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COPY RECE
DN|E ,/ TIME:'4
TOWN
STJMMARYPAGE
.
NAIIE OF Cr}Nf]\TITTEE
Ldt
Sultx
Jeffrey
3. TREASTIRM.ADDRESS
Stleet .+(xEes
M
Crt]
Coe
State
80 Washington Ave.
.I.
Seymour
S
OIIFTCE SOTJGTIY {Comblat onlv if Ctndirl*e Committeel
CT
6. DISTRICTI\'LqIBER
06483
ELECTIONIREFRENDTAI DATE
inlr'dd}f})j
11t08t2011
T.
First Selectman
ottlv
il
Trde
\fl
Lmt
iuttir
Paul
P Ta-pln ftF ESrLtIlT .lalaL
Roy
fka rl;v\
f.i
Januaq' l0
liling
{ f
f,
O^Ll')
tcr
dal's lbllorving
retbrendun .f
Arnerdment
l0
tiling tiling
T1-pe.f Report:
f'
October l0
i*
Terminatioa
On\)
?r-#;;;."-
J5
o DI'Bf(lTt arffir?iuDft
Begrnning Date
Ending Date
a7rc1tz0fi
thnr
09/30/2011
IO. CIIRTTF"ICTITION
herebl' certih ancl state" under penalties of talse statement. that all of the intbrmation set tbrth on this ltemized Cnmpaign Finance
Disclosure Statement tbr tlre period cor-ered is true. accruate and complete.
lonilz0ll.
D.{TE (mm
dd,lll
TO EXCEED
SEAC FORJ}I20
Itcm ized Crmpaign Flnance Disclosurc Statcm cnt
CONNECTICUT STATE ELECTIONS ENX'ORCEIIENT COMMISSION
Rev.
l/0l$
Page 2 of
l?
F,i
COLUMN A
Thic Ptriffl
COLUMN B
AEsresate $0.00
l.
Balanee on hand Januan- I of current 1 ear frrr Ongoing and Pag" Committees OR Balanc.e on haod Aom dal Committee nas ibnned lbr all other committees
12. Balance on hand at the beeinnhs of Reoortinc Period 13. Contributions received t-rom Individuals (Sections A and B) 14- Receiots from Other Commiftees (Sections Cl and C2) 15. Othor Monetan Receipts lSections D-K)
$0.00 $0.00 $0.00 $0.00 $6,631.00 $0.00 $103.00 $o.oo $388.00 $0.00 $7,122.00 $7,122.00 $2,908.00 $4,214.00 $822.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $187.00 $0.00
Ll
) Ttm,n Committees
O!\Ll'
l6c Total Purchass rrf Ar{r-ertisino in a Progranr BrnL- (Section |.11 Aommittea 0lif .l'
17. Total Monetary Receipts {add totals for lines l3-l6c)
18. Subtotals{addtotalsinline12+linelTinColunnAandinlinell+lTinColumoB)
19. Expenses Paid bl"Committee {Section P)
20. Balance on hand at
clos
19
fron line
18 in both l-olumns)
M)
N)
0)
25a.
D)
25b. * 25c. -
InterestandPeaaltiesonLoan
Par-ments on Loan
s0.00
$o.oo $0.00 $0.00
*ill
Unpaid (Section S)
L
IL{IV'EOFCOMMIrIEE Paul Roy 2011
Pase 3 of 17
A.
Lg$trle
1A11n0/1
$
_($ae
fq
Srbtotal Section.A
l\tr
:&r {,'!rile
0.09
Minuts Clinic
NAnrd
.{mo{nt of C;attibsfion
l, ts
l.
No
Seyrsr
ol tsmilol'{
CT
0at&3
APRN
If co*bibdiol is in escers of $400 to e casdid*ecoamillee fora chief $ecuthe oficsr of a nunisigalig'docr co*ibrtor or busbess hc;she b l*soci*d rritt harr E eootrar* rrith srid onnicipalib.'vahed atmore thrn $5.0fi)? lr- r"es i. l.Io
lr
r|rie
contibotiol
assoiated 'lrith a
::'
:!
$eclboll?
l's
No
k contibutor a prhr:ipal
of
shte
{fy'rr. lirtEleot*
Ill9hod of con$ibution: :': Cash l;, Pereoaolt'heck
co*rctor
or prorpesti\ e shte
solrtactof?
sggrggns
IJ
i.
Yes No
qrww{rD
Nloney0rder
N{I
97n7frn11
Fte*rPal {-r!s$t}an$
$100.00
$100.00
.lmount of
l,*t$laur
lMthdmy
116 maple
StFsinbndent of Operations
mt
:rp Lode Name ol
Cortriboiie
lmPlq'ir
St
Seymour
CT
o&183
Metrp-Nor*r
Jl'
r,"es
ij' No
l'es No
No
grincipal of
conErstor?
iggIgse
i'
i-
I Tes
No
0il1ff2011
fuekryd (-'!'ctryaton
$40.00
$40.00
.{mount of
aflme
Wlhelmy
Maureen
)qR
alp Lllde
oist ltor
t 9l s[t[\ 5I
{lontribution
116llapla St
b rroahibutora
Seyrnour
bbblftL spolre.
':1'eg :i- No
'ta
CT
06483
ilsbo.North
to a cand&lale somrdtte for e chlferieculive offrccr ofa nunicip*lilv does contrbutsr or busins$ he/she is Nsocided niith harc a cofiroct rrith said '. ounicipalilr rahed st more than $J.00O? i Ye* :;. No
l-d
No
:,No
Legiclatire
ag8rvgFrE
Iv*;thd of corbibution:
rilt &ecflgt(]
lr{rss
i{ Carh l*
$kurat
Personal
tacuk
'';
Pa$olt Dulduc*i$n
ll
lr.Ionel' C}rder
aBng2a11
Prtncpal
lwt lIffia
\{
xile
$40.00
$40.00
Amounf of Clontribution
(.r'nmtrm
Rondd
.rb'
Regisbar
l!\tnllol.bmPlo]r
:rpl'oile
19 Glen Circls
Ir contibotor a lobb5tsl. spou*e.
Seyrpw
1es
CT
ig
If cohibution
es.cegr
of ${O0
06483
mdcpcnded clrild of
Is this
lotr63'bf
No
arunir:ipalit1'docr cortrbutor or burioess hsrshe b &rsocintd $itb hal s coffract n'ith s&id municipelitl'rahedrtnoretharS5.000? ;'". i-i No
tes
i:
{fl'er.
tistEtut*
i*'
1es
Is
coatibutor
:'-,l'es
No
0V'15/201
ofgoveuneltthecanlrac*ic$ith'j, Ltecuthe
t *c lteccFed
Credit'Dbit Cord
i'Legislath'e
rNo
i''
08r15f2011
i83rrSnFrwrffiE $,{o.m
& B)
(Eater total
L
Paul Roy 291
LdNmc
VYisneski lwFtDgst-awcs
htr
wtt
Itinsi*rl Crccumtion
Amoonl
of
Susan
.;1t)-
Contributior
rNe
ftaE
rll EmP& CI
"' T*r
'No
Bemn Fdls
CT
o&to3
State of CT
If contrihilios i* itr **ccs$ of $40O to r candidats commi8s for o chiet' executive olleer of a municipatiq does cootr&rlor of bu$iders helshe ie rsror:iated n'ittr hate a eoatmcl rtith caid nuahiralitqraHatmorettan$5.000? .-' -r'e .i. No
Iscoatitntuagrincipalofashtecodraetororpmsg*tir-e*trtecontactor?
Ifiu.
list Erent
08/15/201
i. :
r.'e*
No
Legishtite
-.g@tec{:Wl
L!*}odof coakibution:
,.
(-redir.DebitC$d
08r15fs11
krocjpal
Qs.e:upatlon
$40.00
$40.00
Amount of Contribrlrforn
Bums 9 ilominonood
Is cortibotor a lobbfist spousa or d?odd hild of a lobblirl?
Sales
L({
t' ,t
-r-es
No
05403 Beacon Falls CT If contributior h ia escerr of ${00 to a randidale commisee for a chfu{ exectth'e o$cer of a mnicipafirydoee cqr*ihrtoror bu$inels herefteb assoeiated rrithhare a cortrct rtilhscid
ld f'er
:j5' No
l-.r
r-i No
IrcolbibotoraprbcipaloflstaterxntractororproslrectiTestatecost*tor?
of gorernnreot the coffact is
08/15/2001
ffter. indicatcniichblanchorhrilh*
:-, lcs
$ith:
l:
No
Legi*lathe
rE[drs:IirE
lvftrlod of corkiSutinn:
r,IE !trst
NII
Xrecrfa{l
t"i Cash if, Ptrsonnl Che{& i,'r t-reditrDebit Card i:. Prlroll Dedu*ioa [^; \looe-rOrder
Li$I\hma
$40.00
Coyne
alJwtilr Jucsa
Jamg
Attomw
;trte
-tuqG
-ls
51 lnca Drive
Ircoobibutoralobbyirlspousa t Is cdcpcndentchildofalobbyid? .i No
Is thir eolbibution assocfuted $ith a fridrairing ereni li*ted in Section L l?
0661 l Trumbull CT Goyne, von Kdln, Brady & Fries Ifcontrihfion is in escess of${00 to r candklatesomoitee fora chicfurecutir-e off*er ofl municipalitl'dors u:onk&stororbileiness her*lpis rsrorlisd lsi&hs\'a contract sith*oid
:p {l&le
xm
or !mF&t!.et
munhioditv$hsdrtrnotetian$5.000? ii.
Is
Ter . : No
i,
fcs
No
Ifiw.
indicate
or prospectire state
$ith:
Ereeuth'e
1
-.
conbtstor? I ; l,.e* t : No
.
Legirlatire
L|{lS KCe$rl
sEralBBc{ur|m*
hpollDedn*ion i'i
h.Ioney0rder lrtr
08/15/201 Retired
$m0.00
$200.00
.-Lmount of Cotrlribrtion
Coe
s&i[
David
-{uq6\ FlLv
TGreatMeadowRd
k contrib{rtor
a bbbfist. spousa or d+pendent child olu
nucsr
toftl'#
i-'l
Sa-marr
If contribution b
foi esr:ess
lD6re
alp (.'(1de
ri:
r-es
N0
ll
so:itted rriti harc a conbact rrith ilid nuniciprtitrrafuedatmacthan$5.000? l-' :*E* til No Te* Ir contihtor a princfual of r sbte {sntaclor or pmsper:the rtate conhrclor? l- r-x
munieipalit-r docs r:ontribulsr or busines* hels$e is
{/t'c*. i-,
listEted* 0U15nA11
,i.l Per*oaal(hsji
'"1 No
il'
No
I\lslhod of contibdion:
con[$mrrE
Csh
ll
PrgollHuctioa -
Moae,.'Ordcr
08tt5n0t1
hre$at
i.{lllhe
!11
w.00
$40.00
-{mount
nll
)re
:rp L:od.
Qcqpau(lrr
.EmPlOt'{
Hain*
IWNDEGTSNffi
of
Frank
-:rq
Ralired
CT 06483
Contribltfun
I Castle SL
ordependent child
Ssvmour
ofa
b contrihutor a lotblist.
rpousclobbyisfl
Retird If contribntkm is itr cnce*e of $,fi]O to a caldidats cosnitter for a chid esecutile ollcer ofa muoicipalit-t doer codributor or busisess helshe ir associatcd nith hn'e a coatn'act rti& said
mudeioalitr rahed atmore than $J.000?
;_'Ies ..'
r
No
e stale
listEr"ec* 08t15/201
ir Sertionll? ['r No
1
Is
coatilotor a prin+ipal of a strte colka:tor or prospctir ffw. indicatc rrtich bras,;h os bt rchcs
of gorernment the co$blst is
conbtctot?
l'ef
No
wilh:
IJa3i
Itle*hod of costibuticn:
xcefc
['.t
lrtoncyorder
08/1512011
$50.m
$50.00 $370.00
of '-
I. Paul
Rcy2011 B.
Itemized Contributions from Individualc
IT
First
L*lilane
kir&-t{lat {:Lrlrpatisr
Cindy
Admin
contrihlion
.{norat of
fes
No
clitd of a lobbybf
jrtl rgltc Name {n rnrPrq'r fovvn ofSeymou 0648:l Sevmour CT If cmfibution ic in et':esc of $,100 to a modllatc coomi$ee &c r chMeri*atire dher of a noaicipalitl does corsibubr or businerr hclshe ia **ociated nith hare a ccrtrar:t with eaid qunhipalitytatuedetmrelhar$5.000? :-:l'cs i.'': No
No
:;;1'cs
f1u. lisrEvenl+
:-
08J15/2011
ofgoruaosntlheeotractbnit}: i*.8-recoth'e''
uat R6crse{l
I/;w. hdicate*hidrbraochorbran:b
i . l'e* .; No
$100.00 $100.00
.{mount
Legi*lath'e
il&sltod of eontbutiotr:
i*teSSesoKtME
l-}$crrF1oon
;..,h3tollDedoctim Roealie
l: UmeyO*er
N,II ruL
08t1s2011
[tlnc{al
sf
Averill
ffi)trett.+dfes
_:rD'
SalEs
4rr,.(u9
:{olle of EnFlfl'er
Contrlbrtioa
38 N. Bmham Lane
ls
Sepnour
Tes
CT
06483
Self-emdoyed
cfa lot$lirt?
Nc
S40O to a caadidate comnifi* for I chief eiecuth'e ol]'icer of municlpalit-v doe* contribotor or bwitrss hetsh fo nssoebted nith hare coatract rrith said
If contributioft is in esc*ss of
I
1'es
munhioalih'rahedatmor,ethan$5.00tr1
No
Il
:: [1 No
l-ea
O8l15fZA11
::-*'
ntichbranchorbrmc[r*
lr.Ioney(Her
cotrtfl{*or? :-'
I
tg:8trRgilE
i No
l-.,Legielatirc
GmsrwRW
L!*lrod of conhibntioa:
CrditiDebitCrrd flxs
i-..
PalrottDeduetion
04n512011
te*rprl
\ame ol i-LictlFilt{Xt
$80.00
$80.00
[{l
ilite
-tp L
Loresr
_;rl1.
Retirsd
ru(
Cortribltiol
Amoult of
sletnilt
Seymour
No monicip*litrdoer
CT
06483
loDlc!'rl Retired
If contribstioo b in ssc.ss of
$:K)0 to a candidatccommitee for I dtidercrcuti\'. ot'icer of a contrilutor or b$siness ler'shc b $socistcd n-ilh hor:e a goatracd n'ith said
No
Irthiscolhibotionaesociatedrritha
irndniring srvot listed in $eetionll? {f}.d'- lirt El'ert * 08/15/201 1 Lldhod ofcontibstion: '
j".
r:
,'.
Iscortibotoraprincilnlofastdeos&&{ororprospe$h?siatcontractor?
r-
'r l'e* No
$/!0.00 $40.00
Amount of Contributiol
.-tgg!gae !'ontrtDuqffi
Clsh {'i
PEreonrl
Chedi
. CrcdilDetrit
}tone-v Order
08t15/2011
PlmcrFd QceuFilrcn
AI
Fulte
arp L-ode
Garofolo
(trlselElnl )Ireel .{alrlf es
Jamee
I-tq'
Professor
Nar$e oI .EmploJ's
163 Bunoay Rd
ls
{
l!
Seymour
'l'es No
ot dcpendent child
ofa lobbf
ist?
Sulfpm CT State Univ. 08183 Iicontributiu is ir e*cerg of $dO0 to I candidate condiffeg for a chief secutir-c ollicer of n muniuipati$ doa eonbibutor or blshess hejsb b ltaociated n'ith barr a co$ract rith said
CT
No
listR"entc 08/15J201
Pe,rronal
Is contibutcr a prinr:ipal of a sttte conilrrstor or pmslnctire state conhador? Iflus. iadicate ntieh brnnch or brm$e*
l-l
i:'
r*es
l.lo
olgorvnmtlbecontr.etifrrith:
lrloney Order I,II
lllErersrtir= i-lLegisl*h'e
iEEIElirEcwun]M
1
Ilethod of eonbibution:
t&B xec$e{l
i , Cgsh sl
Ch*,;k
i:l
CrediuDebit C.ard
i I Palroll Huction I
Saundra
08115/201
Pr$tcrpnl
$m'oo
$80.00
Aglotlnt of Coatrlbutiol
flIs
()cclpahst
Geeek
:is'
ReUrcd
iL1te .Sr
(_'ftle
Nsme $t.!,nrpln]'er
3TColonv Rd
b contributor a lobb-r.iat spoue"
'-' fes
a
Relired 0&$83 CT Seymour If contribrsiotr is in ercess of$400 to n candidatc r;omoittee fot e chl*
l?
