David Baker Ward 13

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SEECFORM20Itemized Campaign Finance Disclosure StatementCONNECfICUT STATE ELECfIONS ENFORCEMENT COMMISSION

Rev. 1/08 Do Not Mwk in This S!!8Ce Foc

Official Use OnlyPa;e 1 oft7

SUMMARY PAGE

1. NAME OF COMMITTEE

F R , e - ~ $ 6F "b+vlD B 4 , < e ~ ." . -

2. TRltA.RTTR1i:R NA

Title First MI Last

:fou ~ - r A A t t J ~ U ~ . a J O 3. TREASURER ADDRESS

Suffix

Street Address I C ~ a u IState

IZip Code

531 Q., bJ tJ.PlAL ~ \ J e J j cr ~ - 5 ( ~ 4. ELECTIONIREFERENDUMDATE S. OFFICE SOUGHT {Co"""tleonlv lfCMuli4llte Committed

6. DISTRICf NUMBERAI' . ..........

(mm/ddIyyyy

A L0 EI2tVf,(3N'

7. CANDIDATE NAME (CtllflPltle " i f ~ (11'

r .G

Title MI I L ' ~ ISufflX-;;'::>AV I b 8 t 4 - K ~

I f l .TVPROIt' { ~ n - . R n ' Y l o January 10 filing 'JItlth day preceding primary o 7th day preceding referendum o Initial Contribution or Disbursement

(pACsONLY)

o April 10 fJ.1ing o 30 days following primary o 45 days following referendwn o Amendment to

o July 10 fJ.1ing o 7th day preceding election o Deficit Type of Report:

o October 10 fJ.1ing o 12th day preceding election o Tennination(State Central Committees Only)

o Independent Expenditure045 days following election

DPrimary DElectionnot held in November c....,

I · ~ - ; - ~ . v ft1 C ) .:.:

.9. r I ' .Kn . ,u I . . ' IV " .K IM '

,r-- . ~ ' :

J

Beginning Date Ending Date0 Q:.:.; ..

1> -..:::- ( ~ : 1 ' r ~ ' . .,

g/,Loilll q I' I ' ) .CI I- c ~ ; ; ~ · :

thru -n

.r::

10.1.. :A.TION

I hereby certify and state, under penalties of false s t a t e m e ~ that all of the infonnation set forth on this Itemized Campaign Finance

Disclosure Statement for the period covered is true, accurate and complete.

6 l l 2 ~ - : : S : j l ~ ' Q -R j i toOCl D P r n 1 ~ d l /T R E A S U R E ~ DEPUlY TREASURER (SIGNAIDRE) PRINT NAME OF SIGNER .

PENALTY FOR FALSE STATEMENT IS PUNISHABLE BY FINE NOT TO EXCEED$1,000, OR IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.



SEEC FORM 20Itemized Campaign Finance Disclosure StatementCONNECTICUT STATE ELECfIONS ENFORCEMENT COMMISSION

Rev. 1108 Page 2 of 17

SUMMARY PAGETOTALS

NAME Of ............ 6""""'TEE FILING DUE DATE

F ~ E ' P 1 : > S ,,1= -r:>4V/f.) BAJ,<€1't. q /( ; / J.fJI'

COLUMNA

This Period

COLUMNBAg2fegate

11. Balance on hand January 1 of current year for Ongoing and Party Committees ORBalance on hand from day Committee was formed for all other committees

12. Balance on hand at the ~ i n n i n g of R rKJI UIl!! Period t d · ~ 13. Contributions received from Individuals (Sections A and Bl $I}l l{O 1 '"

0

14. Receipts from Other Committees (Sections C 1 and C2) $I2J •00

15. Other Monetary Receipts (Sections D-K) ~ e · t 1 0 16a. Total Small Food and Beverage Receipts at Fair (Section L1) Town Committees ONLY

J · e ~ 16b. Total Proceeds from Small Purchases at Tag Sales, Auctions or Other Sales (Section L2) tr= -'c

Municipal muITown16c. Total Purchases of Advertising in a Program Book (Section L3) Committees ONLY

-d. ¢

17. Total Monetary Receipts (add totals for lines 13-16c) t J1 ILtD · eO

18. Subtotals (add totals in line 12 + line 17 in Column A; and in line 11 + 17 in Column B) f 1 ~ 1 1 f ( ) ' C O 19. Expenses Paid by Committee (Section P) 1130'()O

20. Balance on hand at close of Reporting Period (Subtract line 19 from line 18 in both Columns) 1" 4 to'''O

21. In-Kind Donations not Considered Contributions Received (Section L4) i f22. In-Kind Contributions Received (SectionM)

23. Refundable Deposit to Telephone Company (Section N) <l'....

24. Receipts of Organization Expenditures (Section 0) $kr

25. Beginning Loan Balance ttr25a. + Loans Received (Section D) 4u25b. + Interest and Penalties on Loan

25c. - Payments on Loan {V

25d. Total OutstandingLoan Amount i926. Campaign Expenses Paid by Candidate (Section Q) 1 1 b ~ .'1'

27. Expenses Incurred on Committee Credit Card (Section R) ig

28. Exoenses Incurred bv Committee During this Period but Not Paid (Section S) 1tf

28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)



L MONETARY RECEIPTS (Sections A-I{) Page30fl7

!NAME OF ",.,." ... l'""lEE IFIUNG DUE DATE

FIaEM>5 IJF ~ U t b CJ/&/ UIC

A. Total Contributions from Small Contributors-Received this Period ONLY$

100

.(See instructionsfor definition Q{Smali Contributor) Subtotal Section.A

B. Itemized Contributions from IndividualsLast Name t < ' H O ~ e b I First ALEx IM I

Principal Occupation Amount of, 4 \ A ~ e r f ~ b ContributionResidential Street Address ~ i ~ E \ I I r ~ t F i O ~ ; ' ? Name of Employer

' ' f ~ SVMPl r [ 5'TIlet:r " " ~ \ ) C N L U " ~ C . "l.}J£r •Is contributor a lobbyist. spouse, DYe s I f contribution is in excess of $400 to a candidate committee for a chiefexecutive officer of a

or dependent child of a lobbyist? iii No municipality does contributor or business helshe is associated with have a contract with said1)50unicipality valued at more than $5,000? DYe s D No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? D Y e sfundraising event listed in Section Ll ? I [ No Jfyes, indicate which branch or branches ,at NoJfyes, list Event # of government the contract is with: D Executive D Legislative

Method of contribution: IDate Received

D Cash "Personal Check D Credit/Debit Card D Payroll Deduction D Money Order A u ~ ':).0\ \ .

