ansonia republican town committee 2011 campaign finance

8/3/2019 Ansonia Republican Town Committee 2011 Campaign Finance

1/40

SEEC FORM 20

Itemized Campaign Finance Disclosure Statement

Rev. 1/08

Office Use OnlyCONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Electronic Filing

Page 1 of 40

SUMMARY PAGE

1. NAME OF COMMITTEE

2. TREASURER NAME

Ansonia Republican Town Committee

3. TREASURER ADDRESS

4. ELECTION DATE

7. CANDIDATE NAME

8. TYPE OF REPORT

9. PERIOD COVERED

10. CERTIFICATION

5. OFFICE SOUGHT (if applicable) 6. DISTRICT CODE (if applicable)

Title

Title

First

First

MI

MI

Last

Last

Suffix

Suffix

Street Address City State Zip Code

Jennifer Jones

145 Platt St Ansonia CT 06401

October 10 Filing - Original

Beginning Date Ending Date

07/01/2011 thru 09/30/2011

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

10/04/2011 4:02:53 pm

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 Jennifer Jones


2/40

Page 2 of 40

SUMMARY PAGE

SEEC FORM 20Itemized Campaign Finance Disclosure Statement

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Rev. 1/08

TOTALS

NAME OF COMMITTEE FILING DUE DATE

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

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 + C2)

15. Other Monetary Receipts (Section D-K)

16c. Total Purchases of Advertising in a Program Book (Section L3)

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

19. Expenses Paid by Committee (Section P)

16b. Total Proceeds from Small purchases at Tag Sales, Auctions or Other Sales (Section L2)

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

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)

25. Beginning Loan Balance

25a. + Loans Received (Section D)

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

25c. - Payments on Loan(s)

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)

$3,115.90

$4,053.53

$1,438.00 $3,538.00

$0.00 $0.00

$0.00 $0.00

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

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

$2,098.00 $2,098.00

$0.00 $0.00

$0.00 $0.00

$3,536.00 $5,636.00

$2,238.94 $3,401.31

$0.00 $0.00

$929.53 $929.53

$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

$7,589.53 $8,751.90

Ansonia Republican Town Committee Original 10/11/2011

$5,350.59 $5,350.59


3/40

Page 3 of 40

I. MONETARY RECEIPTS (Section A-K)

AME OF COMMITTEE FILING DUE DATE


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

(See instructions for definition of Small Contributor) Subtotal Section $0.00

B. Itemized Contributions from Individuals

First Name MI

John

Residential Street Address

6 S Cliff St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/07/2011

Principal Occupation

Name of Employer

Is this contribution associated with afundraising event listed in Section L1?

Yes

NoIf yes, list Event #

Tinley, Nastri, Renehan & Dost, LLP

Lawyer

Is contributor a lobbyist, spouse,

or dependent child of a lobbyist?

P

Aggregate Contribution

$128.00

Amount of

Contribution

$8.00

Last Name

Marini

X Cash _ Money Order_ 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 of

government the contract is with:

_

Yes No

_

_ Executive Legislative_

_ Payroll Deduction

Method of Contribution

_

X

First Name MI

Charles


23 Granite Ter

City

Ansonia

State Zip Code

CT 06401

Date Received

07/14/2011


Name of Employer

Is this contribution associated with a

fundraising event listed in Section L1?Yes

No07312011aIf yes, list Event #

Self Employed/Great Northern Excavating

Excavating Contractor



W


$425.00

Amount of

Contribution

$25.00

Last Name

Stowe


Yes_

NoX


officer of a municipality does contributor or business he/she associated with have acontract with said municipality valued at more than $5000?