No
Oe11512011
conbihto aprincipal of a sltte r:o!iln:tot orP$sPecth'e {f;ur. indicate whie.h bra*h or bra:hc* ':-t
olgoremnent
the
strte ronhletor?
]i-r
'les
rNo
co8act
is
rrith:
Ese,nrth'e
Legishthrggreln& rarnsHffi
Itlc{rod of contibutisn:
lr{rg t{i:ctYgJ
[-t Ca*h
[T lloneyorder
08t15I2011
$40.00
$40.00 $340.00 of
Pnqe
L
Paul La*tNoe
MONETARY RECEIPTS
wreoiREroRT
Roy2O11 B.
!
19-11t2O11
rsl
t{
Pttncipql C|is+otltttt
Grarde
-:rt-v
Cerct
ttale
Customer SenrbE
:|PL(U
Nane (rr tilFt(l}-er
Amortnl of Corrrihrtios
347
Sdttl
Sayrow
t-es
CT
06483
brusines* he'she
OEM Contols
chid *ecuth'e offrcer of
a
If r:stribution is
il
No
nunir:ipali{rrelu+d lt more
i.
ls conbibutor
No
0811512011
-. CrcUitOeUltCard
flt-
llonbrqtor?
.{Sqrcgae
i- , tea
No
c(uulm(N
$40.{x} $40.00
.{mount of
ilIoncy
ffier
\.fi
:rF
091s2011
Pfsrc{tal CL'ci$ttm
r!:r
Singh
irt}'
Pnet
rtluc
Researdl Ghsmist
Lode
(4 Ertrlrtl\
{lontribution
52Davis Rd
b c'oatibstor a hbblirl rpouse. ordfprndid child ofa lob&y'irP
Seyrnour
CT
0&183
Cytac
.i'"
r*es
l;r
No
Ifconbibution ir b *lrces3 of$400 !o a caadidate*ommifi.fo*a cbiefcsecslh'e officer ofa nudcipality does r'onbibutor or bosinlss hd# is n$ocisted lriitl har'. c contrast nith sdd I.i }'s lr5 No omfoipoli$tahed aroore rhar S3.008
l"eg
Is
ttb c'ortribntion
aseo,ehted
rrith
::
ir $s:tion L l? * ggl15l201t
k coatibutor a principal
t"l No
orFa
conh*tor9 i ; Te*
,
;-' No
I;lc
KeGll'eO
rggrryEREsFum
$80.00 $80.00
(lontribution
-dmount
Ctcupstrrn
Cud
i. hltoltDdo*ior fi
h.IoneyO.det
h,II
08/1mfi1
Pritrryil
rw
Gru&ias
t@KI
JUdt -1gWS
of
Richard
r'ls
itrte
ll{r
i- t1$e
29 Rimrnon SL
ls
$eymour
CT
05483
'rontributor
lobblist, spours.
depqndnt child
ofa lobbl*fl
ilTes rl No
If conkibulion ir in escegs of $400 to a candirlatr comrnit*c for a ehief erccutive o$ser of a muaicipali$' doer codibttor or bnslress hlsh ir rssoeide{ sith hare l corkact rtith said monicioalih'rtbedetmorethac$1"000?,-lfe* l- No
Yes
Is ah& conhihf,tion assoeiated n-ith furdraising cr;elt listdd irr Section Ll? I/,ycr. list Etec Ogl15l2011
Ir contitntor a prhciral of
No
ofgortromrtthecor&actigrrilh: ii.Exc,xth'e
DAle fi$Ce$'ed
1
fyar"
indicaterrLichbranclrorbram&es
'll
tvlonc'y
colrbrctor? l- ; Yes . No
ASCrl$lF COnqFrurts
:-.Legislath'e
Ords
Ntl
08/15/2011
ttb*rpal (,DcoDf,ton
$40,00
$40.00
.l.mount of
Smith
rKiuluers{ffi
Alloneo
t(-.u!'
Relired
l)6rc
"|8
Contribution
Hunters
a
Lana
b csatributor
or dcpmdent
lobbyist rpcuse.
il
Savmour
If contribution is itr
esr:ess
l'Ne
CT
0a$3
Retirad
1'es
rt- No
of 3,100 b a candidate commitee for a chicf e$ecuth e o&icer of a municipaliry does codributor or burinss heishe b Ns$oci$ed nith let's I coo&*ct ri& *aid
nu$icipali{rnHatmorethaa$5-000{t
oigor:*nmat lS* contnct
f Tes
i-
iTl No
a s,1 l'ee findraising oent listd in Slctionl"l? .^. No Il;'c*. li.st Er-ent ; Ogl15l2D11
Is tl& coabibution associated n'ith IUetiod of contibution:
f,reonilibotoraprincipalorfartater:ontar:tororgrospctirestateconhactor?
fpw. indieatewhichhanchorbrancfis
fu
tjl les
.l
No
$ilh:
I Esq:oth'e
i'l
fegislnthe
Lx[ tf,i;c$.ac
A8ftgBe coll[n}u{rrIrs
Ilo$ey Qrder
N{t
08f15t2011
PrurclFlt-[WA&on
$100.00
$100.00
.lmounl of Cortribution
Michael
1t]' xat
:lP (-rode
Lend Survwof
Nlnre otElr1Flo!'er
gwal
iueal.tut[8s
a
12 Oakwood Dr.
s conbibutor
$eynpur
fes
No
CT
06483
Sdf-erndowd
lobbfisl rpouse.
dcpendent cbild of a
lotrbl**
cxscsr of $400 to o ceudklate r:omnittee for a chif enecutie of icer of n monicipali5' doea coofoibutor or brrsioess her*he is tssocist*d $i& hate a cootract with said
If cmtribr*ioo is
il
Lg
stnte conhactor?
Ii'cr.
[*r
lbt Er-e*
ril No
trts"
A8l 151201
n-ili:
Tes No
illettod of coqtibntion:
fagh
'
credit'Debit card
08il15n011
$40.fl)
$40.00 $300.00
of
L
PaulRoy2011 B.
LastNee
Fl'st
r.!-
hinciml tlqrrnalion
.lmootrt ef
Contnibotioa
Secretrary
Nane or rmPFtcr
Sevmffn
Yes
CT
iB
06483
Town ofSeynow
If contrih:tiod
No :"1
candidate comrnitee for a chief csestti!'e ofrcsr of a ounicipaliq doer conhbutor or busiae*s helsh b arsociated n'ilh b*r l cortrart *'i6 sdd Yes No muabirditt' rahled at nore than $5.0{X}?
<seess of ${&0
a
j'.
l'ef
No
Is wabibutor
prhcipal
orf a state
{fJs.listEred* A&l1$EAfi
!rErt
conhel*or? i . -t*x
'No
Legi*Iatire tg8te8BEfl)ffiruw
lfoneyt}dcr
I\tr
JNG
:rP
08r1s2011
PrancFfll
:{anre
$40.00
$40.00
.{trroltnt of (:0ntribution
tlcnr,fi[on
Kulas
ffic:sllt Jreet*ffis
_'1tl"
Steven
L{u
Atbrmy
ot rmPr$}'cr
31 Skokoret
St
$eyrnow
& consitnrtorolobbyist
spou*c. i'
Ycs
ordepcndeotchildofalobbyhf?
.':;; No
May & Kulas PC If concibgis ir in err,less of S,lO0lo o candlldeeoolnitce fora hlf tel:util-e offr*rofa municipalilr doe* con*ibntor or busintt hC. *g b $cocinted rrith hlve a contract n ith said CT
06481:'
nuoicipditynbedatmre{rnn$5,000?
l-ea
.Lt;
I'es
.1.-i
No
state
nut
l'
lr
coaEihtor a priocipol of
atote corrlractor or
ptospictirc
{f;'e. listEr.*nt
[:.i No
I/16. indiqte$tichbranrhorbrmche*
conbtctod
-08/19?!1
of governrent $e conhaut is
n'itl:
iltrelttd of contribution:
Lastl$i6e
lxlBK$6$!ed
sgregnERW|wu
3*r t--redit'Dcbit
aBt't5t2011 ttrlr$al
Nflme or {,}cupau$tr
w.00
$40.00
,{mount of
Rstitd
lnrFlq'tr
{:ontribution
TIG
:IF L
rut
80 Washinqton Ave,
h cortritnrtor a lohb$sl
Seymour
No
rdrpendentchildofalobbybt?';,
I* lhie conhibuticn
nsrociated $'ith a
0B+83 Ratiled CT If contribution is in txcss of $4{0 to a caadidlte rxmnitet for a *ief eseciltil'c officr of I nunicipalqv doer conkibutor or busini8s hpishe b associited rith hn"e a conFlct n'itb rdd
Scctionll? ABnSlzOl 1
oiloteommt
contmtcr:t
*EErtlsB
l*es
\rit&:
No
l\lrthod of con&ibltion:
llale lllcetsfrl
cwroK(E
$120.00 $120.00
i*. Cssh if, Penond Cher* ' .. CrsditiDebit Carrl l*, Payroll Nur*ioa
t
:l
trloney tlrder
A'I
08/1512011
httcFal i-tccr$ntotl
tBt
Asornl of
Coniributfua
Coe
$sl(Ktllilt 5tf*i,{ddtess
David
F:q'
l}jrtte
!.tP
Rstirsd
l
troe
Na$r
TGreat
Lr
MsadowRoad
sp,ousa
i-
ff Enlp&l'ef
Saymour
CT
06483
Retred
xdcpen&ntfildofa lotrhfisfl
contritntorl lobb-rirt
!l
1-es
It contribotion ir in tnces$ of$-l00 to a cnndirlate commifiee for a qhief aiecutir"* ofticer ofa
municipalit-r do*r con&ibutor or burire$s he/sle b associatd rrilh hare a contmct n'ith rnid
No
I
nunicipalityrahedatnoe&an$51)00? i:'
l's
No
\s
rrl
No i,,)
I/r'cr. listEr-ent *
Is eontitutor a prineipal oft stlte cootraclor orprolpectirr strte conhactor? Ifics. indicaierrhich branoh or braehe*
Ln& t(eeerFeo
'iNo
f.-ee
It.*dhod of coahibution:
.-l83re8BB OnElmJ$OrS
{i:('ash {'l
PcnonalCXrc* Cl t-'reditDebitcard ; I
l,'lrst
PayrcllMu*im - \Ione-vftdet
TII
$180.00
$140.00
.{mount of Clontribution
Averill
llwlucer.aws
tm Tes
Rosalie
*rta
4q L'odc
Sdes
Nere olEmplo)'dr
ordependeotchildofalotrbybt? :i! No
Sdf-emdoyd 0a$3 Se\rmour CT If contribution is b etcers of 9,100 to a candidete conmifce for a ghiefcsecutir e ofticer of a municipalitl.' do* costoib$br or bu*lres$ he;slrcis lEsocilted vith hare r csnlract n'itt gaid nuntiirati$'r'ohed atmorc thaa $5.{X)0? .';: t-es l;- No
Yes
Islhfocsohib{Dtbra$osiatdsitha,''.
-l,.es
No
No
PalrollDcdnctioa
lrlonc]'order
0st09nfi1
$111.00
$25.00 $365.00
of _-
2011
-,,.
..-
TYPE:OFREPORT
1W1112O11
B.
L:r*Nane
Filst
Ptinp'ualfJs'r:natirrn
Bemardini
.:lq'
Ciindv
Admh Assistant
lWC
OI
Aeo$nt of Contributftn
tmpln{'cl
14 Kozev Lane
Is contrib*or a lobbybl.
$eyrpur
CT
06483
Tmnof $eynotr
ordepeadentchildofalobb3:ir9
rpous*
r".
1*es
:i,
l,Io
If coahibutiol b io eeccers of $400 to a eandidate rcodalise fora chiof ess:ulh.e ofiicer ofa nsnicipalitl. does coatibulor or blsiness helshc is issociated 'nitb hare a eonhact witb said monhip.lit-r$tued atoole than 35.0O0? lf. f e* i;, No
Y3
rrlt
;.:
.No
09/09/2011
;'.. Credit'Dcbitcard Ftst
ofgot*mdtheco*actisnith:
i,
httollDeduction
Ifnr.
iadicate
e rtate
conba'itor?
Yer No
of conkibutioa:
u0l KeceFnI
dgEr:gnacotrsrruw
i: I\ho:'fuq
T,II
rutrS
0910912011
$165.00
$50.00
Aoount of Conlriburho
',rt
."
Yer
No
Welch Teodosio Stand< & Blake h in cxces of $400 to r candidatc coomi$ce fora chiet'.:scsnth-e ollicer of n nrnicipllig doer cootributor or bleiner* Hshe b xsoci*ed rtiti h*t l corbact nith sakl CT 06401
U contribdion
muairipalih rabed
Is thb coabibnrtbu *sochted rtith a firndnfoing er.+nt listed in $ectionl,l?
at
mre
than
$5.{XX}?
Xi'
r*es j-,
No lr-, No
ri
\es
No
Is coabihtor a principal of a stfite con8lqtor or pmspectire etate contstctor? ,''' tes of governnent the uonlnrt b
fgw.
ia Legislath=
388legrGRnqmrffi
xaccli:e{
[-t
r-as] 'i.
Coe
i'.
ogtlgtzoll
Pn L'rF{rl
$2s.00
$25.00
.{mount
l\{I
{-\*r&oglm
of
David
iulle
:lI! t-{1de
Retircd
Na$c r]l lmtrh} cI
Contribatha
sxEISIil )geel
ltr
Saymour
7 Great Meadow Rd
[r conlributor a lobbfist. epouse. r dependent r*ild of a lobbl.bt?
CT
06483
Retired
a
'ti
l!'s
No
$5.000?
q: Ys :-. No
state
sotrhsctor?
l-
Tes
No
iggr8filll cotralFuNtrs
09/09/2011
Plucnal
NArb
$228.00
$40.00
Amount of {lontribrtion
LdNiuB
tr3sKrtElnr
{fmnatrrr Retired
ot!,mp!s:ef
loTskokoratst
a
)ueil.{diris
F,1$
tgcont.ibutoralobblirl.apou*e.
or
dcfodnr cbild of
Saymour
lfrle
Refired 06483 If conbihtirm ia in esrcss of $d00 to I surdidntc commiter for a qhie'f executive ofiicer of a municigalilvdox conhibutororblsbess he/sheis n*sochted rrilbhalea corftact ririthsaid CT
municionlitrr.abedatnorethm$5.000? r-.
Ir conuiheltor
a
l'es nl No
$l leg l-' No
{fttr.
indicate
princigal orfa state conaar*or or Pr$pcth? $trte conhar*or? trticb bnrch orbramhes
{l i'
t..es
]\io
i-lLegislath'e
Sgge$llO clrnlnFuBolls
ltldhod of conbibution:
:
1,1
.l
Palroll Deducion
Nlore-v Order
I\'tr
0ey09r2011
PnncFal {'}cupat({r
$40.s
$40.00
(lontribution
Amount of
Cvnthia
,:tt!
APEDIS
turtt
:rir L'r\le
Nrmc 0I lnrFh}'er
18 Caniaqe Dr
ccntrilnrtor a lobbf i*t spouse. ndegendent child of a lotrbl-ist?
Lr
Sevmour
CT
06483
L*com
r
.t':'
-' Ies it No
auniciiralityrohedotmorethro$5,000?