1ggregate contributions

Last Name C. H ~ 5 T } o t A J J 41 FirstIM I

Principal Occupation Amount ofI A ~ "\ CAeot..'l'JJ ~ H u ' T 0 6 e A ~ ContributionResidential Street Address City

I S e tFiPCode Name of Employer

' l ~ 1 J , 1 I " , . , q ~ AlBv tJAlIAI.I ~ E L F Is contributor a lobbyist, spouse. D Yes I f contribution is in excess of $400 to a candidate committee for a chief executive officer of a

or dependent child of a lobbyist? sa No municipality does contributor or business helshe is associated with have a contract with said

unicipality valued at more than $5,000? DYe s D No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? Dye s

fundraising event listed in Section Ll ? I( No Jfyes, indicate which branch or branches Jil""NoJfyes, list Event # of government the con tract is with: D Executive D Legislative

Method of contribution: IDate Received IAggregate contributions

DCash D[Personal Check D CreditlDebit Card D Payroll Deduction D Money Order Me, ~ , \ Last Name

First M A - ~ ~ IM IPrincipal Occupation Amount or

MU-Sa.'t'IISf'(l TELL£!? ContributionResidential Street Address ~ i t y

ISa F ~ ~ Name of Employer

f ~ ' ,UNtetJ S t ' ~ 1 6UiLHeo bVIL,::otb S4u,.LJE6 6 ' ~ Is contributor a lObbyist, spouse, DYes 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 helshe is associated with have a contract with said

$ l.Ounicipality valued at more than $5.000? Dye s D No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? DYesfundraising event listed in Section Ll ? Li(No Jfyes, indicate which branch or branches jit 'No

Jfyes, list Event # of government the contract is with: D Executive D Legislative

Method of contribution: IDate Received lAggregate contributions

DCash Q!(Personal Check D CreditlDebit Card D Payroll Deduction D Money Order 1\-\1& '.letl

LastName K'oP) First ~ , . t . t ~ IM IPrincipal Occupation Amount of

'OtcN"'

~ 4 r J e » J ContributionlResidential Street Address ~ i t y

FerFiPCOde

Name of Employer

Sll ~ d l f J t . J r A J ' C New S1Prtt!' or- C""Is contributor a lobbyist, spouse, D 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? R No municipality does contributor or business helshe is associated with have a contract with said $ \ ~ Sunicipality valued at more than $5,000? DYes D No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? DYesfundraising event listed in Section Ll ? i (No Jfyes, indicate which branch or branches Slf'NoJfyes, list Event # of government the contrac t is with: D Executive D Legislative

Me1hod of contribution: IDate Received Iggregate contributions

o Cash iiiPersonal Check D CreditlDebit Card D Payroll Deduction D Money Order AU IT "

SUBTOTAL Section B-This Page \\45

TOTAL of additional Seetion B Pages ~ ) O TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS (Sedions A & B) (pnter tot'" 011 LUte 13 ofSi P.-eJ 1. l \ ~ O · ' D

"a'



I. MONETARY RECEIPTS

Section B. Additional Pa2eT\rAUJ; ()J; ( , , ( )UUrrn<'J ; IJ;ItThIO nlTJ; n A'l'I<'.

B. Itemized Contributions from IndividualsLast Name f'irst

IM IPrincipal Occupation Amount of. ~ Z : I $ I ~ I<taSllN ~ A - r D A Contribution

Residential Street Address ~ i t y I S ~ T L ~ , ~ e , 1 . Name of Employer

C)t.t # ( ( t n ~ 0 I E 5 ~ PtJ13LJC

Is contributor a lobbyist, spouse, D 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? gr 'No municipality does contributor or business he/she is associated with have a contract with said

municipality valued at more than $5,000? DYes D No $ lZ)Is this contribution a s ~ i a t e d with a DYes Is contributor a principal of a state contractor or prospective state contractor? Dye s

fundraising event listed in Section L 1 ? ti. No I fyes, indicate which branch or branches .&:.No

I fyes, list Event # of government the contract is with: D Executive D Legislative

Method of contribution: IDate Received 1Aggregate contributions

DCash Rpersonal Check D CreditlDebit Card 0 Payroll Deduction 0 Money Order AOb &2DU

ILast N a m e " F } I W 2 ~ ~ o first '\f0+1\1 IMIPrincipal Occupation Amount of

.At1A4 UE"'nAlc, Contribution

R ~ ~ r S t r ( i : ; } J I ~ L ~ i t y ISZ; ' F

iP

06d

S,SName of Employer H M . ~ 4 I l c~ E W U 4 v e ~ o ;J 1,..0 A.J t.(

Is contributor a lobbyist, spouse, D 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? Z No municipality does contributor or business he/she is associated with have a contract with said

municipality valued at more than $5,000? DYes o No ~ ~ O Os this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? Dy e s

fundraising event listed in Sect ion L1 ? ai tNo Ifyes, indicate which branch or branchesI fyes, list Event # of government the contract is with: D Executive o Legislative

Method of contribution: IDate Received IAggregate contributions

DCash )J..Personal Check D CreditlDebit Card D Payroll Deduction D Money Order AU":l.O 'tLast Name

M)(e1t first

IMIPrincipal Occupation Amount or

'b&A'D JG4-1e"" P/to/'S j?",JJue-'<. ContributionResidential Street Address r--ity IState

FiP

OS(3Name of Employer

Qfl ~ t J l U J I I A A £ , . . . IJ£IU LIAlPiJ C( Cl/1rU:Is contributor a lobbyist, spouse, D 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? 11 No municipality does contributor or business he/she is associated with have a contract with said

$150unicipality valued at more than $5,000? DYes D No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? Dye s

fundraising event listed in Section L 1? • No I fyes, indicate which branch or branches ) <NoI fyes, list Event # of government the contract is with: D Executive D Legislative

