SEECFORM20

Itemized Campaign Finance Disclosure Statement

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Rev. 3/11
Do Not Mark in This Space For Official Use Only
IPagel om
COVER PAGE
o January to filing
o April 10 filing
o July to filing
o October 10 filing
o Independent Expenditure
o Primary 0 Election
D(?th day preceding primary
o 30 days following primary
D 7th day preceding election
o 12th day preceding election
(State Central Committees Only)
045 days following election
not held in November
o Initial Contribution or Disbursement
(pACsONLy)
o Amendment to
Type of Report:
o 7th day preceding referendum
o 45 days following referendum
D Deficit
o Termination
Beginning Date
\
_...J
r:?
.fy and state, under penalties of false statement, that all of the information set forth on this Itemized Finance
Statement for the period covered is true, accurate and complete.
r?/I
DATE (mrnlddlyyyy)
PENALTY FOR FALSE STATEMENT IS PUNISHABLE BY FINE NOT TO EXCEED $1,000, OR IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.
Ending Date
thru
SEECFORM20
Itemized Campaign Finance Disclosure Statement
CONNECfICUT STATE ELECfIONS ENFORCEMENT COMMISSION
Rev.3/ll Page 2 ofl7
SUMMARY PAGE TOTALS
NAME OF COMMITTEE TYPE OF REPORT

DItV
YI" 1
COLUMNA
This Period
COLUMNB
Aggregate
11. Balance on hand January 1 of current year for ongoing and party Committees OR
Balance on hand from day committee was fonned for all other committees
J!)
12. Balance on hand at the beginning ofReporting Period

13. Contributions received from Individuals (Sections A and B)
f$ 4//.
00
1;'-/11.
14. Receipts from Other Committees (Sections Cl and C2)
i 00

15. Other Monetary Receipts (Sections D-K)

$
16a. Total Small Food and Beverage Receipts at Fair (Section Ll) Town Committees ONLY
(1
I
16b. Total Proceeds from Small Purchases at Tag Sales, Auctions or Other Sales (Section L2)
rI
Municipal and Town
16c. Total Purchases ofAdvertising in a Program Book (Section L3) Committees ONLY

,

17. Total Monetary Receipts (add totals for lines 13-16c)
$ {o.411.
(}'O

dO
18. Subtotals (add totals in line 12 + line 17 in Column A; and in Hne 11 + 17 in Column B)
.. f.pJ Lf {,. 00 $
LfIJ.
c."ID
19. Expenses Paid by Committee (Section P)
iL
t
a-s-'
20. Balance on hand at close of Reporting Period (Subtract line 19 from line 18 in both Columns)
$ 4, 5?L/ $ 'l ,)1''-/ Ij
21. In-Kind Donations not Considered Contributions Received (Section U)
22. In-Kind Contributions Received (Section M)
1 '-1/1
5
1. 1':J
$Lf 1 S-I, 7'l,
23. Refundable Deposit to Telephone Company (Section N)
24. Receipts ofOrganization Expenditures (Section 0)
25. Beginning Loan Balance
25a. + Loans Received (Section D)
25b. + Interest and Penalties on Loan
25c.
-
Payments on Loan
25d. Total Outstanding Loan Amount
26. Campaign Expenses Paid by Candidate (Section Q)
27. Expenses Incurred on Committee Credit Card (Section R)
28. Expenses Incurred by Committee During this Period but Not Paid (Section S)
28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)
50
Amount of
Contribution
IUD
Amount of
Contribution
Amount of
Contribution
:H:
Sf 2
DYes

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
DYes
fa(No
I f contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? 0 Yes la-No
Amount of
Contribution
Is this contribution associated with a
fundraising event listed in Section L 1 ?
Ifyes, list Event #
DYes
JKNo
o Legislative
DYes

