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REPORT OF CONTRIBUTIONS AND EXPENDITURES
Article XXVIH of the Colorado Constitatim and Title 1, Article45 of the Colorado Revised Stalute (C.RS.)
�i
COMMITTEE ID NUMBER
Type of Report (check one)
❑ Regularly Scheduled Filing
❑ Amended Filing
This amends previous sport filed on (daze)
Termination Report
(Termination Reports MUST have a Monetary Balance of Zero in Line 5)
❑ Check this boa if this Report Contains Electioneering Communications Information
- Reporting Period Covered: r 1 oe r/ Lk— Through
Date
Declared Total Spending is argesr)
0o7`�io�pz�
etad age
1
on - atthe Be . of Repo Perin mmehryonty)
$
2
Total Monetary Contributions (line i i)
$
3
Total of Monetary Contributions & Beginning Amount pine 1+line 2)
$
4
Total Monetary
Expenditures pine 19)
$
5
Funds on Band
at the End of Reporting Period (mwot ry) pion 3—line 4)
$
The appropriate offer shall impose a penalty of SM per day for each day that a report is tiled late.
(Art XXVM Sec. 10(2)(a)]
perjury, tat to the
contributions receive
Print Registered Agmt's Name:
Registered Agent's Sigaamre:-j
Prim Candidate Name:
the Registered Agent OR the Candidate):? hereby certify and declare, under penalty of
or belief all contributions received during this reporting period, including any
thtp duet transferred by a membership organization, amfrom permissible soraroes.
Candidates Signature: Date:
4 Town ofFnesnne pram No. TOFCF-005