Method of contribution:

IDate Received

IAggregate contributions

ji(Cash D Personal Check D CreditlDebit Card 0 Payroll Deduction D Money Order A-tIb ':).0 l (

Last Name first ~ M I Principal Occupation AmolDltof~ I L ~ $ o . J J ' C ~ ~ ' ( ContributionResidential Street Address ~ i t y

rstate F i ~ ' 3 Name of Employer

61 e-, & Q A J J ~ Ntilu ~ I . J C - ~ Is contributor a lobbyist, spouse, DYe s I f contribution is in excess of $400 to a candidate committee for a chief executive officer of a

or dependent child of a lobbyist? a No municipality does contributor or business he/she is associated with have a contract with said t,OOunicipality valued at more than $5,000? DYes o No

Is this contribution a s ~ i a t e d with a DYes Is contributor a principal of a state contractor or prospective state contractor? D Y e sfundraising event listed in Section L 1? IJl No Ifyes, indicate which branch or branches Jiiit.NoIfyes, list Event # of government the contract is with: D Executive D Legislative

Method of contribution: f Date Received IAggregate contributions

DCash O(Personal Check D CreditlDebit Card D Payroll Deduction D Money Order t)cPt ~ t > it

Last l A \ J 2 J . \ ~ e First JOiN IM IPrincipal Occupation Amount or) . t ~ ( , . V { , Contribution

Residential Street Address r--ity I S C T e ~ ~ > Name of Employer

S ~ q G u ~ V J f \ ! C . Alflu C P i . / ) I J ~ Is contributor a lobbyist, spouse, D 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? a No municipality does contributor or business he/she is associated with have a contract with said

$unicipality valued at more than $5,0007 0 Yes 0 No

Is this contribution associated with a DYes Is contributor a principal of a state contractor or prospective state contractor? D Y e sftmdraising event lis ted in Sect ion L1 ? i l N o I fyes, indicate which branch or branches R N oIfyes, list Event # of government the contract is with: o Executive o Legislative

Method of contribution: IDate Received

D Cash "Personal Check D CreditlDebit Card 0 Payroll Deduction 0 Money Order SEPr :1..11

·1 Aggregate contributions

SUBTOTAL Section B-Thls PaRe Kb'lOPage or ':l.



I. MONETARY RECEIPTS (Sections A-K) Page 4 of17

[NAME OF C ~ M M . i I 11" .. . iFILINa DUE OATR

I = " ~ I ~ tJF ?>AulD BOKeTZ. "I, / I t.Ct. Contributions from Other Committees

Name of Committee IName of Treasurer

IAddressI Is this contribution associated with a 0 Yes Ifyes, list AJnountofContribution

fundraising event listed in Section Ll? CJ No Event #

City State Zip Code Date Received Aggrcgate Contributions

Name of Committee r,me of T.. ., .n .

AddressI Is this contribution associated with a 0 Ye s I fy. .,list AJnountofContribution

fundraising event listed in Section L I? 0 No Event #

City State Zip Code Date Received Aggregate Contributions

Name of Committee IName ofT.. .,,,,,,,

Addressthis contribution associated with. 0 Yes f ly. .,list Amount of Contribution

fundraising event listed in Section Ll? 0 No Event #

City Statc Zip Code Date Received Aggregate Contributions

Name of Committee IName of Treasurec

Addressli s this contribution associated with a 0 Yes Ifyes. list AJnount of Contribution

fundraising event listed in Section Ll? 0 No Event #


Name of Committee IN.me ofT"""mtt

AddressIfS this contribution associated with a 0 Ye s llyes. list AJnount of Contribution

fundraising event listed in Section L l? 0 No Event #


Name of Committee IN.m,om . "...",

AddresslIS this contribution associated with a 0 Yes Ifyes, list AJnount of Contribution

fundraising event listed in Section L l? 0 No Event #

City State Zip C.ode Date Received Aggregate Contributions

C1 ..... L ..L n .L or C'. . 1. ...... !L .f'mm o t h ~ r Cl • ..L

Name of Committee Name of Treasurer

Address Date Received AJnount of Receipt

rity State riP Code CJ Reimbursement for shared expense o Surplus

o Payment fo r goods and services Distribution

Name of Committee Name of Treasurer

Address Date Received AJnount of Receipt

City StateI Zip Code o Reimbursement for shared expense o Surplus

o Payment for goods an d services Distribution

SUBTOTAL Section C .This Page $0TOTAL of additional Section C Pages 0

TOTAl ,OF AI. ' " , . ;UIWIIWIII I ........ \ . ; u n . ~ l l f t . n . l u ~ ~ A N D . fEllttIr IntIJI.ni l 1 ._ 14 of .... pa f t ) " to



L MONETARY RECEIPTS (Sections A-K) P a ~ e 5 0 f l 7 IlITAUP.OPLUMMlIlr.,r., IFILING DUE DATE

F ~ / F ~ iJF %),.4'" t:> 15",A.K£YZ.. ~ ~ / ~ " D. Loans Received this Period

Name of Lender Source of Loan: Is there a Cosigner Amount Receivedor Guarantor of

Street AddressFity

State IZiPCOde DBank D Candidate this loan?DYes (i fyes list

Name of Cosigner/Guarantor name and address of

IJ Individual IJ Other Cosigner/Guarantor)

Committee DNo

~ t r e e t Address r" State IZiPCode Date of Receipt

Name of Lender Soun:e of Loan: Is there a Cosigner Amount Receivedor Guarantor of

Street AddressFity r

ate IZiPCode D Bank D Candidate this loan?DYes (i fyes list

Name of Cosigner IGuarantotCl Individual D Other

name and addressof

Cosigner/Guarantor)

Committee o No

Street Address r"Y StateIZiPCOde

Date of Receipt

Total Section D sO• 00

E. Receipts from Entities other than Individuals or Other Committees tReferetuilultCollllllittees ONLY)

Name of Entity

Street Address pate Received Amount RKeiVed

City State Zip Code Aggregate Contributlons

Name of Entity

Street Address Date Received Amount RKeiVed

City State Zip Code Aggregate ContributIOns

Name of Enttty

Street Address pate Received Amount RKeived

City State Zip Code Aggregate Contnbutions

Total Section E s 0 . 0 0

F. ..l Transferred from Affiliate d Business Tr ~ EntDCo.

ONLYJ

Date of Receipt Amount Date of Receipt Amount Total Transrers

Is this transaction aswciated with a DYes I fyes, list Is this transaction associated with a DYes /fyes, list

fundraising event listed in Section Ll ? o No Event #- -

fundraising event listed in Section Ll ? D No Event#

___$ 0·&10

G. Amount Transferred from Affiliated Labor Union or Other Oraanization T. ~ o 1 J U . Y ,"" r ONLYJ

Date of Receipt Date of Receipt Total Transrers

Amount Amount

S0"'0

u. .1 Funds of the Candidat Received this Period I n~ J I _ C :-'aONLl?

