Colorado Secretary of State
1560 Broadway, Suite 200
Denver, CO 80202
(303) 894-2680
(303) 894-7732
DETAILED SUMMARY REPORT OF CONTRIBUTIONS AND EXPENDITURES
Full Name of Committee:
As Shown on Committee Registration
Address of Committee:
City, State & Zip Code:
Name of Financial Institution:
Address of Financial Institution:
City, State & Zip Code:
Secretary of State Issued Committee Number:
If filed with SOS
Type of Report
This is a Regularly Scheduled Filing.
This is an Amended Filing.
This amends the filing of (date)
Submit only those forms which have been altered, amended or changed.
This is a Termination Report.
(Termination Reports MUST Have a Monetary Balance of Zero in Line 5)
Reporting Period Covered:
Through
date
date
Reporting For Current Period
Funds on Hand at Beginning of Reporting Period
$
1
(monetary )
Total Monetary Contributions
$
2
(line 11)
Total of Monetary Contributions & Beginning Amount
$
3
(line 1+ line 2)
Total Monetary Expenditures
$
4
(line 18)
Funds on Hand at End of Reporting Period
$
5
(monetary ) (line 3 - line 4)
I certify to the best of my knowledge and belief this is a true and correct filing. I understand the submission of
false, erroneous or incomplete information may be subject to sanctions in accordance with CRS 1-45-113.
Printed Name:
Name of Person Completing Form
Signature:
Date:
Colorado Secretary of State Form, Rev: May 2000
Front Page of Detailed Summary Report