CAMPAIGN REPORT
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City of Fort Collins
Full Name of Committee:
(as shown on Committee Registration Form)
I No-on-
Name of Candidate:
(if not reflected in Committee name)
City, State & Zip Code:
O. Box 271751 , Fort Collins , CO , 80527
Name of Financial Institution:
I Bank
Address of Financial Institution:
I 4603 Boardwalk Drive
City, State & Zip Code:
One
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)
January 15,
Reporting Period Covered:
2005
March 13 , 2005
Through
date
date
(start with day following end of last reporting period)
(end 2 days before date due)
Reporting For
Current Period
Funds on Hand at Beginning of Reporting Period (monetary)
Total Monetar Contributions (line 10 on Detailed Summary)
Total of Monetary Contributions & Beginning Amount (line 1+ line 2)
Total Monetar 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:
Vaf)
Title:
orm
Signature:
Rev: Nav 2000
"1 reo..su r-
Campaign Title
Date:
Detailed Summary
Funds on hand at beginning of reporting period (monetary):
Reporting For
Current Period
Itemized Contributions
(monetary contributions
of
Non- Itemized
(monetary contributions
$20 or more and loans)
Contributions
of $19. 99 and less)
Other Receipts
(interest, dividends , refunds , rebates, etc.
Total Monetary Contributions
Itemized Contributions
(non-monetary contributions with value
In Kind
of
$20 or more)
Non- Itemized Contributions in Kind
(non-monetary contributions with value
of $19. 99 and less)
Total Contri butions
Expend itu res/Obi
igations
Contributions Returned
Total Monetary Expenditures
Rev: Nov 2000