SEECFORM20

Itemized Campaign Finance Disclosure Statement

CONNECfICUT STATE ELECfIONS ENFORCEMENT COMMISSION
Rev. 1/08
Do Not Mwk in This S!!8Ce Foc
Official Use Only
Pa;e 1 oft7
SUMMARY PAGE
1. NAME OF COMMITTEE

6F
"b+vlD
." ... -
2. TRltA.RTTR1i:R NA
Title First MI Last
:fou
3. TREASURER ADDRESS
Suffix
Street Address

IState
I
Zip Code
531 Q., bJ tJ.PlAL

cr

4. ELECTIONIREFERENDUM DATE S. OFFICE SOUGHT {Co"""tle onlv lfCMuli4llte Committed
6. DISTRICf NUMBER
AI' . ..........
(mm/ddIyyyy )
.A L 0 EI2tVf,(3N'
7. CANDIDATE NAME (CtllflPltle (11'
r .
G
Title

MI

ISufflX
-;;'::>AVI b


Ifl.TVPROIt'
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 Expenditure
045 days following election
DPrimary DElection
not held in November c....,


v
ft1 C) .:.:
.9. rI'.Kn.,u I..'IV ".KIM'
, r-- J
Beginning Date Ending Date
0
Q:.:.;
..
1>
-..:::-
.,
g/, Lloilll q I' I').CII
-

thru -
en
.r::
10.1.. :A.TION
I hereby certify and state, under penalties of false that all of the infonnation set forth on this Itemized Campaign Finance
Disclosure Statement for the period covered is true, accurate and complete.

- -RjitoOCl
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 20
Itemized Campaign Finance Disclosure Statement
CONNECTICUT STATE ELECfIONS ENFORCEMENT COMMISSION
Rev. 1108 Page 2 of 17
SUMMARY PAGE
TOTALS
NAME Of ,............ 6""""'TEE
FILING DUE DATE

,,1= -r:>4V/f.) BAJ,<1't. q /(;/ J.fJI'
COLUMNA
This Period
COLUMNB
Ag2fegate
11. Balance on hand January 1 of current year for Ongoing and Party Committees OR
Balance on hand from day Committee was formed for all other committees
12. Balance on hand at the ofR rKJI UIl!! Period

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)

16a. Total Small Food and Beverage Receipts at Fair (Section L1) Town Committees ONLY

16b. Total Proceeds from Small Purchases at Tag Sales, Auctions or Other Sales (Section L2)
tr= -'c
Municipal muI Town
16c. 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
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)
if
22. In-Kind Contributions Received (Section M)

23. Refundable Deposit to Telephone Company (Section N)
<l'
....
24. Receipts of Organization Expenditures (Section 0)
$kr
25. Beginning Loan Balance ttr
25a. + Loans Received (Section D) 4u
25b. + Interest and Penalties on Loan

25c.
-
Payments on Loan {V
25d. Total Outstanding Loan Amount i9
26. Campaign Expenses Paid by Candidate (Section Q)
.'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

CJ/&/ UIC
A. Total Contributions from Small Contributors-Received this Period ONL Y
$

100
.(See instructionsfor definition Q{Smali Contributor) Subtotal Section.A
B. Itemized Contributions from Individuals
Last Name

First ALEx
IMI
Principal Occupation
Amount of
Contribution
Residential Street Address


Name of Employer

SVMPl r[ 5'TIlet:r
"l.}Jr
Is contributor a lobbyist. spouse, DYes Ifcontribution is in excess of $400 to a candidate committee for a chief executive officer of a
or dependent child of a lobbyist? iii No municipality does contributor or business helshe is associated with have a contract with said
1)50
municipality 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? DYes
fundraising event listed in Section Ll ? I[ No Jfyes, indicate which branch or branches ,at No
Jfyes, 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 ':).0\ \ .
1Aggregate contributions
Last Name C. 41
First
IMI
Principal Occupation
Amount of
"\ CAeot..'l'JJ

Contribution
Residential Street Address City
ISet
FiPCode
Name of Employer

AlBv
tJAlIAI.I

Is contributor a lobbyist, spouse. D Yes Ifcontribution 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

municipality 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? Dyes
fundraising event listed in Section Ll ? I( No
Jfyes, indicate which branch or branches Jil""No
Jfyes, list Event # of government the contract 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
IMI
Principal Occupation
Amount or
MU-Sa.'t'IISf'(l
TELL!? Contribution
Residential Street Address