_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Joan


198 Wakelee Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/14/2011


Name of Employer




Lear Pharmacey

Pharmacist



P


$300.00

Amount of

Contribution

$75.00

Last Name

Radin

_ Cash _ Money OrderX Personal Check Credit/Debit Card_

Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


4/40

Page 4 of 40





First Name MI

Warner


162 Center Rd

City

Woodbridge

State Zip Code

CT 06525

Date Received

07/21/2011


Name of Employer




Philips Healthcare Informatics

Sales Manager



C


$25.00

Amount of

Contribution

$25.00

Last Name

Pyne


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Philip


27 Eagle St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/24/2011


Name of Employer




Home Depot

Sales




$25.00

Amount of

Contribution

$25.00

Last Name

Tripp


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_

Executive Legislative

_

_ Payroll Deduction


X

_

First Name MI

David


3 High Acres Rd

City

Ansonia

State Zip Code

CT 06401-2951

Date Received

07/26/2011


Name of Employer


Yes


Birmingham Management

Owner



S


$485.00

Amount of

Contribution

$60.00

Last Name

Cassetti


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


5/40

Page 5 of 40





First Name MI

William


85 Pulaski Hwy

City

Ansonia

State Zip Code

CT 06401

Date Received

07/28/2011


Name of Employer




Naugatuck Valley Savings and Loan

Vice President



C


$250.00

Amount of

Contribution

$250.00

Last Name

Nimons


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Irving


14 Highland Ave

City

Ansonia

State Zip Code

CT 06401-2518

Date Received

07/28/2011


Name of Employer




Materials Testing Inc.

Quality Control Manager



F


$135.00

Amount of

Contribution

$30.00

Last Name

Reed


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

John


11 Hawley Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

07/30/2011


Name of Employer


Yes



Lawyer



P


$168.00

Amount of

Contribution

$40.00

Last Name

Marini


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


6/40

Page 6 of 40





First Name MI

Cheryl


16 Harris Rd

City

Ansonia

State Zip Code

CT 06401

Date Received

07/31/2011


Name of Employer




Sinclair Insurance Group Inc.

Commercial Account

Executive




$25.00

Amount of

Contribution

$25.00

Last Name

Henri


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Randolph


40 Fourth St # 10

City

Ansonia

State Zip Code

CT 06401

Date Received

07/31/2011


Name of Employer




Unknown

Unknown




$55.00

Amount of

Contribution

$15.00

Last Name

Carroll


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

Edward


51 Grove St

City

Ansonia

State Zip Code

CT 06401

Date Received

07/31/2011


Name of Employer


Yes


Qwest Communications Inc..

Sr Sales Engineer




$15.00

Amount of

Contribution

$15.00

Last Name

Norman


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


7/40

Page 7 of 40





First Name MI

Patricia


28 W Brookside Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

07/31/2011


Name of Employer




State of CT- Dept. of Childrens and Families

Paralegal Specialist II



J


$150.00

Amount of

Contribution

$20.00

Last Name

Fers


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Nancy


18 Farrel Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

08/04/2011


Name of Employer




Yules and Yules LLC

Legal Assistant




$200.00

Amount of

Contribution

$100.00

Last Name

Valentine


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

Charles


23 Granite Ter

City

Ansonia

State Zip Code

CT 06401

Date Received

09/01/2011


Name of Employer


Yes

NoIf yes, list Event #

Self Employed/Great Northern Excavating

Excavating Contractor



W


$485.00

Amount of

Contribution

$60.00

Last Name

Stowe


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


_

X


8/40

Page 8 of 40





First Name MI

Nancy


18 Farrel Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer



No09292011AIf yes, list Event #

Yules and Yules LLC

Legal Assistant




$380.00

Amount of

Contribution

$180.00

Last Name

Valentine


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Irving


14 Highland Ave

City

Ansonia

State Zip Code

CT 06401-2518

Date Received

09/29/2011


Name of Employer




Materials Testing Inc.