Method of
o Cash Personal Check 0 Credit/Debit Card 0 Payroll Deduction 0 Money Order
D
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,0007 0 Yes Ii! No
municipality valued at more than $5,000? 0 Yes a. No
Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? DYes
fundraising event listed in Section Ll ? lSL-No Ifyes, indicate which branch or branches o No
Ifyes, list Event #
Method of contribution:
ja.cash 0 Personal Check
-
Last Name
7
Is contributor a lobbyist, spouse, DYes
or dependent child of a lobbyist?
ANo
Is this contribution associated with a
fundraising event listed in Section Ll ?
DYes
gNo
Ifyes, list Event #
Method of contribution:
o Legislative
DYes
BNo
o Cash Ilil Personal Check 0 Credit/Debit Card
Last Name
Robe<S[){'\
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000':' 0 Yes
of government the contract is with:
Is this contribution associated with a
fundraising event listed in Section L I?
Ifyes, list Event #
DYes
J2f\-No
Is contributor a principal of a state contractor or prospective state contractor?
Ifyes, indicate which branch or branches
of government the contract is with: 0 Executive 0 Legislative
DYes
AD No
of contribution:
.Cash 0 Personal Check 0 CreditlDebit Card 0 Payroll Deduction 0 Money Order
ff) -
Name of Committee
Address
Name of Committee
Address
Address
City Code
Name of Committee
Is this contribution associated with a 0 Yes Ilyes, list
fundraising event listed in Section L I? [] Event #
Is this contribution associated with a 0 Yes Ilyes, list
fundraising event listed in Section L I? 0 No Event #
Aggregate
Is this contribution associated with a 0 Yes Ilyes, list
fundraising event listed in Section L I? 0 No Event #
Date Received
o Reimbursement for shared expense
o Payment for goods and services
Name ofTreasurer
o Surplus
Distribution
Amount of Contribution
Amount of Contribution
Amount of Contribution
Amount of Contribution
Amount of Contribution
Amount of Receipt
Amount of Receipt
o Bank o Candidate
o Individual 0 Other
Source of Loan:
o Bank o Candidate
Name
o Individual 0 Other
Street Address
City Code
Entity
Date Received
State Zip Code
Date of Receipt Date of Receipt
Amount Amount
or Guarantor of
this loan?
DYes (ifyes list
name and address of
C:osigner/Guarantorj
o No
Is there a Cosigner Amount Received
or Guarantor of
this loan?
DYes (ifyes list
name and address of
Cosigner,Guarantorj
o No
Amount Received
Amount Received
Amount Received
Method of payment: Amount Received
o Cash
o Personal Check
o Credit/Debit Card
I.
Section B. Additional
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
it No municipality valued at more than $S,OOO? t: Yes
Is this contribution associated with a Yes Is contributor a prmcipal of a state contractor or prospective state contractor? G Yes
fundraising event listed in Section L I? It No
.; No
llyes, list Event #
llyes, indicate which branch or branches
Method of contribution:
it Cash n Personal Check
0.00
Is contributor a lobbyist, spouse, r: Yes
or dependent child of a lobbyist? No
Is this contribution associated with a r: Yes Is contributor a principal of a state contractor or prospective state contractor? r-; Yes
fundraising event listed in Section L I ? rtt No llyes, indicate which branch or branches I} No
llyes, list Event # of government the contract is with: n Executive n Legislative
0.00
Is this contribution associated with a CJ Yes Yes
fundraising event listed in Section Ll? No iii. No
Is contributor a lobbyist, spouse, :e Yes If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
or dependent child of a lobbyist? No
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $S,OOO? te Yes Il' No
llyes, list Event #
Method of contribution:
nCash a Personal Check
tt '5t
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
c.l Yes
(J No
Is this contribution associated with a
fundraising event listed in Section L I?
llyes, list Event #
Method of contribution:
Cash C1 Personal Check
(:1 Yes
No

