ansonia dtc october 2013 filing

7/27/2019 Ansonia DTC October 2013 Filing

1/35

SEEC FORM 20

Itemized Campaign Finance Disclosure Statement

Revised January 2012

Do Not Mark in This Space For Official Use Only

CONNECTICUT STATE ELECTIONS ENFORCEMENT

COMMISSION

Electronic Filing

Page 1 of 35

COVER PAGE

1. NAME OF COMMITTEE

2. TREASURER NAME

Ansonia Democratic Town Committee

3. TREASURER ADDRESS

4. ELECTION/REFERENDUM DATE

7. CANDIDATE NAME (Complete only if Candidate or Exploratory Committee)

8. TYPE OF REPORT

9. PERIOD COVERED

10. CERTIFICATION

5. OFFICE SOUGHT (Complete only if Candidate Committee) 6. DISTRICT NUMBER(if applicable)

First

First

MI

MI

Last

Last

Suffix

Suffix

Street Address City State Zip Code

James D. Hubbard

10 Harris Rd Ansonia CT 06401

October 10 Filing - Original

Beginning Date Ending Date

07/01/2013 thru 09/30/2013

I hereby certify and state, under penalties of false statement, that all of the information set forth on this

Itemized Campaign Finance Disclosure Statement for the period covered is true, accurate and

complete.

PRINT NAME OF THE SIGNER DATE CERTIFIED

10/03/2013 2:51:46PM

PENALTY FOR FALSE STATEMENT IS PUNISHABLE BY FINE NOT TO EXCEED $1,000, OR

IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.

SIGNATURE

Electronic Filing James Hubbard


2/35

Page 2 of 35

SUMMARY PAGE TOTALS

SEEC FORM 20Itemized Campaign Finance Disclosure Statement

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Revised January 2012

NAME OF COMMITTEE TYPE OF REPORT

COLUMN A

This Period

COLUMN B

Aggregate

11. Balance on hand January 1 of current year for Ongoing and Party Committees OR

Balance on hand from day Committee was formed for all other Committees

12. Balance on hand at the beginning of Reporting Period

13. Contributions received from Individuals (Section A and B)

14. Receipts from Other Committees (Sections C1 and C2)

15. Other Monetary Receipts (Section D through K)

16c. Total Purchases of Advertising - Program Book or Sign (Section L3)

18. Subtotals (add totals in Line 12 + 17 in Column A and in Line 11 + 17 in Column B)

19. Expenses Paid by Committee (Section P)

16b. Per Public Act 11-48, effective January 1,2012 Section L2 removed

20. Balance on hand at close of Reporting Period (Subtract line 19 from line 18 in both colum

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

22. In-Kind Contributions Received (Section M)

23. Refundable Deposit to Telephone Company (Section N)

24. Receipts of Organization Expenditures (Section O) OPTIONAL

25. Beginning Loan Balance

25a. + Loans Received (Section D)

25b. + Interest and Penalties on Loan(s)

25c. - Payments on Loan

25d. Total Outstanding Loan Amount

26. Campaign Expenses Paid By Candidate (Section Q)

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

28. Expenses Incurred by Committee During this Period but Not Paid (Section S)

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

$5,725.45

$5,811.22

$4,440.80 $4,941.80

$0.00 $0.00

$0.00 $25.77

16a. Total Proceeds from Small Puchases (Section L1 Subpart 1 + Subpart 3)

17. Total Monetary Receipts (add totals for lines 13 through 16c)

$0.00 $0.00

$5,645.08 $6,086.08

$0.00$0.00

$0.00 $0.00

$0.00 $0.00

$0.00 $0.00

$0.00

$0.00 $0.00

$0.00 $0.00

$0.00 $0.00

$0.00

$0.00 $0.00

$0.00 $0.00

$0.00

$0.00

$10,252.02 $10,693.02

Ansonia Democratic Town CommitteeOctober 10 Filing - Original

$0.00

Municipal and Town Committees Only

$4,440.80 $4,967.57

$4,606.94 $4,606.94

$0.00


3/35

Page 3 of 35

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE TYPE OF REPORTOctober 10 Filing - OriginalAnsonia Democratic Town Committee

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

(See instructions for definition of Small Contributor) Subtotal Section A$304.00

B. Itemized Contributions from Individuals

Fran

Residential Street Address

165 O Neil Ct

City

Ansonia

State Zip Code

CT 06401

Date Received

09/05/2013

Principal Occupation Name of Employer

Is this contribution associated with a

fundraising event listed in Section L1?Yes

No09162013aIf yes, list Event #

Is contributor a lobbyist, spouse,

or dependent child of a lobbyist?

