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CAMPAIGN REPORT
f Fort Collins
Full Name of Committee:
(.~ -.M1
Corrmittte
~on
~orm)
Name of Candidate:
(II not 1'IIIect8(llft
COrmiIt.. '*"'*)
City, State & Zip Code~
Name of Financial Institution:
Address of Financial Institution:
C~~
~AT C.""-'(;~ ~c.
&.I).
La&$
~c
~"'k
Ce
City, State &Zip Code:
6.S"~1.
Type of Report:
Regularly Scheduled Filing
5Zl21 days before electIon
30 days afb=r election
14 days before election
Annual
FridilY before erection
00
Amended Filing. replacing prior report dated:
0.3
I -3. (
dat.
Termination Report (Termination Repons MUST Have a Mooetal'y Balaooe of ZeJ'\) in Une 5 Below)
Reporting Period Covered:
\fJ "a..i)
(nwt. day foIlOYAnfJend
Through
of tast repcxtlno period) ..",... 2 .Y' date
before dati due)
.- no . .
Reporting For
Current Period
Funds on Hand at Be innin of Re rtln Period (moneta,y)
Total Moneta Contributions (line 10 on work$heet
Tolat of Moneta Contributions & Be innin Amount Olne 1+ line 2
Total Moneta Ex nditures (line 16 on worksheet)
Funds on Hand at End of Reportln Period (monetarv) (lIne 3 . line 4)
0 \:~
:t~
~S.
City Code.
, 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
Printed Name
Signatu
NC)~2000
~V\
C-+\-
Title: ()
Date: