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CAMPAIGN REPORT
ty of Fort Collins
of
Full Name
Committee:
Northern Colorado Neighborhood Committee
(as shown on Committee Registration Form)
Name
of
Candidate:
(if not reflected in Committee name)
City, State & Zip Code:
Name
of
Address
2519 S. Shields St. , #177 , Fort Collins , CO 80526
Financial Institution:
Financial Institution:
of
City, State & Zip Code:
I Compass Bank
I 3131 S. College Ave.
Fort Collins , CO 80525
Type of Report:
Regularly Scheduled Filing
21 days before election
30 days after election
14 days before election
Annual
Friday before election
Amended Filing, replacing prior report dated:
Termination Report (Termination Reports MUST Have a Monetary Balance of Zero in Line 5 Below)
Reporting Period Covered:
March 21 , 2005
March 30 , 2005
Through
date
date
(end 2 days before date due)
(start with day following end of last reporting period)
Reporting For
Current Period
Funds on Hand at Be innin
Reportin Period (monetary)
of
Total Moneta Contributions (line 10 on Detailed Summary)
Total
of
Moneta Contributions & Be inning Amount (line 1+ line 2)
Total Moneta Expenditures (line 16 on Detailed Summary)
Funds on Hand at End
of
Reporting Period (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 Section 7- 144 of the
City Code.
Printed Name:
And rew
Boucher
Title:
Campaign Title
Signature:
Rev: Nav 2000
Date:
4/1/2005
:", , " :
,.
Detailed Summary
Funds on hand at beginning' of reporting
182. 00
period (monetary):
Reporting For
Current Period
Itemized Contributions
(monetary
contributions of $20
loans)
or more and
Non- Itemized Contributions
(monetary
contributions of
$19. 99 and
less)
Iii:'
Other Receipts
(interest, dividends, refunds, rebates, etc.)
Total Monetary Contributions
Itemized Contributions In Kind
(non-monetary contributions
Non- Itemized
(non-monetary contributions
with value
of $20
Contributions
with value
of
in Kind
$19. 99 and
Total Contributions
Expend itu res/Obi
igations
Contributions Returned
Total Monetary Expenditures
Rev: Nov 2000
or more)
less)

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