ansonia rtc october 2013 filing

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  • 7/27/2019 Ansonia RTC October 2013 Filing

    1/19

    SEEC FORM 20

    Itemized Campaign Finance Disclosure Statement

    Revised January 2012

    Do Not Mark in This Space For Official Use Only

    CONNECTICUT STATE ELECTIONS ENFORCEMENT

    COMMISSION

    Electronic Filing

    Page 1 of 19

    COVER PAGE

    1. NAME OF COMMITTEE

    2. TREASURER NAME

    Ansonia Republican Town Committee

    3. TREASURER ADDRESS

    4. ELECTION/REFERENDUM DATE

    7. CANDIDATE NAME (Complete only if Candidate or Exploratory Committee)

    8. TYPE OF REPORT

    9. PERIOD COVERED

    10. CERTIFICATION

    5. OFFICE SOUGHT (Complete only if Candidate Committee) 6. DISTRICT NUMBER(if applicable)

    First

    First

    MI

    MI

    Last

    Last

    Suffix

    Suffix

    Street Address City State Zip Code

    Linda A Vaccaro

    515 Beaver St Ansonia CT 06401

    October 10 Filing - Original

    Beginning Date Ending Date

    07/01/2013 thru 09/30/2013

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

    Itemized Campaign Finance Disclosure Statement for the period covered is true, accurate and

    complete.

    PRINT NAME OF THE SIGNER DATE CERTIFIED

    10/06/2013 10:59:03AM

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

    IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.

    SIGNATURE

    Electronic Filing Linda Vaccaro

  • 7/27/2019 Ansonia RTC October 2013 Filing

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    Page 2 of 19

    SUMMARY PAGE TOTALS

    SEEC FORM 20Itemized Campaign Finance Disclosure Statement

    CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION

    Revised January 2012

    NAME OF COMMITTEE TYPE OF REPORT

    COLUMN A

    This Period

    COLUMN B

    Aggregate

    11. Balance on hand January 1 of current year for Ongoing and Party Committees OR

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

    12. Balance on hand at the beginning of Reporting Period

    13. Contributions received from Individuals (Section A and B)

    14. Receipts from Other Committees (Sections C1 and C2)

    15. Other Monetary Receipts (Section D through K)

    16c. Total Purchases of Advertising - Program Book or Sign (Section L3)

    18. Subtotals (add totals in Line 12 + 17 in Column A and in Line 11 + 17 in Column B)

    19. Expenses Paid by Committee (Section P)

    16b. Per Public Act 11-48, effective January 1,2012 Section L2 removed

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

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

    22. In-Kind Contributions Received (Section M)

    23. Refundable Deposit to Telephone Company (Section N)

    24. Receipts of Organization Expenditures (Section O) OPTIONAL

    25. Beginning Loan Balance

    25a. + Loans Received (Section D)

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

    25c. - Payments on Loan

    25d. Total Outstanding Loan Amount

    26. Campaign Expenses Paid By Candidate (Section Q)

    27. Expenses Incurred on Committee Credit Card (Section R)

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

    28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)

    $3,423.45

    $3,883.45

    $2,310.00 $3,532.50

    $0.00 $0.00

    $0.00 $0.00

    16a. Total Proceeds from Small Puchases (Section L1 Subpart 1 + Subpart 3)

    17. Total Monetary Receipts (add totals for lines 13 through 16c)

    $0.00 $0.00

    $5,446.94 $6,209.44

    $0.00$0.00

    $0.00 $0.00

    $0.00 $0.00

    $0.00 $0.00

    $0.00

    $0.00 $0.00

    $0.00 $0.00

    $0.00 $0.00

    $0.00

    $0.00 $0.00

    $0.00 $0.00

    $0.00

    $0.00

    $9,993.45 $10,755.95

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    $3,800.00

    Municipal and Town Committees Only

    $6,110.00 $7,332.50

    $4,546.51 $4,546.51

    $3,800.00

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    Page 3 of 19

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORTOctober 10 Filing - OriginalAnsonia Republican Town Committee

    A. Total Contributions from Small Contributors-Received this Period ONLY

    (See instructions for definition of Small Contributor) Subtotal Section A$0.00

    B. Itemized Contributions from Individuals

    Patricia

    Residential Street Address

    28 W Brookside Ave

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    08/21/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    State of CT- Dept. of Childrens and FamiliesParalegal Specialist II