Yeg lii
No
&lhircontibntioaassocirtedrrilho :i l'cs
frndnising e\ent listed in Sectioll.l? [-r No
ls contsibalot
{/ye.
lial Event
::*d
+ 09/091201
principal of
a state
cotrhilctor? i -t Tcs 1r No
.{sgrtEc {
Lldhod of sortributisa:
!'it-ffL
PersaaalChec& :;'i
(-leditDebiteild
[, pg1.rollfu&*ion Fhtoaqrorcet
09r0sr2011
of
--
I.
Paul Roy 201
1
MONETARY RECEIPTS
i
10t1'l'2911
kmrrpal Occuitauon
Amount
of
Fries
ilti
CollEgn
llp t.!tse
1\U
Attomev
Ot
Contribution
l$Plrl}Ci
f;
Yes
Coyne, von Kuhn, Brady & Fries 06483 CT Seymour If contribution is io esees of $4O0 to a candidate eoarmitee for a ehiof esecutite oflreer of a
municipalitl' does coatributor or business he'she is associated n'ith har-e a coffrast n-ith said C Yes {, ttio municipalitr ralued at rnore than $5.000?
Yes
No
iij .t
Is contibutor
No
principal of
conhacior? f.
Legislative
oiiovernment
n-ith:
{.
Executh-e
1
f.
fl
Yes
No
Date Kece*'etf,
.{eigregate conErDutsons
f.
f;
ii.
09r09t201
hrlrryal
$100.00
$100.00
Amount
iLst
Garofolo
(slgufl JEeer.+dqs
,lq
James
CT
I
I
\tr
tlccupats(rn
of
Professor
lame oI Bmplq'er
Contribution
,rP L os
163 Bunoav Rd
ls aontributor a lobbli.st. spouse. or dependent child ofa lobbrisfi
Sevmour
06483
Ies
li3, No
Il' conhibutioa is in excess of S-lO0 to a candidate committee tbr a chief esecutir"e offieer of a muoicipaliq'does contributor or business hershe is associoted n'ith hare a conhact rtith said lfi :*es ifr No nuniciiali* ralued at more than $5$00?
Is contibutor
a
Is tbis ,roqtibution associated $ith a frndraising er.ent listed in Sectionll? Ifi'es. list Er.ent * 09/09/201:l \.lethod of conEihution:
lfl les Ft No
prineipal of
Ifi'es.iodicitet'hichbranchorbranches .fl Executir-e lfi Legislative ol gor ernment the ,rontract is rr-ith:
Date Recen..ed
contactor'l f'
r*es
'fi
No
lfl
Credit'Debit Card
f: PaFoll Ftrst
'rq'
Deductior
Nlone-v Order
o9/09t2011
hncrpal Occupauon
$120.00
$40.00
Amoutrt of Contributiol
Kulas
Ksrde$ral street,+dd$s
Steven
,tAte
I
I
Nx
Attomey
}lame lal EmPlq'eI
:rp Lod,e
31 Skokorat St.
Is cootributor a lobb5ist. spouse. or depeldent child ofa lobblist?
Seymour
CT
06483
fl ;''
:*es No
for a chiet^ exeluth-e officer of a municipalilv does contributor or business hershe is assot)iated sith hare a Qonhact n-ith said municioalitv valued at more than $5"000? f. Yes f: No
If conhibution is in ericess of
{: f.
res
No
Ls
contibutor a principal of
fes a state contractor or Prospscti\ts stlte *ontaclor? No indicate rvhich branch or Esecutir-e Legislatite oigovernnrent 6e conbact is .{ggreg:arw conurDwotr uate KecelYeq fy'er.
brancher n'ith: f,
{i f.
f.
og/09/20't
$&4.00
$40.00
-A.mount
Fust
Haines tsrdeilnl xrcet.+oqres 8 Castle
Frank
lJre
I ltfi
I arp
&inclpal Liccupstron
of
Retired
Jme
or lmPrQ] er
Contribution
St.
a
F.lt)
Seaour
Il:
eode
CT
06483
Retired
ls conhibutor
lobbfist. spouse.
fl r!.
Yes No
iontitutioa ls in sreess of $4O0 to a caodidate qonmitee for a ,rhief executir-e officer of a municipalitv does ,rontributor or business he'she is associated n'ithhare a Qontact with said munieipalit-rr-aluedatmorethan$5,000? C: r*es f: No
Is conhibutor a prineipal of a state contractor or prosPecti\t state contactor? {.l Yes No f;'es. indicate s'hich branch or Legislatir-e Executire oigorernruent dre contract is -l8lega corurguEQ$ ute KseFec
Is this ,ronbibution associated rvith a fimdmising etent listed in SectionLl? I 'e$. list Erent * 09/09/201 1
IUethod of contibution: fi, t'ash {-l Personal Check
branches fl n-ith:
fi
{l
fl
CreditDebit Card
Pa}toll Deduction
fl
IUoney Order
09/09t2011
Prncrpal {-lcfirFatron
$e0.00
$40.00
.{monnt of
Mitter
KSSrUennAr Jtret
Fust Navnit
l1h
I \tr
I
Contribution
-{d(trcs
:P Lee
of Emplqer
77 Brookfield Rd
ls contributor a lobbf ist, spcuse. or dependeat child oiu totttl'lrti
.f lfi
Yes
Seymour If contdbution
CT
0a+83
Labcorp
No
is in esicess of $100 to a gandidate somrni$ee for a chief executire officer of a municipalilv does contributor or busisess he,she is associated nith harc a contract n-ith said No .'0 municipalib-rabed at more than
$5,000?
Yes i6
Is this conhibution a,cgociated $ith a fundraising er"ent listed in Section Ll? 09109/201 {f1'es. list Event
.'f; Yes
ltt
No
f1'a,
contactor',) f'
fi
t:es No
h.Iethod of
contibution:
.{ggregnle rlrnErDuBlrN
Pa-rrollDeductioa
Ntoael'Order
osr0g/2011
$25.00
$25.00 $245.00
of
--
I.
Paul Roy 201
1
MOI\TETARY RECEIPTS
B:
L#tNme Potash
K6lwat
Dqtrr -{qcs -rq'
FiIst
?rurcrpal
0cupatql
Carmelita
!tE:
Retired
NAm Or EmPra5'er
.{mount of Contributiou
23 Glen Cirle
Is conhibutor a lobbrisl spouse. or dependent child of a lobbf ist?
Seymour
CT
i* i"
08+si
Retired
{'.
{.
Yes No
escess of $4O0 to a eandidate coomittea for a shief esecutive officef of a municipalitl.does contributor or business he.ghe is associated sith har-e a conhact nith said
"o"ttit*i*
municipalitr.vahredatmorethan$5"000?'f:
Is thir conkibutiol associated r-ith a furdraising event llsted in Sectionlt? fJ'es" list Evest + 09/091201 1 lrlethod of conhibution:
C. t-ash fil Personal Cherd; LNt Nilre
Yes f, f.
No
f] C
Yes
No
Is coatibutor a principal of a shte coakactor or prospe,ctire state cotrbactor? I/1o. indicate l'hich branch ol branches Legislatir-e Lxeeutire oiiovernment &e eonbact is
f. r*es {- No
$40.00
*-ith:
f.
IJaIe Kece$es
-tregare conqFuu(rs
1
091091201
$40.m
.{mount of Contribution
Fiftt
I\{I
mre :lP
Prs,;lpal Ctccupa!0n
Roy
Kesldetaru )ueer -{utres
Paul
lib-
First Selectman
rlq
Name
ot bilpllrl'er
80 Washinoton Ave.
Is conhibutor
a
Seymour
Yes
CT
06483
Town of Seyrnour
lobblist.
spouse, il
lS'
No
to a candidate sommi$ee for a ehief esecotite officer ofa municipalit-r does coatributor or husiness hershe is associated $ ith hare a contraet n"ith said No 3-' munieipalitv valued at more than
$5.000?
a
Yes :f'
ls
coatibutor a principal of
0910-91201
fJ6. hdi;te
$'hich bnnch or
con&actor',) {r
ngEltgdrc
'.fi No
Yes
:i
F' \'Ione3'Order
\,II
;tate
09/09/201 Princioal
$170.00
$50.00
AmouBt of
[ast]il
Simpson
K6lderf$l
Sheet
?rincrpal rlcetpaton
James
]Ib'
3p
Contribution
-ld,f ess
Lde
\arue oI tsmplcler
4 Falbo Dr.
Ig soltributor a lobbfist. spouse. or depended child ofa lobbyist?
$eymour
if
Yes
tf
No
{31
""nttibutio municipalitl.doeg coahibutor or businEss heishe is associated $-ith ha\.e a contract n-it& said muni)ipalit\.'vahed at more thao $5.000? f. fes f, No
Is contributor a principal of a state conbaator or prospectire state conhactor? f1,es. indieate nliich branch or Legislative Executir-e oilor-emment the contract is
Town of Waterbury ir in excess of ${00 to a calrdidate committee for a chief executir-e offrcer of a CT 06483
Yx
lNo
branche$ f. n'ith,
Uate Kece$ ed
f.
{, fe" f , No
$40.00 $40.00
Amount
Ir.Iethod of conhibution:
{ggregate canElDu[Qs
1
f.
Cash Si
Personal Check
{:
Ctedit'Debit (--ard
i
f,
Palroll Deduction
ll
lt{oney Order
N{l
09/09/201 Registar
rst
of
Skurat
Rsldenhnl
Ronald
Cmtributioo
Steet.\dte:s
19 Gln
Circle
t-)t]'
l
h.
Seymour
mudcipality
lJhte
LIP
LNC
CT
06483
Tmrn of Seymour
Yes No
o? $d00 to a caadidate commi$ee for a ebief executi\-e o*icel of a does conhitrutor or busbess her'she is associated Jrith ha\''e a corhact rtith *aid
municipalitvraluedatmorethan$5.000?
No
Is this contibution aqsociated $ ith a firndraising e'r-elt listed in Section Ll? It'(,r. list E ent *
N.Iethod of
{il
r*e.g
{*l
No
fl, Cash
contibutiol:
$':l Personal Checli
{,] Ies ts conhibutor a principal of a state *ontractor or prospectirc state contractor? No f.1'es. indicate rr-hich branch or brafirhes dll Esedsti\-e Legislatirr oi'ior-crnnent lhe conhast is lgxe8BE ct)nErDuq(rN Uate Kffel\-eil
sith:
fl
fl
ill
Credit'Detrit Card
rust
{) Payoll
Fred
Deduction
lrlonel'Order
IUl
09/09/201
$80'00
$40.00
.{mount of
hincrpal ctcupaurx
Attomey
itsR
.rP
Contribution
.:rb.
rluc
Name ol
!r1pl$'6r
'{
i#t
Sevmour
CT
06483
fes
No
{a
It'"*ttiUd*
l-es
is i" crices* of $4O0 to a candidate conrmiftee for a chif esesutir-e office{ of a nunicipaliq. does contributor or busioess heishe is associated rvith have a contract rvith said municipalit-rrahred atmore thaa $5"000? lf r*es lfl No
Is conhibutor a priacipal of a state contractor or prospecti-e state
contibution assosiated n ith a fundraising erent liste{ in Section L l? I/ler. list Event 0Si091201 1
No
flvs,
contrsatot? f'
Legislatile
fi
Yes
No
AgglegaE conErBu[om
'fi
lrlonel'Order
09r0s12011
$25'00
$25.00 $195.00
!19
_-
of "--
I.
Paul Roy 2O'11
MONETARY RECEIPTS
ffiF
10t11t2s11
-lmount of Contributiotr
ot EnrprcS'el
a contracl
B.'
LastName
Frsl
:nnclpal Occupatson
Stanek
Kestcel{$l JEei Aogress
.'rD
Karen
l.e
NAnre
Retired
22 N. Bneham Rd
Is contributora
ordepeadentchildofalotrbyist? {r, No
Is tbis conhibnrtion associated with a fundraising event listed in Section Ll?
lobblisl
spouse. C.
Yes
Retired CT 00483 Seymour If corbibution is in excess of $lO0 to a caldidate coarmittee for a shief esecutil'e officer of a
municipali!'does contfibutof or business he;she is associated r*'ith harc municipalit-vrahredatmorethaa$5.000? i", fes $, No with said
,:: Y*
.r. No
09109/2011
Is contibutor a principal of a state contrastor or Ptospective state contaetor',) indicate ntich braneh or branches Etecutir-e {. Legislatirre olgovernment tle conbact is
fler.
i. I"t f* No
$55.00 $25.00
AmouEt
n-ith:
{.
flate KecerFed
-agelegate contrlbuafirs
1
i.
Chedi
l.
lli
lrlonel'Order
I\11
09/09/201
tffit
Stauffer
ilq'
Christine
tate
:rp Lrrde
of
Contribution
oMPlo)-er
21 Briohtwood Dr.
Is contributora lobblist spouse, or dependent child ofa lobb-r'ist?
.f.
r"es
06525 self-employed CT Woodbridge If contribution is in eJrcess of $400 to a candidate conmitee for a chief esecuti\
16lNo
e officer of a orunicipalitl- does conhibutor or business hershe is asso,)iated n-ith harri a conFact rtith said muairipali&' r'alued at more than $5"000? f' le's lfr No Is cootributor a principal of a statc cootractor ot prosPectht state
Is rtris mntribution msociated q-ith a fuodraising event listed in SectionLl? 091091201 I fy'es. list Event
Yes
Ki
No
lf'
No
Legislative
Ag-elegale comrouoQm
ii
Che{k :l' Credit Debit Card Fl Palrolt Dedu*ion F' \{one1- order
0s/09r2011
krncipal (:iccupauoD
$50.00
$50.00
.lmount of Contributior
Fifft
Stelma tsxlefiat Jlrer.{d&ess 3 Oriole Lane
Is contributor a lobblist. or dependent child ofa
:lN
John
)uI9
I \tr
I
1rP LDale
Suoervisor
Nme 0l Smplc!'er
spouse. lobbtist?
r.: Yes
r5l
t)648i! GW lnd. Westem GT CT Seymour If cootribution is in oicess of $400 to a candidate comrnitee tbr a chief executive ofticer of a
municipalitl' does contributor or business hershe is associated rrith har-e a ,ronh&ct n-ith said f,; No munieipalitl- ralued at more than $5.000?
No
f, res
Is this contibution associated r-it} a fuldraising er-ent listed in Sectioo L l? !fi'es" list Event; 09/091201 1
f
I
Yes
Is conhibutor
No
pdncipal of
conbastor? {:.
-l,-es
t-
No
f.
L"gi*lutit'.
.lgglegste contsrbutrons
\{othod of eontibution:
f.
t-'asn tr.
Personal Checli
i-
CreditDebit Card
I lrsi
f,
lrlone-v Order
09/09/2011
PnncrFal Occupatton
$25.00
$25.m
Amount
La$ Nanre
\II
lJtate lrp
of
Strumello
{srdedral
ls Street
Edward
Retired
LNe
lame !)t gmplo-\:er
Contribution
Atidss
188 Mountain
Rd
il-l
IJt}'
Sevmour
CT
06483
Retired
'l
tes
No
Ifr;ontribution is in ercess of$lO0 to a candidate committee for a chiefesecuti\-e ofriser ofa municipali$' does contributor oc business hershe is associated *-ith har-e a eontraat $-ith taid municipalitl'rahedatmorethan$5'000? fl Yes fil No
Yes
Isthisconbibutionassociated$itha
firndraising er-ent listed in Section Ll?
fi.]
f.
No
ls conbibutor a principat of a state conbactor or prospecti\? state codEactor? C.l r*es {1l No I$'es. indicate w*ch branch or Legislatile Esecuti\e olgor-e,rnment the contract is
branches s'ith: fl
Date Recell'ed
f'
\Iedrod of contibution:
ugeRrE
fl
\IoneJ'Order
09109/2011
Pmcrpal L)!'cupa!on
$25.00
$25.00 of Contlibutio[
..Lmount
LastNane
Fffit
irN
Karl
J{ate
ll.tr
I lrP
lnstructor
!449
Na$e or lmProter
fwuel]B )rcgt.tgqgs
20 Old Ansonia Rd
Is contrihutor a lobbfist spouse, or dependent child ofa lobtrl-ist?