ISa
Name of Employer

,UNtetJ 6UiLHeo
bVIL,::otb S4u,.LJE6

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.O municipality 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? DYes
fundraising 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

IMI
Principal Occupation
Amount of
'OtcN
"'
Contribution
lResidential Street Address

Fer
FiPCOde
Name of Employer
Sll 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

municipality 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? DYes
fundraising event listed in Section Ll ? i(No Jfyes, indicate which branch or branches Slf'No
Jfyes, list Event # of government the contract is with: D Executive D Legislative
Me1hod of contribution: IDate Received
IAggregate contributions
oCash iii Personal Check D CreditlDebit Card D Payroll Deduction D Money Order AU IT "
SUBTOTAL Section B-This Page
\\45
TOTAL of additional Seetion B Pages

TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS (Sedions A & B) (pnter tot'" 011 LUte 13 ofSi P.-eJ
1.
"a'
I. MONETARY RECEIPTS
Section B. Additional Pa2e
T\rAUJ; ()J; (,,()UUrrn<'J; IJ;ItThIO nlTJ; n A'l'I<'.
B. Itemized Contributions from Individuals
Last Name f'irst
IMI
Principal Occupation
Amount of
I<taSllN
Contribution
Residential Street Address


Name of Employer
C)t.t


PtJ13L
J
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? 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 with a DYes Is contributor a principal of a state contractor or prospective state contractor? Dyes
fundraising event listed in Section L 1 ? ti. No Ifyes, indicate which branch or branches .&:.No
Ifyes, 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 first '\f0+1\1
IMI
Principal Occupation
Amount of
.At1A4 UE"'nAlc,
Contribution


ISZ;' F
iP
06
d
S,S
Name of Employer


o;J1,..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

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 L1 ? aitNo Ifyes, indicate which branch or branches
Ifyes, 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't
Last Name
M
)(e1t first
IMI
Principal Occupation
Amount or
'b&A'D JG4-1e""
P/to/'S
j?",JJue-'<.
Contribution
Residential Street Address r--ity
IState
Fi
P
O
&S(3
Name of Employer
Qfl
IJIU 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
$150
municipality 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? Dyes
fundraising event listed in Section L 1 ? No Ifyes, indicate which branch or branches )<No
Ifyes, 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

Principal Occupation
AmolDltof

Contribution
Residential Street Address

rs
tate

Name of Employer
61
e-, Ntilu
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? a No municipality does contributor or business he/she is associated with have a contract with said
t,OO
municipality valued at more than $5,000? DYes o No
Is this contribution with a DYes Is contributor a principal of a state contractor or prospective state contractor? DYes
fundraising event listed in Section L 1 ? IJl No Ifyes, indicate which branch or branches Jiiit.No
Ifyes, 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 it
Last
First JOiN IMI
Principal Occupation
Amount or

Contribution
Residential Street Address r--ity

Name of Employer
Alflu

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
$
municipality 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? DYes
ftmdraising event listed in Section L1 ? ilNo Ifyes, indicate which branch or branches RNo
Ifyes, 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'lO
Page

or
':l.
I. MONETARY RECEIPTS (Sections A-K)
Page 4 of17
[NAME OF I 11".... iFILINa DUE OATR
tJF ?>AulD BOKeTZ.
"I, /
It
.
Ct. Contributions from Other Committees
Name of Committee
IName of Treasurer
IAddress
I 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.
Address
I Is this contribution associated with a 0 Yes Ify..,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...,,,,,,,
Address
this contribution associated with. 0 Yes fly..,list
Amount of Contribution
fundraising event listed in Section Ll? 0 No Event #
City Statc Zip Code Date Received Aggregate Contributions
Name ofCommittee
IName of Treasurec
Address
lis this contribution associated with a 0 Yes Ifyes. list
AJnount of Contribution
fundraising event listed in Section Ll? 0 No Event #
City State Zip Code Date Received Aggregate Contributions
Name of Committee
IN.me ofT"""mtt
Address
If
S
this contribution associated with a 0 Yes llyes. list
AJnount ofContribution
fundraising event listed in Section Ll? 0 No Event #
City State Zip Code Date Received Aggregate Contributions
Name of Committee
IN.m, om."...",
Address
lIS this contribution associated with a 0 Yes Ifyes, list
AJnount of Contribution
fundraising event listed in Section Ll? 0 No Event #
City State Zip C.ode Date Received Aggregate Contributions
C1 ..... L ..L n .L
or C'.
. 1.
...... !L
.
f'mm Cl
..L
Name of Committee
Name of Treasurer
Address Date Received
AJnount of Receipt
rity
State
riPCode CJ Reimbursement for shared expense o Surplus
o Payment for goods and services Distribution
Name of Committee
Name of Treasurer
Address Date Received
AJnount of Receipt
City State
I Zip Code o Reimbursement for shared expense o Surplus
o Payment for goods and services Distribution
SUBTOTAL Section C ..This Page
$0
TOTAL ofadditional Section C Pages