of government the contract is with: G Executive
Aggregate contributions
If contribution is in excess of $400 to a candidate committee a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $S,OOO? eJ Yes .-1 No
Is contributor a principal of a state contractor or prospective state contractor? 01 Yes
llyes, indicate which branch or branches .. No
of government the contract is with: C) Executive Legislative
Is this contribution associated with a t( Yes Is contributor a principal of a state contractor or prospective state contractor? r;: Yes
fundraising event listed in Section L I? BP No llyes, indicate which branch or branches No
llyes, list Event # of government the contract is with: n Executive n Legislative
of government the contract is with: Q Executive
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor 01 business he/she is associated with have a contract with said
municipality valued at more than $5,000? (0 Yes :.. No
/0
Amount of
Contribution
5
Amount of
Contribution
Amount of
Contribution
Amount of
Contribution
Method of contribution:
[Q Cash 11 Personal Check
Last Name
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
Yes
No
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
munic valued at more than $S,OOO? Yes It; No
Is contributor a principal of a state contractor or prospective state contractor?
llyes, indicate which branch or branches
Page ----L- of
.00
I. MONETARY RECEIPTS
Contribution
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? r::: Yes No
Is this contribution associated with a
fundraising event listed in Section L I?
G....) Yes Is contributor a principal of a state contractor or prospective state contractor?
No Ifyes, indicate which branch or branches
G Yes
f)i{ No
Ifyes, list Event #
of contribution:
CJ Personal Check
r: Yes
It No
Is this contribution associated with a
fundraising event I isted in Section L I?
ti Yes

Ifyes, list Event #
Method of contribution:
r!1 Cash Jt Personal Check
I .rf-
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
CJ Yes

Is this contribution associated with a
fundraising event I isted in Section L I?
fJ Yes

Ifyes, list Event #
Method of contribution:
L Cash Check
Last Name
Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
t1 Yes
C1 No
Is this contribution associated with a
fundraising event listed in Section L I?
C1 Yes
No
Ifyes, list Event #
Method of contribution:
r.: Cash C] Personal Check
of government the contract is with: C; Executive n Legislative
0.00
If contribution is in excess of $400 to a committee for a chief officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? OC':'; Yes rot.. No
Is contributor a principal of a state contractor or prospective state contractor?
Ifyes, indicate which branch or branches
of government the contract is with: r:: Executive p. Legislative
o Yes
i{..No
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? r: Yes No
Is contributor a principal of a state contractor or prospective state contractor?
Ifyes, indicate which branch or branches
of government the contract is with: n Executive
Date Received
? . J 2--' I (
Princioal Occuoation
n Yes
j;(No
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? a Yes t] No
Is contributor a principal of a state contractor or prospective state contractor?
Ifyes, indicate which branch or branches
of government the contract is with: C] Executive d Legislative
01 Yes
01 No
0.00
Last Name First Principal Occupation

Is contributor a lobbyist, spouse,
or dependent child of a lobbyist?
Yes
r:: No
Is this contribution associated with a
fundraising event listed in Section L 1 ?
r: Yes
[0 No
Ifyes, list Event #
If contribution is in excess of $400 to a candidate committee for a chief executive officer of a
municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? re Yes r:; No
Is contributor a principal of a state contractor or prospective state contractor?
Ifyes, indicate which branch or branches
of government the contract is with: n Executive n Legislative
r;; Yes
D No
Amount of
Contribution
Amount of
Contribution
Amount of
Contribution
a
Amount of
Contribution