Total

Method of payment: Method of payment: Amount ReceivedDate of Receipt Date of Receipt

D Cash D Cash

D Personal Check D Personal Check

Amount o CreditlDebit Card Amount D CreditIDebit Card $ 0,00



L MONETARY RECEIPTS (Sections A-K) P a ~ 6 o f 1 7 INAME OF ~ O M M I T i ' E E iFlLING DUE DATE

r - e ~ A J ~ (J'::' ~ , ~ ~ A I < t I ? - . q/"/:U;II. Anonymous C o n t r i b u t i o n s , ~ - - : , ~ dolItIr tIIfIOIUItoftAebills recelvetO

.bate Received IAm01mt

Date Received Amount Total

Amount Received

$

$1 bills $5 bills

coins $10 bill

$1 bills $5 bills

coins $10 bill

J .. . from r .in Authorized A ~ ~ n IIOts

Date Received I Amount Date Received AmountTotal

Amount Received

$

Name of Institution Name of Institution

Street Address Street Address

CityI State IZiPCode City

I State IZiP Code

K. MisteDaneous Monetary Receipts not Considered ContributionsName Date of Transaction

Amount Received.

$

Street Address I C i ~ ISw, IZip Cod,

Description

Name Date of TransactionAmount Received.

$

Street Address I City Ismre IZip Co""

Description

Name Date of TransactionAmount Received

$

Street AddressI Crty IStare IZip Cod<

Description

Total Section K $ 0

Summary ofOther Monetary Receipts (Sections D-K)

Total Loans Received this Period (Section D) O-CXJ

Total Receipts from Entities other than Individuals or Other Committees (Section E) + 4" o · ~ Total Amount Transferred from Affiliated Business Treasur y (Section F) + .) o .. ~ ( ) Total Amount Transfe rred from Affiliated Labor Union or Other Organization Treasury (Section G) + »

o ..)Total Amount of Personal Funds of the Candidate Received this Period (Section H) + (

0 "OD

Total Amount of Anonymous Contributions (Section I) + l) 0 Ou

Total Amount of Interest from Deposits in Authorized Accounts (Section J) + (0·

Total Miscellaneous Monetary Receipts not Considered Contributions (Section K) + S O · .:.0

Total of Other Monetary Receipts (Add Sections D-K)(Biller tdtalOIl Line 15oJSulfllfUll 'y Page) $ C



II. FUNDRAISING EVENT ACTIVITY Page 7 oft7

INAME OFCOMMrr:EE FILING DUE DATE

F ~ / t : A / D ! I t J ~ "1>A\I,1':) 8Atrm '1/&/ ~ / ' LI. Fundraiser Event Information

}4undraising Event #Description

Location: Street Address City State Zip CodeDate of Fundraiser Letter

Subpatt 1: (AU Committees)

Was this fundraising event hosted at a personal residence? DYes (llyes, go to Section lA In-Idnd Donations not Considered Contributions

and complete required infonnation for purchases made by host(s) for food,

beverage and invitations.)DN o

Did this fundraiser include items donated by a business entity of up to DYes (llyes, go to Section lA In-kind Donations not Considered Contributions

$100 or items donated by an individual of up to $50?DNo

and complete required infonnation.)

Was this fundraiser a tag sale, auction, or other sale of donated itenlS DYes (/fyes, go to Section L2 Proceeds from Tag Sale, Auction, or Other Sale of

with purchases from an individual of up to $50'1 Donated Items.)

DNo

Subpatt 2: (Town Committees tIIId Municipal CandUlllte Committees ONLy)

Were there purchases of advertising space in a program book associated DYes (llyes, go to Section L3 Purchases of Advertising Space in a Program Book

with this fundraiser? and complete required information.)

o No

I Subpart J: (l'own Committees ONLy)

o Yes (/fyes, enter Total Receipts from smaR pUKhases h e r e ~ 1$

Iid your committee sell food or beverage at a fair or similar mass

gathering held within the state?

o No

FundralsJng Event #Letter Description

Location: Street Address City State Zip CodeDate of Fundraiser

Subpart 1: (AU Committees)

Was this fundraising event hosted at a personal residence? DYes (/fyes, go to Section lA In-kind Donations no t Considered Contributions

and complete required infonnation 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 (/fyes, go to Section lA In-kind Donations not Considered Contributions

$100 or items donated by an individual of up to $50? and complete requi red information.)

ONoWas this fundraiser a tag sale, auction, or other sale of donated items DYes (/fyes, go to Section L2 Proceeds from Tag Sale, Auction, or Other Sale of

with purchases from an individual of up to $50?0

Donated Items.)