'il'
Yes
Sevmour tf contribution
CT
06483
Uconn
lffr No
:f, \-s ti-' No
ie in ericess of ${O0 to a candidate commitee for a chief esecutire officer of a mtnicipatit-r. does conhibutor or btrsiness he,she is associated n'ith hale a contraet *'ith said
tf'd.
principal of
sith:
lfi
No
E:ieeutive 5i Legislati'e
lggregate conrlbuorxrs
Date RtreFel,
lfl
e-redit'Dettit
card F
Pa5roll Deduction
lrtronel-
tlrder
$25.00
$25.00 $150.00 of
BThis PrgePage
I.
Paul Roy 201
1
MOh{ETARY RECEIPTS
l.tl
arp Llode
Prrrcipal Ocrrpation
Valeski
-1S'
Dawn
.{mount of Contribution
20 Osprev Dr.
Is conkibutor a lobbyis( or dependent child of a lotrb-visf?
Sevmour
CT
06483
Toan ofSeyrnour
spouse, f . lr,
r-es
No
eseess of $4O0 to a caadidate gommittee for a chief executire officer cf g municipalitl- does coatribulor or business he'she is associated rrith hare a contsact rtith said ouoicipali{. rrlue at qrore than $5.000? fl Yes !i, No
If contribution is in
f,
Tes
.f.
No
*-ith:
f. Erecuti'e f.
1
f. Tes f* No
$50.00 $50.00
-{mount
Legislatir-e
{gggatB conErDuuos
f. Cash f
, Personal C.heck
i.
ii, Paltoll
Maureen
Dedur)tioo
]f. Irlonel'Order
09/09/201
Last Nane
rlt
ilare
.lI)
?nncrpal ocdrpabon
lMlhelmy
lq'
of
Dist Mqr
rgqc
lame ot bmFt(l}ir
Contributlon
,fr
CT 0B+83 Metro-North Seymour If conhibution is in sxcess of $.1O0 to a candidate commifiee for a chief sxecutive officer of a
municipali$' does conhibutor or business hershe is assosiated sith hare a contract n'ith said municipali!.raluedatmorsthao$5,000? Irt fes,fi No
Yes
Is contributor a principal of a state contlaetor or prospati\ state
No
lfr
FNo
091091201
c$nkactor'.)
.tg*qrc,srE
f,
l*es
ifr
No
ceurwqrTs
li
o9/09J201
$s0.00
$50.00
Amount of
\{I
1lP L;lrde
Itulcrpal occupatron
Garofolo
Glmunl J&eet Ao&es 1&3 Bunsav Rd
ls conhibutor a
.rB
James
Professor
NAme or iJmptcS-er
Contribution
lobblisl
ordependentchildofalobhvist?
spouse, fi f,
Yss No
0648i:| Sevmour Southem CT State Univ. CT If contribution is in cncess of $lO0 to a candidate comrnittee for a chief executite offrcer of a municipalif'
Yes does contributor or business hetshe is associated rr-ith harc a rrontract $'ith said
municipalih ralued atmore than $5.000? Is this conkibution associated rvith a fitndraising elent listed in SestionLl? I/.1'es. list Event * _
IUethod of contibution: f. Cash dti Personal
Last Na$e
fl r*es {,
No
r
{t.
I*
No
'Jootibutor
principal of
t.i I$
f.
No
KeeIFelJ
Checli
{.
C--redirDebit Card
Partoll Deduction
f.
lr.Ionev C)rder
09/13/201
$420.00
$300.00
.{mount
!mt
\tr
IJtat
Principal (trupation
Simpson
lsuru *ee[ -{qqffi 5 Walnut
Judith
!-.lt)e'l Yes
Retired
:lp L:oft
of
St.
Sevmour
If conhibution is in
\ee
Contribution
or tsmPrct'et
CT
06483
Retired
tr: No
a
ex'ress of $400 to a candidate committee for a chief executive officer of a municipalit-l' does contributor or business he.rshe is associated rr ith har-e a ,ronhact \$ith said No municipalitvralued atmore than
$idl
.t
; {*l
Ies No
Is contibutor a priacipal of a state contlactor or prcspeti1-e state corta,rtor? {f.r'es. iadicate *'hich btanch or Lxe,ruti\e . Legislatire of gorernnreat the contract is
f.l
:*es
ll-'
No
fl
fl
lrlone-v Order
o9t21t2011
kmcrpal O:cupatrm
$110.00
$s0.00
.{mount of Contribution
rst
III
*aIt
alp Lrode
Gridzias
tuguil JEet.aoqN
Richard
-lq'
Retired
Name ot llmpl0.Ter
29 Rimmon St.
Is contributor a lobb$sl spouse or dependent u'hild oin tolf3i*ti
?l'
Yes
Sevmour If contritr$ion
CT
0a+&3
Ratired
'.$r No
is in eicess of ${00 to a pandidate com"orittee for a chief executir-e offrcer of a municipalilv does cootributor or business heishe is associated with hare a conkact rrith said municipali!'r-alued at nrore than $5"000? ,r_r I gs .,.+ 1\o
Yes
fi,
No
Is conbihutor a principal of a shte conhactor or pro*pectir e state .Ifi,es. indicate s'hieh branch or
09/30/201
conhactor',)
f' fes Ir No
$130.00 $90.00 $580.00
lfiLegislatir-e
AggIente cont rbudore
Ile*hod of contibutioa:
K$ered
fi
Personal
ChE*
.'f-r
Credit'Debit Card
[i
Parroll Dedu*ion
\Ionev Order
o9t21t2011
of -
I.
Paul Roy 201 1
i
10t11t201',1
B.
LastNase
Frrst
Welch
--I]
Tom
llrurs
Atorney
Qr EUPR-_a sr
-Lmount of contrib{tion
47 Old Shelbn Rd
Is eonhibutor a lobbfist. spouse or depeodent *hild oia lotb-visf
r'
i6,
Shelbn
Yes
No
Yes
Welch Teodosio Stanek & Blake If eontribution is in ur,Jess of ${OO to a candidate '}ommite for a chief esecutir-e oti rer of a
CT
06484
municipali$.'does contributor or business he''she is associated with hare a contract n-ith said 'f' Yes l, No nruaicipali!-r'ahred atmore than $5.000? Is conhibutor
a
lsthiscontibutionasso*iatedx-itha Sj
firndraising etent listed in Sectionll? If'a. list Event * 09130/2011
Nlelhod of contibrtion: Castr :tl Personal
f.
No
.t*es principal of a state eonhactor or prospectir-e state conbaqtor? fl . f No Ifi'ns- indicate rrLich branch or branJhes f. Executite f. Legistatire of gor-ernnent the contract is'n-ith:
Irate
l(sereo
{Iegate contrbuoons
f.
Parroll Deduction
li. ltloner
Order
N.II
agt?1nafi
Plncrpal Occupanon
$100.00
$100.00
^{mount of
LLst Name
Coyne
jlt]'
Atorney
L\me or rlmProlq
C0ntribution
401 Davis Rd
le contributor a lobblisl spouse, or dependent ehild ofa lobbyisP
r*es
,t.: No
is in encess of $.1O0 to a candidate comnri&ee for a dtief executir-e officer of a municipalit-v does sontributor or business hershe is associated \r ith hare a eontract n"ith said No municipalih'r'alued at more than $5.000? 'F,
Yes lir
Is conbibutor a priocipal of a state !-ontactor or prospecti\- state conhaetor',) f;'es. indicate n'hich branch or Lrecutir-e lfr Legislatir-e of gor ernmelt the contract is
btanches rtith: li
uare Kecereo
3*- Pa-rroll
09121/2411
PrmcFal {)ccuFaton
Stanek
KSlGnUat blreel .loflress
Karen
Retired
;late
:rtr Lrode
Contribution
}w r . les ior No
Nme ot !$ptc}'er
22 N. Benham Rd
Is contdbutor a lobbfist. spouse" or dependent child ofa lobbr.ist?
06483 Retired Seyrnour CT If contribution is in excess of $400 to a candidate tJommitee for a chief executir-e officer of a mulicipalif' does cortributor or business he;she is associated rrith hare a conhact with said
municioalitr valued at more &an
$5.000']
f. Yes fi
No
Is this contibution associated n ith a firndraising er-ent listed ifl SectionLl? Ifi'er. list Er.ent * 09/301201 1
\Iethod of *onbibution:
La$tNme
Yes Is confiibutor a principal of a state conhactor or prospcti\ stat conhactor? No {fi,es. indie*te n'hich branch or of gotemment thE conkaet is f,. Executive Legislatir-e tggregaG clrnEpwom HIEKrcST'R
branche$ $ith:
f.
{r f.
i.
\Ionel Order
a{l
o9t21t2Q11
krnclpal C]ecupabor
$145.00
$90.00
Amount of
![st
John
Retird
lmre
lIP L,NE
r
Contribution
Ten.
F-ts
ur suPru)
Ansonia
coatibutor
l.] fl
res No
Retired 06401 CT If sontribution is in ercess of $400 to a sandidate qom$ittee for a chief enecutive othcer of a ounicipalilr. does conkibutor or bsshess he:, he i, associated rrith harc a eonbact \rith said r- I es t!, l\o municipalitl'ralued at more than $5,000:)
Ls
Is thb coahibution associated n ith a firndraising errent listed in Section L l? Ifi'es. list Event = 09/30/2011
dil
fl
r*es
contibutol
principal of
No
.fy'g.
'JonbactorJ
{-.i
$ith:
fl
fl
I es
No
\{ethod of conhibution:
Date
Ksel'ed
Credit,Debit Card
fl
Parroll Deduction
fl
lrlonev Order
o9l2'u2911
ltnrclPal Cbcupaion
$45.00
$4s.00
.{mount
irst
\.ll
of
'f ..'
Yes No
'rf' Name or l]nprq'er .{, L.rus )BTC 06483 Retired Sevmour CT lf conbibution is in ericess of $400 to a sandidate committee lbr a chief esecutl'e offrcer of
municipatiq- does contributor or business he;she is associated nit$hare a contract n'ith said
Anthony
Retired
Contribntion
municipali!'raluedatmorethan$5,000?
Is this contibution associated n'ith a fundraising elent listed in Section L 1?
.f
l-es
C, No
Yes Is conhibutor a principal of a state contrastor or prospcti\ state cotrhactorJ l{1 No Ifi'es. indicate n-hich branch or Esecutive lfl Legislatir-e of gor-ernment the contract is
branctres $ith: ii
Date &ecesed
t:grggaF cQruouu!tr
F t'ash fi
a9121120'11
$4S.OO
$45.00 $600.00
-_.-
of
L
Paul Roy 2011
B,
LmtName Fkst
Prircipal 0ccurratroa
Condon
tsroat JusI -aw$
-iR-
Kevin
Atomey !.re
l\U
Ot
-{mount of
Contribution
EmproJer
30 Laural Lane
Is c+ntributor a lobbl.ist. spouse, or dependent child ofe lobbf isP
fl
Yes
Condon & Smith o&72 Oxford CT If conkibution is in ercess of $ilOO to a eandidate committee for a ehief esEcutir-e officet of a
municipalit_v does conhibutor or business hershe is associated rrith hare a contract rsith said
fi. No
arunicipalig.raluedatmoretlan$5"000?
Is this contibution associated with a foadraising er-ent listed in Section L l? ti'er. list E\-ent * 09/30/201 1
Nlethod of contibution: fi, Personal Check C:
l-. Yes f:
No
q; 1-es .f. No
Is eontributor a principal of a skte cosbaetor or prospectis state If'es. iadicite s-hich bransh or branches
contactor? f
Legislath-e
{*
. Yes No
oiioverument
the coabaet is
n'ith
t.
Executh'e
f.
l.)ate
!{setred
{:8Iee3E COnErouqLrD
clsl
f,
Creait'Debit Card
t
f,
Pat'roll Deduction
lf. Nlonel'Order
l\II
;tate
a9/2112011
Prncrpal Cha:pattrn
$50.00
$50.00
.{mo*nt of
Est
Phelan
(slctrIlta Jusr -{wes 19 Cedar Dr.
Is sonhibutor a lobbvist, spouse or depeadent child ofa lobbybti
Is this
Marie
irq'
Atomey
:{l UNE
or grPru) sr
contIibution
Killingworth
CT
06419
res
No
lsl
It' itonhibution is in qicess of $.100 to a caadidate commifiee for a chid esecutire officel of a municipalitl' does eontributor or business hsshe is associated rtith hal"e a contract n ith said l,' No nrunicipalitl' r'alued at more than $5.000? if-' te
Is cootibutor
conhibutiol asso,Jiated n-ith a frndraising er.ent listed in Section Ll? In'er. listErerts 091301201 1
fi YEs FNo
principal of
a state
codrastor or prospecti\
e state
contactor? {'
Legislative
Yes
:fl No
lfl
Nlethod of contribution: Cash if. Personal Chec& F.l Credit Debit Llard
3l Patrotl Deduclion
Karl
fi
\loney Order
AT
xaae
09t21t2011
tmcrpal !)ccupatrsl
$45.m
$45.00
Amount
LastNme
[St
of
Trybus
slgcrunt nrser.aNN
2O Old
'rtl
lnstructor
,!p!]e
\ame ot lJlnprq'er
Contribution
Ansoflia Rd
Seymour
Yes
CT
06483
Uconn
Is contributor a lobblist.
ordependentchild
No
Il- contritrution is in ericess of $.1O0 to a candidate committee for a chief executive ofti,Jer ofa municipalig.' does contrihutor or business hershe is associated with hate a conEact rvith said
mnnicioalitr"rahred atmore tftan Is this contitlution associated n ith a fiindmising elent listed in Section Ll? {fi'sr. listEr-ent + 09130/201 1
Ir.fethod of
$5,000?
ofa
A Yes F, No f,
f;l
les
Is conhibutor a prinuipal
CNo
state conkactor o{ prosPeltive state contraqtor? Ifi'es. indicate n-hic$ braneh or bratches Legislatirc Eseoutirre olgovernment &e contract is
lij
f".
res
No
$ith:
f.
contibution:
Date Rwe*'ed
igElcEgtc u([u&,uaus
f,
PaFoll Deduction
fl
Nlore-v Order
o9t2lna11
ltrncrpal ()c$rpauon
$70.00
$45.00
-\mount
lrsa
l\il
lJare
4rP
of
David
F:l['
r*es
Lllrde
Retired
Nele
or .ErDproJ'et
Contribution
TGreatMeadowRd
h contrihutor a lobbS.ist, xdependentchildofa lobbf
Seymour
CT
06483
Retired
No
$4O0 to a candidate commifiee lbr a chief esecuth'e officer ofa orunicipalig' does contributor or business heishe is associated n-ith harrE a contra,rt \Tith said C'Yes 6l No municipalit-r'ralued at more than $5,000?
If conhibution is in espess of
fu rhis conhibution associated with a ixrdraising er-ent listed in Se,)tioa L l? 09/301201 1 r1'gr, |tu1f,1'ga1
6l
fl
Yes
No
Is contibutor a principal of a state contractor or prospecti\? state coltactor? Ifi'er" indicate rrhieh branch or branches f.l Esecutir-e {ll Legi.slatile oi gor-ernment the conkact is n
ith:
f.l fl
Yes
No
Date
Rsesed 091281201
1
-{SelegAte crlntrlDunom
fl
t-redit Debit
Csd
Fust
fl
pa'r'roll Deduction
fl
Nlonel' Order
Ntr
$328.00
$100.00
.{mount of Contribution
Prncipal Occupatnn
Susan
.lS'
lnlplotor
CT
06403
State of GT
encesg of ${00 to a candidate eommittee for a chief executi\-e office'r of a does conhibutor or business hershe is assoeiated $ ith have a uontract s"ith said
municipalit-vraluedatmorethan$5.000?