Quality Control Manager



F


$235.00

Amount of

Contribution

$100.00

Last Name

Reed


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

Deirdre


23 Granite Ter

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer


Yes


Yale

Business analyst



M


$60.00

Amount of

Contribution

$60.00

Last Name

Stowe


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


9/40

Page 9 of 40





First Name MI

Patricia


28 W Brookside Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer




State of CT- Dept. of Childrens and Families

Paralegal Specialist II



J


$175.00

Amount of

Contribution

$25.00

Last Name

Fers


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Richard


13 Murray St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer




Retired

Retired



S


$20.00

Amount of

Contribution

$20.00

Last Name

Bruchal


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

Joan


198 Wakelee Ave

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer


Yes


Lear Pharmacey

Pharmacist



P


$458.88

Amount of

Contribution

$40.00

Last Name

Radin


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


10/40

Page 10 of 40





First Name MI

David


3 High Acres Rd

City

Ansonia

State Zip Code

CT 06401-2951

Date Received

09/29/2011


Name of Employer




Birmingham Management

Owner



S


$585.00

Amount of

Contribution

$100.00

Last Name

Cassetti


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

Philip


27 Eagle St

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer




Home Depot

Sales




$85.00

Amount of

Contribution

$60.00

Last Name

Tripp


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

First Name MI

Vincent


199 Pulaski Hwy

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer


Yes


Self-Employed

Cabinet Maker




$40.00

Amount of

Contribution

$40.00

Last Name

Scarlata


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_


11/40

Page 11 of 40





First Name MI

Randolph


40 Fourth St # 10

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer




Retired

Retired




$75.00

Amount of

Contribution

$20.00

Last Name

Carroll


Yes_

NoX




_

Yes

X

No




_

Yes No

_


_ Payroll Deduction


X

_

First Name MI

John


11 Hawley Dr

City

Ansonia

State Zip Code

CT 06401

Date Received

09/29/2011


Name of Employer





Lawyer



P


$188.00

Amount of

Contribution

$20.00

Last Name

Marini


Yes_

NoX




_

Yes

X

No




_

Yes No

_

_


_

_ Payroll Deduction


X

_

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

Total of Section B $1,438.00

$1,438.00


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Page 12 of 40

I. MONETARY RECEIPTS (Section A-I)

NAME OF COMMITTEE


FILING DUE DATE

C1. Contributions from Other Committees

Original 10/11/2011

ame of Committee Name of Treasurer

ddress

City State


fundraising event listed in Section L1?

Yes

No

If yes, list Event #

Zip Code Date Received Aggregate Contributions

Amount of Contribution

Total of Section C1


13/40

Page 13 of 40

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

NAME OF COMMITTEE


FILING DUE DATE


Original 10/11/2011

me of Committee Name of Treasurer

Address

City State Zip Code

Date ReceivedAmount of Receipt

Reimbursement for shared expense

Payment for goods and services

Surplus Distribution

Total of Section C2


14/40


15/40

Page 15 of 40

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



Original 10/11/2011Ansonia Republican Town Committee

Street Address

City State Zip Code

Amount

Received

Name

Date Received

Aggregate Contributions

Total of Section E


16/40

Page 16 of 40

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




AmountDate of ReceiptIs this transaction associated with a fundraising event listed in Section L1?

Yes No If yes, list Event #

Total of Section F


17/40

Page 17 of 40

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




AmountDate of Receipt

Total of Section G


18/40

Page 18 of 40

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




Amount Method of PaymentDate Received

Cash Personal Check Credit/Debit Card

Total of Section H


19/40

Page 19 of 40

I. Anonymous Contributions




Amountcoins$ 10 bill$ 5 bills$ 1 billsDate Received

Total of Section I


20/40

Page 20 of 40

J. Interest from Deposits in Authorized Accounts

I. Monetary Receipts (Section A-I)



Zip CodeStateCityStreet Address

Date ReceivedName of Institution Amount

Received

Total of Section J


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Page 21 of 40

K. Miscellaneous Monetary Receipts not Considered Contributions




Street Address Cit State Zip Code

Description

Amount

Received

Name Date of Transaction

Total of Section K


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Page 22 of 40

L1. Fundraiser Event Information

II. FUNDRAISING EVENT ACTIVITY



Zip Code

LetterDate of Fundraiser

Fundraising Event # Location: Street Address City State

07/31/2011 a 18 Farrell Dr 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 by an

individual of u to $50?

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

X _Yes No

Yes

Yes

No

No

X _

_ X

Picnic Event

Description

Were there purchases of advertising space in a program book associated with this is fundraiser?

Did your committee sell food or beverage at a fair or similar mass gathering held within the state?

Yes

Yes

No

No

_ X

_ X

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

Subpart 3: (Town Committees ONLY)

If yes, enterTotal Receipts $0.00

If yes, go to Section L4




from small purchases

Subpart 1: (All Committees)

Zip Code



09/18/2011 A French Memorial Park Seymour CT 06483





_ XYes No

Yes

Yes

No

No

X _

_ X

Fair Event

Description



Yes

Yes

No

No

_ X

X _



If yes, enterTotal Receipts $2,098.00







Zip Code



09/29/2011 A 70 Main St Ansonia CT 06401





_ XYes No

Yes

Yes

No

No

_ X

_ X

Dinner Event

Description



Yes

Yes

No

No

_ X

_ X



If yes, enterTotal Receipts $0.00







Total of Section L1 $2,098.00


23/40

Page 23 of 40

L2. Proceeds from Tag Sale, Auction, or Other Sale of Donated Items




Zip CodeStateCityResidential Street Address

Method of payment:e of the Purchaser Aggregate

Amount of

PurchasesLast Name

First Name MI

Event #

Items Purchased

Personal CheckCash Credit/Debit Card

Date Received

(Individuals ONLY)