Amount Received
$1 bills
---
$5 bills
---
$Ibills ____ $5 bills
---
$10 bill coins $10 bill coins
--- ---
Amount Received
Name oflnstitution
Street Address
City
Street Address City
Description
Name
Date of Transaction
Amount Received
Street Address City
Zip Code
Description
Name
Date of Transaction
Amount Received
Street Address City
Description
Total Loans Received this Period (Section D)
Total Receipts from Entities other than Individuals or Other Committees (Section E) +
Total Amount Transferred from Affiliated Business Treasury (Section F) +
Total Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Section G) +
Total Amount of Personal Funds of the Candidate Received this Period (Section H) +
Total Amount of Anonymous Contributions (Section I) +
Total Amount ofinterest from Deposits in Authorized Accounts (Section J) +
Total Miscellaneous Monetary Receipts not Considered Contributions (Section K) +
Subpart 1: (All Committees)
Was this fundraising event hosted at a personal residence? DYes (Ifyes, go to Section L4 In-kind Donations not Considered Contributions
and complete required information for purchases made by host(s) for food,
beverage and invitations.)
DNo
Did this fundraiser include items donated by a business entity of up to DYes (Ifyes, go to Section L4 In-kind Donations not Considered Contributions
$100 or items donated by an individual of up to $50? and complete required information.)
DNo
Was this fundraiser a tag sale, auction, or other sale of donated items Yes (Ifyes, go to Section L2 Proceeds from Tag Sale, Auction, or Other Sale of
with purchases from an individual of up to $50? Donated Items.)
DNo
Subpart 2: (Town Committees and Municipal Candidate Committees ONLY)
Were there purchases of advertising space in a program book associated DYes (Ifyes, go to Section L3 Purchases of Advertising Space in a Program Book
with this fundraiser? and complete required information.)
D No
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass DYes (Ifyes, enter Total Receipts from small purchases 1....$_____.....
gathering held within the state?
D No
Subpart 1: (All Committees)
Was this fundraising event hosted at a personal residence? DYes (Ifyes, go to Section L4 In-kind Donations not Considered Contributions
and complete required information for purchases made by host(s) for food,
beverage and invitations.)
DNo
Did this fundraiser include items donated by a business entity of up to DYes (Ifyes, go to Section L4 In-kind Donations not Considered Contributions
$100 or items donated by an individual of up to $50? and complete required information.)
DNo
Was this fundraiser a tag sale, auction, or other sale of donated items DYes (Ifyes, go to Section L2 Proceeds from Tag Sale, Auction, or Other Sale of
with purchases from an individual of up to $50? Donated Items.)
DNo
Subpart 2: (Town Committees and Municipal Candidate Committees ONL 11
Were there purchases of advertising space in a program book associated [] Yes (Ifyes, go to Section L3 Purchases of Advertising Space in a Program Book
with this fundraiser? and complete required information.)
D No
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass DYes (Ifyes, enter Total Receipts from small 1....$_____----1
gathering held within the state?
D No
o Cash 0 Personal Check o CreditlDebit Card
Purchases
Residential Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First
MI
Method of payment:
Aggregate
o CreditlDebit Card
Amount of
o Cash 0 Personal Check
Purchases
Residential Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First MI
Method of payment:
Aggregate
o CreditlDebit
Amount of
o Cash 0 Personal Check
Purchases
Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First
MI
Method of payment:
Aggregate
o Cash 0 Personal Check o Credit/Debit
Amount of
Purchases
Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First MI
Method of payment:
Aggregate
o CreditlDebit
Amount of
o Cash 0 Personal Check
Purchases
Residential Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First MI
Method of payment:
Aggregate
o CreditlDebit
Amount of
o Cash 0 Personal Check
Purchases
Residential Street Address City
State Zip Code Date Received Event #
Items Purchased
Last Name First
MI
Method of payment: Aggregate
o CreditlDebit
Amount of
o Cash 0 Personal Check
Purchases
Residential Street Address
City
State Zip Code Date Received Event #
Items Purchased
Street Address City
Name of Purchaser
Address City
Name of Purchaser
Street
Name of Purchaser
Street Address
Name of Purchaser
Street Address
Name of Purchaser
Street Address City
Name of Purchaser
Street Address City
Name of Purchaser
Street Address City
Name of Purchaser
Street Address City
Name of Purchaser
Street Address City
Name of Purchaser
Street Address
Name of Purchaser
Aggregate Purchases
Amount of
for All Events
Purchase
Aggregate Purchases
Amount of
for All Events
Purchase
Aggregate Purchases
Amount of
for All Events
Purchase
Purchases
Amount of
for All Events
Purchase
Aggregate Purchases Amount of
for All Events
Purchase
Aggregate Purchases
Amount of
for All Events
Purchase
Aggregate Purchases
Amount of
for All Events
Purchase
Aggregate Purchases Amount of
for All Events
Purchase
Amount of
Purchase
Amount of
Purchase
Aggregate Amount of
for All Events
Purchase
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Zip Code
Entity
Event #
DYes
DNo
Business Date Received
Entity
Event #
DYes
DNo
Business
Date Recei ved
Entity
Event #
DYes
DNo
Business
Date Received
Entity
Event #
DYes
DNo
Business
Date Received
Entity
Event #
DYes
DNo
Business
Date Received
Entity
DYes
DNo
Entity
DYes
DNo
Business
Entity
DYes
DNo
Business
Entity
DYes
DNo
Business
Entity
DYes
DNo
Business
Entity
DYes
DNo
Business
Entity
Event #
Date Received
Event #
Date Received
Event #
Date
Event #
Date Received
Event #
Date Received
Event #
Date Received
Purchase
DescriptIOn of
Name Donor
Zip Code
Name of Donor
City
DescriptIOn
Name of Donor
Name of Donor
Name of Donor
City
Aggregate value for this event
Event
Donation
given by:
o Individual
o Business Entity
Aggregate value for this event
Donation
given by:
o Individual
o Business Entity
Aggregate value for this event
Individual
Value of Donation
Fair
Value of DOlnationl
Fair
Value of DOlnationl
Donation
given by: o Business Entity Value of Donation
Aggregate value for this event
Donation
given by:
o Individual
o Business Entity
Aggregate value for this event
Donation o Individual
given by: o Business Entity
value for this event
Event #
Donation o Individual
given by: o Business Entity
Aggregate value for this event
Event #
Donation o Individual
given by: [] Business Entity
Aggregate value for this event
Fair
Value of DOlnatiionl
Fair Market
Value of Donation
Fair Market
Value of Donation
III. NONMONETARY RECEIPTS
Page 11 oft7
NAME OF COMMfITEE
ITYPE OF REPORT
tVUJHfIUuJ L RI I -,.. iYfLI Bf.h/Lt
M. In-Kind Contributions
Name U,(JI-Te
TIP
g,
Loc4 -(.'
Type ofContributor: Fair Market
0
Individual Value oUhis