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    J

    Aggregate Contributions

    $190.00

    Amount of Contribution

    $150.00

    Last Name

    Fers

    Cash Money OrderX Personal Check Credit/Debit Card

    Yes_

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches ofgovernment the contract is with:

    _

    Yes No

    _

    Executive Legislative

    Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

    JANET

    Residential Street Address

    83 Prospect St

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    08/21/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    Aggregate Contributions

    $10.00

    Amount of Contribution

    $10.00

    Last Name

    VITARIUS WAUGH

    X Cash Money OrderPersonal Check Credit/Debit Card

    Yes

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    Yes No

    _ Executive Legislative_

    Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

    WARNER

    Residential Street Address

    162 Center St

    City

    Woodbridge

    State Zip Code

    CT 06525

    Date Received

    09/01/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    Aggregate Contributions

    $25.00

    Amount of Contribution

    $25.00

    Last Name

    PYNE

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    Yes No

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    X

    First Name MI

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    Page 4 of 19

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORTOctober 10 Filing - OriginalAnsonia Republican Town Committee

    B. Itemized Contributions from Individuals

    Irving

    Residential Street Address

    14 Highland Ave

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    09/02/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    Materials Testingquality control manager

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    Aggregate Contributions

    $500.00

    Amount of Contribution

    $500.00

    Last Name

    Reed

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    Yes No

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    X

    First Name MI

    RONALD

    Residential Street Address

    515 Beaver St

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    09/02/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1? Yes

    NoIf yes, list Event #

    NBC UNIVERSAL SPORTSEDITIORIAL DIRECTOR

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    Aggregate Contributions

    $500.00

    Amount of Contribution

    $500.00

    Last Name

    VACCARO

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes_

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    _

    Yes No

    _

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

    Lorie

    Residential Street Address

    515 Beaver St

    City

    Ansonia

    State Zip Code

    CT 96488

    Date Received

    09/03/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    noneRetired

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    Aggregate Contributions

    $550.00

    Amount of Contribution

    $500.00

    Last Name

    Vaccaro

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes_

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    _

    Yes No

    _

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

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    Page 5 of 19

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORTOctober 10 Filing - OriginalAnsonia Republican Town Committee

    B. Itemized Contributions from Individuals

    Charles

    Residential Street Address

    23 Granite Ter

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    09/05/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    Self Employed/Great Northern ExcavatingExcavating Contractor

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    W

    Aggregate Contributions

    $575.00

    Amount of Contribution

    $525.00

    Last Name

    Stowe

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    Yes No

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    X

    First Name MI

    Joanne

    Residential Street Address

    37 Morningside Dr

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    09/05/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1? Yes

    NoIf yes, list Event #

    YALE UNIVERSITYSR ADMIN ASSIST

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    M

    Aggregate Contributions

    $75.00

    Amount of Contribution

    $75.00

    Last Name

    Czeczot

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes_

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    _

    Yes No

    _

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

    Patricia

    Residential Street Address

    28 W Brookside Ave

    City

    Ansonia

    State Zip Code

    CT 06401

    Date Received

    09/05/2013

    Principal Occupation Name of Employer

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes

    NoIf yes, list Event #

    State of CT- Dept. of Childrens and FamiliesParalegal Specialist II

    Is contributor a lobbyist, spouse,

    or dependent child of a lobbyist?

    J

    Aggregate Contributions

    $215.00

    Amount of Contribution

    $25.00

    Last Name

    Fers

    _ Cash _ Money OrderX Personal Check Credit/Debit Card_

    Yes_

    NoX

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

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

    a contract with said municipality valued at more than $5000?

    _

    Yes

    X

    No

    Is contributor a principal of state contractor or prospective state contractor?

    If yes, indicate which branch or branches of

    government the contract is with:

    _

    Yes No

    _

    _ Executive Legislative_

    _ Payroll Deduction

    Method of Contribution

    _

    X

    First Name MI

    TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS (Sections A & B) (Total on Line 14 of Summary Page)

    Total of Section B $2,310.00

    $2,310.00

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    Page 6 of 19

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE

    Ansonia Republican Town Committee

    TYPE OF REPORT

    C1. Contributions from Other Committees

    October 10 Filing - Original

    me of Committee

    Address

    ity State

    Is this contribution associated with a

    fundraising event listed in Section L1?Yes No

    If yes, list Event #

    Zip Code Date Received Aggregate Contributions

    Amount of Contribution

    Name of Treasurer

    Total of Section C1

    C2. Reimbursements. Payments. or Surplus Distributions from other Committees

    NAME OF COMMITTEE

    Ansonia Republican Town Committee

    TYPE OF REPORT

    I. MONETARY RECEIPTS (Section A-K)

    October 10 Filing - Original

    Name of Committee Name of Treasurer

    Address

    ity State Zip Code

    Date ReceivedAmount of Receipt

    Reimbursement for shared expense

    Payment for goods and services

    Surplus Distribution

    Total of Section C2

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    Page 7 of 19

    D. Loans Received this Period

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Street Address City State Zip Code