Total of Section L2


24/40

Page 24 of 40

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





Business EntityName of Purchaser Amount of

PurchaseEvent # Date Received

Aggregate Purchases

NoYes

for All Events

for All Events

Total of Section L3


25/40

Page 25 of 40

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 E ntity

Total of Section L4


26/40

Page 26 of 40

M. In-Kind Contributions

III. NONMONETARY RECEIPTS

NAME OF COMMITTEE


FILING DUE DATE

Street Address

Type of Contributor: Fair Market

Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee

Is Contributor a lobbyist, spouse, or

dependent 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

Yes

No

Is this contribution associated with a fundraising event

listed in Section J1?

If yes, list Event#

Yes

No

Description of In-Kind ContributionAggregate contributions

Cassetti David

07/14/2011

3 High Acres Rd Ansonia

CT 06401

x

_

07312011a

_

x

60 pre-printed tickets for fundraiser

$15.00 $15.00

_

x

Other

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

No

X

_

_

_

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Valentine Nancy

07/31/2011

18 Farrel Dr Ansonia

CT 06401

x

_

07312011a

_

x

use of home for picnic fundraiser

$100.00 $25.00

_

x

Other


No

X

_

_

_


27/40

Page 27 of 40



NAME OF COMMITTEE


FILING DUE DATE

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Radin P Joan

07/31/2011

198 Wakelee Ave Ansonia

CT 06401

x

_

07312011a

_

x

food and beverages for picnic fundraiser

$349.29 $49.29

_

x

Other


No

X

_

_

_

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Valentine Nancy

07/31/2011

18 Farrel Dr Ansonia

CT 06401

x

_

07312011a

_

x

plates, napkins, condiments and

plasticware $100.00 $10.00

_

x

Other


No

X

_

_

_


28/40

Page 28 of 40



NAME OF COMMITTEE


FILING DUE DATE

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Radin Kathy

09/18/2011

214 Roosevelt Dr Seymour

CT 06483

x

_

09182011A

_

x

Hamburgers, buns and onions

$706.29 $637.89

_

x

Other


No

X

_

_

_

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Radin P Joan

09/18/2011


CT 06401

x

_

09182011A

_

x

ice for coolers

$418.88 $39.59

_

x

Other


No

X

_

_

_


29/40

Page 29 of 40



NAME OF COMMITTEE


FILING DUE DATE

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Radin P Joan

09/18/2011


CT 06401

x

_

09182011A

_

x

fire extinguisher rental

$418.88 $30.00

_

x

Other


No

X

_

_

_

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Radin Kathy

09/18/2011

214 Roosevelt Dr Seymour

CT 06483

x

_

09182011A

_

x

bottled water

$706.29 $68.40

_

x

Other


No

X

_

_

_


30/40

Page 30 of 40



NAME OF COMMITTEE


FILING DUE DATE

Street Address


Value of this

Contribution

Name

City

State Zip Code

Date Received

Individual

Committee



No




Yes

No



If yes, list Event#

Yes

No


Diotalev Gene

09/18/2011

51 D Wedgewood Rd Stratford

CT 06614

x

_

09182011A

_

x

cheese for burgers

$54.36 $54.36

_

x

Other


No

X

_

_

_

Total of Section M $929.53


31/40

Page 31 of 40

N. Refundable Deposit to Telephone Company


ME OF COMMITTEE FILING DUE DATE


Zip CodeStateCityResidential Street Address

Date ReceivedLast Name (Individuals Only) Amount of

Deposit

Name of Telephone company


First Name MI

Total of Section N


32/40

Page 32 of 40

O. Non-Monetary Receipts of Organization Expenditures Made By

Legislative Leadership, Legislative Caucus, and Party Committee




Street Address Date Notice Received

Description of Donation

Fair Market

Value of

Donation

Name of Committee

City State

Name of Treasurer

Aggregate DonationsZip Code

Purpose of Expenditure

A B C D E

Total of Section O


33/40

Page 33 of 40

P. Expenses Paid By Committee

IV. EXPENDITURES




Description

Amountame of Payee Date of Payment Method of Payment

Pur ose of

Check #

Debit Card

Event #

Candidate(s) Name Office Sought

Ansonia Rotary: Harvest Festival Committee

PO Box 575 Ansonia CT 06401Misc *

Booth Fee for the Harvest Festival

$50.00

X

_

000107/08/2011

Type of Expenditure (if applicable)