Subpart 2: (l'OWII Committees andMunicipal Candidate Committees ONLy)

Were there purchases of advertising space in a program book associated DYes (llyes, go to Section L3 Purchases of AdvertisJng Space in a Program Book

with this fundraiser? and complete required infonnation.)

o No

Subpart 3: (l'own Committees ONLy)o Yes (I fyes, enter Total Receipts from smaR purchases h e r e ~ 1$ Iid your conunittee sell food or beverage at a fair or similar mass

gathering held within the state?o No

SUBTOTAL Section Ll (Town CoIlflllittt!f!SONLy) Total Receipt ..ThIs Page

TOTAL ofadditional Secdoo Lt Pages +

TOTAL OF ALL RECEIPTS FROM SECTION Ll (Elitei' tlllill OR Lille 1611 ofS"""". . ,PIIp) 10 • C c)



IL FUNDRAISING EVENT ACTIVITY Page 8 of17

INAME OFcr" n""1'EF IFILING DUE DATE

R a D J ~ tiP: J¥Vr'D B41<£Yl. ~ / " I ~ D l t L2. Proceeds from Tal Sale, Auction, or Other Sale of Donated Items

!Name of Purchaser Last NameI First

IM IMethod of payment: Aggregate

(Individuals ONLy) [ leash [ l Personal Check CJ Credit/Debit Card Antountof

Residential Street Address r l ~ IState IZiPCode Date Received rEvent# Purchases

Items Purchased

Name of Purchaser Last Name

(IndividJlals ONLy)

Residential Street Address

Items Purchased


(IndividJlals ONLy)


Items Purchased

lName of Purchaser Last Name

(Individuals ONL I)


Items Purchased


(Individuals ONLy)


Items Purchased


(Individuals ONLl)


r t y

Fity

i i ty

l i ~

IFirst

IFirst

IFirst

IFirst

I irst

Istate

Istate

Istate

rate

IState

IM I

IZiP Code

1M!

rZiPCode

r

MI

IZiPcode

IMI

~ Z i P Code

, MI

~ Z i P c o d e

Methodof

payment:[ ] Cash [ ] Personal Check [ ] Credit/Debit Card

Date Received Ivent #

Method of payment:

DCash [ ] Personal Check CJ Credit/Debit Car d

Date Received I Event #

Method of payment:

CJ Cash CJ Personal Check [ ] Credit/Debit Card


Method of payment:

[ ] Cash [ ] Personal Check [ ] CreditlDebit Card

Date Received I Event #

Method of payment:

[ ] Cash [ ] Personal Check o Credit/Debit Car d


Items Purchased

lName of Purchaser Last Name I First Method of payment:(Individuals ONLy) [J Cash CJ Personal Check D CreditJDebit Card

Residential Street Address Date Received[state [ZiP Code fEvent#

Items Purchased

!Name of Purchaser Last Name Method of payment:irst(Individuals ONLy) [ ] Cash [ ] Personal Check [ ] CreditJDebit Card

Residential Street Address tate Date ReceivedIZiPcode Ivent #

Items Purchased


Fity r

Method of payment:irst(IndividJlals ONLy) [ ] Cash [ ]

PersonalCheck

D CreditJDebit CardResidential Street Address Date ReceivedIState IZiPcode IEvent #

Items Purchased

~ i t y

SUBTOTAL Section Ll...ThIs Page

TOTAL of additional Section 1.2 Pages

TOTAL OF ALL SMALL PURCHASES FROM TAG SALES, AUCTIONS OR OTHER SALES OF DONATED ITEMSIEIltI!r t••1m t LiIM l6IJsf, ....P..l! l

AggregateAmount of

Purchases

Aggregate

Amount of

Purdlases

AggregateAmount of

Purdtases

Aggregate

Amount of

Purchases

AggregateAmount of

Purdlases

AggregateAmount of

Purchases

Aggregate

Amount of

Purchases

Aggregate

Amount ofPurchases

0 .

0

$0



D. FUNDRAISING EVENT ACTIVITY Page 9 of17

I N A M R O F ( " n u M " T " ~ I ' ~ F g , T N ~ ~ 1 : >

FILTNll TV mnA ITc , 7 , 7 ~ / J

LJ. Purchases of Advertisio2 in a Pro2ram Book 11:'o

--CtDuli4tIte tIIUl Town CtnnInitteaONL})Name of Purchaser Business

Entity

DYes

DNo

Date Received Aggregate Purchases

for All Events

AmountoC

Purdtase

Street Address ICrt, I"lat'IZip Cod< Event #

Name of Purchaser Business

Entity

DYes

DNo


for All EventsAmountoC

Purchase

Street Address I " ~ Itate IZip Cod< Event #

Name ofPmchaser Business

Entity

DYes

DNo



Purchase

Street Address Iity Itate IZip Code Event #


Entity

DYes

DNo



Punhase

Street Address ,"tare IZipCod< Event #


Entity

DYes

DNo


for All Events

AmountoC

Punhase

Street Address I C i ~ ISla" IZip Cod< Event #


Entity

DYes

DNo



Purchase

Street Address I C i ~ ria"

IZip Cod, Event #


Entity

Dyes

DNo


for All EventsAmount oC

Purchase

Street Address I C i ~ IS'"

IZip Cod, Event #

Name of PurchaserBusinessEntity

Cl Yes

DNo

Date ReceivedAggregate

Pmchases

for All Events AmountoCPurchase

Street Address Itate IZip Code Event #


Entity

DYes

DNo



Purchase

Street Address I C i ~ I"tat, rCod

'Event #


Entity

Dyes

DNo



Purchase

Street Address I C i ~ ISlat< IZip Cod< Event #

Name of Purchaser BusinessEntity

DYes

DNo


for AU EventsAmountoCPurchase

Street Address

r"I"tat, IZip Cod, Event #


Entity

Dyes

DNo



Punhase

Street Address I C i ~ I"lal< IZip Code Event #

SUBTOTAL Section Ll-This Page

TOTALof additional Sedion l...l Pages

TOTAL OFALL PURCHASES OF ADVERnsING IN A PROGRAM BOOK (Enter totIIIOil Line 16c 0 /SIIIIIIIMIIYPee)



IT. FUNDRAISING EVENTACTMTY Page 10 oft7

I N A M F . O F C O M M ~ E FILING DUE DATE

tIff, / ~ ( ) I ItaeNDS (F " 'l>A"ID BM'ttt2...

L4. In-Kind Donations Not Considered ContributionsName of Donor

Street Address UW Zip CodeICily rDescription of donation Date Received

Name of Donor

Street AaaTess laW Zip CodeICily rescription of donation Date Received

Name of Donor

Street Address Zip Coderly1'''''

Date Received

Name of Donor

Description of donation

Street Address

raW Zip CodeICily

Date Received

Name of Donor

Street Address


Zip CodeICily1"1a"

Description of donation Date Received.

