Seec Form 20 PDF Details

Understanding the complexities of campaign finance is essential for ensuring transparency and accountability in the political process. One vital tool in this effort is the SEEC Form 20, an Electronic Filing Itemized Campaign Finance Disclosure Statement that candidates for statewide offices and the General Assembly in Connecticut must complete. This comprehensive document, designed by the Connecticut State Elections Enforcement Commission, details every aspect of a campaign's financial transactions, including contributions received, expenses paid, and the balance on hand at the end of the reporting period. Specifically, the form requires information on the committee's name, treasurer's details, the election date, the office sought, district code, and the candidate's name. It also calls for a meticulous accounting of monetary receipts, in-kind donations, loans, and unpaid expenses, offering a clear snapshot of a campaign's financial health and its adherence to regulatory compliance. With strict penalties for false statements, including fines and imprisonment, the importance of accurate and honest disclosure cannot be overstated. As such, the SEEC Form 20 not only promotes ethical campaign practices but also serves as a crucial resource for voters, researchers, and oversight bodies seeking to understand the flow of money in politics.

QuestionAnswer
Form NameSeec Form 20
Form Length25 pages
Fillable?No
Fillable fields0
Avg. time to fill out6 min 15 sec
Other namesctform seec form 20 blank 2019, 2008, C2, Payee

Form Preview Example

SEEC FORM 20

 

 

 

 

 

 

 

 

 

 

Electronic Filing

 

 

Itemized Campaign Finance Disclosure Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Candidates for Statewide Offices and General Assembly

 

 

 

 

 

 

 

 

 

 

 

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

 

 

 

 

 

 

Office Use Only

 

 

 

 

 

 

 

 

 

 

 

Rev. 1/08

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 25

 

 

 

 

 

SUMMARY PAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.NAME OF COMMITTEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Burlington Republican Town Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. TREASURER NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

First

 

 

MI

Last

 

 

 

 

 

Suffix

 

 

 

 

Donna

 

 

 

Mullen

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. TREASURER ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

City

 

 

State

 

Zip Code

 

 

65 CANTON RD

 

 

BURLINGTON

 

 

CT

 

06013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. ELECTION DATE

 

 

5. OFFICE SOUGHT (if applicable)

 

 

6. DISTRICT CODE (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11/04/2008

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. CANDIDATE NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

First

 

 

MI

Last

 

 

 

 

 

Suffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. TYPE OF REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

January 10 Filing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. PERIOD COVERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beginning Date

 

 

Ending Date

 

 

 

 

 

 

 

 

 

 

 

 

10/24/2007

 

thru

12/31/2007

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. CERTIFICATION

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

Itemized Campaign Finance Disclosure Statment for the period covered is true, accurate and complete.

 

 

 

 

 

 

 

Electronic Filing

 

Donna Mullen

 

 

 

01/07/2008

 

 

 

 

 

 

 

TREASURER (SIGNATURE)

PRINT NAME OF THE SIGNER

 

DATE CERTIFIED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

OR IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 2 of 25

SEEC FORM 20

Itemized Campaign Finance Disclosure Statement

Candidates for Statewide Offices and General Assembly

CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

Rev. 1/08

SUMMARY PAGE

TOTALS

NAME OF COMMITTEE

FILING DUE DATE

Burlington Republican Town Committee

01/10/2008

 

 

 

 

COLUMN A

 

 

COLUMN B

 

 

 

 

This Period

 

 

Aggregate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Balance on hand January 1 of current year for Ongoing and Party

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$1,811$0.060

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

Balance on hand at the beginning of Reporting Period

 

 

$669$0.4400

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Contributions received from Individuals (Section A and B)

$50.00

 

 

$7,56791.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Receipts from Other Committees (Sections C1 + C2)

$0.00

 

$250.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

Other Monetary Receipts (Section D-K)

$0.08

 

 

$1. 3

 

 

 

 

 

$2.80

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

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

$50.08

 

 

 

 

 

 

 

 

$7,819.80

 

 

 

 

 

 

 

 

 

 

 

 

 

42. 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

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

$50.08

 

 

$$9,6307,842.863

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19.

Expenses Paid by Committee (Section P)

$0.00

 

 

$$8,9116,232.3400

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

$719$50.52.08

 

 

$$1,610719..5283

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21.

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

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.

In-Kind Contributions Received (Section M)

$732.19

 

$732.19

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

23.

Refundable Deposit to Telephone Company (Section N)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24.

Receipts of Organization Expenditures (Section O)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

Beginning Loan Balance

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25a. + Loans Received (Section D)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25c. - Payments on Loan(s)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25d. Total Outstanding Loan Amount

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26.

Campaign Expenses Paid By Candidate (Section Q)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28.

Expenses Incurred on Committee Credit Card (Section R)

$0.00

 

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29.