_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported

OpposedCoordinated with reimbursement sought

Coordinated without reimbursement sought

Independent

Organization (see Instructions)

(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


Seymour Pumpkin Festival

PO Box 860 Seymour CT 06483FNDR

09182011ABooth Fee for the Seymour Pumpkin Festival on 9.18.11

$175.00

X

_

000207/14/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported

OpposedCoordinated with reimbursement sou ht


Independent

Or anization see Instructions

(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


American Heart Association

PO Box 417005 Boston MA 02241CHAR

Charitable donation in memory of a member's father

$50.00

X

_

000307/27/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


34/40

Page 34 of 40


IV. EXPENDITURES




Description


Pur ose of

Check #

Debit Card

Event #


Naugatuck Valley Health District

98 Bank St Seymour CT 06483FNDR

09182011ATemporary food permit fee for Seymour Pumpkin Festival Booth

$50.00

X

_

000408/04/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported


Coordinated without reimbursement sou ht

Independent


(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


Nancy Valentine

18 Farrel Dr Ansonia CT 06401RCW

07312011aReimbursement for food and ice for picnic fundraiser on 7.31.11

$62.09

X

_

000508/05/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


The Hartford

Hartford Plaza Hartford CT 06115OVHD

Yealry insurance premium

$425.00

X

_

electronic09/01/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


35/40

Page 35 of 40


IV. EXPENDITURES




Description


Pur ose of

Check #

Debit Card

Event #


Ansonia Commons, LLC

14 Davis Rd Woodbridge CT 06525OVHD

cost of having a Republican Headquarters for three months

$1,000.00

X

_

000609/01/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


Ansonia Rotary/ Harvest Festival

PO Box 575 Ansonia CT 06401A-OTH

Having a booth at the Harvest Festival- not a fundraiser

$50.00

X

_

000709/12/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


Massimino's Pizzeria

70 Main St Ansonia CT 06401FOOD

09292011APizza and soda for fundraising event

$264.50

X

_

001009/29/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


36/40

Page 36 of 40


IV. EXPENDITURES




Description


Pur ose of

Check #

Debit Card

Event #


Joan Radin

198 Wakelee Ave Ansonia CT 06401FNDR

09182011ASoda for Pumpkin Festival

$64.58

X

_

000809/30/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure


Description


Pur ose of

Check #

Debit Card

Event #


Kathy Radin

214 Roosevelt Dr Seymour CT 06483FNDR

09182011ADecorations for the booth

$47.77

X

_

000909/30/2011


_

_

_

_

_ _A B _ C _ D _ E

_

_

Supported



Independent


(if applicable)

b code

Expenditure

Total of Section P $2,238.94


37/40

Page 37 of 40

Q. Campaign Expenses Paid By Candidate

IV. EXPENDITURES




Description

AmountName of Payee (Name of Vendor who candidate paid directly) Date of PaymentIs Reimbursement

Claimed?

Event #

Purpose of

Expenditure (by code)

Yes No

Total of Section Q


38/40

Page 38 of 40

R. Expenses Incurred on Committee Credit Card

IV. EXPENDITURES




Name of Vendor Amount

Name of Issuing Institution

Date of Transaction

Event #

Type of Credit Card:

Purpose of Expenditure (by code)

Description

Visa Master Card Discover American Express

Other

Total of Section R


39/40

Page 39 of 40

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

IV. EXPENDITURES




Description

Name of Creditor Date Incurred Amount Incurred

(Estimate or

Actual)

Purpose of

Expenditure (by

code

Event #

Candidate(s) Name (if applicable) Office SoughtType of Expenditure (if applicable)

A B C D E

Supported



Independent


Total of Section S


40/40

Page 40 of 40

IV. EXPENDITURES


Ansonia Re ublican Town Committee Original 10/11/2011

T. Itemization of Reimbursements to Committee Workers and Consultants


Secondary Payee

AmountName of Worker/Consultant Date of Payment Method of Payment

Purpose of Expenditure

Check #

Debit Card

Other Candidate(s) Name Office Sought

Description

Supported

Opposed


Coordinated with reimbursement sought


Independent


A B C D E

Total of Section T

ansonia republican town committee 2011 campaign finance

Documents