Name of Donor

Street Address Zip CoderOyria"

Description of donation Date Received

Name of Donor

Street Address Zip CodeICilyI"lato

Date Received

Name of Donor

Street Address lato


Zip CodeIity rescription of donation Date Received

SUBTOTAL Section J.A..This Page

TOTAL of additional Section IA Pages

TOTAL OF ALL IN-KIND DONATIONS NOT CONSIDERED CONTRIBUTIONS IEnter t«tIl on Line 21 o f ~ PlII!e) io

Donation o Individual Fair Market

given by: o Business Entity Value of Donation

Aggregate value for this event

Event #

Donation o Individual Fair MarketValue of Donationiven by: o Business Entity


Event #



Event #



Event #



Event #



Event #



Event #



Event #



Ill. NONMONETARY RECEIPTS Page 11 oft7

INAME OF COMMI'ITEE FILING DUE DATE

F ~ / E J . A > S 6F l'.l4V1D 1S4K"e7L c,/r;LM. In-Kind Contributions

Name Type of Contributor:

[J Individual

D Committee

D Other (Applicable only to Referendum Committees)

Fair MarketValue of this

Contributiontreet AddresslCity fState Zip Code

Is contributor a lobbyist, spouse, D Yes

or dependent child of a lobbyist? D No

I f contribution is in excess of $400 to a candidate committee for a chiefexecutive 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? Dye s DNo

Date Received Is this contribution associated with a DYes

fundraising event listed in Section L 1? D No

Jfyes, list Event #

Description of In-Kind Contribution Aggregate contributIOns

Name

IType of Contributor:

0 Individual

D Committee

D Other (Applicable only to Re fere ndum Committees)

Fair MarketValue orthJsContributiontreet Address rty State Zip Code


or dependent child of a lobbyist? CJ No

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a


municipality valued at more than $5,000? DYes DNo

Date Received Is this contribution a s s o c i a ~ d with a DYes

fundraising event listed in Section LI ? D No

Jfyea, list Event #

Description of In-Kind Contribution Aggregate contributIOns

Name Type ofContributor:

D IndividualD Committee

CJ Other (Applicable only to Referendu m Committees)

Fair Market

Value of thisContributiontreet Address rty State Zip Code

Is contributor a lobbyist. spouse, D Yes


I f contribution is in excess of $400 to a candidate committee fo r a chiefexecutive officer of a

municipality, does contributor or business he/she is associated with have a contract with said


Date Received Is 1his contribut ion associated wi1h a DYes

fundraising event listed in Section Ll ? CJ No

/fyea, list Event #

Descriptionof In-Kind C ~ n t r i b u t i o n Aggregate contributIons


D Individual

D Committee

D Other (,4pplicable only to Referendum Committees)

Fair MarketValueofthb

Contributiontreet AddressICity ~ S t a t e Zip Code

Is contributor a lobbyist, spouse, CJ Yes





Date Received Is this contribution associated with a DYe s

fundraising event listed in Section Ll ? D No

/fyea, list Event #

Description of In-Kind Contribution Aggregate contributions


D Individual

D Committee

D Other (Applicable only to Referendum Committees)

Fair MarketValue of this

Contrlbudootreet AddressICity \State Zip Code






Date Received Is this contribution associated with a DYe s

fundraising event listed in Section Ll ? D No

I fyea, list Event #

Description of In-Kind Contribution Aggregate contributions

SUBTOTAL Section M-This Page

TOTAL of additional Section M Pages

TOTAL OF ALL IN ..KINJ) CONTRIBUTIONS tEnter toltllon LiM 22 ofS PtIIle) $D

N. Refundable Deposit to Telepbone Company(NOTE: TIt;. s«tim '.l1l'i 0IJ(y to .""CM of by ilUlivillwhfrompenonal ftIIUIs to btrneJil1M . 1UJt IItIJde by tJae COIffIIIitta),

Lalit Name ofTndividual first IM I Date Deposit Made Amount ofDeposit

Residential Street Address City (state ~ Z j p Code

Name of telephone company

Street Address r ' ~ IState IZiP Code

Total Section N (Ellter totlll 011 Line 23 of,'" Page) fb



IlL NONMONETARY RECEIPTS Page 12 of17

INAME OF COMMiTTE..... lFILINO DUE DATE

~ F N r . 6 11= ~ I D 1J4K81.... q / 6 / ~ / ( O. Non-Monetary Receipts of Organization Expenditures Made ByLe2islative Leadershio. Le2islative Caucus. and Party CommitteeIame of Committee (Legislative Leadership, Legis/lltive CIIIlCUS, IIIfd Party Committees ONLY) Name of Treasurer .

Street Address Date Notice Received Fair Market Value

of Donation

City I State IZ iP Code Aggregate Donations

Description of Donation I Purpose of Expenditure (see instructions)

DADBDcDDDE

Name of Committee (Ugisllltive Leadership, Legislative CauClU. and Party Committees ONLl,) IName of Treasurer

Street Address

IDate Notice Received Fair Marke t Value

of Donation

City I State Zip Code Aggregate Donations

Description of Donation I Purpose of Expenditure (see instructions)

D A D B D c D D D EIame of Committee (Ugislative Leadership, Legislative CIUlClU, and Party Committees ONLy) Name of Treasurer

Street Address Date Notice Received Fair Marke t Valueof Donation

~ i t y I State I Zip Code

IAggregate Donations

Description of Donation Purpose of Expenditure (see instructions)

O A D B D c D D D E

Name of Committee (LegislDlive Leadership. Legislative CIUlCU8, and Party Committees ONLy) I Name of Treasurer

~ t r e e t Address

IDate Notice Received Fair Market Value

of Donation

~ i t y [ State Zip Code Aggregate Donations

Description of Donation IPurpose of Expenditure (see instruction.s)

DA D B D c O D D EIame of Committee (Legislative Leadership, LegisUuive CIUlCUS, IlIId Party Committees ONLY) Name of Treasur-er

tstreet Address Date Notice Received Fair Market Valoe

of Donation

[city I State I Zip Code

IAggregate Donations

Description of Donation Purpose of Expenditure (see instructions)

DA D B D c D D D E

Name of Committee (Legis/Jltive Leadership, LegisUuive Caucus, and Party Committees ONLl') I Name of Treasurer

Street Address Date Notice Received Fair Marke t Valueof Donation

[city I State I Zip Code Aggregate Donations

Description ofDonation /Purpose of Expenditure (see instructions)

D A D B D c D D D E

Name of Committee (Legislative Leadership, LegisUui)'e CIIIlCUS, and Party Committees ONLy) Name of Treasurer

Street Address Date Notice Received FairMarke t ValueofDonation

City I State IZip Code Aggregate Donations

Description of Donation IPurpose of Expenditure (see instructions)

DA D B D c D D D E

Total SediOD 0 (Enter totlll tm Line24o fS, Pud fpf



IV. EXPENDITURES Page 13of17

INAMEOFt.:(JMMII-I-tt;tt; IFILINGOHF. OATR

- P ; ~ . = , J f ' ; ) $ ~ , t : ' 1)A".t>_A _.