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

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

29a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)

$0.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3 of 25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I. MONETARY RECEIPTS (Section A-K)

 

 

 

 

 

 

 

 

Page 1 of 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF COMMITTEE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FILING DUE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Burlington Republican Town Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

01/10/2008

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name

 

 

First

 

 

 

MI

 

Principal Occupation

 

 

 

 

 

 

Amount of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Doerr

 

 

Jeanne

 

 

 

 

Housewife

 

 

 

 

 

 

 

 

Contribution

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residential Street Address

 

 

 

City

 

 

 

State

 

Zip Code

 

Name of Employer

 

28 Woodhaven Dr

 

 

 

BURLINGTON

 

 

 

CT

 

06013

 

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is contributor a lobbyist, spouse,

_

Yes

 

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

_

Yes

 

or dependent child of a lobbyist?

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

X

No

 

contract with said muncipality valued at more than $5000?

 

 

 

 

 

X

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this contribution associated with a

 

_

Yes

Is contributor a principal of state contractor or prospective state

 

 

 

 

_ Yes

X No

 

fundraising event listed in Section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, indicate which branch or branches of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

X

 

 

_ Executive

_ Legislative

 

 

 

If yes, list Event #

 

 

No

government the contract is with:

 

 

 

 

Method of Contribution

 

 

 

 

 

 

 

 

 

 

Date Received

 

 

Aggregate Contribution

 

_ Cash

X Personal Check

 

_

Credit/Debit Card

_ Payroll Deduction

_ Money Order

 

10/25/2007

 

 

 

$130.00

$50.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total of Section B

$50.00

TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS

(Sections A & B)

(Total on Line 14 of Summary Page)

 

 

 

$50.00

Page 4 of 25

I. MONETARY RECEIPTS (Section A-I)

NAME OF COMMITTEE

FILING DUE DATE

C1. Contributions from Other Committees

Name of Committee

Address

Name of Treasurer

Is this contribution associated with a

Yes If yes, list Event #

Amount of Contribution

 

findraising event listed in Section J1?

No

 

 

 

City

State

Zip Code

Date Received

Aggregate Contributions

Total of Section C1

Page 5 of 25

I. MONETARY RECEIPTS (Section A-I)

Page 1 of 1

NAME OF COMMITTEE

FILING DUE DATE

C2. Reimbursements or Payments from other Committees

Name of Committee

Address

City

 

 

 

Name of Treasurer

 

 

 

 

 

 

 

 

Date Received

 

 

 

 

 

Amount of Contribution

State

 

Zip Code

Reimbursement for shared expense

 

 

 

 

 

 

Payment for goods and services

 

 

 

 

Surplus Distribution

 

 

 

 

 

 

Total of Section C2

Page 6 of 25

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE

FILING DUE DATE

D. Loans Received this Period

Name of Lender

Street Address

City

State

Zip Code

Source of Loan:

BankCandidate

Individual Other

Is there a cosigner or Guarantor of this loan?

Yes

Amount Received

Name of Cosigner/Guarantor

No

Street Address

City

State

Zip Code

Date Received

Total of Section D

Page 7 of 25

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE

FILING DUE DATE

E. Receipts from Entities other than Individuals or Other Committees

Name

Street Address

 

 

Date Received

 

Amount

 

 

 

 

 

 

 

 

Received

 

 

 

 

 

 

City

State

Zip Code

Aggregate Contribtions

 

 

 

 

 

 

 

 

Total of Section E

Page 8 of 25

I. MONETARY RECEIPTS (Section A-I)

NAME OF COMMITTEE

FILING DUE DATE

F. Amount Transferred from Affiliated Business Treasury

Is this transaction associated with a fundraising event listed in Section L1?

Yes

No

If yes, list Event #

Date Received

Amount

Total Transfers

Page 9 of 25

I. MONETARY RECEIPTS (Section A-I)

NAME OF COMMITTEE

FILING DUE DATE

G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury

Date Received

Amount

Total Transfers

Page 10 of 25

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE

FILING DUE DATE

E. Personal Funds of the Candidate Received this Period

Date Received

Amount

Method of Payment

Cash

Personal Check

Credit/Debit Card

Total Amount Received

Page 11 of 25

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE

FILING DUE DATE

F. Anonymous Contributions

Date Received

$ 1 bills

$ 5 bills

$ 10 bill

coins

Amount

Total Amount Received

Page 12 of 25

I. Monetary Receipts (Section A-I)

NAME OF COMMITTEE

Burlington Republican Town Committee

FILING DUE DATE

01/10/2008

J. Interest from Deposits in Authorized Accounts

Name of Institution

 

Date Received

 

 

Total Amount

 

 

 

 

 

 

Farmington Savings Bank

 

12/31/2007

 

 

 

Received

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

City

 

State

 

Zip Code

 

 