Is this conkibution associated n'ith
a
r*es
3a No
!"-*' r*es
:f
tl
J
No
contibutor a principal of a shte coohactor or proslleqtive state sontaator? fy,es, ildiciten'hichbranchorbranchs lfi Ese,Jutile 5i Legislative oigoleroment the contract is $ith:
!)ate
"f
lfi
No
Kserfec 091281201
1
.{ggregaB cotrErouuotB
fi
$85.00
$45.m
$285.00
of
1011 1/201
B. Itemized Coniributions
LstNmr
tgemar DEst First
from Individuals
Pnncg,al (:hcupatlon
\,II
fiale
::P
Theresa
-+ws
.:rq'
Minute Clinic
LNE
Nme ol !mprc5's
.\mount of Contribution
r'
Ys
APRN 0a+83 Seyrnour CT If cootributior is in ercess of $dOO to a candidate ,rommittee tbr a chiefeiecutire oftieer ofa
munieipati['does co$tributor or busioe*s he'she is assorriated $ith hav" a conhact n-ith said 'i', Yes f: No municipalit-vrahred atmore ftaa $5.000?
fr: No
{E
a
Is this eontibution associated x'ith a fundraisiog event listed in Seetion L l'l I/;.es. list Etent + 09130/2011 lile{hod of conhibutior:
fes
No
Is coahibutor
a principal of a shte cotrhactor or Prospectir-e state contador? .f}.as" hdicate rrhich branch or branches f. E:recutir-e f Legislatil'e olgor-ernment the contract is rr'ith:
l. f
Yes
No
Date Keees-ed
Personal
Chedi
if
09128/201
$235.00
$135.00
Amount
{l
*ate :E cod
hmcrpalOcmption
of
Fries
K$lcefflal ilIet -{geffi
Colleen
Ittt'
Nanre
Afiomey
oI !,mFro)-{
Contribution
Seymour
CT
06483
C
n
1
r*es
If
lO
l.io
',1i Tes F No
contribution is in excess of $4O0 to a candidate committee for a chiet- esecutire oficer of a municipali$. does eontributor or business heishe is associated rr-it,h har-e a cootract rvith said municipalitvrahred at more than $5"000? lfii Yes .fi No Is contibutor t*es a state ,rontraqtor or prospecti\ state colrhac*cr? No branch or i{' Executir-E lfi Legistatite o?gotemment the eonlraet is {ggregac conErDuEoN Date Rwere.i
a
princigal of
fundraisinger-enttstedinsectionll?
.I/)'.'s. list E\-ent * 09130801
Nfethod of contibution: F Cash Personal
branches with:
fi ifi
f.
(Aedr '.fl
CreditDebit Card
t,ret
o912u2011
hurcrpal Occupaton
$187.00
$55.00
.{mount
L6t
NXIne
of
Demmino
lgwl Dg9et.tqqc$ .'ltl'
Mary
'AI
Educator
)
Contribution
0l lJmPrq'et
q; No
Yes
Seymour Bd of Ed. 06483 CT Seymour If contrihution is in excess of $400 to a candidate sommiftee for a chief executil-e ofti:er of a
municipaliq'dox conkibutor or
municioalitt'ralqed
at orore
n'iti
said
thal
$5,000? f, Yes f.
No
{3
t"
Yes
No
Is contibutor a principal of a state conhactor or prospecti\-e state contactor? !r.1'o" indicate which braoch or branehes
r ; lgs f- No
compuuoN
oigolernnrenttheeontractisrtith, f.Executive
!)ate
f.Legislatir-e
It'fetlod of eonbibution:
Ksered
:tggle8nte
It Curtr fl
f,
Parroll Deduction
ll
lvlooel'Order
ost28t2011
hmcipal t)qcurtatron
$s0'00
$50.00
,{mount of Contributiotr
f-st
\{I
lJerE
llP Lfr]e
Gesek
tesloerural >treet
Szudra
Retired
lame ol Empl.r)'er
-{doress
37 Colony
Rd
F.rq
ft
h_.
Seymour
CT
06483
Retired
Yes
No
I1'contribution is in ercess of $.1O0 to a qandidate corumi$ee for a chief executir-e offieer of a municipalitl' does contributor or business hershe is assoeiated rtith hate a contract s'ith said municipali{'raluedatmorethaa$5.000? i]. Yes i-{ No No
Is this cnnhihutinn associated *'ith a ftindraishg er-ent list*d in Sectioa Ll? tt]'cs. list Elent n 09130/201 1
lvlethod of coabibution: {-: Cash *il Personal
LastNam
S-] Yes
{-'
C] r"es Is conhibutor a princigal of a state cootracto! or piosperti\ e state contartor? t_. l\o f1m. indicate shich branch or braaqhes Executir-e {11 Legislative oi- gor-ernment dre contract is r\gtr.aG cm[DuuQD Lrate K*etreo
with:
f;l
fl
PaFoll Deduction
fl
ilIooe1'[hder
09t2f]/24fi
Pmcpal Clcmpahon
$93.00
$45.00
.{mount
\tr
*ale
:ry
of
Conroy
Ke$deilru )ueet.-tooress
Anna
lltr
spouse"
Retired
Contribution
lwe
)'lanre
lrl lmPlcl'el
Yes
Seymour ff coniribution is ir
CT
08483
Retired
lfri No
'{1- l'es
escess of $dO0 to a candidate committee tbr a chief executite officer of a municipalitl' does contributor or btrsiness hershe is associated n-ith hale a contract n ith said municipalit-vvaluedatmorethat$5,000? i* Yes F, No
Ls
F-i No
coctib{rtor a princigal of a state corrhactor or prospectir-e f1'es, indicate n-hich braach or branchos
o?lorernnrent the co$kaet is
state conhactor?
f'Yss
09/30/201
$ith:
fi
fr
No
J-)ate
Kecefeu
-tegnE uQnElw[eD
fi
09/281201
$90.00
PaEe
$e0.00 $375.00 of
Pase
I.
raur t(oy
LutNme
First
\fi
jtate
lPrmrpal (rccuP
lrene
lib-
Retireo
trase of Emplc5's
Contributior
Scvmartl
cT l0e+e3
,
lzlPu(M
tetired
r a chief esecuti\-e officr of-a conhact $ith said
hbhfist. sPousa
r:
a l'l
-r-es
or deperdent cbild
ofa lobb1'ht?
s, No
ffiilitill";*
l-es
Is
",.:;;:bfy:.."".".:,l;;X,0."0.
"n1*lli*oo**j^=
{'
"
* !9/30/201
-r-L--rf
f.
No
contibutor a PrinciPal of a st rte )oohactor of prcspecta-e Ifies. indicate shich branc hor braruhes
of gor-ernnrent the contracl I
$tate gonIracrori
fNo
$20.00
Amount of
th:
\le{hod of coatibution:
'
,'{-.
I[oney Otder
09t28/2011
?fincFal OccuPabon
$20.00
ust
Blaze
Jane
litv
Fletirerl
Contribution
ffiffiISilAil&ess
21 Glen Girc,le
itate
Sevmour
-t,"es
cr
lZlF
L o,J
Natre ot
gnplq'r
I oe+e3
Retired
lb.
i* ussociated with har-e '.ff No .!'fr t'x
a chief executhe ofllcer oJ a a contrast n ith said
No
E.ffifffi.-tt*
{x}o'l
l"t*L
rr.,-
a l")
Yes
Is eonbibutor
u.i u,---t
C'
No
f}Or"nr?O{
"ii'-Ll-l"iu"#;;;;lh,
f.
Pa5rollDeduc*ion
If
rc-
s}ntracror;
' rs
r,
s*"fr'"
l{*' No
nL:ttu
\gg:egate clrntrrDuBw
Date Reclved
"SCJ-'r-.p:;;;;ic,",*
lr'{ethod of conhibutionl
lfr credicDebitcard
First
[fi \'rosevorder
\,tr
-lp L.mle
091281/2011
Pnncrpal OccuPaton
$100'00
$100.00
.{mount of lontributiol
-=------4
llinr{v
CT 06483
Admin Asst.
SanJ-I-Enpl))u
iltl
Seymour d*l
Town ofSeYmour
f,,
Yes
No
or a 0 to a candidate comoifiee for a chief esecutn'e o$rcer Ifcontributron $ m qxcel rrith har-e a goilract n-ith said municipalitl' does contril rlltor or t*iu"*t n"g. it associated q5 oool r*l Yes -f, No or ptospeetirc state contractor ls coatributor a principal of a state contractor
Yes
No
"ii"-;il"t
lart
iust
': fl
I e$ No
i- curn fi,
$255.00
$90.00
Amount of
ffiffici"""p;tt;
lJure
Bilodeau
Marcia
F:tr)'
[ffiffiISEeet.rd*s
14 Momingsiar Dr
[s contributor a lobb-r'ist' spouse a.p."O."i"ftifO oi' u tot Ulire
lp
alode
ffiIEFFtr
USPS
Lettor Canisr
Contribution
Anso nta
cl
Yes
r!. No
f*;"hief exec$tive offtcr of a If gontfltrutlol ls s o"*o ,. *'" gontrnst $ith said or br rsbess hetshe is associatd $'ith hare a municioalih'does conhibutor then $ t 0tx)? C'Yes No -rl^r:i-,--r,-.t .r ---'
CT
06401
"TidG;ffi;
-nrr
iil
Is this contibution associated t"ith a fundnising ercnt listed in Section Ll? f1.ar. list Er-ent * O9/3Cl/201 1 itlethod of conhibution:
r-r r s
fl
No
ii
C-' Credit'Det
fl
Paltoll Deducrion
Nlooey Ordet
09t2u2A11
PrrnclFal ClccuPatlon
$45.00
$45.00
Amount of
Moher
Michaet
1rh
ffiiEFfSFI.\d':kes
163 Brent Hill Rd.
ls coatributor a lobbf ist. spouse. oi' u totuui,ti
ttate
1{r (-ode
C!arrmnt
CT
06483
Contribu6oa
; ;-";;.J
.'f
ofa
r-es
'.{tr No
;#$;t$+l;+fbf::.-::f
uo
"htld
i'ffiX
heshe
is-rssociateqJ''*l^"'
{a ltr
i't
ls eolhibutor a prilcipal of a state contractor or ltrla$. hdicate $tich branch or branches . .rr i* *ith, ;i:":;;;e.-;;;.i
'JJ
lvtethod of contibution:
Eie
PersonalCheck :{i (--reditDebitCard
Reeived
-F|?;i-'fl
Pa5'roll Deduction
fi
\Ione5'Order
0!|/2812011
$100.00
$100.00 $355.00
of
I.
Paul Rov 201
LdtNme Potash
K6rdenflal steet
1
lf
Pnncrpal Occupaaon
-{mount of
Daniel
Jrq'
Assembler
jlale
,lP
Contributioa
A(ktes
Yes
i..
!.rus
Name ot Smplq er
23 Glen Circle
Is cootributor a lobblist. spouse.
or dependent child
CT
0e+83
Thule, lnc
ofa lobbyist?
No fr.. Yes
of $,100 to a candidate commitee for a chief executh'e offreer of a municipalit5.'does contributot or business hershe is associated qith har-e a conhact with said i. Yes f, No -..'-'--muoicipalitl- ratued at more than $5.000?
Is eonbibutor
a
*"*s
*ith l
principal of
coctactor? f.
firndraisinger.entlistedinSectionll?
f.
No
fy:r.indicitentichbranchorbranches
09/28/201
Yes
No
f,
$'15'00
$45.00
ADrount
Fffit
Itinclpal Qccupaton
of
Potash
lB$leilral street.{d{trs
Carmetita
]rt''
tta!
,IP
Retird
L{M
Contribution
er
Nme ot .Emplq
23 Glen Circle
Is conhibutor a lobblist spousa or dependent ehild ofa lobbyist?
Is
Seymour
CT
06483
Retired
Ies
:n No
a
ffi"ti*
Yes
of $4o0 to a ctndidate commisee for a chief eswutir-e offiser of a i" i" does conhibutor or business he,she is associated with hare a cootract rvith said muoicipalit-v ralued at more than
.\--t.
municipali['
$5'000?
a
'.f
Si
Is contsibutor
principal of
*on&actor? f'
Ves
Ll?
No
oiiorernment
*-it&:
fi L3gqt",i*-
lft
No
Date Rrcesed
,{ggtegati l'onEloullolls
('iCash F.
personalChe,li
lfl
09128t2011
Prirnrpd rlccupanon
$130'00
$90.00
Amount
\{I
MI
:rP (:otle
of
Crystal
-lt}-
Sbn Maker
I
Contributiol
otgBplcT'er
fi f,
Yes
No
0a$3 Nu-age DesiEns, lnc CT Seymour If *"ttitr"ti"r ir i" s.l"*s of $400 to a candidate commitee tbr a chief exeeutir e officer of a municipali$' does coatributor or busin*s heishe is asscciated rdth hare a contract rlith said
muni,:ipalitv vahred at more than
$5"000? fl r*es f:
a
No
l'es
No
09/301201
state contractor or prospectire state conhsctor'J Is eontibutor If,es. indicate n"hich braneh or braachet Executile oigoternment fte cootract is
a
principal of
l.le8 {No
$ith;
f.
f.I.:gftutl:
Dat Rece$ed
AggIegA: C(rnrtouuoffi
{.
CreditiDebit Card
Ftrst
f,
PaFoll Deduction
fl
lrloae!'order
l\[
lrP LOse
0gt28na11
hrn rpal()ccrFaton
$90.00
$90.00
.{mount of Contriblltion
lesiiLntinl 1OO
steet.{d&e*
Charmel
Patrick
W. Meadow
Rd
fl
l!
Hamden
ffi
t}-
Nme oI lrsployer
CT
06518
Grifnn HosD.
for
a
Yes
a candidate commi$ee
No
muricigalitl. does contributor or business her she is asso,riated with har-e municipalitrtalued atmore than $5.000? f Yeg fl No
tlis contibution
associated n-ith a
*i-t Yes
Ll?
1
fl
No
Is conbibutor a prineipal of a state contractor or prospectir $tate contactol? Ifius. indicate rr-hicb branch or Legislotire Executive oilosernment the conbact is
Cl
branches {l nith:
D*te Kecered
fl
fl lto
Yes
+SIegnte
{:l
fl
Pa!'roll Deduction
fl
o9t28t2011
?trncrpal Occupattrn
$90.00
$90.00
Amount of
Weaving
(esr'Jentral litseet Arl{tress
Jason
&vns
lstate
ir it
I GetUsedParts.com LLC
Contribution
12 Eleanor Rd
seymour
b coohibutor
of $d00 to a candidate eomndltee for a chief sse'Juti\e oftter of a ""rhibr"r.r muoicipaliq- does conkibntor or business he,she is associated rvith hali- a ,:ontract rtith said nunicipalilr'r'afued at more thar $5"000? lfr tes F No
Is conbibutor a priocipal of a state cotttsactof or pfospectil'e state
*"t*t
lcr
lztP L'od
){dne oi Emplq er
loo483
self-employed
F Ie" fiNo
(f
contradof? {]'
091301201
fys.
'3'i
LeSilllt!1-
fi
r*es
No
Itlethod of cootibution:
+tegaE coNrou(lN
fi
Cash R
Payoll fleducrioa
hlone.r'Order
a9t28t2911
STTBTOTAL Section
$45.00
$4s.00 $360.00
BThis
Page
$g
of *
L
aO1!{L,llTTFrE,:'
I 'l
l
MONETARY RECEIPTS
10/11/20',t
R'
lr!'i
!f
LstNme
Fk$t
PrncEal (Jcspanm
-{mount
of
Wallaca
Resrde$$l Ste.t Addrffi
Stanley
Mail CaniBr
Contribution
13'l lnwood Rd
Is contributor a lobb;-isl sPouse, or dependent child ofa lobbl'bt?
16 Tirmhutl f. r,
Tes
1state
!,wr
ffiifiIE$pEs
USPS
executile ofticer ofa
lCf
06611
No
----r-r'--r:i-.,^r,-t
Ifvas.
tr..*
r;.i c,-**
= n0ran/?nl 1
{-h*l- f'
fl: l.
les
No
Is contsibutor
! Iw state eooracror I a princigal of a state coltractof or PfosPeltn-e tr No hdicaterrtichbraoshorbranches { Executite f Legislativo , ,, ..' Ag-qegaie contrbuu!1ns "iir.=t"-*iU""ootu,rtito'ith' Receivdd Date
lrlooev Ordet
^-..t
r-."AitiDebit lard
[,trst
arroll Deduclion
o9t2a2011
Prmcrpal QccuPaton
$4s.00
$4s.00
Amount of
Sawicki, Sr.