'/&/").611....--" --'P. r.o Paid by Committee

Name of Payee K!r-1£J3E6LE'( 6 A ~ pate of Payment Method of Payment Amount

IStreet Addre ssI City I S t i ~

\

Zi

D65135f?r 5 f2(Check # , , , ' ~

G } u \ M f J I P ~ UEW lJ4vEJJ DDebitCard

~ ; I ' ~ ~ IEvent #

PRN'T....

tAwAl .,-'IAIS

of Expenditure (if applicable): Candidate(s)Name Office Sought D SupportedCoordinated with reimbursement sought

(i fapplicable) D Opposed

CJ Coordinated without reimbursement soughto Independento Organization (see Instructions)

$D A ClB D c ClD D E

Name of Payee ? C41l/t;1dfllt'7l f):j'lCKlIJate 01 f'ayment IMethod of Payment Amount

IStreet Address l ~ ~ ~ Istate I Z i P " ~ ' 3 5EPr S rz(Check # to \VJ}, Pcll-c ME CT o Debit Card

l ~ o s e o I R ; ; ' ; ~ Event #

c . . J J ~ j . . ~ CJ\)J6e LMJJtJ+ CL?,4.vv? i i = E E ~ T i ~ o f ~ " (i fapplicable): Candidate(s) Name Office Sought gSupported

,. , "le

, with reimbursement sought(i fapplicable) oOpposed

-0'Coordinated without reimbursement sought

o Independento Organization (see Instructiona)

$ )10A D B D c O D D E

Name of Payee Date of Payment Method of Payment Amount

Street Address City \ State \ZiPCode DCheck#

DDebitCard

I Purpose 01

I(by

IEvent #

I T B ~ of Expenditure (if applicable):Candidate(s) Name Office Sought gSupported

Coordinated with reimbursement sought(i fapplicable) oOpposed

o Coordinated without reimbursement sought


$D A D B D c D D D E

Name of Payee [Date ot payment 'Method of Payment Amount

Street Address ,CityIstate IZiP Code

DCheck#

D Debit Card

~ ~ O I ....,,,, ~ . ; Event #

Tlr of Expenditure (i fapplicable):;)Name Office Sought DSupported

Coordinated with reimbursement sought(i fapplicable) DOpposed

D Coordinated without reimbursement sought

D IndependentD Organization (see Instructions)


Name of Payee bate of Payment Method of Payment Amount

IStreet Address ICity Istate IZiPCode D Check #D Debit Card

I ~ i o s e o t Event #

I T ~ ~ of Expenditure (i fapplicable):Candidate(s) Name Office Sought DSupported

Coordinated with reimbursement sought(i fapplicabk) DOpposed




SUBTOTAL Section p..This Page i ~ ' 3 a · o ~ TOTALof additional Section P Pa2es ~ ; : .

TOTAL OF ALL EXPENSES PAID BY COMMITTEE_ (Eltter totiIll1ll LiM190 / .., PIIge)



IV. EXPENDITURES Page 14 ofl7

INAMF. OF ("tlU\A"T""'EF. IF1UNG nrw nA'T'P.

F / ? I ~ $ " ,: ~ v l b & W ~ <1/';/ ::uJ"

Q. Campaip Expenses Paid by CandidateName of Payee ofVmdor who conditJatepaid directly) Date of Payment Is Reimbursement Claimed? Amount~ l r n d1J ~ A R .

<i In/26 11treet Address ~ i t y I SKS t i ' 1 ~ \ ) . . DYes

115, , ~ L f\ , \ , , ~ !J. R t ~ ~ · ' R o ~ lvt c.w 1..Ut-Purpose of Expenditure Description Event #

(by code) J\.-DTij t : . / U I t ~ ~ A . I \ ) l ~ " Name of Payee (Name ofVendor who candidate paid directly) Date of Payment Is Reimbursement Claimed? Amount~ ~ E " " 5

3 / 0 l / ~ 1treet Address City

rtC\ J Z o ~ ~ ~ ~ Cl Yes

t . . \ ~ O I t l \ l r r O ~ blU.va1 M>LrU- tJAv6J jiiitNo

1ft) 'l.Purpose of Expenditure Description Event #

(by code)A - ()1'M- T ~ F O ...o l > . A - ~ t ) . ~ w£'l...(;Name of Payee (Nameof Vendor who contlidatepaid directly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City Ilate IZiPcode Dyes

D N o

'1>iiij)Ose OiEXpenditure Description Event #(by code)

Name o[Payee (Name of Vendor who caiilllilaJe ptiiifillrectly) IDate Of Payment Is Reimbursement Claimed? Amount

Street Address City

rate ,Zi P Code DYes

Cl No

P u r p o s e Q f E x p e n l f i ~ e Descripticm Event #

(by code)

Name of Payee (Name of Vendor who condidatepaid directly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City Itate f Zip Code Dyes

D N o

Purpose of Expenditure Description Event #

(by code)

Name of Payee (Name of Vendor who candidate paid directly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City

rate IZip Code DYes

D N o


(by code)

N arne of Payee (Name ofVendor who candidatepaiddirectly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City rate JZip CodeDyes

DNo


(by code)

Name of Payee (Name of Vendor who candidatepaid directly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City

rate IZip Code DYes

Cl No

Purpose ofExpendilure Description Event #

(by code)

Name of Payee (Name ofVendor who clUldidote paid directly) Date of Payment Is Reimbursement Claimed? Amount

Street Address City rate IZip Code DYes

D N o


(by code)

SUBTOTAL Sedion Q-This Page I t t 6 ~ · 't6

TOTAL of additional Section Q Pages SOTOTAL OF ALLEXPENSES PAID BY CANDIDATE fElllei' totIII.#Line 26 td'Bi PtIB) 116C£" ct6



IV. EXPENDITURES Page 15 oft7

INAMP_ 01 " LUMM I .J:,.c, fFILING DUE.DA1'E.