Dr Committee
Contribution
2.s Ile!lf.e t- O
Other (Applicable OIIly to Re/ereJIdum Comm/ltees)
Is contributor a lobbyist, spouse, o Yes If contribution is in excess of$400 to a candidate committee for a chief executive officer of a
or dependent child ofa lobbyist? 8. No municipality does contributor or business helshe is associated with have a contract with said
municipality valued at more than $5,000? DYes I!l No
Date Received
Is this contribution associated with a DYes
Description ofIn-Kind Contribution Aggregate contributions
<6/30/ II
fundraising event I isted in Section L 1 ? Ii!. No
LJA-G-e: 11ZQ,)D
1121'.
l/yes, list Event #
Name !-O Ut f
3S P/rC
Type ofContributor: Fair Market
D
Individual Value of this
Street Address
Il7uw tf7tven ZiPotS-C I
ra Committee
Contribution
tfZt) (p1l4..e-J-r 0 Other (AppUcable o"ly to Referelldum Committees)
Is contributor a lobbyiSt, spouse, o Yes If contribution is in excess of$400 to a candidate committee for a chief executive officer ofa
or dependent child ofa lobbyist? f.i.. No municipality does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? DYes aNo
Date Received
Is this contribution associated with a DYes
Description of In-Kind Contribution Aggregate contributions
8'/30/ \\
fundraising event I isted in Section L 1 ? Ii... No
WAG-
7b4.0'-/
7h'-l. Or
l/yes, list Event #
Name
LtJw
PAG
Type ofContributor:
Fair Market
?'f
0
Individual
Value oUhis
Street Address
ICAlM Hztvtn IStatc.r
a.. Committee
Contribution
L/25
Si- D
Other (ApplJcable o"ly to ReferendMm Committees)
Is contributor a 10bbyi'6t, spouse,