    Date of Receipt

    Name of Cosigner/Guarantor (if applicable) Amount Received

    Name of Lender

    Street AddressCity Zip Code

    Is there a cosigner or

    Guarantor of this loan?

    Yes No

    Source of Loan:

    Bank IndividualCandidate Other

    Total of Section D

    E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLY)

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    Street Address

    City State Zip Code

    Amount Received

    Name of Entity

    Date Received

    Aggregate Contributions

    Total of Section E

    F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)

    I. MONETARY RECEIPTS (Section A-I)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    AmountIs this transaction associated with a fundraising

    event listed in Section L1?Yes No If yes, list Event #

    Date of Receipt

    Total of Section F

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    Page 8 of 19

    G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)

    I. MONETARY RECEIPTS (Section A-I)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    AmountDate of Receipt

    Total of Section G

    H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    AmountMethod of PaymentDate of Receipt

    Cash Personal Check Credit/Debit Card

    Total of Section E

    J. Interest from Deposits in Authorized Accounts

    I. Monetary Receipts (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    Zip CodeStateCityStreet Address

    Date ReceivedName of Institution Amount

    Total of Section J

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    Page 9 of 19

    K. Miscellaneous Monetary Receipts not Considered Contributions

    I. MONETARY RECEIPTS (Section A-K)

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Street Address City State Zip Code

    Description

    Amount

    Received

    Name Date of Transaction

    Total of Section K

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    Page 10 of 19

    L1. Fundraiser Event Information

    II. FUNDRAISING EVENT ACTIVITY Sections L1 - L4

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Zip Code

    LetterDate of Fundraiser

    Fundraising Event #

    Location: Street Address City State

    08/24/2013 T

    1 High Acres Rd Ansonia CT 06401

    Was this fundraising event hosted at a personal residence?

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

    items donated b an individual of u to $100?

    Was this fundraiser a tag sale, auction, or other sale of donated items with

    puchases from an individual of up to $100?

    _

    X

    Yes

    No

    Yes

    Yes

    No

    No

    _

    X

    X

    _

    Sale Event

    Description

    Were there purchases of advertising space in a program book or on a sign associated

    with this fundraiser?

    Did your committee sell food or beverage at a fair or similar mass gathering held

    within the state with this fundraiser?

    Yes

    Yes

    No

    No

    _

    X

    _

    X

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

    Subpart 3: (Town Committees ONLY)

    (If yes, enterTotal Receipts here.) $0.00

    (If yes, go to Section L4 In-Kind Donations not Considered

    Contributions and complete required information for puchases made by

    host(s) for food, beverage and invitations.)

    (If yes, go to Section L4 In-Kind Donations not ConsideredContributions and complete required information.)

    (If yes, enter Total Receipts here.)

    (If yes, go to Section L3 Purchases of Advertising Space in a ProgramBook or on a Sign and complete required information.)

    Subpart 1: (All Committees)

    $1,090.00

    Zip Code

    LetterDate of Fundraiser

    Fundraising Event #

    Location: Street Address City State

    09/22/2013 R

    French Memorial Park Seymour CT 06483

    Was this fundraising event hosted at a personal residence?

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

    items donated b an individual of u to $100?

    Was this fundraiser a tag sale, auction, or other sale of donated items with

    puchases from an individual of up to $100?

    _

    X

    Yes

    No

    Yes

    Yes

    No

    No

    _

    X

    _

    X

    Fair Event

    Description

    Were there purchases of advertising space in a program book or on a sign associated

    with this fundraiser?

    Did your committee sell food or beverage at a fair or similar mass gathering held

    within the state with this fundraiser?

    Yes

    Yes

    No

    No

    _

    X

    X

    _

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

    Subpart 3: (Town Committees ONLY)

    (If yes, enterTotal Receipts here.) $2,710.00

    (If yes, go to Section L4 In-Kind Donations not ConsideredContributions and complete required information for puchases made by

    host(s) for food, beverage and invitations.)