0 ,
TOTAl ,OF AI.'",.;UIWIIWIII I ........ . I fEllttIr IntIJI. nil 1._14 of.... paft)
"to
L MONETARY RECEIPTS (Sections A-K)

IlITAUP.OPLUMMlIlr.,r., IFILING DUE DATE
iJF %),.4'" t:> 15",A.KYZ..

D. Loans Received this Period
Name of Lender
Source of Loan: Is there a Cosigner
Amount Received
or Guarantor of
Street Address
Fity
State
IZiPCOde
DBank D Candidate this loan?
DYes (ifyes list
Name of Cosigner/Guarantor
name and address of
IJ Individual IJ Other
Cosigner/Guarantor)
Committee
DNo
Address
r"
State
IZiPCode
Date of Receipt
Name of Lender Soun:e of Loan:
Is there a Cosigner
Amount Received
or Guarantor of
Street Address
Fity
r
tate
IZiPCode
D Bank D Candidate
this loan?
DYes (ifyes list
Name of Cosigner IGuarantot
Cl Individual D Other
name and address of
Cosigner/Guarantor)
Committee o No
Street Address
r"Y
State
IZiPCOde
Date of Receipt
Total Section D sO
00
E. Receipts from Entities other than Individuals or Other Committees tReferetuilult Collllllittees 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.
00
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 Ifyes, 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. Y
,""
r
ONLYJ
Date of Receipt Date of Receipt
Total Transrers
Amount Amount
S0"'0
u. .1 Funds of the Candidat Received this Period In

C :-'aONLl?
Total
Method of payment: Method ofpayment: Amount Received
Date of Receipt
Date of Receipt
D Cash D Cash
D Personal Check D Personal Check
Amount o CreditlDebit Card Amount
D CreditIDebit Card
$ 0,0
0
L MONETARY RECEIPTS (Sections A-K)
INAME OF iFlLING DUE DATE
(J'::'
q/"/:U;I
I. Anonymous dolItIr tIIfIOIUIt oftAe bills 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 IIOts
Date Received
I Amount
Date Received Amount
Total
Amount Received
$
Name of Institution Name of Institution
Street Address Street Address
City
I State IZiPCode
City
I State
IZiP Code
K. MisteDaneous Monetary Receipts not Considered Contributions
Name Date of Transaction
Amount Received.
$
Street Address
I
ISw, IZip Cod,
Description
Name Date of Transaction
Amount Received.
$
Street Address
I City
Ismre
IZip Co""
Description
Name Date of Transaction
Amount Received
$
Street Address
I Crty
IStare IZip Cod<
Description
Total Section K
$
0
Summary of Other 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"

Total Amount Transferred from Affiliated Business Treasury (Section F) + .)
o ..
Total Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Section G) +


o ..)
Total Amount ofPersonal 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 tdtal OIl Line 15oJSulfllfUll'y Page)
$ C
II. FUNDRAISING EVENT ACTIVITY Page 7 oft7
INAME OF COMMrr:EE FILING DUE DATE

"1>A\I,1':)
8Atrm
'1/&/
LI. Fundraiser Event Information
}4undraising Event #
Description
Location: Street Address City State Zip Code
Date 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.)
DNo
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 $50'1 Donated Items.)
DNo
Subpatt 2: (Town Committees tIIId Municipal CandUlllte Committees ONLy)
Were there purchases of advertising space in a program book associated DYes (llyes, go to Section L3 Purchases of Advertising Space in a Program Book
with this fundraiser? and complete required information.)
o No
I Subpart J: (l'own Committees ONLy)
o Yes (/fyes, enter Total Receipts from smaR pUKhases 1$
I
Did 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 Code
Date of Fundraiser
Subpart 1: (AU Committees)
Was this fundraising event hosted at a personal residence? DYes (/fyes, go to Section lA In-kind Donations not 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 required information.)
ONo
Was 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 $50?
0
Donated Items.)
Subpart 2: (l'OWII Committees and Municipal Candidate Committees ONLy)
Were there purchases of advertising space in a program book associated DYes (llyes, go to Section L3 Purchases ofAdvertisJng Space in a Program Book
with this fundraiser? and complete required infonnation.)
o No
Subpart 3: (l'own Committees ONLy)
o Yes (Ifyes, enter Total Receipts from smaR purchases 1$
I
Did 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!S ONLy) Total Receipt ... ThIs Page
TOTAL of additional Secdoo Lt Pages +
TOTAL OF ALL RECEIPTS FROM SECTION Ll (Elitei' tlllill OR Lille 1611 ofS"""".., PIIp)
10
Cc)
IL FUNDRAISING EVENT ACTIVITY Page 8 of17
INAME OF cr" n""1'EF IFILING DUE DATE n