Gr
alStretAd&ess
13 Lantem Dr.
ls cortributor a lobbltst' spouse Yes
.t..'
CPA
;tate
CoBtribution
,IPL]e
ffiETsplo't's
Maranm, LLP
CT
0a[83
- a-.p*4..t-ftifa rr.,-
oia toUt-virti
.t{i Ye
?n No
Is this conkibution associated $'ith a frndraisins er-ent listed in Sestion L l? li"; Fr.Fnt nqr3nf7ol 1
#
P.
contagtor? ! I
r es
$-' No
lfles.
"ii"..t
Fint
---=----r-r-
No
t.*"*icL".:tc. lf
\Ione.v ordEr
0912812011
lPrinclpal ()ccupatlon
Kozey
Donna
ffiffiia=l$Ft.{d*es
7 Kozev Ln
th
Yes
spouse. f I ordependentchildoialot'bfist? f.
I"
*ntibtt *
t"ttbjitt,
No
Ptate
I :p ti* 06483 I
Ls
\tr
Secretarv
Lrt
lName
lmplq
el
TownofSeymour
a ehit^esecutir-e oflrcor
associat't
]ltl^= '
of qontnct.ith said
Isthiseontibutionassosiated$iths'i,
frndraisine e,;ent listed in Sectiou L
Yes
corrha')tfl
Lesislati\',e"
Asgregst
rr..,"
ti"i
rr-*r =
l?
f.
No
O9/30/201
lr{ethod of sonbibutioo:
f ..."r f;'p*^-"lclre"t {.
Kalako
steet.ld&es
CreditiDebit
trith:
il'
Eseeutir-e
f^
..-,."..--.
Date Recel\'ed
Nlone-t Ortler
ost2u2a11
ffiGcupaA;Barista
Melanie
l-jlD
Glffiial
lJBre
7 Third Ave.
lg *oqtributor a lobbf ist. spouse. or dependent rhild ofa lobbvist?
{l
i!
Yes
9eymo ur If contributiol s ln
No
ffitiveoffirerofa sisess with hare a contract n'ith snid munieipaliq'does conhibutor or bu siness he, she is assoeiated ,----: -:l--r:*..--k,J .r mne thrn S' i_000? ft Yes l No
state coltractor Is contibutor a principal of a state contractor or pro$pectire Ifree, indicate *-hich braoch or branches
SAitEtEnpryaStarbucks
ls this eonhibution
asso,liated with
a
1
S] lts
{-
' r6
$4s.00
.{mount
fundraisingerentlistedirSectionLl?
I/-ac
lict Ftenf
* n0/lnltnl
fl
No
#;;;;;d.;*"t'
Dat Receri'e,J
iggregnte conEmalrD
\{ethod of eontitrution:
LastNarue
Ir'Ione-v
Order
091301201 t
PrrncrFal OccuPanon
$45.00
of
I
I
Kristen
Vhe-Pres.
lstate
:qr L:oile
Contribution
ilsavmorrr
Yes
'.m
ffi;EEmp$er
Hanhon GrouP
executh'e officer of'a a contract with said
lCf
06483
No
;*'*[l ::i:]"::1*f"x'"ffi
Is con&ibutor
a
* *'
T#.,y:.*.,1''$]'*
snbacto{'l i-' I s
lf 1-es l{ llo
[r
principal of
I/r.as.
iodieate'$-hichbranchortrranches -.
Date
'fi
No
Fr
"i!.''!'"-*id "'
Pagoll Deduciirro
R*enetl
0913012011
.{ggregnle
c$rrDuus
$420.00 $45.00 $205.00
crcdit'Debitcard "f'
F \Ione1'otder
SSBIOTAI.Sq{ FlldsPas
Page
_.__ -of-
L
Paul Roy 201 1
from Indivitlu
Amount of Contributiol
Is"oanibutorolobbfislspouse" I:
I'iith
ordependentchildoialobbyist? f,.
Is
Yes
No
Yes
;;6;ttt;"*
No
a chiefexecuth-e officer ofa s-ith said conhibutor or bwiaess hershe is;ssoeiated withhar-e a conha':t 'fi r*es No r-il"uii'i"ft.a at more tbaa
$5-000?
f''
state ccnbactor? Is eontibutor a prineipal of a state colhaetor or prospective nhich branch or branches lfrer. indicate i* rir
i".=tt-*ia.
l:
";;"t "@
A.61[f,-
e^.
F"*"*f Cfr""t
5. Palroll Deduction
Irtoney Order
$50.00
Amount of
Contribution
;;"rp"lild"*
Yes
Is
r a chief eseeuti\ e officer of a with said contributor or businese hErshe i$ as19':iatefvil\hare a coatract
a state conbactor or pfospesti\ rtate conbactor? n hich branch or branches Legislative Erecutive contraet is
Ifi'a.
listEvent
a F Sectionlll fl'
1
contibutor a principal of
No
09/3Cl/201
"ii..=t"-"tit"
rtith:
fi
F";i-
$85.m
Amount of
Contribufion
spouse. fl f* ordependertchildoialobbviqt? f, No
Is sontributor a lobb1ist.
ee
for
;;;;li$;;;;;ontributor.or
i"il.ri*.rfu"a
Yes
blsiness heahe is
at more than
$5"000? f, tes f
t*ittt'
associate$ri{fare
No
{; f.
No
stnte conbsclor? Is conbibutor a prineipal of a state consactot or FfosPe':tile If indi,:ate rrhich braoch or branches
lc. ;i [;.eirnreni,il
*rrrtu-t i*
f ' Esecuth'e f
' Legislath'e
$50.00
.dmount
of
Contribution
St.
sPouse
Seymour
a
S]
\'e$
C.t
contibutor or business heishe isrssoeiated with hare
No
;ilffii';;heJaimorethan$5$oo? f Yes rl
No
e state coabactor? Is eonhibutor a princlral of a state coltractor or ProsPectil I^'cs. indicate shich branch or brun"htt ..
"ii"-"-"Ja;;;"*",
b"tft'
^, E f: -
$90.00
.{mount of Cotrtrib$tion
i ;;"tp.ttil;*;nhibutor-or
Sj
No
chiefexesuti$ officerofa
brsiness he she
u corrbact $-ith said
isrssoci:rttlJ'tl^= lS No i"i'""rit-'r"f,t"dutmorethao$5.000?
IsthisconbibutionassociatEdnitha'F \s
irndnising event listed in Seetionll? Ifi'es. listEvent+ 09/301201 1
Ir.te$od of conhfuution: '.f. Personal Checli K] Cash
prospcth-e state Is conhibutor a principal of a state codractor or Ifr'es. indicate n'hich branch or branches
"$r-es ^-L-^*.k-.
lfi
No
"ii"t'.tr*""it"-";*;"tth,
F
\tone--s Order
{'E**'i-"
SUBTOTAL Sectisr FThis
fr
?r
I,
Paul Roy 201't
MONETARY RECEIPTS
1A11n011
Section B. Additional P
Indtviduals
.\mount of
ffi
Yes
No
for a chief executir-e oftlcer of a municipaliS.does cootributor or busiaess he,sbe is associated $ith ha\e a contraet rrith said municipatq ratued atmore than $?O
t'o a eaodidate comodgee
16'r.listE\-ent* qqBQr2q]l
a Ll?
f'
'il.
No
eonbactorl i*.
Yes
No
f.in*l
\Ione}'order
$320.00
Amount of
Contributiotr
'ronhibutor
C'
-fes
'O
ffi
Uo
a candidate committee for a chief esecutir-e officer of a nruoicipal!.' does coakibutor or busiless hershe is associated,sith hare a conkact rvith said ioatinvahredatmorethan$5"000? [F' Yes i' No
Is this
'rontibution
associated
$ith
Ll?
Is coobibutor a principal of a state conhactor or prosPecti\-e $tate contactor? /f yes" indicate nhirh brasch or Legislative Eseeutive oi Lo.-ernment the conlract is
fi
il lethod
n C*l-
of contibution:
F, Per"onal check
fl
creait'Debit card
of
Contribufion
Is cootributor a l,obblist.
ordependentchildoialo6tyist: f,
Is lLisqontsibution associated n'ith a firndraising er-ent listed in Section I.l1 f1'er, list Er-ent 09130/201 1
spouse" {-l
Yes
No
iciiralitrtaluedatmorethan$5.000? f. Yes f,
No
fi,
fNo
Is contibutor a principal of a state contraetor or prospesti\- stat conkfictor"r fy'e*. indicate which bnnch or branches Legislative Esecutir-e oiiol-.n"** O" contract ie
with:
f.
f.
{.
CredirDebit Card
f.
Pa$otl Deduction
|l
\Ione,v Order
$45.00
Amount of
Confiibution
ordependettchildofalobbvist? l
Is this contibution associateds-ith a firndraising er-ent listed ia Seetion L l? Ifi'rs" list E\-rnt * 0S130/201 1 Nlethod of conhibution: cash Sl Personal Che,rli
fl
Yes
No
committee for chief executire ofticEr of $4O0 to a candidate commrttee toI a cblet execuln'e olltcer oI a n ith said munieipalit-v does eontributor or business he,she is associated,rritlr harc a contract No municipalit-v'rahred at more than
If conhibution is in arcess of
$5"00{?
f tes l
fil Yes f I No
principal of a state contractor or prospectise state cotrtactor? Ls conhibutor {f;'es. indicate which bralch or branehes ill Esecutite fll Legislatirc oiior.ntru.ot U. contract is nith:
a
fl
i:l
Credit'Debit Card
t'l Paltoll
Deduction
lrlone-v
(hder
$107.00
.{mount of Contribution
coanibutor
ffi 5.
res
,;andidate comnriuee for a chi"f executive officer nf a tloes contributor or business hershe is associated:rith harrr a coffact rtith said municipalit-v ',ft No iciialin talued at more than ''f'
$5$00?
Tes
Is this contribution associated rvith a fundraising event tisred in Section Ll? dfJ'es. list E\-ent + 09/30/201 1
F-l No
oig*=.nm*t6tcontractisrvith: iil
Pa]roll Dedustion
branches
of prospectfis state
eontaclol? !f'
"
'fi
Yes
No
Executir-e
I}L*gislative
$60.00
Itlethod of cortribution: -
Ki
'fi
lrlone:- order
S.
LastNamc F$st
bncrpal Occupatitur
Amount of
Crystal
lttl' Yes
Sign Maker
.4 !-Ne
Na$e ot Emplq'd
Contribation
Seymour If
CT i" i"
06483
No
for a chief esecutic officer of a "f ""lkibtti"t mudcipaliq.'does contributor or business he:she is associated $ith hale a contract rvith said
$4OO to a candidate committee
*".-t
a
municipalih'vafuedatmorethan$5.000?
ttis conhibutiou associated n'ith a firodraisiag er-ont listed in Sectiol Ll? f1.er. list Event + 0gl3O/2O11
Nlethod of conhibution:
irj
Yes
Is conbibutor
lC No
l,
principal of
conbactor? {.' ls
No
h Ca$ fl
PersonalCheck
lli
Cr.ditD"UitCard
Frst
Pa3totlDeductiou
f-
Irloney0rder
T{I
;tatc
091301201
$243.00
$153.00
Amount
Prrncpal (tcrpaaon
of
Niezelski
(e$cettnl JtIee[ Aqcres
Joe
Sales CT
ot lnpkYer St. Anthont's Book /Gifts to acandidatecommitteefora shief executi\-e officerof
Contribltion
:lpllre
)'lame
Seymour
08+83
)es
Itr a
ffi
Yes
No
munieipatirl- does sonkibutor or bBiness heishe is associoted n'ith har-e a contract rvith said icr No municioalitr tahred at more than
$5'000?
lf Yes
'f,'
ftradraisinger-entlistedinseetionll?
Ifi'c.
K1
listEved
No
0g[30j-2Q11
eolEaclor? f'
fl
I.es No
{ggregale coll[rwBrlm
lrlethod of confribution:
Cash lf.
Roy
Personal ChecL
'fl
f.
0913l/2011
hmcrpal Ctctpatnm
$126.00
$126.00
Amount of
Itr
}Ialc
Evelyn
-]lti
Retird
!p Lo{e
Name ofEmployu
Contribution
80 Washington Ave.
Is soahibutor a lobblist, spouse, or dependent child ofa lobbvist?
Seymour
i-'l Yes
No
CT
06483
a caadidate
Retired
commitee for
a chief esecutir"e offieor of a municipaliq. does contributor or business hejshe is associated n ith ha\.e a contract rrith said fl tes f, No mulricipalih. valued at more than $5'000?
ffito
fr: \es
iNo
Is conhibutor a -fii,er,
f.
princigalof
shtecontractof of pfospecth'estatesontactof?
oiiorernrnentfrecontractiswith: (.Executise
I)ate Kserved
aioi"it .r*ch
branch or
braoches
ilj
f.
r*es
No
f,
{-
Credit'Debit Card
09130/201
FEt
Prmcrpal t]ccupaton
Valeski
Rsidedial SSet.\d,iess
K.rb
Dawn
Lse
ot EnPlc')er
20 Osorev Or
Is eontibutot a lobbSisl spouse. or depordent child of a lobbf ist?
Seymour
CT
06483
Town of Sevmour
lll f,l
Yes
ffi
Yes
No
,Jindidate eoormi$ee for a chief ese,:uti\ E officer of n municipaliq' does contributor or business he'she ia assopiated nith har-e a conha.)t n'ith said municipali!.vafuedatmorethan$5.000? f' fes ffl No
Is conbibutor a
Is this conhibution assooiated n'itb a firndraisiag el-ent listed in Section L 1? 09/30/201 1 {f}.es. list Elent
r]
r::
No
fl,es,
princiral of a state conhaetor or prospective state uonbartor? indicate *-hich branch or branches
L, les
rr-ith:
fl EseTtive-fl
1
fl
No
I-3gis!:tile
\gregate
l\lethod of contibution:
llate Rece$.ed
i. Ca"n fl
Personal Check
fl
fl -
Paltoll Deduction
Nlonel' Order
09130/201
$105.00
$55.00
.{mount of
LstNrm
lesldeDtnl Stseet A$tess
\fl
itate [Z$
Ltrile
Prncrpal tl}tcup:um
Contribution
N[frEoiFplc-r'er
;rt\
ls
conhibutor
rr dependent child of
'f' lfi
Yes
No {.
tes
a caadidatecommitteefora chief erecutive officerof a municipalitl'does conhibutor or business he'she is associated rvith hare a contrret rrith said ',$ r*es if: No muoicipalitvtahed atmore thao $5'000?
ffito
f}'es.
list Er-ent
in
uo
Is conaibutor a principal of a state coltractor of prospeetive state cotrtrftctor? Ift'es. indicate n{rich branch or branches Legislatir"e la Esecutive oi io. ernment &e eontra,rt is
iF fes
ir
No
n'ith,
Date ReceiYed
"f"l
Aggre8ie conttbuuom
Che,*
'.{"i
Credit'Debit Card
Pagoll Dedu,;tion
Nfonel'Order
$409.00 of
t"r.{ug
a.
:[ (-uulllxrrwr
Name ol lfeasrer
ot
Nme
r :
Is th is
:;;ll:-!Ilil]
$0.00
rd&ess
Jtate
contibution
asso cAtedn'ilh a
f. fs l/;s'
lis'
lp GT
Code
Ete
ecCn ed
\ggega*ruuruswr
f, No=El.Tt.i.T_
$0.001
list
ilili'culmrttee
Ad,te$
li1 Tes l/}'s' list this coDttbuton asso( ,iated n-ith No radraising er-ent I rcted: n Sectionl-l?'fi ::l: Flliltlii-'" r:
r
I
-^--t
af flnntrihution
Eren11.,....$o.oo
lib'
lcr
State
tz*i lode
rteRNeNed
I
a
-lggrsSdrs
$0.00
a, -l-es
-td,*ess
:fifaueTTctm;tttee
GT
l*
No EI*:-:=
Ifi
s' list
-^--r
nf (.nntributioD
:eived
l.{gIe8:aE I uruuuqqD
: I :il--.