Aggregate Contributions

$100.00

Amount of Contribution

$100.00

Last Name

Pepe

X Cash Money OrderPersonal Check Credit/Debit Card

Yes_

NoX

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

officer of a municipality does contributor or business he/she associated with have

a contract with said municipality valued at more than $5000?

_

Yes

X

No

Is contributor a principal of state contractor or prospective state contractor?

If yes, indicate which branch or branches ofgovernment the contract is with:

_

Yes No

_

Executive Legislative

Payroll Deduction

Method of Contribution

X

First Name MI

Florence


163 O'Neils Ct

City

Ansonia

State Zip Code

CT 06401

Date Received

09/05/2013








$50.00


$50.00

Last Name

Camilleri

X Cash Money OrderPersonal Check Credit/Debit Card

Yes

NoX




_

Yes

X

No


If yes, indicate which branch or branches of

government the contract is with:

Yes No

_ Executive Legislative_

Payroll Deduction


X

_

First Name MI

Ann Marie


26 Page St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/05/2013








$50.00


$50.00

Last Name

Caporale

X Cash _ Money Order_ Personal Check Credit/Debit Card_

Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI


4/35

Page 4 of 35




Diana


56 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







L


$50.00


$50.00

Last Name

Branch

_ Cash _ Money OrderX Personal Check Credit/Debit Card_

Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Denice


6 Myrtle Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013



fundraising event listed in Section L1? Yes




R


$50.00


$50.00

Last Name

Hunt


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Rita


16 Myrtle Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

St Jacques


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


5/35

Page 5 of 35




Pat


1205 Racebrook Rd

City

Woodbridge

State Zip Code

CT 06525

Date Received

09/16/2013








$50.00


$50.00

Last Name

Crisco


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Bartholomew


28 Pinecrest Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







R


$50.00


$50.00

Last Name

Flaherty


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Jo Lynn


28 Pinecrest Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Flaherty


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


6/35

Page 6 of 35




Kay


2 Gracie Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







E


$50.00


$50.00

Last Name

Jeanette


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Vincent


26 Fairview Ter

City

Derby

State Zip Code

CT 06418

Date Received

09/16/2013








$50.00


$50.00

Last Name

Tonucci


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Tara


14 Farrel Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







L


$50.00


$50.00

Last Name

Kolakowski


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


7/35

Page 7 of 35




Kevin


19 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$50.00


$50.00

Last Name

Blake


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Susan


16 Kathy Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







L


$50.00


$50.00

Last Name

Kowalczyk


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Ralphine


222 1/2 N State St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Siggars-Ford


