HomeMy WebLinkAboutMickIreland2015.com - Mick Ireland_Filing 3 Run-Off CAMPAIGN REPORT FORM
REPORT OF CONTRIBUTIONS AND EXPENDITURES
(C.R.S. 1-45-108) Full Name of Committee/Person:
As Shown On Registration Address of Committee/Person:
City, State & Zip Code:
Committee Type:
Name and Address of Financial Institution
Type of Report Regularly Scheduled Filing. Amended Filing. This amends previous report filed on (date)
Submit changes or new information ONLY Termination Report. (Termination Reports MUST have a Monetary Balance of Zero in Line 5)
Reporting Period Covered: Through
Date Date Totals Detailed Summary Page 1 Funds on Hand at the Beginning of Reporting Period (monetary
only) $
2 Total Monetary Contributions $
3 Total of Monetary Contributions & Beginning Amount
$
4 Total Monetary Expenditures $
5 Funds on Hand at the End of Reporting Period (monetary)
$
The appropriate officer shall impose a penalty of $50 per day for each day that a report is filed late.
[Art. XXVIII Sect. 10 (2) (a)]
Authorization (Must be completed by either the Registered Agent OR the Candidate)
Print Registered Agent’s (Treasurer’s) Name:
Registered Agent’s (Treasurer’s) Signature: Date:
Candidate’s Signature: Date:
Schedule A Instructions
Candidate, Issue, Political Party and Political Committee Are required to disclose occupation and employer for all $100 or more contributions made by
natural persons (Article XXVIII, Section 7)
Contribution Limits
Section 9.04. Candidates
No person shall make, solicit or accept a contribution that will cause the total contributions by
such person on behalf of any candidate or a political committee supporting or opposing the election of
such candidate to exceed two hundred fifty dollars ($250.00) with respect to any single election No person shall accept any contribution (including contributions to a candidate from the candidate
himself or from members of his immediate family) later than seven (7) days prior to any election.
PROHIBITED CONTRIBUTIONS
[Art. XXVIII, Section 3]
• No candidate's candidate committee shall accept contributions from, or make contributions to, another candidate committee.
• No person shall act as a conduit for a contribution to a candidate committee.
• No candidate or candidate committee shall accept a contribution, or make an
expenditure, in currency or coin exceeding one hundred dollars.
• No person shall make a contribution to a candidate or candidate committee with the
expectation that some or all of the amounts of such contribution will be reimbursed by another person.
• No person shall make, nor shall any campaign treasurer, candidate or political committee
accept, any anonymous contribution to a candidate, committee, or anyone, for the
purpose of influencing the election or defeat of any candidate or the passage of defeat of any issue. The intended recipient of an anonymous contribution shall, promptly upon
receipt of such contribution, transmit such contribution to the City Clerk for deposit in the
general fund of the City of Aspen.
• No candidate committee, political committee or political party shall knowingly accept contributions from any natural person who is not a citizen of the United State or a foreign
government.
DETAILED SUMMARY
Full Name of Committee/Person:
Current Reporting Period: Through
6 Funds on hand at the beginning of reporting period (Monetary Only)
7 Itemized Contributions $20 or More [CRS 1-45-108 (1) (a)](Please list on Schedule “A”)
$
8 Total of Non-Itemized Contributions (Contributions of $19.99 and Less)
$
9 Loans Received (Please list on Schedule “C”)
$
10 Returned Expenditures (from recipient) (Please list on Schedule “D”)
$
11 Total Monetary Contributions $
12 Total Non-Monetary Contributions $
13 Total Contributions $
14 Itemized Expenditures $20 or More [CRS 1-45-108 (1) (a)]
(Please list on Schedule “B”)
$
15 Total of Non-Itemized Expenditures
(Expenditures of $19.99 or Less)
$
16 Loan Repayments Made (Please list on Schedule “C”)
$
17 Returned Contributions (To donor)
(Please list on Schedule “D”)
$
18 Total Monetary Expenditures
(Total of lines 14 through 17)
$
19 Total Spending
(line 12 + line 18)
$
Schedule A – Itemized Contributions Statement ($20 or more)*
[CRS 1-45-108 (1) (a)] Full Name of Committee/Person:
WARNING: Please read the instruction page for Schedule “A” before completing!
PLEASE PRINT/TYPE 1. Date Accepted
4.Name (Last, First):
5. Address: 6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt. $
3. Aggregate Amt. $
1. Date Accepted
4.Name (Last, First):
5. Address: 6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt. $
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First):
5. Address: 6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt. $
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt. $
3. Aggregate Amt.
$
* Occupation and Employer only required on each person who has made a contribution of $100 or more
to a candidate committee, political committee, issue committee or political party.