Yes Ifcontribution is in excess of$400 to a candidate committee for a chief executive officer ofa
or dependent child of a lobbyist? No municipality, does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? DYes a.N"0
Date Received
Is this contribution associated with a DYes
Description ofIn-Kind Contribution Aggregate contributions

fundraising event listed in Section Ll? Ii!... No
WAG.
20l5b ,
OJ

l/yes, list Event #
Name 5; I r

Type ofContributor:
Fair Market
..f9- Individual
Value oUhis
S-r
rOr-
IJ
Committee
Contribution
0
Other (Applicable ollly to Referendum Comm/Itees)
Is contributor a lobbyis( spouse, DYes If contribution is in excess of$400 to a candidate committee for a chief executive officer of a
or dependent child ofa lobbyist? municipality does contributor or business helshe is associated with have a contract with said
municipality valued at more than $5,000? 0 Yes II. No
Date Received
Is this contribution associated with a o Yes
Description ofIn-Kind Contribution IAggregate contributions
2)6.
1
'1
g/30/ll
fundraising event I isted in Section L 1 ? aNo
FDOD
l/yes, list Event #
SUBTOTAL Sectioa M-This Page
'-I q SI, 72
TOTAL of additioaal SediOD M Pages
0
TOTAL OF ALL IN-KIND CONTRIBUTIONS (Elller tollll 011 Une 22 0/SIIIIfIIIIII1 Ptlge)
Lf CfS}, 7-2
N. Refundable Deposit to Telephone Company
(NOTE: This sectiOil refers OIIly to flIlwIIIces 0/deposI/8 by bttllvldllalsfrompersOil.jim_ to bmeflt the C01ffIIflttee, not deposI/8l11t1de by tile commIttu.)
Last Name oflndividual First MI Date Deposit Made
Amount of
Deposit
Residential Street Address City State Zip Code
Name oftelepbone company
Street Address City State Zip Code
TOTAL SECTION N (Entu tot. 011 Une 23 o/Slunnulty Ptlge)
City
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Comminees ONLY)
Street
City
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Comminees ONLY)
Street Address
City
DonatIOn
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Committees ONLY)
Address
City
Description of Donation
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Comminees ONLY)
Address
City
Description of Donation
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Comminees ONLy)
Street Address
City
DescriptIon of Donation
Zip Code
Zip Code
Zip Code
Zip Code
Name ofTreasurer
Zip Code
Name of Treasurer
Date Notice Received
Donations
Date Notice Received
Donations
Date Notice Received
Aggregate Donations
Date Notice Received
Aggregate Donations
Date NotIce
Fair Market Value
of Donation
Fair Market Value
of Donation
Fair Market Value
of Donation
Fair Market Value
of Donation
Fair Market Value
of Donation
Fair Market Value
of Donation
Type of Expenditure (if applicable).
o Coordinated with reimbursement sought
[J Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA 08 Oc OD OE
ype of applicable):
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA 08 Oc OD OE
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA 08 Oc OD OE
Name of Payee
Street
Purpose of Expenditure
(by code)
Description
of Expend iture (if applicable):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
oA 08 Oc OD
Candidate(s) Name Office Sought
(if applicable)
j)f3LP!frItJC: tL-ytltll.2{ (