    (If yes, go to Section L4 In-Kind Donations not ConsideredContributions and complete required information.)

    (If yes, enter Total Receipts here.)

    (If yes, go to Section L3 Purchases of Advertising Space in a ProgramBook or on a Sign and complete required information.)

    Subpart 1: (All Committees)

    $0.00

    Total of Section L1 $3,800.00

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    Page 11 of 19

    L3. Purchases of Advertising in a Program Book or on a Sign (Municipal Candidate and Town Committees ONLY)

    II. FUNDRAISING EVENT ACTIVITY Sections L1 - L4

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Zip CodeStateCityStreet Address

    Purchase Made By:Name of Purchaser

    Event #Date Received Aggregate Purchases for All Events Amount of Program Ad Purchase Amount of Sign Purchase

    Business Entity Individual

    Sole Proprietorship

    Total of Section L3

    L4. In-Kind Donations Not Considered Contributions

    II. FUNDRAISING EVENT ACTIVITY Sections L1 - L4

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    Zi CodeStateCityStreet Address

    Donation Given b :

    Name of the Donor

    Fair Market Value of

    Donation

    Aggregate value for this event

    Descri tion of Donation

    Date Received Event #Individual

    Business Entity

    Sole Proprietorship

    Total of Section L4

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    Page 12 of 19

    M. In-Kind Contributions

    III. NONMONETARY RECEIPTS (Sections M - O)

    NAME OF COMMITTEE

    Ansonia Republican Town Committee

    TYPE OF REPORT

    October 10 Filing - Original

    Street Address

    ype of Contributor:

    Fair Market Value of this

    Contribution

    Name

    CityState

    Zip Code

    Date Received

    Individual / Sole Proprietorship

    Committee

    s Contributor a lobbyist, spouse, or

    ependent child of a lobbyist?

    Yes

    No

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

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

    associated with have a contract with said municipality valued at more

    han $5000?

    Yes

    No

    s this contribution associated with a

    undraisin event listed in Section J1?

    f yes, list Event#

    Yes

    No

    Description of In-Kind ContributionAggregate contributions

    Other

    Is contributor a principal of state contractor or prospective state contractor? Yes

    NoIf yes, indicate which branch or branches of

    government the contract is with: Executive Legislative

    Total of Section M

    N. Refundable Deposit to Telephone Company

    III. Non Monetar Recei ts Sections M - O

    NAME OF COMMITTEETYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Zip CodeStateCityResidential Street Address

    Date Deposit MadeLast Name of Individual

    Amount of

    Deposit

    Name of Telephone company

    Zip CodeStateCityStreet Address

    First Name MI

    Total of Section N

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    Page 13 of 19

    O. Non-Monetary Receipts of Organization Expenditures Made By Legislative Leadership,

    Legislative Caucus, and Party Committee - OPTIONAL See Public Act 11-48

    III. NONMONETARY RECEIPTS (Sections M - O)

    NAME OF COMMITTEE TYPE OF REPFORT

    Ansonia Republican Town CommitteeOctober 10 Filing - Original

    Street Address Date Notice Received

    Description of Donation

    Fair Market

    Value of

    Donation

    Name of Committee (Legislative Leadership, Legislative Caucus, and Party Committees ONLY)

    City State

    Name of Treasurer

    Aggregate DonationsZip Code

    Purpose of Expenditure

    A B C D E

    Total of Section O

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    Page 14 of 19

    P. Expenses Paid By Committee

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    IV. EXPENDITURES (Sections P - T)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    ANSONIA CULTURAL COMMITTEE

    Main Street AnsoniaCT 06401

    FNDR *09222013P

    ANSONIA HARVEST FESTIVAL

    $50.00

    X

    _

    12909/01/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sou h Inde endent Or anization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    NAUGAUTIC VALLEY HEATLH DIST

    98 Bank St SeymourCT 06483

    FNDR *09222013P

    FOOD LICENSE

    $72.00

    X

    _

    13009/16/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sou ht

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    BJ'S WHOLESALE

    DIVISION STREET DerbyCT 06418

    FOOD09222013P

    FOOD & BEVERAGE FOR PUMPKIN FESTIVAL

    $304.48

    X

    _

    13109/21/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    STOP & SHOP

    BANK STREET SeymourCT 06483

    FOOD09222013P

    FOOD ROLLS AND NECESSARY ITEMS

    $28.88

    X

    _

    132

    09/22/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sou h Inde endent Or anization

    Expenditure #

    (if applicable)

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    P. Expenses Paid By Committee