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


8/35

Page 8 of 35




Dawn


37 Berkshire Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$50.00


$50.00

Last Name

Nihill


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Saleh Gamal


44 Buswell St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Hanaif


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Fred


19 Wychwood Ln

City

Oxford

State Zip Code

CT 06478-1850

Date Received

09/16/2013








$50.00


$50.00

Last Name

D'Amico


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


9/35

Page 9 of 35




Kay


2 Gracie Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







E


$50.00


$50.00

Last Name

Jeanette


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Nina


60 Rockwood Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$50.00


$50.00

Last Name

Phipps


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Christopher


60 Rockwood Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







W


$50.00


$50.00

Last Name

Phipps


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


10/35

Page 10 of 35




Louis


55 Hubbell Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







R


$50.00


$50.00

Last Name

Macero


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Jonathan


87 Ochsner Pl

City

Trumbull

State Zip Code

CT 06611

Date Received

09/16/2013







D


$50.00


$50.00

Last Name

Degnan


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Thomas


15 Macintosh Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







E


$100.00


$100.00

Last Name

Lynch


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


11/35

Page 11 of 35




Christine


10 Lingren Ter

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$100.00


$100.00

Last Name

Collicelli


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Jerome


36 Cedar St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$100.00


$100.00

Last Name

Fainer


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Nancy


4 Pin Oak Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







H


$100.00


$100.00

Last Name

Sharkey


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


12/35

Page 12 of 35




Michelle


7 Chestnut Tree Hill Ext

City

Oxford

State Zip Code

CT 06478-1463

Date Received

09/16/2013







M


$100.00


$100.00

Last Name

Ives


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Janice


40 Bunting Rd

City

Seymour

State Zip Code

CT 06483

Date Received

09/16/2013







E


$25.00


$25.00

Last Name

Silva


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

James


10 Harris Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







D


$25.00


$25.00

Last Name

Hubbard


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


13/35

Page 13 of 35




Richard


20 Sobin Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$50.00


$50.00

Last Name

Bshara


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

James


22 Holbrook St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







P


$50.00


$50.00

Last Name

Vartelas


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Carmen


159 Pulaski Hwy

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







T


$50.00


$50.00

Last Name

Pitney


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


14/35

Page 14 of 35




Fran


8 Elliott Rd

City

Ansonia

State Zip Code

CT 06401-2611

Date Received

09/16/2013








$50.00


$50.00

Last Name

Digiorgi


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Mike


Clark St

City

Ansonia

State Zip Code

CT

Date Received

09/16/2013








$100.00


$100.00

Last Name

Tracz

_ Cash X Money Order_ Personal Check Credit/Debit Card_

Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Jay


35 Turnberry Rd

City

Wallingford

State Zip Code

CT 06492

Date Received

09/16/2013







K


$250.00


$250.00

Last Name

Jayanthan


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


15/35

Page 15 of 35




Joseph


6 Jensen Farm Rd

City

Oxford

State Zip Code

CT 06478

Date Received

09/16/2013







A


$50.00


$50.00

Last Name

Maffeo


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Timothy


23 Charles Rd

City

Seymour

State Zip Code

CT 06483

Date Received

09/16/2013







E


$50.00


$50.00

Last Name

Lynch


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Patrick


15 Macintosh Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







M


$50.00


$50.00

Last Name

Lynch


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


16/35

Page 16 of 35




Madeline


31 Webster Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







H


$50.00


$50.00

Last Name

Bottone


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Robert


38 Greenfield Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Jaskilka


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Matthew


30 Church St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$100.00


$100.00

Last Name

Gregono


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


17/35

Page 17 of 35




Stacey


1 Poplar Dr

City

Seymour

State Zip Code

CT 06483

Date Received

09/16/2013








$100.00


$100.00

Last Name

Pettinella


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Ed


19 Kathy Ln

City

Ansonia

State Zip Code

CT

Date Received

09/16/2013








$100.00


$100.00

Last Name

Adamowski


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Ronald


272 Hyland Terrance

City

Orange

State Zip Code

CT 06477

Date Received

09/16/2013








$50.00


$50.00

Last Name

Mangano


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


18/35

Page 18 of 35




Maryanne


272 Hyland Ter

City

Orange

State Zip Code

CT 06477

Date Received

09/16/2013








$50.00


$50.00

Last Name

Mangano


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Danny


15 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Lynch


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Pauline


54 Finney St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Sampieri


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


19/35

Page 19 of 35




Jamie


28 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Pyro


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Peter


100 Kathy Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Marcnko


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Brittany


14 Vose St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Shortell


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


20/35

Page 20 of 35




Louis


13 Locke St

City

Ansonia

State Zip Code

CT

Date Received

09/16/2013








$25.00


$25.00

Last Name

Uvino


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Nasir


347 Pinetree Dr

City

Orange

State Zip Code

CT 06477

Date Received

09/16/2013








$50.00


$50.00

Last Name

Ahmad


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Peter


21 Melba St

City

Milford

State Zip Code

CT 06460

Date Received

09/16/2013







F


$50.00


$50.00

Last Name

Burns


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


21/35

Page 21 of 35




Fonso


1 Unters Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013







L


$100.00


$100.00

Last Name

Smith


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Susan


26 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$50.00


$50.00

Last Name

Coughlin


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Francis


18 Shortell Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013








$25.00


$25.00

Last Name

Tyszka


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI


22/35

Page 22 of 35




Ronald


45 Morningside Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013




NoIf yes, list Event #

City of AnsoniaTreasurer




$421.80


$421.80

Last Name

Greski


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

First Name MI

Elizabeth


15 Macintosh Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

09/16/2013




NoIf yes, list Event #

City of AnsoniaTown clerk assistance



S


$215.00


$215.00

Last Name

Lynch


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


_

X

First Name MI

TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS (Sections A & B) (Total on Line 14 of Summary Page)

