv.w.
6. C" tv/ tat/r�tf -
3, ,. -r me Anil,
7. Descrtfattclt�: :
.'Fi�tj�lc?�9`t�tttpp[€cal'+��:,tl�etr�c3atc�rc�t, ,
"(tech boxt1
a, L^ tt ili'Line ;....
9...'k...,r�,°cripatimi €la7,it3�?�€4: x.t�AtC. nl;�rit�itl C77 "tm _..
Con initilltc;lttitn
1. Otte �'�cc e tct�
�.i
4. ame {Lrst. Firm
.5. Address,
I C � ntributi to Amt.
x
& tty/ t"tt Zip-
. Ac, *re ate' Ami.. "
d,
7, i Deem tiort- <:
`, Employer tit �tpplic�tl�lc €tlltidittrr't'B;
Tlh
ek box if'
cli, ilE:k',t�t:n-
, ''s�. �'dw€i.:(,1�, attC.�ltt €Tt': ck('Mt4itl`tt%i�C., i7`7itlti ittl7€'4`l:.
i. cttt m ntcatsctn
Datccettc
1 ar
, Name (Last. Fir t);: .
24 Con `ibmion Aint.
`. Acres-
rcr ivt_Tikt Amt. `"
7. Description,
fi
9. Employer (v a;�t,}i �E,1i t�� €�cii or , '
i � ° box toµ
ec. C, 1
9, Oceupatitrtt cit�tppliEti tent€nttalctrc l
f. om un[c°ntictn
' ForColl 1.Ti1'furio€'1 limits tt ittt8li a COITITTl§to' '+ i tt C'6III i:vdc or 4'oitil Nit 14111 Cycle, pleaNe refer to the ttl Ilctw 41 �, Ci ➢tormto t< o nstlttll id nial 6tt" Catididarc
t,"t'99 imittee Art. ,"XVttt, See. 2(6;.Pvfl t➢c,0 Pam An. 5i?ti.'w`'111-< Sec, 30,l Political t,'4tYn€ilince Art, `t4.r`'liV1tt. "ci: 3B ;i1: Small t.'1YA€or C&tFt$.FR itive Art.
XV111, Sec
F" rv„xtd rwe town { terk CPF form: 1211-1 Y",t.
Schedule B - Itemized Expenditures Statement ($20 or more)
I 1145-MMH(a), C,RS,�
Fir; stow hmn Oak CPF form, 12,20-13
Total c) t'A I I Loarts Thi s Report in cr
period: $
(Place tin hne 8 of Detailed Summary Repino
Total Repayments Made: $
(Sum of Schedule C page,,, Place on line l6of
Dmoled Summary r
Due [)jle For Final papileef
OF T141S LOAN
— — Z is — — — F —A m—(—)u n—Gt ——ua ra`n —te e—d7 p
Full Name of Conin
Schedule C - Loans
Candidate Committees (pith:
!/Person-' Vey)
LOANS - Loans Owed by the Committee
(Use a separate schedule for each loan. This forni is for line itern 8 and 16 Of the Detailed Stanniary Reportj
INo infonnation copied frorn Such rctawts 4l Id I he Sold or used he my person ti)r the Purpose or"ofic it ing i.,,oturibulierr s or for an) commereial
purpose, lArt, XXV1 I L See, 9(e) I Nomiltiquirdingan% to the conryary—a candidate'scandidkale collitnitlectnay receive a
loult from a fillancial inslilution oremwrd tulder stale or fedend, law ifthe loan hoars the usual and customart interest r.,Ae. is n-radeon a basis that
assures mpaymcnl, is evidenced "by a wrMen instrument. and IssubJect ki a due date or amortizahon �chcdule jArt, XXVIII, See- 3(8fl
LOANSOURCE
Name (Last, First or Institution):
Address:
City/State/Zip;
Original Amount of Loan: S-- Interest Rate:
Loan Amount Received This Reporting Period: S-
Principal Amount Paid This Reporting Period:
Interest Aniount Paid This Repo-irting Period,
Arai punt Repaid This Reporting Period: $ 1
(A mould Repatf.1 is aural off'rincipa I& twercst entered on Detad Summai)
OLAS'tauding Balance: S
TERtv1S OF LOAN:
le ce
0 0
DaL(em Rei%cd
le I , ,
LIST ALLENIDORSERS (GrUIARAN"
rull Name
tine stone "I own k lerk t rr MrITI: 1—
Schedule — Returned Contributions Expenditures
Cull Name of Committee/Person:
Returned Contributions
( Pr"t=vious'lt3 r°epor-tett rrrr , cIrc'd le A --= Contributions arc°celmrrt ctrtcl tlrert returned' rr doltor:s)
I; Date ���� tw�ci 4. Nair3lt � t..„6,�E. #�ir^�! N�
jQ
t r 5. Address:
Amour 6, C it rwrState,Zip:
7, Purpose,
7, Purpose
L Da e .�' c e ted
4_ Name (I-rat,Firsrt
+Dqte,turned_ 5. Address, Alnou
T Purpose -
Returned Expen tur
(Pr-cpviously r'epwrted on 5(Irr!dule B — Expet f tares r°e$turrtc*dor- refunded to the committee)
[. Date EiDencled
. Name (La,,t. F irsi):
I Date Relurned 5. Address,
6, Cit:'�,fr`St al Zi
w�r , '�CClCYuitr
Statement of Non -Monetary Contributions
jArt, '�XVIIL Stx, & See, 50) & C.R,S,j
2. FIr Njirk'et Va-lue
1
$ ,1
6, City/S tat e/Zip:
3, Aoar Bate Atra,
7, Description:
$
S, Employer
The k box it'
"h" k bo"' il'
OCCLIpation (11'applicable, jllatrdatorv):
eL L �ert
-e'-Itto ecrung
�tt() n1
Couna nication
10'
-heck hox if Coordinated will a Candidate/Candidate Committee or political Party. -
ided
1, Date Provided
1, Date Provided
4, Name r
5, Address.—
2, Fair arket Value
E4
$
6. City,Statel,Zip:
-
3, Au elate Anil-
7, Descriptiow
$
1
S. Employer
k-',11 k box if
1), Occupation i Japplicuble, _nxindatorvi
, I_ _no eel�l ng
aa _.Ilion
it Coordinated kvi h7a �Cindidatv/(
10. leack box if Coordinated wi h a Candidate/Candidate Committee or no
Date ro" ided
1, ate rovided
4. Name(Last,UITsit:
5, Address -----
, Vtk2 'tit I Value
Fair arkel Value
$
6. City/Stato"Zip,
3, L re ate Int_
3, Aa re Lite Arnt,
7, Description -
8. Employer Of applicable.wanda r:
h , A x If
o
L I
(), Occupation (if applit:able, marrmaor 1):
Hee Rat e uh,
Co)mt1\Un'c tin
10, [:]Cbeck box if Coordinat d W"It a Candidate/Candidate Committee or Political Party.
NotcIt cv.,)r 4iatcd. then contribution
tnu,,t also be rcportcd as :! n,')tj_jjjt)j ;Irj' c,%pcntlitun; on Doailed Summary Art, XXV111, Scv2(9) statm ". ..E1xpcnd4Ure''
t1raarecot tr cil I)y, i rr coAwtji
nated wit 1i it eifltl oatv m candidt't deemed to he haTh contributions b� thr imiker ofthe t'xlvrrdrluros,and expenditures by
Firestoncl'own Clerk CPF forim 12112023