HomeMy WebLinkAboutTermination Report 05-01-2024FIRESTONE TOWN CLERK
9950 Park Avenue
Firestone, CO 80520
TownClerk@FirestoneCO.gov
Ph: (303) 531-6264
Fax: (720) 713-4106
www.firestoneco.gov
TOWN OF FIR TSE O�
Town Clerk's Office
FIRESTONE MA
(10 1, 0 R r1 1) 0 S Time
REPORT OF CONTRIBUTIONS AND EXPENDITUR Reo;NE
Article XXVIII of the Colorado Constitution and Title 1, Article 45 of the Colorado Revised Statute (C.R.S.)
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- 12024
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I Full Name of Committee/Person: I •ter A4 1, L.n I
on
Address of Committee/Person.
G
City, State & Zip Code:
R• p
Committee Type:
Name and Address of Financial
Institution
/ �f
COMMITTEE ID NUMBER
Type of Report
u Regularly Scheduled Filing.
Amended Filing. This amends previous report filed on (date)
Submit changes or new information ONLY
Termination Report. (Termination Reports MUST Have a Monetary Balance of Zero in Line 5)
Fj-&ck this box if this Report Contains Electioneering Communications Information
Reporting Period Covered: ( � - !� - Z t f Through l 5-- ) "Z q I
Date Date
Declared Total Spending tie applicable) $
lArt. XXVIII, Sec. 4(1)]
Totals Detailed Summary Page
1
Funds on Hand at the Beginning of Reporting Period (monetary only)
$
2
Total Monetary Contributions (line 11)
$
3
Total of Monetary Contributions & Beginning Amount (line 1 + line 2)
$
4
Total Monetary Expenditures (line 19)
$
5
Funds on Hand at the End of Reporting Period (monetary) (line 3 - line 4)
$
The appropriate officer shall impose a penalty of $50 per day for each day that a report is filed late.
[Art. XXVIII Sec. 10(2)(a)]
Authorization (Must be completed by either the Registered Agent OR the Candidate): I hereby 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 front
permissible sources.
Print Registered Agent's Name: r ��
Registered Agent's Signature:
Print Candidate Name:
Candidates
Dater
Firestone Town Clerk CPF form: 12/2023
DETAILED SUMMARY
Full Name of Committee/Person:
Current Reporting Period: Through L
Funds on hand at the beginning of reporting period (Monetary Only)
$
6
Itemized Contributions $20 or More [C.R.S. 1-45-108(i)(a)]
$
(From Schedule "A")
7
Total of Non -Itemized Contributions
$
(Contributions of $19.99 and Less)
8
Loans Received
$
(From Schedule "C")
9
Total of Other Receipts
$
(Interest, Dividends, etc.)
10
Returned Expenditures (from recipient)
$
(From Schedule "D")
11
Total Monetary Contributions
$
(Total of lines 6 through 10)
12
Total Non -Monetary Contributions
$
(From Statement of Non -Monetary Contributions)
13
Total Contributions
$
{
(Line 1 I + line 12)
14
Itemized Expenditures $20 or More [C.R.S. 1-45-108(1)(a)]
$
(From Schedule `B")
15
Total of Non -Itemized Expenditures
$
I
(Expenditures of $19.99 or Less)
16
Loan Repayments Made
"C")
$
(From Schedule
17
Returned Contributions (To donor)
$
(Please list on Schedule "D")
18
Total Coordinated Non -Monetary (in -kind) Expenditures
$
(Candidate/Candidate Committee & Political Parties only)
19
Total Monetary Expenditures
$
(Total of lines 14 through 17)
20
Total Spending
$
(Line 18 + line 19)
Firestone Town Clerk CPF form: 12/2023
Schedule A - Itemized Contributions Statement ($20 or more)
l
Full Name of Committee/Person: 1
WARNING: Please read the instruction page for Schedule "A" before completing!
PLEASE PRINT/TYPE
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Contribution Amt.
6. City/State/Zip:
$
3. Aggregate Amt.
I. Description:
�
8. Employer (if applicable, mandatory):
Check box if
ectioneering
9. Occupation (if applicable, mandatory):
Communication
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Contribution Amt.
6. City/State/Zip:
$
3. Aggregate Amt. *
7. Description:
$
8. Employer (if applicable, mandatory):
box if
PCheck
ectioneering
9. Occupation (if applicable, mandatory):
Communication
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Contribution Amt.
6. City/State/Zip:
$
3. Aggregate Amt.
7. Description:
�
8. Employer (if applicable, mandatory):
9. Occupation (if applicable, mandatory):
Dcheck box if
Electioneering
Communication
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Contribution Amt.
6. City/State/Zip:
$
3. Aggregate Amt.
I. Description:
$
8. Employer (if applicable, mandatory):
heck box if
ectioneering
9. Occupation (if applicable, mandatory):
Communication
For contribution limits within a committee's election cycle or contribution cycle, pleas refer to the following Colorado Constitutional cites: Candidate
Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political ommittee Art. XXVIII, Sec 3(5); Small Donor Committee Art.