Total of Section B $4,136.80

$4,440.80


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NAME OF COMMITTEE


TYPE OF REPORT

C1. Contributions from Other Committees


me of Committee

Address

ity State


fundraising event listed in Section L1?Yes No

If yes, list Event #

Zip Code Date Received Aggregate Contributions


Name of Treasurer

Total of Section C1

C2. Reimbursements. Payments. or Surplus Distributions from other Committees

NAME OF COMMITTEE


TYPE OF REPORT



Name of Committee Name of Treasurer

Address

ity State Zip Code

Date ReceivedAmount of Receipt

Reimbursement for shared expense

Payment for goods and services

Surplus Distribution

Total of Section C2


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D. Loans Received this Period



Ansonia Democratic Town Committee October 10 Filing - Original


Date of Receipt

Name of Cosigner/Guarantor (if applicable) Amount Received

Name of Lender

Street AddressCity Zip Code

Is there a cosigner or

Guarantor of this loan?

Yes No

Source of Loan:

Bank IndividualCandidate Other

Total of Section D

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




Street Address

City State Zip Code

Amount Received

Name of Entity

Date Received


Total of Section E

F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)

I. MONETARY RECEIPTS (Section A-I)



AmountIs this transaction associated with a fundraising

event listed in Section L1?Yes No If yes, list Event #

Date of Receipt

Total of Section F


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Page 25 of 35

G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)

I. MONETARY RECEIPTS (Section A-I)



AmountDate of Receipt

Total of Section G

H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)




AmountMethod of PaymentDate of Receipt

Cash Personal Check Credit/Debit Card

Total of Section E

J. Interest from Deposits in Authorized Accounts

I. Monetary Receipts (Section A-K)



Zip CodeStateCityStreet Address

Date ReceivedName of Institution Amount

Total of Section J


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K. Miscellaneous Monetary Receipts not Considered Contributions





Description

Amount

Received

Name Date of Transaction

Total of Section K

L1. Fundraiser Event Information

II. FUNDRAISING EVENT ACTIVITY Sections L1 - L4



Zip Code

LetterDate of Fundraiser

Fundraising Event #

Location: Street Address City State

09/16/2013 a

314 Main St Ansonia CT 06401

Was this fundraising event hosted at a personal residence?

Did this fundraiser include items donated by a business entity of up to $100 or

items donated b an individual of u to $100?

Was this fundraiser a tag sale, auction, or other sale of donated items with

puchases from an individual of up to $100?

_

X

Yes

No

Yes

Yes

No

No

_

X

_

X

Meet and Greet Event

Description

Were there purchases of advertising space in a program book or on a sign associatedwith this fundraiser?

Did your committee sell food or beverage at a fair or similar mass gathering held

within the state with this fundraiser?

Yes

Yes

No

No

_

X

_

X

Subpart 2: (Town Committees and Municipal Candidate Committees ONLY)

Subpart 3: (Town Committees ONLY)

(If yes, enterTotal Receipts here.) $0.00

(If yes, go to Section L4 In-Kind Donations not ConsideredContributions and complete required information for puchases made by

host(s) for food, beverage and invitations.)

(If yes, go to Section L4 In-Kind Donations not Considered

Contributions and complete required information.)

(If yes, enter Total Receipts here.)

(If yes, go to Section L3 Purchases of Advertising Space in a Program

Book or on a Sign and complete required information.)

Subpart 1: (All Committees)

$0.00

Total of Section L1 $0.00


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L3. Purchases of Advertising in a Program Book or on a Sign(Municipal Candidate and Town Committees ONLY)





Purchase Made By:Name of Purchaser

Event #Date Received Aggregate Purchases for All Events Amount of Program Ad Purchase Amount of Sign Purchase

Business Entit Individual

Sole Proprietorship

Total of Section L3

L4. In-Kind Donations Not Considered Contributions





Donation Given by:

Name of the Donor

Fair Market Value of

Donation

Aggregate value for this event

Description of Donation

Date Received Event #Individual

Business Entity

Sole Proprietorship

Total of Section L4


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Pag

ansonia dtc october 2013 filing

Documents