$0.00
so.oo
I
ffi
nt\
'ess
lls thi"
lstate
lcr
.r
I
I
6'cffi
xilh a ir r sectionll?
ldount
.:::
of Contributron
\gEIEdF
$0.00
4
ffi-f taffi,tt* ia$-es-,iated rrith b this contitrution asso( frrndraising event I sted r nsectionll'?
^f
{'ontribution
5ir$ame olCwtmrttee
Itate
lzlP L(
66Eect n'ed
i
=,r,.:::f
$0.00
$0.00
CT
{ame
\d,tes
:'.t\.
this fundraisi
[s
co rtsibutior i AggC
I1g
lsurte
lcr
Cu l' l4r
I
I
,liated
event listed
eived
-^--r
nf Cnntriblltloll
::
::
$0.00
ni*friiiidd*srmir';tt'*r
of Trexwer
'Tmre
)ate ReceNed
.{mount of ReceiPt
ffi
1t\'
$ame ot Uommrllee
I I
I
CT
espense
-il
Surplus
$0.00
Distribution
of Treasucr
Date
RseNed
-\mount of ReceiPt
Ad,$es
Irb'
lSifr.
lcr-
lZrp tlrrle
il#;,f*;J**a""i"."
$0.00
Distrib ution
$0.00 $0.00
t
loNTRI
Pns'il
$0.00
PTS
$ l f, t[ r}tr frfll\' fl\ ITTTIIE
(Sections
A-K)
{T.INGI}LIEDAIE 10t11'2411
Paee 5 of
li
Source of Loan:
ln
,rp L'ode
i, Bank
3t. Candidate
CT
lf lndiliduat'f t)*r.r
Conmittee
Is there o Cosig!r or Guarrtrtor of this loan? 'il Yes f/.r'es IFt raw mda&ess of Cosigrerfruaret r)
"{mount Receir-ed
INo
$0.00
itret.\ddres
ofJ-ender
llh'
lrp Lltde
Dateoffmp
Source of Loan:
CT
'Jame
itreet "{dffess
$ame ol Ctxtgner'(iuaranttrr
.'$
llp
Llrrde
l. gant
;:l
-{mosnt Receired
this loan?
'f'Yes
?-t No
16.r'estl*
nane atdad&ess
C6igneflGualettol)
$0.00
r-nmrnis+
Street,{dftess
lip
L-*1e
Kecelpr
CT
':
Total Ser'tiqr D:
0.00
n
{me
of Bnah
D.irii-rc.f.*r,rr I'ntitir.c n*hertiien Indivlduals oI: Other COmmittees (&eterenifuryCofrtinittb* ONLI] ,'
\g-segate
C(utrlbutl(s
$0.00
I
I
$0.00
Nme
of Enhn
CT
r
lp
$0.00
$0.00
$o.oo $0.00
CT
TofalSectiurEls
Date of
0.0O
Receipt
hansa,Jtion associated
-{'mount
Date of
Receipt
.{mount
Total Transfers
$0.00
I* this
$0.00
ls this trarsaction associated $ith
firndraisingeventlistedinSestionLl?S
0.00
-z '
Date ofReceipt
ir-:^;
^; frat.;;J il;;nlzoi*nr
Date of Receipt
lf'hoa*i.trtioa fommjncix0Tif.lll
Total lrnnslers
lmount
$0.00
$o.oo
-{mount
$
(Coildidare Cqtttr?iree's
0.00
If
Dateof
O.\ZI? ,
\Iethod of palment:
Date of Receipt
.{mount Received
Receipt
09/28i201
t_. Cash
$90.00
-{mount
Amount
$0.00
lr
Cash
90.00
i-ffiffiRY
Paul Roy 201 1
Prge 6 of 17
t- Anonvmour Contributions
)ate Recese,l
bjw
so.oo
s:
-lmount
Datc
Raerved
I sr(1m
09/30/201
$r
$13.00
uit
$3'00
$:
uills W bitl
t
$10'00
g1
coirs $0.00
Date Rece$'ed
$ro
uru*
$0'00 $o'oo
slo
bil
$
$o.oo
13.00
r
$0.00
ffiffiffim
Str*t.{dlles
iState Zrp L-ode
lcr
Lrih'
State
Zrp Code
CT
0.00
rt
Nme
Stset,{illres
Coqtribution$
lati
of Trma".trcn
'
,lmount Received
Lrrq
Zb
L-ode
CT $0.00
flesdFi$l
$
Date of Transactm
Nme
1b-
.{mount Received
Zp
L--od
S8eet -\,llress
CT
$
l
D*uiF*1d1
$0.00
;i:::
::?
ii::::::;::=
.{mount Receired
Street Addres
lllt)'
CT $o.oo 0.00
D*-trptrd
$
Tofal
SettimK
$
0.00
F)
-'''---
: :
n'.-t {-^-'-rT--*-t^*-'rr-^-
Lrftli4ts'llehorllnionorOtherOremiuationTreasur'l'(SectionG)
(Secti'on
+
+
tI)
+
+ +
---r
^. l-.^-*]
e^-
n^-^-ik
ih I
s
)*--t-7*ttw.
z*-t cl4-t
^- t t--
l1 nf ttstwrmr
Paspl
10/11/2011
Pae
$12.00
lggregate
Amount of Purchsres
Section
Darrl Pnv?Ol
t2. A
l'-.''
1
!4r I tUlBUt
I
porr
I
lruu
.rri*
tBb
or:
I\'Il
riame of
i,n6'i.xilxzrt Wlhelmy
Resrdenhal lEeet -{nrJles
h.uclnser Lct
Nue
ttl'
* .
nnit
Code
Cash'
PersonalCheck
)ate Rserred
to"*"
CreditDebitcard
,{ggregate Amount of
Purchases
Saymour
CT
06483
og/30i2011
$25.m
Io* I
IiI
Card
arp
I
\Iethod of palment:
Dtte RceFed
Aggreg*te
Credit Debit Card -Amount of Purchases
S"rtou.,
"*.
:tt\
uoce
jrent:
CT
06483
ogt3o12o11
io. e,o
$46.00
\{I Evelyt
daa9
creditiDebit Card
1
.{ggregate Amount of
Purchases
4p Ll1qe
lvent =
Seymour
CT
064&i
09/30/201
$50.00
Ftrst
Mexican basket, N
l\{I
ffiil"ttotr-LmtNanre
tnitnituatsz*Ll]
ffiffimlSiteet -\ddress 4o1 Devis Rd
Items Pwchased
GOyne :ll\
Kovin Seymour
'6I
1rP
--
F
Nlethod of pa1'nent:
born' b
Persoaalcheck
areni =
.\ggregate Credit'Debit'!111
.{mount of
Purchases
tode
Reen'ed
CT
0&{83
tl
09R012011
$20.00
Bracelet
\tr
Kristen
l6t
Aggregate
PersonalCheck
i{i
CredittDebitcard
Amo[Dt of
Purchases
Seymour
CT
iings I
\,II
lgretf=
oei3cy2o11
$30.00
lethod of oarment: -.f, Personal Curn'
6Jofhlr"ha".t
27 Patrick Dr
#
ltems Ruclms,J
tnitiriil*atsolrLl)
Harmeling
.lq
Kurt
)EIF
Checg
FSFntral Steet.{dffe$s
,{t
uode
Fte
Received
Ever$
ii Credrfielrt'llj!
og/go/zo1
1
Aggregate Smount of
Purchases
Seyrnour
CT
06483
$30.00
LmtName 'Itl'
Fust itrte
:rp Cld
6iof-P*"t*"*
tndfiiitualsA*LD
f Cash
PersonatChe"k Cjsent
C-4rtE!{C*!
Aggregate Amount of
Purchases
>tteRseNed
tms hrchNed
tl*" .t'P*"-l**t
Last Nnme
Fst
tnilhiilueb AliLi)
C; Ca*n'
PersonalCheck
E\.erf =
fl Ctdit&bitcard
Aggreglte
Amount of
Purchases
}h
lEte
crl crl
[Zp t't{e
)ate Rserved
iiffi'ffiE?il
$0.00
Ir{ethod ofpa-rrnent:
ffi.'ffit"t
Tnilititftiak
O\LI}
r*tNi'
]ltl-
Frnl
CreditDebitCard
itate
lzlp l-ode
Date RecelretJ
ltms
Pwchased
$o.oo
$201.00
Paae
of
'o11
rO
of
ry;-tx;
{
\1 ,*"tE
)o\
F*?]5'i
$ ).00 I
\tate
*' ,.00
nt
o'
Lls
io.( r0
runt of
rcha se
reE.glY
tor -{r
-..".tr
$0.00 \
sbte
Lffit
l.\cg.e
$t ,.00
nou trt o{
'urC Il&se
r'or
\sel
f il-AllE(ents I
$o.l
$0.00 \
t0.00
Am, )unt
of
Pu rchtse
State
r@-
jrerf
)o\
$0.00
Gount ot
Purchase
CT
#ffiff--...N
{l
P*"to*t
State
$ ).0t
I
$0'00
q*H.ff*\
Fount
of
Purchase
CT
\g
\
State
ed
$0.00
:Y:,-lt+;;
1
G-tootof
Purchase
$o'or
$0.00
,A.mount {
il"g:,X.'H1
Purchas
-'*
$0. A$oun
ffiH.*-""\
Purch
I
Stnt
so.oo
$
,\nor ?urt
CT
eiva
TAJ
f.. It6o
mI
Page l0 of 17
$71.00 $751.00
$s22.00
'en
oution
br-; fi
value
fi'nAir-iaual
Business Entih'
thrs erent
Fegate
fd
iJr*rotn,
gisenbv: f'
BusinessEntit]'
Name of
r)onor
Kristine Bourret
Sir=ot-t, f'
BusbessEnti$'
ffiii[i---f,udi.iauol
uir-enbY: 0
BusinessEntib'
$132.00
DLrnc{
Karen Stanek
Name
otDonu
gi-;Ut,
Rosalie Averill
ft
BusinessEntit-t
evgnt
ibrth$
$131.00
NAt{Ii oii
rr}I\rMrrTFF.
, ! !
,,, I
.
| ! | !l !!
.
T'ltJilinifill tffil*****************
'
itial.'?-L+::ln
r0t1112011
' ' l!' rf
Paul Rov2011 -
.,.
Nafi e of Donlrr
ll
.krlith Simoson
G .r5ilil
i
t/Valnut St.
F ffi
il
:it]-
i-T crl
Fair llarke{
'alue ofDonatior
Zrp Code
06483
Date KseN*e{
iu tns
etent
gro.oo
09/091201',|
$10.00
Eser$:
1
dpticn of donahon
c JOK|es
Evelyn Roy
-\ddles
itate
09/091201
)onation rlndiridual
rh'en b-v: fr
.4lF L.wc
Busi*e*sEntitl''
SQate
Shet
80 Washington Ave'
qavmf)trl
CT
06483
fhte Rece$ ed
$40'00
$40.00
Dffi;Iffiron
ftoldes,
rolls, wne
Nme of Domr
Fffi=
09109t2011
09/09/2011
Donatios Qlndilidual
Fair 1\larLet
Yalue ofDonation
Judith SimPson
_rit} JutIE
givenby: fi
BusinessEntiq'
Seyrnour
CT
06483
Jurt
$10'00
Evrf
1
$10.00
Kg:ereq
I
Fair l\Iarke*
\:alue ofDonatioa
09/09/201
ffi
Kristen Harmeling
ffi
27 Patrick Dr,
Dewlr{rm .lt
Nme
donatkln
iSevmour
srI
CT
Tz@ I oo+e3
:.]at
.A,ggregate
$200.00
$200.00
Eied
=
llervvs
09/09/2011
09/09/2011
Fair \Iarket
alue ofDonation
Donation 'Indi\idual
l)ontr
Anna ConroY
givonb1: S
lrtl
Seymour
JUIId
BosinessEntig'
FE;ISK
167 Skokorat St'
Desariptnn ofdonatron
CT
0e$3
)ate Rcerve,f,
E-r.ent
$50'00
=
1
$50.00
09/30/201
09/3012011
oo*tioo
givenby-:
XR'
I
QlodiriAuat
Fair l\'Iarkd
Yatue of Donation
Lhuor
$eymour
fi
BusinessEntiqtils
evnt
lcr
state
Zrp-t5de
0e483
Date
$30'00
1
$30.00
F-i6imof
Nme
Rsen'ed
domtton
09/301201
0st301201
Donatior llndi\"idual
gh-enby: fi
$egate
Ese* =
Fair \larket
Value of Donation
BusinessEntiS
Antonio's Restiaurant
StrJiEEi.
kess--
}q'
Ansonia CT
f4'Ge-06401
)aie Kecel\'eo
$20'00
0w3t)/2011
$20'00
09,30/2011
gir-en
--rt]'
nooutlo"
{:'Indi\idual Entitr
Fair I\Imhet
\:alue ofDonation
Antonio's Restaurant
br': G Business
Ansonia
CT
06401
Date RE;eFed
$20'00
09130/2011
$20.00
dt-mtron
09130/2011
,ir*r"p"r'
$380'00
Page
-of -
n run-snqc
6d
EYENT
acrrYITY
contriuulllH,
NameafDonu
gir-enb1-: fJ
H. Preet singh
BushessEntiq'
Nme tf Donw
Si.;"U.,
Vera WlhelmY
f-r BusinessEntih
givenbl': fi
$egate
BusinesrEntiS'
m NOI\{MONETARYRXCEIPTS
$ALr'ilE'r.r1ldi'frTTTg r'.. ..
.:,
PagelloflT 10ll
11201
1
.'
$ame
iate
ls contributor a lobbyist.
ordepeldentchildofalotrbfist? {*'
)ate Rrceir-ed
spoure, li
Yes
No
a chief esecuth-e ofhser ofa q'ith har-e a contract r-ith said municipalilv does contributor ot bnsinms hershe is associated fl' Yee f , No municipalitf'r'alued at more than $5.000?
crl
lt
f f
Committee
Oher
iommitee for
s this contibutioo msoliated $-ith a irndraising event listed in Section Ll? {ft'as^ list Er-ent =
fl fes 3No
agrwaR
$0.00
Type ofContributor:
$0.00
li'air 1\larf,el Value of this
$me
]treet^L:':res
'rh'
Julle
4Ip L otle
CT
Is qootribrtor a lobbfisl spouse o, A"p.na*t *nila oia toUtf irti
)ate Re{erved
'S li fi
Indir-idual
Committee Other figplicable onll' to Refren&tm Committees)
Contribution
'O
iJ
Yes
NO
a cardidate commitee for a chief eseeuti\ e officer of a rvith said municipalit-v does coohibutor or business he'she is associated rvith hare a contract O C' No municipalig'valued at more than
ffi
$5.000?
Ies
f'
f1'rs)trame
li$t E\-ent
e,
Yes
{ggIcg"l!
No
T5.pe ofContributor:
$o.oo
$0.00
li-air luerx.t Value of ttis
Fstldffiss
Iscontributoralobhfist.spouse.
or dependert
)ate Received
'lh'
)Bre
arp C(lde
CT
f f; f,, $5'000?
Individual
Committee Other (4pplicabte n 4' to Referenitum Cmm,tteed
Contribution
Yes tqo
ateaommiceefora chief executive ofiicerof a does conhibutor or business he:she is associated n'ith hare a conhact with said nrunicipalitl'"
iir*"ii,Jtq't"r"ed
atmor than
No
conhibution associated $'ith a fundraising event listed in Section Ll? f;l'ec, list Erent *
fis
hN"
{ t lEs
gIcEaE
$0.00
T3'pe of Ccnhibutor:
$0.00
.l'air l\Iarltet \:alue ofthis
{me
tust Adjrss
s contributor a lobbf ist. sPoue. >r dependent child of a lobhf ist?
)ats Receivod Is this
ilt\
1rp Cl)de
CT
f fl. f.