tiP: JVr'D B41<Yl. I
L2. Proceeds from Tal Sale, Auction, or Other Sale of Donated Items
!Name of Purchaser
Last Name
I First
IMI
Method of payment: Aggregate
(Individuals ONLy)
[leash [l Personal Check CJ Credit/Debit Card Antountof
Residential Street Address

IState IZiPCode
Date Received
rEvent#
Purchases
Items Purchased
Name ofPurchaser
Last Name
(IndividJlals ONLy)
Residential Street Address
Items Purchased
Name of Purchaser
Last Name
(IndividJlals ONLy)
Residential Street Address
Items Purchased
lName of Purchaser
Last Name
(Individuals ONL I)
Residential Street Address
Items Purchased
Name of Purchaser
Last Name
(Individuals ONLy)
Residential Street Address
Items Purchased
Name of Purchaser
Last Name
(Individuals ONLl)
Residential Street Address
rty
Fity

iit
y

IFirst
IFirst
IFirst
IFirst
IFirst
Istate
Istate
Istate
r
tate
IState
IMI
IZi
P
Code
1M!
rZiPCode
r
MI
IZiPcode
IMI
Code
, MI

Method of payment:
[] Cash [] Personal Check [] Credit/Debit Card
Date Received
IEvent #
Method of payment:
DCash [] Personal Check CJ Credit/Debit Card
Date Received
I Event #
Method of payment:
CJ Cash CJ Personal Check [] Credit/Debit Card
Date Received
IEvent #
Method of payment:
[] Cash [] Personal Check [] CreditlDebit Card
Date Received
I Event #
Method of payment:
[] Cash [] Personal Check o Credit/Debit Card
Date Received
IEvent #
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: I First
(Individuals ONLy)
[] Cash [] Personal Check [] CreditJDebit Card
Residential Street Address tate Date Received
IZiPcode IEvent #
Items Purchased
Name of Purchaser Last Name
Fity
r
Method of payment: I First
(IndividJlals ONLy)
[] Cash [] Personal Check D CreditJDebit Card
Residential Street Address Date Received
IState IZiPcode IEvent #
Items Purchased

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 ITEMS
IEIltI!r t1mt LiIM l6IJ sf,....P..l!l
Aggregate
Amount of
Purchases
Aggregate
Amount of
Purdlases
Aggregate
Amount of
Purdtases
Aggregate
Amount of
Purchases
Aggregate
Amount of
Purdlases
Aggregate
Amount of
Purchases
Aggregate
Amount of
Purchases
Aggregate
Amount of
Purchases
0.
0
$0
D. FUNDRAISING EVENT ACTIVITY Page 9 of17



FILTNll TV mnAIT

LJ. Purchases of Advertisio2 in a Pro2ram Book 11:'
o
-- CtDuli4tIte tIIUl Town CtnnInittea ONL})
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
Date Received Aggregate Purchases
for All Events
AmountoC
Purchase
Street Address

IState
IZip Cod<
Event #
Name ofPmchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Purchase
Street Address
ICity IState IZip Code
Event #
Name of Purchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Punhase
Street Address

,"tare
IZipCod<
Event #
Name of Purchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Punhase
Street Address

ISla"
IZip Cod<
Event #
Name of Purchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Purchase
Street Address

ria"
IZip Cod, Event #
Name of Purchaser
Business
Entity
Dyes
DNo
Date Received Aggregate Purchases
for All Events
Amount oC
Purchase
Street Address

IS'"
IZip Cod, Event #
Name of Purchaser
Business
Entity
Cl Yes
DNo
Date Received Aggregate Pmchases
for All Events
AmountoC
Purchase
Street Address

