ansonia dtc october 2015 filing

8/20/2019 Ansonia DTC October 2015 Filing

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SEEC FORM 20

Itemized Campaign Finance Disclosure Statement

Revised January 2015

Do Not Mark in This Space For Official Use Only

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Electronic Filing

of 40

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

07/01/2015 thru 09/30/2015

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

10/03/2015 12:56:28PM

SIGNATURE

Electronic Filing James Hubbard

A Person who is found to have knowingly and willfully violated any provisions of the campaign finance statutes faces a civil

penalty or imprisonment or both.



of 40

SUMMARY PAGE TOTALS

SEEC FORM 20Itemized Campaign Finance Disclosure Statement

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Revised January 2015

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository) 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)

23. In-Kind Contributions Received (Section M)

24. Refundable Deposit to Telephone Company (Section N)

25. 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)

$4,110.48

$4,970.48

$2,070.00 $2,515.00

$0.00 $0.00

$0.00 $400.00

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

$3,868.06 $4,376.06

$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

$7,040.48 $7,548.48

Ansonia Democratic Town Committee October 10 Filing - Original

$0.00

$2,070.00 $3,438.00

$3,172.42 $3,172.42

$523.00

22. In-Kind Donations not Considered Contributions - House Party (Section L5) $0.00 $0.00



of 40

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository) 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$390.00

B. Itemized Contributions from Individuals

Elizabeth

Residential Street Address

7 Ford St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015

Principal Occupation Name of Employer

Is this contribution associated with an

event reported in Section L1?Yes

No06252015AIf yes, list Event #

Is contributor a lobbyist, spouse,

or dependent child of a lobbyist?

Aggregate Contributions

$25.00

Amount of Contribution

$25.00

Last Name

Maffeo

Cash Money Order X Personal 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

Maureen


90 N State St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







C


$25.00


$25.00

Last Name

Levine

Cash Money Order X Personal 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