Candidate(s) Name Office Sought
OE;P;;;l()e
Candidate(s) Name
(ifapplicable)
gf)e'7t'iYr AS/a--(- US
Candidate(s) Name
(ij applicable)
Del (!Ll( BtlK-l-/
B
Candidate(s) Name
(if applicable)
City
Office Sought
Opposed
IH()E-&11M
Opposed
Date of Payment
State Code
Supported
o Opposed
Amount
Amount
Method of Payment
g Check#
t::r" Debit Card
Amount
Method of Payment
Check#___
Debit Card
Amount
Method of Payment
o Check#___
o Debit Card
Amount
Purpose of Expenditure
(by code)
Description
Name of Payee (Name of Vendor who candidate paid directly)
Purpose of Expenditure
(by code)
Description
Name of Payee (Name of Vendor who candidate paid directly)
Purpose of Expenditure
(by code)
Description
City
Name of Payee (Name of Vendor who candidate paid directly)
Purpose of Expenditure
(by code)
Description
Name of Payee (Name of Vendor who candidate paid directly)
Purpose of Expenditure
(by code)
Description
Name of Payee (Name of Vendor who candidate paid directly)
treet Address
Purpose of Expenditure
(by code)
Description
Name of Payee (Name of Vendor who candidate paid directly)
City
Is Reimbursement
Claimed?
DYes
o No
Event #
Is Reimbursement
Claimed?
DYes
o No
Event #
Is Reimbursement
Claimed?
DYes
o No
Event #
Is Reimbursement
Claimed?
0 Yes
0 No
Event #
Is Reimbursement
Claimed?
DYes
o No
Event #
Is Reimbursement
Claimed?
DYes
o No
Event #
Amount
Amount
Amount
Amount
Amount
Amount
0 Visa o Master Card o Discover o American Express
Other
Date of Transaction
Amount
Street Address City State Zip Code
Purpose
Event #
(by code)
Name of Vendor Date of Transaction
Amount
Street Address City State Zip Code
Purpose DescriptIon
Event #
(by code)
Name of Vendor Date TransactIon
Amount
Street Address City State Zip Code
Purpose
Event #
(by code)
Name of Vendor Date of Transaction
Amount
Street Address City State Zip Code
Purpose Description
Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City State Zip Code
Purpose of Expenditure DescriptIOn Event #
(by code)
Name of Vendor Date of Transaction
Amount
Street Address City State Zip Code
Purpose of Expenditure Description Event #
(by code)
Name of Vendor Date of Transaction
Amount
Street Address City State Zip Code
Purpose of Expenditure Event #
(by code)
Name of Creditor Date Incurred

City
Type of Expenditure (if applicable):
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
Description
o Independent
o Organization (see Instructions)
OA 08 OC OD OE
Name of Creditor
Street Address
City
Type of Expenditure (if applicable):
o Coordinated with reimbursement sought
by code)
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA 08 OC OD OE
Name of Creditor
Candidate(s) Name (if applicable)
oSupported
OOpposed
Candidate(s) Name (if applicable)
oSupported
DOpposed
Office
Date Incurred
Event #
Office Sought
Date Incurred

(by code)
Name of Creditor
Street
City
Zip Code
Type of Expenditure (if applicable):
o Coordinated with reimbursement sought
[] Coordinated without reimbursement sought
o Independent
[] Organization (see Instructions)
OA 08 OC 0 D OE
Type of Expenditure (if applicable):
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA 08 OC OD
ICEmdidat,e(s) Name (if applicable)
oSupported
DOpposed
Candidate(s) Name (if applicable)
Office Sought
Date Incurred
Event #
Amount Incurred
(Estimate or Actual)
Amount Incurred
(Estimate or Actual)
Amount Incurred
(Estimate or Actual)
Amount Incurred
(Estimate or Actual)
IV. EXPENDITURES
Section T. Additional Page
NAME OF COMMITTEE
ITYPE OF REPORT
Ne\,{)t+fn....t-VI
R(S,rVb
I 1"1' DAY B bI"V/U;' I'/!-< I
T. Itemization orReimbunements to Committee Worken and Consultants
Last Name ofWorker/Consultant
IFirst SlfPffA"'1
lW
,
Method of Payment