IState
IZip Code
Event #
Name of Purchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Purchase
Street Address
I"tat,
r
pCod
'
Event #
Name of Purchaser
Business
Entity
Dyes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Purchase
Street Address
ISlat<
IZip Cod<
Event #
Name of Purchaser
Business
Entity
DYes
DNo
Date Received Aggregate Purchases
for AU Events
AmountoC
Purchase
Street Address
r"
I"tat,
IZip Cod, Event #
Name of Purchaser
Business
Entity
Dyes
DNo
Date Received Aggregate Purchases
for All Events
AmountoC
Punhase
Street Address

I"lal<
IZip Code
Event #
SUBTOTAL Section Ll-This Page
TOTAL of additional Sedion l...l Pages
TOTAL OFALL PURCHASES OF ADVERnsING IN APROGRAM BOOK(Enter totIII Oil Line 16c 0/SIIIIIIIMIIY Pee)

IT. FUNDRAISING EVENT ACTMTY Page 10 oft7
FILING DUE DATE
tIff, / FtaeNDS
(F"
'l>A"ID BM'ttt2...
L4. In-Kind Donations Not Considered Contributions
Name of Donor
Street Address UW Zip Code
ICily
r
Description ofdonation Date Received
Name of Donor
Street AaaTess laW Zip Code
ICily
r
Description of donation Date Received
Name of Donor
Street Address Zip Code
rly
1'''''
Date Received
Name of Donor
Description of donation
Street Address
r
laW Zip Code
ICily
Date Received
Name of Donor
Street Address
Description of donation
Zip Code
ICily
1"1a"
Description of donation Date Received.
Name of Donor
Street Address Zip Code
rOy
ria"
Description of donation Date Received
Name of Donor
Street Address Zip Code
ICily
I"lato
Date Received
Name of Donor
Street Address lato
Description of donation
Zip Code
I City
r
Description 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 ttIl on Line 21 PlII!e) io
Donation oIndividual Fair Market
given by: o Business Entity Value of Donation
Aggregate value for this event
Event #
Donation o Individual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Donation oIndividual Fair Market
Value of Donation given by: o Business Entity
Aggregate value for this event
Event #
Ill. NONMONETARY RECEIPTS Page 11 oft7
INAME OF COMMI'ITEE FILING DUE DATE
6F l'.l4V1D 1S4K"e7L c,/r;L
M. In-Kind Contributions
Name
Type of Contributor:
[J Individual
D
Committee
D
Other (Applicable only to Referendum Committees)
Fair Market
Value of this
Contribution Street Address
lCity fState
Zip Code
Is contributor a lobbyist, spouse, D Yes
or dependent child of a lobbyist? D 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? Dyes 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
I
Type of Contributor:
0
Individual
D
Committee
D
Other (Applicable only to Referendum Committees)
Fair Market
Value orthJs
Contribution Street Address
r
ity
State
Zip Code
Is contributor a lobbyist, spouse, D Yes
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 does contributor or business he/she is associated with have a contract with said
municipality valued at more than $5,000? DYes DNo
Date Received
Is this contribution with a DYes
fundraising event listed in Section LI ? D No
Jfyea, list Event #
Description of In-Kind Contribution
Aggregate contributIOns
Name
Type of Contributor:
D
Individual
D
Committee
CJ
Other (Applicable only to Referendum Committees)
Fair Market
Value of this
Contribution Street Address
r
ity
State I
Zip Code
Is contributor a lobbyist. spouse, D Yes
or dependent child of a lobbyist? D 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? DYes DNo
Date Received
Is 1his contribution associated wi1h a DYes
fundraising event listed in Section Ll ? CJ No
/fyea, list Event #
Description of In-Kind Aggregate contributIons
Name
Type of Contributor:
D
Individual
D
Committee
D
Other (,4pplicable only to Referendum Committees)
Fair Market
Valueofthb
Contribution Street Address
ICity
Zip Code
Is contributor a lobbyist, spouse, CJ Yes
or dependent child of a lobbyist? D 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? DYes DNo
Date Received
Is this contribution associated with a DYes
fundraising event listed in Section Ll ? D No
/fyea, list Event #
Description of In-Kind Contribution Aggregate contributions
Name
Type of Contributor:
D
Individual
D
Committee
D
Other (Applicable only to Referendum Committees)
Fair Market
Value of this
Contrlbudoo Street Address
ICity
\State
Zip Code
Is contributor a lobbyist, spouse, D Yes
or dependent child of a lobbyist? D 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? DYes DNo
Date Received
Is this contribution associated with a DYes
fundraising event listed in Section Ll ?
D
No
Ifyea, 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 toltll on LiM22 ofS PtIIle) $D
N. Refundable Deposit to Telepbone Company
(NOTE: TIt;. stim'.l1l'i 0IJ(y to .""CMof by ilUlivillwhfrom
penonal ftIIUIs to btrneJil 1M . 1UJt IItIJde by tJae COIffIIIitta),
Lalit Name ofTndividual first
IMI
Date Deposit Made Amount of
Deposit
Residential Street Address City
(state Code
Name of telephone company
Street Address