1=Ia\etJ\), ff b \ \ ) \ ~ t , 5 ~ " ' " /6 I ).() ((

R. E x ~ n s e s Incurred on Committee Credit CardName ofIssuing Institution Type of Credit Canl:

o Visa o Master Card o Discover o American Express

o Other

Name of VendorDate of Transaction Amount

Street Address City I State r p cod e


(by code)

Name of Vendor Date of Transaction Amount

Street Address CityI State f P c od e

Purpose of Expenditure !Description Event #

(by code)


Street Address City

rate

i iPcode

P u r p ~ e of Expenditure jDescription Event #

(by code)


Street Address CityI State IZiP C()de

Purpose ofE.xpenditure Description Event #

(by code)


Street Address City [ State i iPcode


(by code)


Street AddressI City I State fP code


(by code)


Street Address CityI State IZiPCOde


(by code)


Street Address City [state i i P c od e


(by code)

SUBTOTAL Section R-This Page ioTOTAL of additional Sedion R Pages .-#0

- - - - .. - - -

TO'IALOF ALL,EXPENSES INI ' I IKKIUJ ON CO.lYliftJ.J. J . ~ E CREDIT CARD fEltterlotlll_LiIte 17018 PIIIlId $0



IV. EXPENDITURES Page 16 oft7

INAMROFCO'MMlJ 11'.1'. iFTT .INO nim. nATI:

Ff2IOJo$ of n4\A'O 8 I I K ~ y/, / :A.IJII

S. Expenses Incurred by Committee but Not Paid Durina this PeriodName of Creditor Date Incurred Amount Incurred

(Est.i.ttu1U or Actual)

Street Address Event #

City \sqre

rCOd

'

Candidate(s) Name (i fapplicalk) Office Sought

oSupported

OoPPosed

Purpose of Expenditure

(by code)T of Expenditure (i fapp/iCllhk):

Coordinated with reimbursement sought


o Independent

o Organization (see Inmuctions)OA 0 B Dc OD DE

Description

Name of Creditor Date Incurred Amount Incurred(EstintlJk or Actual)


City\ State IZiPCode Candidate(s) Name (i fappliCllbk) Office Sought

oSupported

OOpposed


(by code)Ttf< of Expenditure (i fapplicable):


o Coordinated without reimbursement soughto Independent

o Organization (see Instructions)OA DB Dc OD DE

Description

Name of Creditor Date Incurred Amount Incurred(EstintlJk or Actual)


CityI State r iP Code Candidate(s) Name (i fappliCllble) Office Sought

oSupported

C]opposed


(by code)T of Expenditure (i fapplicable):



o Independent

o Organization (see Instructions)O A DB Dc OD DE

Description

Name of Creditor Date Incurred Amount Incurred(EstillfQU or ActJlal)


City \Sqre IZiP Cod, Candidate(s) Name (i fapplicalk) Office Sought

o Supported

OoPPosed


(by code)Ttl< of Expenditure (i fapplicable):



o Independent

D Organization (see Inmuctions)O A DB Dc OD DE

Description

SUBTOTAL Section S-Tbis Paae 1tf

TOTAL of additional Section S Pa2es fJ¥TOTAL OF ALL EXPENSES INCURRED BY COMMITTEE DURING THIS PERIOD BUT NOT PAID

(Elltel't«lIl 011 Line 21 0 /SIUIIIItIIIY PtlpJ if)Previously reported Expenses Unpaid aDd still Outstanding + <j to

TOTAL OF ALL " , y u " ' ' ' ' ' ~ E S IN f ' l l l l l l l i . n BY C" .. IYIIYII I I . . . . I!. BUT·NOT PAID 1E1Il/!#' tDtIIl. 011 Line 28 .0( 'PIIN) 1G¥



IV. EXPENDITURES Page 17 ofl7

MAUl<' 0 .... ( 'II '- " ~ E IFILINGDUE DATE

~ £ U D S OF ' ] ; )4U' l ) ~ A - I f E / 2 - q/i,/j()1/

T. Itemization or Reimbursements to Committee Workers and ConsultantsLast Name ofWorker/Consultant IF;'" Date of Payment

Method of Payment

o Check #

Amount

$

Secondary Payee Purpose of Expenditure

(by code) o Debit Card

Street Address ICity IState Zip Code

Description

Ttf< of Expenditw-e (i fapplicabh):



o ndependent

o Organization (see Instructions)DA DB Dc DD DE

Candidate(s) Name Office Sought o Supported~ applicable) oOpposed

Last Name ofWorker/Consultant

IFi'"Date of Payment

Method of Payment

o Check #

Amount

$

Secondary Payee Purpose of Expenditure(by code) o Debit Card


Description

Ttf< of Expenditure (if applicable):



o Independent

o Organization (see Instructions)DADBD cDD DE

Candidate(s) Name Office Sought o Supported~ applicab/.e) oOpposed

Last Name ofWorker/ConsuJtant

1i'"Date of Payment

Method of Payment

o Check #

AmoWlt

S


(by code) o Debit Card


Description

TBe of Expenditure (if applicable):


D Coordinated without reimbursement sought

o Independent

o Organization (see Instructions)DA DR Dc DD DE

Candidate(s) Name Office Sought oSupported(i f applicable) oOpposed

Last Name ofWotkerfConsultant IFirst IWDate of Payment

Method of Payment

o Check #

Amount

$


(by code)

1Cl Debit Card

Street Address ICity State Zip Code

Description

of Expenditure (if applicablt!):



o Independent

o Organization (see Instructions)DADBDcDD DE

Candidate(s) Name Office Sought o Supported(i f applicable) oOpposed

SUBTOTAL Section T..This Paae

TOTALofadditional Section T Pages

TOTAL OF ALL REIMBUBSEMl!!NTS TO COMMITTEE WORKERS AND CONSULTANTS $0

Documents

David Baker Ward 13