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    IV. EXPENDITURES (Sections P - T)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    KIRK PRODUCTS COMPANY INC

    1 Rimmon St SeymourCT 06483

    FNDR *09222013P

    FIRE EXTINGUISHER

    $30.00

    X

    _

    13309/22/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sou h Inde endent Or anization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    LORIE VACCARO

    515 Beaver St AnsoniaCT 06401

    FNDR *09222013P

    FOOD FOR PUMPKIN FESTIVAL

    $390.59

    X

    _

    13409/23/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sou ht

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    GIANCARLO CEFALU

    EAGLE STREET AnsoniaCT 06401

    FNDR *09222013P

    FOOD FOR PUMPKIN FESTIVAL

    $48.44

    X

    _

    13509/23/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    VINNIE SCARLATA

    BENZ STREET AnsoniaCT 06401

    FNDR *09222013P

    SIGNS FOR PUMPKIN FESTIVAL

    $25.52

    X

    _

    136

    09/23/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sou h Inde endent Or anization

    Expenditure #

    (if applicable)

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    P. Expenses Paid By Committee

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    IV. EXPENDITURES (Sections P - T)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    THE HARTFORD INSURANCE COMPANY

    301 Woods Parks Dr ClintonNY 13323

    Misc * HARTFORD INSURANCE POLICY

    $425.00

    X

    _

    13709/25/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sou h Inde endent Or anization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    EVER READY PRESS

    78 Clifton Ave AnsoniaCT 06401

    A-SIGN LAWN SIGNS AND PALM CARDS

    $4,020.03

    X

    _

    13809/25/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sou ht

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Street Address City State Zip Code

    Description Amount

    Name of Payee Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Event #

    NAUGATUCK VALLEY HEALTH

    98 Bank St AnsoniaCT 06483

    Misc *09222013R

    FOOD LICENSE FOR THE HARVEST FESTIVAL

    $52.00

    X

    _

    13909/25/2013

    Type of Expenditure (if applicable) Itemization in Addendum P Required

    _ _

    _

    _ _ _A B _ C _ D _ E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sough Independent Organization

    Expenditure #

    (if applicable)

    Total of Section P $5,446.94

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    Page 17 of 19

    Q. Campaign Expenses Paid By Candidate

    IV. EXPENDITURES (Sections P - T)

    NAME OF COMMITTEE TYPE OF REPORT

    October 10 Filing - Original

    Street Address City State Zip Code

    Description Amount

    Name of Payee (Name of vendor who candidate paid directly) Date of Payment Is Reimbursement Claimed?

    Event #Purpose of Expenditure

    (by code)

    Yes No

    Total of Section Q

    R. Expenses Incurred on Committee Credit Card

    IV. EXPENDITURES

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Street Address City State Zip Code

    Name of Vendor

    Amount

    Name of Issuing Institution

    Date of Transaction

    Event #

    Type of Credit Card:

    Purpose of Expenditure

    (by code)

    Description

    Visa Master Card Discover American Express

    Other

    Expenditure #

    (if applicable)

    Type of Expenditure (if applicable) Itemization in Addendum R Required Coordinated with reimbursement sought

    Coordinated without reimbursement sough Independent A B C D EOrganization

    Total of Section R

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    Page 18 of 19

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

    IV. EXPENDITURES

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee October 10 Filing - Original

    Street AddressCity

    State Zip Code

    Description

    Name of Creditor Date Incurred

    Amount Incurred

    (Estimate or Actual)

    Purpose of Expenditure

    (by code)Event #

    Type of Expenditure (if applicable) Itemization in Addendum S Required

    A B C D E

    Coordinated with reimbursement sought

    Coordinated without reimbursement sough Independent Organization :

    Expenditure#

    (if applicable)

    Total of Section S

    IV. EXPENDITURES

    NAME OF COMMITTEE TYPE OF REPORT

    Ansonia Republican Town Committee

    T. Itemization of Reimbursements to Committee Workers and Consultants

    October 10 Filing - Original

    Street Address City State Zip Code

    Secondary Payee

    Amount

    Last Name of Worker/Consultant Date of Payment Method of Payment

    Purpose of Expenditure

    (by code)

    Check #

    Debit Card

    Description

    Type of Expenditure (if applicable) Itemization in Addendem T Required Coordinated wi th reimbursement sought

    Coordinated without reimbursement sough Independent Organization: A B C D E

    First MI

    Event #

    Expenditure #

    Total of Section T

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    Page 19 of 19