IState IZi
P
Code
Total Section N (Ellter totlll 011 Line 23 of,'" Page)
fb
IlL NONMONETARY RECEIPTS Page 12 of17
INAME OF COMMiTTE..... lFILINO DUE DATE

11= 1J4K81....
O. Non-Monetary Receipts of Organization Expenditures Made By
Le2islative Leadershio. Le2islative Caucus. and Party Committee
I Name 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 IZiP 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
I
Date Notice Received
Fair Market Value
of Donation
City
I State Zip Code
Aggregate Donations
Description of Donation
I Purpose of Expenditure (see instructions)
DA DB Dc DD DE
I Name of Committee (Ugislative Leadership, Legislative CIUlClU, and Party Committees ONLy) Name of Treasurer
Street Address Date Notice Received
Fair Market Value
of Donation

I State I Zip Code
I
Aggregate Donations
Description of Donation Purpose of Expenditure (see instructions)
OA DB Dc DD DE
Name of Committee (LegislDlive Leadership. Legislative CIUlCU8, and Party Committees ONLy) I Name of Treasurer
Address
I
Date Notice Received
Fair Market Value
of Donation

[ State Zip Code
Aggregate Donations
Description of Donation
IPurpose of Expenditure (see instruction.s)
DA DB Dc OD DE
I Name 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
I
Aggregate Donations
Description of Donation
Purpose of Expenditure (see instructions)
DA DB Dc DD DE
Name of Committee (Legis/Jltive Leadership, LegisUuive Caucus, and Party Committees ONLl') I Name of Treasurer
Street Address Date Notice Received
Fair Market Value
of Donation
[city
I State I Zip Code
Aggregate Donations
Description of Donation
/Purpose of Expenditure (see instructions)
DA DB Dc DD DE
Name of Committee (Legislative Leadership, LegisUui)'e CIIIlCUS, and Party Committees ONLy) Name of Treasurer
Street Address Date Notice Received
Fair Market Value
of Donation
City
I State IZip Code
Aggregate Donations
Description of Donation
IPurpose of Expenditure (see instructions)
DA DB Dc DD DE
Total SediOD 0 (Enter totlll tm Line24 ofS, Pud
fpf
IV. EXPENDITURES Page 13of17
INAMEOFt.:(JMMII-I-tt;tt; IFILING OHF. OATR
$
1)A".t>
_A _.
'/&/").611 ,....--"
--'
P. r.o
Paid by Committee
Name of Payee K!r-1
J3E6LE'(
pate of Payment Method of Payment Amount
IStreet Address
I City

\
Zi
D6513
5f?r 5
f2(Check #
UEW lJ4vEJJ
DDebitCard


I Event #
PRN'T
....
tAwAl
.,-'IAIS
of Expenditure (if applicable):
Candidate(s) Name Office Sought
D Supported
Coordinated with reimbursement sought
(if applicable)
D Opposed
CJ Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
$

DA ClB Dc ClD DE
Name of Payee ? C41l/t;1
d
fllt'7l
f):j'lCK
lIJate 01 f'ayment I Method of Payment Amount
IStreet Address

Istate

5EPr
S
rz(Check # to \
VJ}, 'Pcll-c ME CT
o Debit Card


Event #
T
CJ\)J6e LMJJtJ+ CL?,4.vv? i

" (if applicable):
Candidate(s) Name Office Sought
gSupported
,., "le
, with reimbursement sought
(if applicable)
oOpposed
-0' Coordinated without reimbursement sought
o Independent
o Organization (see Instructiona)
$
)10
DA DB Dc OD DE
Name of Payee Date of Payment Method of Payment Amount
Street Address City
\ State \ZiPCode
DCheck#
DDebitCard
I Purpose 01
I(by
I Event #
of Expenditure (if applicable):
Candidate(s) Name Office Sought
gSupported
Coordinated with reimbursement sought
(if applicable)
oOpposed
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructiona)
$
DA DB Dc DD DE
Name of Payee [Date ot payment ' Method of Payment Amount
Street Address ,City
Istate IZiP Code
DCheck#
D Debit Card