 

 

 

 

 

253 Spielman Highway

BURLINGTON

 

CT

 

06013

$0.08

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total of Section J

$0.08

 

 

 

 

 

 

 

Page 13 of 25

I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE

FILING DUE DATE

K. Miscellaneous Monetary Receipts not Considered Contributions

Name

 

Date of Transaction

Amount

 

 

 

 

Received

 

 

 

 

 

Street Address

City

State

Zip Code

 

 

 

 

 

 

Description

 

 

 

 

 

 

 

 

 

Total of Section I

Page 14 of 25

II. FUNDRAISING EVENT ACTIVITY

NAME OF

COMMITTEE

FILING DUE DATE

L1. Fundraising Event Information

Fundraising Event #

 

Description

Location: Street Address

City

 

State

Zip Code

Date of Fundraiser

Letter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Was this fundraising event hosted at a personal residence?

Yes

No

 

 

 

 

 

 

 

 

 

 

 

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

Yes

No

 

 

 

 

 

 

 

 

 

 

 

individual of up to $50?

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Yes

No

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

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

Yes

No

 

 

 

 

 

 

 

 

 

 

 

Subpart 3: (Town Committees ONLY)

 

 

 

 

 

 

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

Yes

No

Total Receipts from small purchases

 

 

 

 

 

 

 

 

 

 

 

Total of Receipts from Section L1

 

 

 

 

 

 

 

 

 

 

 

 

Page 15 of 25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. FUNDRAISING EVENT ACTIVITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF COMMITTEE

 

 

 

 

 

 

 

 

 

 

FILING DUE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of the Purchaser Last name

 

First name

 

MI

Method of payment:

 

 

 

 

 

Aggregate

 

 

 

 

 

 

 

 

 

 

 

 

Amount of

 

 

 

 

 

Cash

Personal Check

Credit/Debit Card

Purchases

 

 

 

 

 

 

 

 

 

 

 

 

Residential Street Address

City

State

Zip Code

 

Date Received

 

Event #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Items Purchased

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total of all small purchases from Tag Sales, Auctions or Other Sales of Donated I

 

 

 

 

 

 

 

 

 

Page 16 of 25

 

 

 

 

 

 

 

 

 

 

 

 

II. FUNDRAISING EVENT ACTIVITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF COMMITTEE

 

 

 

 

 

 

 

FILING DUE DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L3. Purchases of Advertising in a Program Book

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of the Purchaser

 

 

 

Business Entity

 

Date Received

 

Amount of

 

 

 

 

 

 

 

 

 

Purchase

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

City

 

State

Zip Code

Event #

Aggregate Purchases for All Events

 

 

 

 

 

 

 

 

 

 

 

 

Total of All Small Purchases from TAG SALES, AUCTIONS or other SALES or DONATED ITE

Page 17 of 25

II. FUNDRAISING EVENT ACTIVITY

NAME OF COMMITTEE

FILING DUE DATE

L4. In-Kind Donations Not Considered Contributions

Name of the Donor

'Donation Given by:

Individual

Business Entity

Fair Market

Value of

Donation

Street Address

City

State

Zip Code

Aggregate value for this event

Description of Donation

Date Received

Event #

Total of All IN-KIND DONATIONS NOT CONSIDERED CONTRIBUTIONS

Page 18 of 25

III. NONMONETARY RECEIPTS

NAME OF COMMITTEE

Burlington Republican Town Committee

FILING DUE DATE

01/10/2008

M. In-Kind Contributions

Name

 

 

 

 

 

 

 

 

 

 

 

Type of Contributor:

Fair Market

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Value of this

Christopher Dupras

 

 

 

 

 

 

 

 

 

 

 

x

 

Individual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contribution

Street Address

 

 

City

 

 

State

 

Zip Code

 

 

_

 

Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 Northridge Road

 

 

BURLINGTON

 

CT

 

06013

 

 

_

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Contributor a lobbyist, spouse, or

 

 

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

 

 

 

 

 

 

 

_

Yes

_

 

Yes

 

Date Received

 

dependent child of a lobbyist?

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

 

 

 

 

 

 

 

 

 

 

 

 

 

x

No

assoicated with have a contract with said municipality valued at more

x

 

No

 

10/27/2007

 

 

 

 

 

 

 

 

 

 

than $5000?

 

 

 

 

 

 

 

 

 

 

 

 

Is this contribution associated with a fundraising event

 

 

 

Description of In-Kind Contribution

 

 

 

 

 

 

Aggregate contributions

 

 

_

Yes

 

 

 

 

 

 

 

listed in Section J1?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, list Event#

 

 

 

x

No

Stationary and postage

 

 

 

 

 

 

$1,081.97

$641.97

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

Type of Contributor:

Fair Market

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Value of this

Roger Powell

 

 

 

 

 

 

 

 

 

 

 

x

 

Individual

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contribution

Street Address

 

 

City

 

 

State

 

Zip Code

 

 

_

 

Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

76 Charlois Way

 

 

BURLINGTON

 

CT

 

06013

 

 

_

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Contributor a lobbyist, spouse, or

 

 

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

 

 

 

 

 

 

 

_

Yes

_

 

Yes

 

Date Received

 

dependent child of a lobbyist?