Carol


8 Shortell Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015








$25.00


$25.00

Last Name

Merlone

_ Cash _ Money Order X Personal Check Credit/Debit Card _

Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI



of 40




Geoffrey


45 Chatham Dr

City

Manchester

State Zip Code

CT 06042

Date Received

07/07/2015







R


$25.00


$25.00

Last Name

Luxenberg


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Christopher


10 Rockwood Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015



event reported in Section L1? Yes




W


$25.00


$25.00

Last Name

Phipps


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Shain


505 Beaver St Apt 15

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







D


$25.00


$25.00

Last Name

Edmonds


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Kevin


19 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







M


$25.00


$25.00

Last Name

Blake


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Linda


158 Hodge Ave Apt 1

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







M


$25.00


$25.00

Last Name

Gentile


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Madeline


31 Webster Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







H


$25.00


$25.00

Last Name

Bottone


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




David


3 Glen Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







A


$25.00


$25.00

Last Name

Knapp


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Diana


56 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







L


$25.00


$25.00

Last Name

Branch


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

07/07/2015








$25.00


$25.00

Last Name

St Jacques


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Denice


6 Myrtle Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







R


$25.00


$25.00

Last Name

Hunt


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Thomas III


10 S Westwood Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







P


$25.00


$25.00

Last Name

Clifford


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Howard


43 Holbrook St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







D


$25.00


$25.00

Last Name

Madigosky


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




James


10 Harris Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







D


$25.00


$25.00

Last Name

Hubbard


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

07/07/2015








$50.00


$50.00

Last Name

Flaherty


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

James


198 1/2 Prospect St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







T


$30.00


$30.00

Last Name

Dellavolpe


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Ilene


12 Jason Wright Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







H


$50.00


$50.00

Last Name

Kennedy


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

07/07/2015







T


$50.00


$50.00

Last Name

Pitney


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Louis


55 Hubbell Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







R


$50.00


$50.00

Last Name

Macero


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Anne


15 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015








$30.00


$30.00

Last Name

Lynch


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Joan


46 N Westwood Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







M


$25.00


$25.00

Last Name

Lawlor


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Tara


14 Farrel Dr

City

Ansonia

State Zip Code

CT

Date Received

07/07/2015







L


$25.00


$25.00

Last Name

Kolakowski


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Elizabeth


15 Macntosh Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2015







S


$50.00


$50.00

Last Name

Lynch


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Elizabeth


7 Ford St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/10/2015




NoIf yes, list Event #




$10.00


$10.00

Last Name

Maffo


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


_

X

First Name MI

Ann


26 Page St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/10/2015







M


$25.00


$25.00

Last Name

Caporale


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Tara


14 Farrel Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015




No07232015BIf yes, list Event #




$25.00


$25.00

Last Name

Kolakowski

X Cash _ Money Order _ Personal Check Credit/Debit Card _

Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Ann


26 Page St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







M


$25.00


$25.00

Last Name

Caporale


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Anne


15 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







M


$25.00


$25.00

Last Name

Lynch


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Jamie


28 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Puro


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Florence


163 O'Neils Ct

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Camilleri


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Lynda


6 Kimberly Ln

City

Ansonia

State Zip Code

CT 06401-2018

Date Received

07/23/2015







M


$10.00


$10.00

Last Name

Supp


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Shain


505 Beaver St Apt 15

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







D


$25.00


$25.00

Last Name

Edmonds


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Fran


6 Elliott Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$50.00


$50.00

Last Name

Digiorgi


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Jo Lynn


28 Pinecrast Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Flaherty


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Milagros


121 Great Hill Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Rios


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Howard


48 Holbrook St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







D


$25.00


$25.00

Last Name

Madigosky


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Edward


19 Kathy Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







J


$25.00


$25.00

Last Name

Adamowski


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Brittany


19 Kathy Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Shortell


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Joseph


2 Gracie Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







A


$25.00


$25.00

Last Name

Jeanette


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Diana


56 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Branch


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




James


130 Wakelee Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Sheehy


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Sean


11 Dempsey Ct

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







P


$25.00


$25.00

Last Name

Rowley


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Kan


2 Dogwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Williams


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Louis


13 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Unno


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Carlos


240 Prospect St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







A


$25.00


$25.00

Last Name

Cosme


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Terrell


240 Prospect St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015








$25.00


$25.00

Last Name

Chellana


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




John


158 Hodge Ave Apt 1

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







L


$25.00


$25.00

Last Name

Gentile


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Jeremiah


12 Jason Wright Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







F


$25.00


$25.00

Last Name

Kennedy


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

David


3 Glen Dr

City

Ansonia

State Zip Code

CT 06401-2911

Date Received

07/23/2015







a


$25.00


$25.00

Last Name

Knapp


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI



of 40




Elizabeth


15 Macintosh Ln

City

Ansonia

State Zip Code

CT 06401

Date Received

07/23/2015







S


$50.00


$50.00

Last Name

Lynch


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

_

First Name MI

Ronald


45 Morningside Dr

City

Ansonia

State Zip Code

CT 06401-1311

Date Received

08/14/2015








$25.00


$25.00

Last Name

Greski


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Louis


55 Hubbell Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/04/2015







R


$25.00


$25.00

Last Name

Macero


Yes _

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


_

X

First Name MI



of 40




Mary


16 Birchwood Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/04/2015







S


$50.00


$50.00

Last Name

Benjamin


Yes

NoX




Yes

X

No




Yes No


_ Payroll Deduction


X

First Name MI

Jamie


28 Locke St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/04/2015








$50.00


$50.00

Last Name

Puro


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 13 of Summary Page)

Total of Section B $1,680.00

$2,070.00



of 40


NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)


TYPE OF REPORT

C1. Contributions from Other Committees


me of Committee

Address

ity State


event reported in Section L1?Yes No

If yes, list Event #

Zip Code Date Received Aggregate Contributions


Name of Treasurer

Total of Section C1

C2. Reimbursements 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

Surplus Distribution

xpenditure # (if applicable) Description

Payment Type

Total of Section C2



of 40

D. Loans Received this Period





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)


NAME OF COMMITTEE TYPE OF REPORT

Ansonia Democratic Town CommitteeOctober 10 Filing - Original

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)




AmountIs this transaction associated with an event

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

Date of Receipt

Total of Section F



of 40

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




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 H

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



of 40

K. Miscellaneous Monetary Receipts not Considered Contributions





Description

Amount

Received

Name Date of Transaction

Total of Section K



of 40

L1. Event Information

II. EVENT ACTIVITY (Sections L1 - L5)



Zip Code

Letter Date of Event

Event #

Location: Street Address City State

06/25/2015 A

557 Wakelee Ave Ansonia CT 06401

Was this event hosted at a personal residence?

Did this fundraiser include goods or services donated by a business entity of

to $200 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

Dinner Event

Description

Were there purchases of advertising space in a program book or on a sign associated

with 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: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)

Subpart 3: (Town Committees ONLY)

(If yes, enter Total Receipts here.) $0.00

(If yes, go to Section L5 In-Kind Donations not Considered

Contributions Associated with a House Party and complete required

information for any puchases made by host(s) for food, beverage and

invitations.)