XXVIII, Sec. 2(14).
Firestone Town Clerk CPF form: 12/2023
Schedule B - Itemized Expenditures Statement ($20 or more)
[1-45-108(1)(a), C.R.S.]
Full Name of Committee/Person:
PLEASE PRINT/TYPE
1. Date Expended
4. Name:
5. Address:
2. Amount
$
6. City/State/Zip:
3. pient is (optional):
tCommittee
Non -Committee
7. Purpose of Expenditure:
heck box if Electioneering Comm ication
1. Date Expended
4. Name:
5. Address:
2. Amount
$
6. City/State/Zip:
3.Recipient is (optional):
Committee
ElNon -Committee
7. Purpose of Expenditure:
E]Check box if Electioneering Communication
1. Date Expended
4. Name:
5. Address:
2. Amount
$
3. ptent is (optional):
Committee
Non -Committee
6. City/State/Zip:
7. Purpose of Expenditure: \
n
'--'Check box if Electioneering Communication
1. Date Expended
4. Name:
5. Address:
2. Amount
$
3.13CIpient is (optional):
Committee
❑Non -Committee
6. City/State/Zip:
7. Purpose of Expenditure:
heck box if Electioneering Communicatio
1 Date Expended
4. Name:
5. Address:
2. Amount
$
3. *pient is (optional):
Committee
Non -Committee
6. City/State/Zip:
7. Purpose of Expenditure:
heck box if Electioneering C munication
Firestone Town Clerk CPF form: 12/2023
Schedule C - Loans
Candidate Committees only
Full Name of Committee/Person:
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
V
Name (Last, First or Institution):
Address:
City/State/Zip:
Original Amount of Loan: $ Interest Rate:
Total of All Loans This Reporting
Loan Amount Received This Reporting Period: $ Period: $
(Place on line 8 of Detailed Summary Report)
Principal Amount Paid This Reporting Period: $
Interest Amount Paid This Reporting Period: $
Amount Repaid This Reporting Period: $ Total Repayments Made: $
(Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16of
Detailed Summary)
Outstanding Balance: $
TERMS OF LOAN:
Date Loan Received Due Date for Final Payment
LIST ALL ENDORSERS OR GUARANTORS O THIS LOAN
Full Name
Address, City, Stab , Zip
Amount Guaranteed
Firestone Town Clerk CPF form: 12/2023
Schedule D — Returned Contributions & Expenditures
Full Name of Committee/Person: JI V4,1
Returned Contributions
(Previously reported on Schedule A — Contributions ccepted and then returned to donors)
PLEASE PRINT/TYPE
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Date Returned
6. City/State/Zip:
7. Purpose:
3. Amount
$
1. Date Accepted
4. Name (Last, First):
5. Address:
2. Date Returned
6. City/State/Zip:
7. Purpose:
3. Amount
$
Returned Expenditur
(Previously reported on Schedule B — Expenditures reti ned or refitnded to the committee)
PLEASE PRINT/TYPE
1. Date Expended
4. Name (Last, First):
5. Address:
2. Date Returned
6. City/State/Zip:
7. Comment (Optional):
3. Amount
1. Date Expended
4. Name (Last, First):
5. Address:
2. Date Returned
6. City/State/Zip:
7. Comment (Optional): /
3. Amount
Firestone Town Clerk CPF form: 12/2023
Statement of Non -Monetary Contributions
[Art. XXVIII, Sec. 2(5)(a)(II)(III) & Sec. 5(3) & 1-45-108(l), C.R.S.]
Full Name of Committee/Person:
PLEASE PRINT/TYPE
1. Date Provided
4. Name (Last, First):
5. Address:
2. Fair Market Value
�
6. City/State/Zip:
Description:
3. Aggregate Amt.
8. Employer (if applicable, mandatory):
9. Occupation (if applicable, mandator ):
box b heck if
ecrionboxring
Communication
10. lCheck box if Coordinated wit Candidate/Candidate Committee or Political Party.
1. Date Provided
4. Name (Last, First):
5. Address:
2. Fair Market Value
�
6. City/State/Zip:
Description:
3. Aggregate Amt.
8. Employer (if applicable, mandatory):
9. Occupation (if applicable, mandatory):
2heck hif
e eek box ox
rmg
Communication
10. ❑Check box if Coordinated wit 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:
3. Aggregate Amt.
8. Employer (if applicable, mandatory):
9. Occupation (if applicable, mandatory):
Check box if
Electioneering
Communication
10. ❑Check box if Coordinated with a C4 didate/Candidate Committee or Political Party.
i
* Note: If coordinated, then contribution must also be reported as a non-moneta�re penditure on Detailed Summary. Art. XXVIII, Sec. 2(9) states: "...Expenditures
that are controlled by or coordinated with a candidate or candidate's agent ar/deemed to be both contributions by the maker of the expenditures, and expenditures by
the candidate committee." /
Firestone Town Clerk CPF form: 12/2023