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

 

 

 

 

 

 

 

 

 

 

 

 

 

x

No

assoicated with have a contract with said municipality valued at more

x

 

No

 

10/28/2007

 

 

 

 

 

 

 

 

 

 

than $5000?

 

 

 

 

 

 

 

 

 

 

 

 

Is this contribution associated with a fundraising event

 

 

 

Description of In-Kind Contribution

 

 

 

 

 

 

Aggregate contributions

 

 

_

Yes

 

 

 

 

 

 

 

listed in Section J1?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, list Event#

 

 

 

x

No

Envelopes, paper and stamps

 

 

 

 

 

$465.22

$90.22

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total of All In-Kind Contributions

$732.19

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 19 of 25

III. Non Monetary Receipts

NAME OF COMMITTEE

FILING DUE DATE

N. Refundable Deposit to Telephone Company

Last Name of Individual

 

First Name

 

 

 

MI

 

Date Deposit Made

Amount of

 

 

 

 

 

 

 

 

 

Deposit

 

 

 

 

 

 

 

 

 

 

Street Address

 

City

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Telephone company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

City

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

Total of Section N

Page 20 of 25

III. NONMONETARY RECEIPTS

NAME OF COMMITTEE

FILING DUE DATE

O. Non-Monetary Receipts of Orgnaization Expenditures Made By

Legislative Leadership, Legislative Caucus, and Pary Committee

Name of Committee

 

Name of Treasurer

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

Date Notice Received

 

Fair Market

 

 

 

 

 

 

 

Value of

 

 

 

 

 

 

 

Donation

City

State

Zip Code

 

Aggregate Donations

 

 

 

 

 

 

 

 

 

Description of Donation

 

Purpose of Expenditure

 

 

 

 

 

 

A

B

C

D

E

 

 

 

 

 

 

 

 

 

Total of Section O

Page 21 of 25

IV. EXPENDITURES

NAME OF COMMITTEE

FILING DUE DATE

P. Expenses Paid By Committee

Name of Payee

Street Address

Date of Payment

City

State

Zip Code

Purpose of Expenditure

 

 

 

 

Method of Payment

Check #

Debid Card

Amount

Description

Event #

 

 

Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent

Organization (see Instructions)

A B C D E

Other Candidate(s) Name

Office Sought

Supported

 

 

Opposed

Total of All Expenses Paid By Committee

Page 22 of 25

IV. EXPENDITURES

NAME OF COMMITTEE

FILING DUE DATE

Q. Campaign Expenses Paid By Candidate

 

Name of Payee

 

 

 

Date of Payment

Is Reimbursement Claimed?

Amount

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

Street Address

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

Purpose of Expenditure

Description

 

 

 

Event #

 

 

 

 

 

 

 

 

 

Total of All Expenses Paid By Candidate

Page 23 of 25

IV. EXPENDITURES

NAME OF COMMITTEE

FILING DUE DATE

R. Expenses Incurred on Committee Credit Card

Name of Issuing Institution

 

 

 

Type of Credit C

 

 

 

 

 

 

 

 

 

 

Visa

Master Card

 

Discover

American

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Vendor

 

 

 

 

 

 

 

Date of Transaction

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

City

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purpose of Expenditure

Description

 

 

 

 

 

 

 

Event #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total of All Expenses Incurred on Committee Credit Card

Page 24 of 25

IV. EXPENDITURES

NAME OF COMMITTEE

FILING DUE DATE

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

Name of Creditor

Street Address

Description

Date Incurred

City

State

Zip Code

Purpose of Expenditure

 

 

 

 

Event #

Amount Incurred

(Estimate or

Actual)

Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent

Organization (see Instructions)

A B C D E

Other Candidate(s) Name

Office Sought

Supported

Opposed

Total of All Expenses Paid By Committee but Not Pai

Page 25 of 25

IV. EXPENDITURES

NAME OF COMMITTEE

FILING DUE DATE

T. Itemization of Reimbursements to Committee Workers and Consultants

Name of Worker/Consultant

Secondary Payee

Date of Payment

Purpose of Expenditure

Method of Payment

Check #

Debid Card

Amount

Street Address

City

State

Zip Code

 

 

 

 

Description

Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent

Organization (see Instructions)

A B C D E

Other Candidate(s) Name

Office Sought

Supported

 

 

Opposed

Total of All Itemization of Reimbursements to Committee Workers and Consultants