Secondary Payee
Purpose of Expenditure
o Check #
nCO
(by code)pttftl r
o DebitCard
Street Address
ICity
I J
2(p2
S-t
rJevJ

Amount
Description

teU' 4--Ju.,r-e
./
Type ofExpenditure (ifappUcoble): ... Candidate(s) Name
Office Sought
[J<upported
I!;o.

o Coordinated with reimbursement sought

(if appIktlble)
oOpposed
o Coordinated without reimbursement sought
8r&1k -4(ll5

o Independent
o Organization (see Instructions)
OA oD oC OD OE
Last Name of Worker/Consultant
IFirst STh PH4J\Ji
IW
Method of Payment
AJ(...:Pr 8'3<.) cl
Secondary Payee Purpose of Expenditure
o Check #
s +ttO 1-(<;
(by coti tcHcG o DebitCard
Street Address ,
4:;D
Ut" ,V
Dr.

f-b,u&\
State IZip Code
ex
Amouut
Description
ta5el
Pttcl
ofExpenditure (If appUcable):
Candidate(s) Name Office Sought
[JtS'Gpported
Coordinated with reimbursement sought
(if tIf1PUcable)
oOpposed
o Coordinated without reimbursement sought
Byevt)lt
-f1>
S
fL4


33LfJ
o Independent
o Organization (see Instructions)
OA oD oC OD oE
Last Name ofWorker/Consultant
IFirst sn;:P f-t AN ( r; IW
Date of Payment
Method of Payment
,
Secondary Payee Purpose of Expenditure
o Check #
1)VtJl((tJ ODJ'JUI.s
(by code) poo()
o DebitCard
Street Address
\\11
st-

SCr- IZiPC
OtPS
( , Amount
D=ription Re-h-es'" Me,.h
fo
VOlLtVl+ee1LS
/
Type ofExpenditure (if appUc4ble):
Candidate(s) Name Office Sought
iB'S"upported

o Coordinated with reimbursement sought
(if appUcabIe)
oOpposed
o Coordinated without reimbursement sought
Bru4
CifUJ
o Independent
o Organization (see Instructions)
OA oD OC OD OE
Last Name of Worker/Consultant
IFirst
-1
M Date of Payment
Method of Payment
Secondary Payee Purpose of Expenditure
o Check #
(by code)
o Debit Card
Street Address
I City
State
I Zip Code
Amount
Description
Type ofExpenditure (if applJcabk): Candidate(s) Name Office Sought
oSupported
o Coordinated with reimbursement sought
(if appUcable)
oOpposed
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA oD OC OD OE
SUBTOTAL Section T -Dis Page I
"1-2". 0 Z
Page __, _ or __1_
Amount
Description
"tvo d -f;R I/D
Type of Expenditure (if applicable): Office Sought
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
oOpposed
o Independent
o Organization (see Instructions)
oA 08 oc OD OE
First
Method of Payment
Check #
-e.
Description
oA 08 oc OD OE
First
Type of ture
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
oA 08 oc OD OE
Office Sought
MI
Office Sought
oOpposed
Date of Payment
f5{3v
Purpose of Expenditure
(by code) fob])
oOpposed

5Tb"tJt-fAN ( :
II
o Debit Car-d--
Amount
_____
State Zip Code
C'r J
Type of Expenditure .
o Coordinated with reimbursement sought
Candidate(s) Name Office Sought
(if applicable)
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
4(US
oA 08 Oc OD OE
Type of Expenditure .
o Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
Method of Payment
o Check # ____
o Debit Card
Amount
Method of Payment
0 Debit Card
Amount