#-
CAMPAIGN REPORT
City
of
Fort Collins
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Committee:
of
Full Name
(as shown on Committee Registration Form)
Name
of
Candidate:
(if not reflected in Committee name)
City, State & Zip Code:
Name
of
Financial Institution:
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Financial Institution:
of
Address
of
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J.
a1b OJ
City, State & Zip Code:
Type
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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
Reporting Period Covered:
Geh ::t J
(start with day following end
L ,,
IIJ~
of
Zero in Line 5 Below)
Through
r::l
~e
~/)O
11tJt:.
date
date
(end 2 days before date due)
of last reporting period)
Reporting For
Current Period
Funds on Hand at Beginning
of
Reporting Period (monetary)
Total Moneta Contributions (line 10 on Detailed Summary)
Total
of
Monetary Contributions
& Beginning Amount (line 1+ line 2)
Total Monetary Expenditures (line 16 on Detailed Summary)
Funds on Hand at End
Reporting Period (monetary) (line 3 - line 4)
of
my knowledge and belief this is a true and correct filing. I understand the submission
I certify to the best
of
false, erroneous or incomplete information may be subject to sanctions in accordance with Section 7- 144
of
the
City Code.
Printed Name:
t.
2;e.
tJ
Name
Signatur
Rev: Nav 2000
Sf(
of Person Completing Form
Title:
Date:
E$1S
Campaign
1'-
Title