Indisidual
Committee
Contribution
fi Yes f'No
ir"i"ii,ofitl","f"ed
rrith
Yes
atmore thar
omnoittee fot a chiefesecuth-e ofticer ofa assoeiated with har-c a contract rdth said
No
{Egrega to[trrouuQlD
contibution
fundraising
$ame
No
T-'l'pe
$0.00
of Conhibutor:
W;eiTI&ffi
rt\
iure
1ip ('ode
GT
Value of this
Contributior
Committes)
comruisee for a chief executi\-e officer of a Yes Iscontributoralobbfist a"* contsibutor or business he'sbe is associated *-ith hare a contract rvith said No dependent ,:hild oia lobb-vist? or "to*"ipnfitt }'Io municipali*rahedatmorethan$5.000? lgglegaK Descryrtrtrr of In-Xmd Llruklbutron Yes )ate ReceiYed associated sith a Is this contibution No fundraising event listed in SectiorLl? In'e$. list Event =
spou*e, f; i*'
ffitdate
{' Yes fi
fr
f'
$0.00
$trBToT?lt'wtion.1lL'rms*Page
:.:....:.:..:]j:]:.].,]:.l.',:ToT.lNLof,'.'il.lifioit.lsGctsiMPdss
ffity ro
\{I
CT
telephone compml'
I Date Dposrt
\Iade
.\mouot of
Deposit
$0.00 CT
$0.oo
III.
Oar rl Elnrr ?11'l 'l
NOI{MONETARY RECEIPTS
rffrlrrrtrT$TF
Page 12 of
l7
flitil
1At1112011
@ip,
iFeetA,:ltes
O;. Non'Monetarl', Rgceipts, of orgQnizatiotr- $xpefinru rs.E+a.trF D.! f ,roielilire f ,eedeirshln Lcdslath'e Caucus'and IAXE Comriitts NaneTE;asuel I*gistat*e caueus, anil Part! cs,'mittees QNL l)
Date
.,
Notice Rece$'ed
lil'
CT
Desmrtlln of Donatrm l-mmftee (Legislath'e Latlenhip, I*gisbfi'e Cau&s,
and Par4'L Mmttrees
Z,p ca{e
\ggresaiB Donahons
$0'00
Ptlltr\)se
ol g\Pendltue Pes
trsw@o6,t
$0.00
Name (rf
itret-\dtes
llbZrp Code
RslYed
\ggreg"b &rnatlons
CT
Descnpbm ofDonatron
Pwpose
$0'00
Ci.lfBncflDClE
anil Pdfi! Co'nmittees O^LV
Name of Treasuftr Date NL:drce Recex'ed
tf
$0.00
iEet-ldAess
ZrpC.ode
ofDonation
\ggrate Donatons
Irq' ).scrr$lm
(rf DonatNn
CT
$0.00
Purps of E\pndrfirc (see ifistructtorls)
$0.00
@lifi'e
ilret Ad&ess
o\z't)
Name ofTreasurel
afDonation
Zrp Code \ggregate Donatlors
.'lt-l'
CT
lrrp..p of Eyonditure
$0.00
(see inlfr,rctions)
$0.00
O^Lt
Nme of Treasuer
liB'
Zrp L:rrJe
\ggegate Donatlotr
GT
)esmptr(x ot Lbmtr(\n
$0'00
Purpo* of Expendinre {see insfitetions)
f,'E
$0.00
anl
Iteet -\d&es
A^Lt)
ffieETrcasrm
Fair l\Iarket Vulue of Donation
_iitl'
Zrp L--ode
\grgate Donahons
CT )ewiprmof Domuon
$0'00 lrpos
$o.oo
lkw
r!! t
Fair
llarket Vdue
of Donrtion
State
llt\'
)escnFtlon ofn\natron
Zrp cltde
\ggregate Donahons
CT
lnrpose of
$0'00
Cr
Erlrndihre
(see
infiilctions)
C,B
{ic frD
if'E
$0.00 $o.oo
W. n)(PENDITI]RES
iri r*f nr ra n t.TIl
Page 13 of 17
,.T?Yl
Name of Pa].e
,RoI
291
J.,,,,,.,,,,,,,,,,
cit.
,,',
cr I
,.'
P.IExncnsesPnidbr:
'tot't1t2011
,
hlethod of Palment
-lmount
ttri.{dfies
48 Wakelee St.
PwpN
n5'.o:"i
ot E\Tiendrhre
Seynnur ffiiotrm-r!*Hrr\rr
ATT
lzp t Ne 06483
8i1&fz0fi
f;
Kick ofi party for re'election of Paul Roy for 1st Seled
0a15/2011
lvpe of Espenditure Qf opplicable) : f . C*rainuteO n-ith reimbursement sought f Coordimted rtithout reimbursement sought
6f @ielbte)
E E
Supported opposed
f,Otg*izution
Independent
@nr.t**igns,
;bet Ad;kss
f;.r
C,B {:,c rl o
LLC
..e
late ot
480.00
l.aJn*I lle&od of Pa.rment
.{moutrt
llh
itate
132 Silvermine Rd
Seymour
cr I
lzrPLN oo+s3
9f22n011
G check
+-
102
fl
Debit Card
lilmF
tt .o:er
ol lr{Fenolurg
ffiint1-n-/L'!r'!u('l
--
E{ent
*
Eopposed
AOTH
[r-pe of Expenditrne ft!aPdicade): C Coordinated n-ith reimbursement soug&t C; Coordinated *'ithout reimbursement sought C Independent
tlalrdilati:t
li Nane (ifapplicable)
$
)ate 0t ltr):ment
868.00
'
v'lelhod ot PaJrrretrl 6p
Colleen Fries
9p,zna1l
ghggl *, 1 03
ffi
POST
Seymour
CT
064&3
rb.''"odei
'!r!rrPq\zr
09/30/2011
f: fi fl fl
Coordinated with rei.arbursenent sougbt Coordinated without reimburssment soughl Independent Organization (sce Instructions)
(i!appliuble)
opposed
130.00
ff
oI ra)-_ug& l!.lethod
f;,
otYalment
AEounl
itate
cr [
lZtP c{r'l
980/2011
Bcheck* 104
SDetitcard
Event 4
06483
tbrjcodet
ATT
09130/201
I1'pe of Erpenditure G! applieble) : r.0 Coordinated n-ith reimbursement sought ,rS Coordinated n-ithout reimbunenrent sou glrt l{T Indepeodent
f{qptimble)
E opposed
Fl Organ4ation
Name of Pa\ce
f r f o fin
{see
Iu snaoion s)
f1
n f.r
)ate of Pa.v$er$
s
\'[ethod of Palment
-.p l\1de
1,430.00
-{mouDl
ttreet.tdlles
P|llnse ol.Experulrtuf
x\CT
)escnpttctr
f ft
Check
+_*
Debit Card
Event
lb!
code) Cmdrdatets)
[-rae ofEspendittue 6f apficaue): fll Coordinated n-ith reinbursement sougfit '{J Coordinated s ithout reimbursenrent songht S Indepeadent 'fi Oreanrzation (sec Instructions)
Nme
(ifapplicoble)
flopposed
0.00 $2,908.00
$0.00
_
$2,908.00
IV. NXPENDITURES
frtlt
trar rl Flnv 2O1
1 :rr
l"n:
ntg.
10t11f?.911
11 "111
@piitilirectg
itret -.\(Eres
)ate o{Pa}ment
Is Reimbursement Claimed?
.lmount
Sbples
llt]' :{r r,.Ne
a7/23t2g11
ti\.ent a
f'Yes
{!} No
3 Armstrong Dr
Pwtrns ot.b\:pDarnre
{b}'coJei
CT
06484
$7e.00
undiihte
piil
irt!
ilirectls)
US pOSt O{fiCe
:lp u)de
ls Reimbursement Claimed?
.dmount
a$ftzzarl
$;nt]ate ot falmenr
fr ro
'No
91 Main St.
Prnpose ot Br?endmre
Seyrnour
DscrrDucn
CT US Flag
oa$3
$44.00
{b'codei
GIFT
'
;eles
Steet.{ddrs
rrq:
Is Reimbursemetlt Claimed?
Amount
4IP L:!{e
0tt1st2011
EvIf
{:
*
res $64.00
3 Armstrong Dr
PuqDs ot EsPndrnre
Shelton
CT
08184
SNo
femrtrtu
POST
dnditute piddnecfl))
tb code.t @o
of Pal-lrent
Ls
Reimbursement Claimed?
.Amount
'lB'
1lp Clade
{'Yes
{-r l\o Bve$:
CT
)scnFtiofl
$0.00
Amount
Sbeet-TdlF
Rxpsse (rt EliQmdrtue
rlb'
ZrF Ctr1e
O les
CT
Desrlpttrn
Date
Fno
$o.oo
isent
(bj'codel
ot lAlmenl
Is Reimbursement Claimed?
Amount
SEeet
-{d&es
litv
Desorptieu
liate
crl
lZrp Code
EYent :
{^, Yes
fNo
$0.00
Rrpose of Eryen&tul
{by code)
Date of Pa,vnrent
Is Rel$hunement Claimed?
.\nount $0.00
ItreetAidiess Parflos
!1t
ci6'
Descriptrern
)IAIE
Zlp C.ode
'ft tes
GT
-BxPendrare
f*
F-ent:
)ate of Payment
No
ibv cojei
Is Reimbursement Claimed?
{ Yes
\mounl
F-rTffms
flulLrse ot E:iPendrtue
artj
Dmentrtion
jtale
Zp
L-ode
GT
f'No
Stelrt a
$0.00
ft'cute)
Nme
trf ?a]-ee
(\ a n e of
I'en dor
t*
c9 n
di date
paul ar
e c n )'
I
iAI
Zry Crrde
I)ate,rf Pa]-mEnt
Is Reimbursement Claimed?
Amouni
ffiFdesffiofEspendttue
(t't'code)
]h'
Descnptlm
CT
Event =
(-,Ies SNo
$0.00
$187.00
$0.00
$187.00
TV. E}PtrF{DITI]RES
!'t
Fage 15 of
Eilr l.'t'}a.r:fJTili:Tt :t
l7
j:a,:fq
Al! fli:rhtf,]n'Pllgs.
TF,
10t11n411
Card
Neme of Issuing Instifution
5. \-isa
Nlaster
Card f:
Discover ll'.{merican
ExPress
f.
Nme cf \-mdor }p
other
Date of TrascL-trotr
.\mount
ffiEEGs,s
Rxpose ofE:penditure
Crh'
)6I
Code
CT
)esx1ptu6
Uril
t
TnNactim
$0.00
Date of
.{moutrl
Street.\ddrN
lp
Crrde
CT
R:rpos ofExpendrhre
Elent:
Dat oiTransaatLn
$0.00
t\.code)
Amounl
Sbeet Adke$s
City
itate
Zip Code
CT
Rrpos
of E:gendrnre iby codei
FGffi-
El'erll
$0.00
Nme of \:endor
cih''
Jtate
Date of Tram{ctron
-dmortnt
SheetAdches
lp
L-ode
CT Rrpo*
of ErAenditue t14. c*de)
)es!T$t(n
Erenl +
$o.oo
$me of \-md(.r
Citv Jhte
,4r Code
Date of Tra$actlcn
.\mount
Steet.{ddress
CT
Rupose ofEr?endrurre
{qnr
EurEM
Event
$o.oo
coje)
Date of TraNact[Yl
f{ame of Vendcrr
^{mount
Street AdJress
c1R'
XAI
}p taile
CT
R[pose oflxpendtturo ib:'co.Jei
Name of
$0.00
Ererf =
)6cnptrr'n
lendor
Date ofTra0sactron
Amounl
St eet -\ddress
C1h
Jtate
Zip Code
CT
Purpose ofErpendinre (.bf code) Name of \.endor
)csrlFlm
E\.ent
$0.00
Date of Trmsaction
Amount
Stret -{d&ess
citi' )smpEm
Jtate
lp
Cerje
CT
Erent
$0.00
Pr,rpose of Erlendtture
{b1'ctrdei
$0.00
i''':
......., . . ,,,
..
"''
?o|fAllofiilAifiomrseadotRF.egg', -. !
lt
$0.00 $0.00
!-
IV.
rI
E)(PEIYDITI]RES
;lr
.TN.]. r}rlB,
Page 16 of 17
TTF"E
t|{TF
1W11t2011
nurinc
this. Period
Amount Incurred lEstimdte ot.ldaal)
Date Incurred
)u&r-{wes
crqState 4lo L.ode
Er$t
alplicable)
Otbce Sougld
CT
rwl4s !
!_v ceJe j
f:
)estrrptrm
f.
C,E
f'fpp.xed
Ilsuppt'roa
)ate Incwed
$0.00
Amount Incurred
(Eslimate otActual)
Nme
rrf Llredrtor
Slr*t-\dlles
CiE.
Siat
Ecelf *
lp
CoJe
lardidate{sl Narae
lil apptiebte)
Office Stryfu
CT
'Urpw
lrl E:qEnOilue l1'pe of Expendihre (if aplicable):
b1- code )
C
Jesmptld
f,
{-.
f.
Naure ofCredrtor
OgagizitioA{see
'frsryporao fr;ppmed
)ate Incured Everf 4
$0.00
.{mount Incurred
Estimate
orAarcl)
kmt.{ddres
citv
4rp Llo{te
]mdidate(s)Name
f/alryIicable)
{-)!llce SougJf
CT
a[Iw
or !\Penqrure
Il?e
\"cuJe)
)e$cnptill
f. f.
*uifi'.1,.F*;"
rtYT,l, .,
C,Suppl.dsd
fii-)ppse.l
Date l-*:urred
$0.00
Amount Incurred
(Estinate or.4ctaal)
Nme
of
Credts
SEst.lites
--ltj'
jrnposo ot lJxpesorere
State
E\-qf =
,4r Clode
Jmdidatet.s) Naule
{fappliofilel
Otbce Soug$l
CT
bf'ctriei )6ixlp&dr
Ji. Coordinated n-ith reimbursement sought il: Coordinated *ithout reinrbursement sought
f,
f B C'c C D C
| ,_)pFsed lupputed
Prttiirylt*b
fiipiiri,thiirn6:ind*dtto.gx1
Line
2E a
$0.00 $0.00
af Sttmmarv Paeej
TV. UGE}{DITIJRES
\IttrlE lfF eClllo*{IFrFF:: Paul Roy 201
1
Page 17 of
l7
T. Itemization
"mt
Name of l4iorkerconsulbDt
N{ethod of Palment
Imount
Fclrum-ra\-d
Jttfrt -{dilres
Desfiryhi,n
f;
C
,p
Check*
Code
Dbitcar;-
CT
Tlpe of E:pendibte
ll {: L
Af apdi cabl e) : Coordinated rr-ith reimbursement soudt Coordiaut d *ithout reimbursement soug&t lndependent
Candrdate{$} Name
t'itlce
Soughl
f!aq*limblel
fi
Supported ()pposed
! - Organization
Lmt
(see Instrurrions)
:i:n:r]n
Ftrst
$0.00
Nme ol\\iorhuiComukurt
vll
Date oiPa:$mmt
llethod ofPa"wrent
.{nou[t
Jccnda$' tb:'ee
1trpw
or L\pensrNe
$
stet Air(lfes
L,IE'
cule)
f,
GT
Cheek+Debit card
Zlp O)de
L)scrrytrlxr
CmdirJatetsi Nane
O$ice Sougl$
l{ *t
L
6f awlieablel
'
nrf
nfic'{^,nf.n
FGI
$0.00
.{mourrt
*t Nme
of
1\'orkertonqltnt
r{l
)at ofPavment
Nlethod of Paprent
xcmm'raiai
Street -{dfiess L:rE'
irpos
0I
uErnaMe
bn-cuii)
CT
Jand&te(s)Nme
8f appliuble)
Ollice Sought
{]lSupported
f; f, fl
-1
r'Opposed
Indemdent
*rD rip
Fnst
$
r{l
Date of Pavmmt
$0.00
lt{ethod of Pa-rment
Amount
ECmOm'fa\'?i
i{plrs
or E}])Fnqrwg
bl.ccrie)
fi Chech*.-_f'uebitCard
Zlp t-ode
Jtret -{dlles
C-rt1'
Jtate
Ds4tuon
Candrdab(s)Nme
e)
Otfrce Sougtrt
ffqpliuble)
iugnt
ft
hdependent
0rganizrtion
F'r lc p, i-:r.
(see
Instrudions)
1.
D '.'F
$0.00