1. Date Accepted 4.Name (Last, First):
5. Address:
6. City/State/Zip: 7. Occupation and Employer:
2. Contribution Amt.
$
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First): 5. Address:
6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt.
$
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First): 5. Address:
6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt.
$
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First): 5. Address:
6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt.
$
3. Aggregate Amt.
$
1. Date Accepted
4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Occupation and Employer:
2. Contribution Amt.
$
3. Aggregate Amt. $
* Occupation and Employer only required on each person who has made a contribution of $100 or more to a candidate committee, political committee, issue committee or political party.
Schedule B – Itemized Expenditures Statement ($20 or more)
[CRS 1-45-108 (1) (a)]
Full Name of Committee/Person:
PLEASE PRINT/TYPE 1.Date Expended 3. Name (Last, First):
4. Address:
5. City/State/Zip:
6. Purpose of Expenditure:
2.Amount
$
1.Date Expended 3. Name (Last, First):
4. Address:
5. City/State/Zip:
6. Purpose of Expenditure:
2.Amount
$
1.Date Expended 3. Name (Last, First):
4. Address:
5. City/State/Zip:
6. Purpose of Expenditure:
2.Amount$
1.Date Expended 3. Name (Last, First):
4. Address:
5. City/State/Zip:
6. Purpose of Expenditure:
2.Amount$
1.Date Expended 3. Name (Last, First):
4. Address:
5. City/State/Zip:
6. Purpose of Expenditure:
2.Amount
$
Statement Of Non-Monetary Contributions
[Art. XXVIII, Sect 2, (5) (a) (II) (III), Sect. 5, (3)] [CRS 1-45-108 (1)]
Full Name of Committee/Person:
PLEASE PRINT/TYPE 1.Date Provided:4.Name (Last, First):
5. Address:
6.City/State/Zip:
7. Description:
2.Aggregate Amt.:
$
3.Fair Market Value:
$
1.Date Provided:4.Name (Last, First):
5. Address:
6.City/State/Zip:
7. Description:
2.Aggregate Amt.:
$
3.Fair Market Value:
$
1.Date Provided:4.Name (Last, First):
5. Address:
6.City/State/Zip:
7. Description:
2.Aggregate Amt.:
$
3.Fair Market Value:
$
1.Date Provided:4.Name (Last, First):
5. Address:
6.City/State/Zip:
7. Description:
2.Aggregate Amt.:
$
3.Fair Market Value:
$
1.Date Provided:4.Name (Last, First):
5. Address:
6.City/State/Zip:
7. Description:
2.Aggregate Amt.:
$
3.Fair Market Value:
$
Schedule D – Returned Expenditures & Contributions
Full Name of Committee/Person:
Returned Expenditures (Previously reported on Schedule B – Contributions then returned from recipient)
PLEASE PRINT/TYPE 1.Date Accepted:4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Comment:
2.Date Returned:
3.Amount:$
1.Date Accepted:4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Comment:
2.Date Returned:
3.Amount:$
Returned Contributions
(Previously reported on Schedule A – Contributions returned to donors)
PLEASE PRINT/TYPE 1.Date Accepted:4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Purpose:
2.Date Returned:
3.Amount:
$
1.Date Accepted:4.Name (Last, First):
5. Address:
6. City/State/Zip:
7. Purpose:
2.Date Returned:
3.Amount:
$
Schedule C – Loans This form details loans received and repaid by the committee/party (Money received by committee from a financial institution
and/or repayment of a loan to a financial institution.)
Full Name of Committee/Person:
LOANS - Loans Owed by the Committee
(Use a separate schedule for each loan. This form is for line item 9 and 16 of the Detailed Summary Report.) [No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial purpose.
Notwithstanding any other section of this article to the contrary, a state candidate’s candidate committee may receive a loan from a financial institution organized under state or federal law if the loan bears the usual and customary interest rate, is made on a basis that assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule Article XXVII, Sec. 3(8).
LOAN SOURCE Name (Last, First or Institution):
Address:
City/State/Zip:
Original Amount of Loan: $ Interest Rate:
Loan Amount Received This Reporting Period: $ Total of All Loans This Reporting Period:
(Place on line 9 of Detailed Summary Report)
Principal Amount Paid This Reporting Period: $
$
$ Total Repayments Made: $Interest Amount Paid This Reporting Period:
Amount Repaid This Reporting Period:
(Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16 of Detailed Summary)
$ Outstanding Balance:
TERMS OF LOAN: Date Loan Received Due Date for Final Payment
LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN
Full Name Address, City, St., Zip Amount Guaranteed
$