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

Was this a fundraising event?

No _ YesX

Zip Code

Letter Date of Event

Event #

Location: Street Address City State

07/23/2015 B

557 Wakelee Ave Ansonia CT 06401

Was this event hosted at a personal residence?

Did this fundraiser include goods or services donated by a business entity of

to $200 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

Party Event

Description

Were there purchases of advertising space in a program book or on a sign associated

with 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: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)

Subpart 3: (Town Committees ONLY)

(If yes, enter Total Receipts here.) $0.00


Contributions Associated with a House Party and complete required

information for any puchases made by host(s) for food, beverage and

invitations.)


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

Was this a fundraising event?

No _ YesX



of 40

Total of Section L1 $0.00

L3. Purchases of Advertising in a Program Book or on a Sign

II. EVENT ACTIVITY Sections L1 - L5




Purchase Made By:Name of Purchaser

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

Business Entity

Individual/Sole Pro rietorshi

Other

Total of Section L3

L4. In-Kind Donations Not Considered Contributions

II. EVENT ACTIVITY Sections L1 - L5




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



of 40

II.EVENT ACTIVITY Sections L1 - L5



L5. In-Kind Donations Not Considered Contributions Associated with a House Party


Name of the Host

Fair Market Value of

Donation

Aggregate value of all Events - this host/candidate

Description of Donation

Event #

Is this event supporting more than one candidate or committee?

Yes NoIf yes, complete Itemization in

Addendum L5

Aggregate value of this Event - all hosts

Total of Section L5

M. In-Kind Contributions

III. NONMONETARY RECEIPTS (Sections M - O)

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)


TYPE OF REPORT


Street Address

ype of Contributor:

Fair Market Value of this

Contribution

Name

CityState

Zip Code

Date Received

Individual / Sole Proprietorship

Committee

s Contributor a lobbyist, spouse, or

ependent child of a lobbyist?

Yes

No

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

executive officer of a municipality does contributor or business he/she is

associated with have a contract with said municipality valued at more

han $5000?

Yes

No

s this contribution associated with an

vent reported in Section L1?

f yes, list Event#

Yes

No

Description of In-Kind ContributionAggregate contributions

Other

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

NoIf yes, indicate which branch or branches of

government the contract is with: Executive Le islative

Total of Section M



of 40

N. Refundable Deposit to Telephone Company

III. Non Monetar Recei ts Sections M - O



Zip CodeStateCityResidential Street Address

Date Deposit MadeLast Name of Individual

Amount of

Deposit

Name of Telephone company


First Name MI

Total of Section N



of 40

P. Expenses Paid By Committee



IV. EXPENDITURES (Sections P - T)


Description Amount

Name of Payee Date of Payment Method of Payment

Purpose of Expenditure

(by code)

Check #

Debit Card

Event #

Molto Bene Resturant

557 Wakelee Ave AnsoniaCT 06401

FNDR *06252015A

$450.00

X

_

124707/01/2015

Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)

_

_

_

_ _ _ A B _ C _ D

Coordinated with reimbursement sought (joint expenditure)

Coordinated without reimbursement sought (in-kind contribution)

Independent

Organization

Expenditure #

(if applicable)

_

EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Eliabeth Lynch

15 Macintosh Ln AnsoniaCT 06401

POST Stamps envelpoes

$93.67

X

_

124807/07/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

DSCC

30 Arbor St Ste 404 HartfordCT 06106

Misc * Voter File Access

$442.00

X

_

124907/07/2015


_

_

_

_ _ _ A B _ C _ D

Coordinated with reimbursement sou ht oint ex enditure


Inde endent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX



of 40






Description Amount



(by code)

Check #

Debit Card

Event #

Elizabeth Lynch


A-NEWS Caucus meeting

$139.51

X

_

125007/07/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_

EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Bank of America

Main St AnsoniaCT

BNK

$3.00

_

_

07/13/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

X EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Molto Bene

557 Wakelee Ave AnsoniaCT 06401

FNDR *07232015B

Pizza Party

$600.00

X

_

125107/23/2015


_

_

_

_ _ _ A B _ C _ D



Inde endent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX



of 40






Description Amount



(by code)

Check #

Debit Card

Event #

Elizabeth Lynch


POST

$29.40

X

_

125207/25/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_

EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Elizabeth Lynch

15 Macintosh Ln AnsoniaCT

OFFICE

$25.07

X

_

125307/25/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Hong Tran

East Main St AnsoniaCT 06401

OVHD Campaign Headquaters

$600.00

X

_

125408/04/2015


_

_

_

_ _ _ A B _ C _ D



Inde endent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX



of 40






Description Amount



(by code)