....,,,,
Event #
Tlr of Expenditure (if applicable):
;)Name Office Sought
DSupported
Coordinated with reimbursement sought
(if applicable)
DOpposed
D Coordinated without reimbursement sought
D Independent
D Organization (see Instructions)
$
DA DB Dc DD DE
Name of Payee bate of Payment Method of Payment Amount
IStreet Address ICity
Istate IZiP Code
D Check #
D Debit Card

Event #
of Expenditure (ifapplicable):
Candidate(s) Name Office Sought
DSupported
Coordinated with reimbursement sought
(if applicabk)
DOpposed
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructiona)
$
DA DB Dc DD DE
SUBTOTAL Section p..This Page
i
TOTAL of additional Section P Pa2es

TOTAL OF ALL EXPENSES PAID BY COMMITTEE_(Eltter totiIll1ll LiM 19 0/ .., PIIge)

IV. EXPENDITURES Page 14 ofl7
INAMF. OF ("tlU\A"T""'EF. IF1UNG nrw nA'T'P.

",:

<1/';/::uJ"
Q. Campaip Expenses Paid by Candidate
Name of Payee of Vmdor who conditJate paid directly) Date of Payment
Is Reimbursement Claimed? Amount
d1J
<i In/26
11
Street Address

ISKS
DYes
115,
!J. lvt c.w 1..Ut-

Purpose of Expenditure
Description Event #
(by code) J\.-DTij

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


Street Address City
rtC\

Cl Yes
blU.va1
M>LrU- tJAv6J
jiiitNo
1ft) I 'l.
. Purpose of Expenditure
Description Event #
(by code) A - ()1'M-
...o w'l...(;
Name ofPayee (Name of Vendor who contlidate paid directly) Date of Payment
Is Reimbursement Claimed? Amount
Street Address City
ISlate IZiPcode
Dyes
DNo
'1>iiij)Ose OiEXpenditure Description Event #
(by code)
Name o[Payee (Name of Vendor who caiilllilaJe ptiiifillrectly) IDate OfPayment
Is Reimbursement Claimed? Amount
Street Address City
r
tate
,ZiP Code
DYes
Cl No
Descripticm Event #
(by code)
Name of Payee (Name of Vendor who condidate paid directly) Date of Payment
Is Reimbursement Claimed? Amount
Street Address City
IState f Zip Code
Dyes
DNo
Purpose of Expenditure Description Event #
(by code)
Name of Payee (Name of Vendor who candidatepaid directly) Date of Payment
Is Reimbursement Claimed?
Amount
Street Address
City
r
tate
IZip Code
DYes
DNo
Purpose ofExpenditure Description Event #
(by code)
N arne of Payee (Name of Vendor who candidatepaid directly) Date of Payment
Is Reimbursement Claimed? Amount
Street Address City
r
tate
JZip Code
Dyes
DNo
Purpose of Expenditure Description Event #
(by code)
Name of Payee (Name of Vendor who candidatepaid directly) Date of Payment
Is Reimbursement Claimed? Amount
Street Address City
r
tate
IZip Code
DYes
Cl No
Purpose ofExpendilure Description
Event #
(by code)
Name of Payee (Name of Vendor who clUldidote paid directly) Date of Payment
Is Reimbursement Claimed? Amount
Street Address City
r
tate
IZip Code
DYes
DNo
Purpose of Expenditure Description Event #
(by code)
SUBTOTAL Sedion Q-This Page 't6
TOTAL of additional Section Q Pages SO
TOTAL OFALLEXPENSES PAID BY CANDIDATE fElllei' totIII.# Line 26td'Bi PtIB) 116C" ct6
IV. EXPENDITURES
Page 15 oft7
INAMP_ 01" LUMM I .J:,.c,
fFILING DUE.DA1'E.
1=Ia\ etJ\),
ff


/6 I ).() ((
R. Incurred on Committee Credit Card
Name ofIssuing Institution
Type of Credit Canl:
o Visa o Master Card o Discover oAmerican Express
o Other
Name of Vendor
Date of Transaction
Amount
Street Address City
I State rpcode
Purpose of Expenditure
Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
I State
fPcode
Purpose of Expenditure
!Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
r
tate
iiPcode
of Expenditure
jDescription Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
I State IZiP C()de
Purpose ofE.xpenditure
Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
[ State iiPcode
Purpose of Expenditure
!Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address
I City
I State fPcode
Purpose of Expenditure
Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
I State IZiPCOde
Purpose of Expenditure
Description Event #
(by code)
Name of Vendor
Date of Transaction
Amount
Street Address City
[state iiPcode
Purpose of Expenditure
!Description Event #
(by code)
SUBTOTAL Section R-This Page
io
TOTAL of additional Sedion R Pages
.-#0
- - - - .. - - -
TO'IALOF ALL,EXPENSES INI'IIKKIUJ ON CO.lYliftJ.J. 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