Check #

Debit Card

Event #

Olderman& Hallihan

400 Main St Ansonia AnsoniaCT 06401

Misc * Liability Insurance

$877.84

X

_

125508/05/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_

EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Alzheimer's Assoc

200 Executive Blvd # 4B SouthingtonCT 06489

Misc * Memory of Pauline Sampieri

$25.00

X

_

125608/10/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

James D. Hubbard

10 Harris Rd AnsoniaCT 06401

Misc * Flowers to Madeline Botton

$26.57

X

_

125708/10/2015


_

_

_

_ _ _ A B _ C _ D



Inde endent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX



of 40






Description Amount



(by code)

Check #

Debit Card

Event #

Bank of America

Main St AnsoniaCT 06401

BNK check Service

$3.00

_

_

08/11/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

X

EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

The Vinci Group

54 Robert Rd ManchesterCT 06040

CNSLT

$500.00

X

_

125908/31/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX


Description Amount



(by code)

Check #

Debit Card

Event #

Ansonia Cultural Comm

253 Main St AnsoniaCT 06401

FNDR * basket sale

$50.00

X

_

126009/02/2015


_

_

_

_ _ _ A B _ C _ D



Inde endent

Organization

Expenditure #

(if applicable)

_ EFT

None of the belowX



of 40






Description Amount



(by code)

Check #

Debit Card

Event #

Bank America

Main St AnsoniaCT 06401

BNK

$3.00

_

_

09/10/2015


_

_

_

_ _ _ A B _ C _ D



Independent

Organization

Expenditure #

(if applicable)

X

EFT

None of the belowX

Total of Section P $3,868.06

Q. Campaign Expenses Paid By Candidate





Description Amount

Name of Payee (Name of vendor, Person or Entity who candidate paid directly) Date of Payment Is Reimbursement Claimed?

Event #Purpose of Expenditure

by code)

Yes No

Total of Section Q



of 40

R. Expenses Incurred on Committee Credit Card

IV. EXPENDITURES




Name of Vendor, Person or Entity

Amount

Name of Issuing Institution

Date of Transaction

Event #

Type of Credit Card:


(by code)

Description

Visa Master Card Discover American Express

Other

Expenditure #

(if applicable)

Type of Expenditure ( Itemization in Addendum R Required unless "None of the below" is checked)



Independent

A B C DOrganization

None of the below

Total of Section R

S. Expenses Incurred By Committee but Not Paid During this Period

IV. EXPENDITURES



Street AddressCity

State Zip Code

Description

Name of Creditor Date Incurred

Amount Incurred

(Estimate or Actual)


(by code)Event #

Type of Expenditure (Itemization in Addendum S Required unless "None of the below" is checked)

A B C D


Coordinated without reimbursement sought (in-kind contribution

Independent

Organization :

Expenditure#

(if applicable)

None of the below

Total of Section S



of 40


NAME OF COMMITTEE (Provide Com lete Name as Re istered with Filin Re ositor ) TYPE OF REPORT


T. Itemization of Reimbursements and Secondary Payees


Street Address of Vendor, Person or Entity Paid by Committee Worker/Consultant City State Zip Code

Name of Vendor, Person or Entity Paid by Committee Worker/Consultant

Amount

Last Name of Worker/Consultant Date of Payment to Vendor, Person or Entity

Payment to Reimburse Committee Worker/Consultant as reported in Section P


(by code)

Check # Debit Card

Description

Type of Expenditure ( Itemization in Addendem T Required unless "None of the below" is checked)



Independent

Organization: A B C D

First MI

Event #

Expenditure #

EFT

None of the below

Total of Section T

L5. In - Kind Donations Not Considered Contribution Associated with a House Party - Addendum

TYPE OF REPORTNAME OF COMMITTEE

Section L5. ADDENDUM

Event #

Name of Candidate or Committee



of 40

P. Expenses Paid By Committee - Addendum

Section P. ADDENDUM


Expenditure #Supported Opposed

Amount of Expenditure

Name of Candidate or Committee Office Sought (if applicable) Cost Allocated to Candidate or Committee

R. Expenses Incurred on Committee Credit Card - Addendum

Section R. ADDENDUM





S. Expenses Incurred by Committee but Not Paid During this Period - Addendum

Section S. ADDENDUM







of 40

T. Itemization of Reimbursements and Secondary Payees - Addendum

Section T. ADDENDUM





ansonia dtc october 2015 filing

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