y/, / :A.IJII
S. Expenses Incurred by Committee but Not Paid Durina this Period
Name of Creditor Date Incurred
Amount Incurred
(Est.i.ttu1U or Actual)
Street Address Event #
City
\sqre
r
pCOd
'
Candidate(s) Name (if applicalk) Office Sought
oSupported
OoPPosed
Purpose of Expenditure
(by code)
of Expenditure (if app/iCllhk):
Coordinated with reimbursement sought
o Coordinated without 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)
Street Address Event #
City
\ State
IZiPCode
Candidate(s) Name (if appliCllbk) Office Sought
oSupported
OOpposed
Purpose of Expenditure
(by code)
Ttf< of Expenditure (if applicable):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA DB Dc OD DE
Description
Name of Creditor Date Incurred
Amount Incurred
(EstintlJk or Actual)
Street Address Event #
City
I State
riP Code
Candidate(s) Name (if appliCllble) Office Sought
oSupported
C]opposed
Purpose of Expenditure
(by code)
of Expenditure (if applicable):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
OA DB Dc OD DE
Description
Name of Creditor Date Incurred
Amount Incurred
(EstillfQU or ActJlal)
Street Address Event #
City
\Sqre
IZiP Cod,
Candidate(s) Name (if applicalk) Office Sought
oSupported
OoPPosed
Purpose of Expenditure
(by code)
Ttl< of Expenditure (if applicable):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
D Organization (see Inmuctions)
OA 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'tlIl 011 Line 21 0/SIUIIIItIIIY PtlpJ
if)
Previously reported Expenses Unpaid aDd still Outstanding
+ <j to
TOTAL OF ALL INf'llllllli.n BY C"..IYIIYII I I. ...I!. BUTNOT PAID 1E1Il/!#' tDtIIl. 011 Line 28. 0( 'PIIN)
1G
IV. EXPENDITURES Page 17 ofl7
MAUl<' 0 .... ('II'-
IFILING DUE DATE
OF
'];)4U'l)

q/i,/j()1/
T. Itemization or Reimbursements to Committee Workers and Consultants
Last Name ofWorker/Consultant
IF;'"

Date of Payment
Method of Payment
oCheck #
Amount
$
Secondary Payee Purpose of Expenditure
(by code)
oDebit Card
Street Address
ICity
IState
Zip Code
Description
Ttf< of Expenditw-e (if applicabh):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
DA DB Dc DD DE
Candidate(s) Name
Office Sought
oSupported
applicable)
oOpposed
Last Name ofWorker/Consultant
IFi'"

Date of Payment
Method of Payment
oCheck #
Amount
$
Secondary Payee Purpose of Expenditure
(by code)
oDebit Card
Street Address
ICity
IState
Zip Code
Description
Ttf< of Expenditure (if applicable):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
DADBDcDD DE
Candidate(s) Name Office Sought
oSupported
applicab/.e)
oOpposed
Last Name ofWorker/ConsuJtant
1Fi'"

Date of Payment
Method of Payment
oCheck #
AmoWlt
S
Secondary Payee Purpose of Expenditure
(by code)
oDebit Card
Street Address
ICity
IState
Zip Code
Description
TBe of Expenditure (if applicable):
Coordinated with reimbursement sought
D Coordinated without reimbursement sought
o Independent
oOrganization (see Instructions)
DA DR Dc DD DE
Candidate(s) Name Office Sought
oSupported
(if applicable)
oOpposed
Last Name ofWotkerfConsultant
IFirst
IW
Date of Payment
Method of Payment
oCheck #
Amount
$
Secondary Payee Purpose of Expenditure
(by code)
1
Cl Debit Card
Street Address
ICity
State
Zip Code
Description
of Expenditure (if applicablt!):
Coordinated with reimbursement sought
o Coordinated without reimbursement sought
o Independent
o Organization (see Instructions)
DADBDcDD DE
Candidate(s) Name Office Sought
oSupported
(if applicable)
oOpposed
SUBTOTAL Section T..This Paae
TOTAL of additional Section T Pages
TOTAL OF ALL REIMBUBSEMl!!NTS TO COMMITTEE WORKERS AND CONSULTANTS
$0