PERSONAL FINANCIAL DISCLOSURE STATEMENT
Personal financial disclosure statements filed for ballot access purposes must be filed within 10 days of filing a
candidate affidavit. A fine of $50 per day will be assessed for late filings related to ballot access.
[Art. XXVIII, Sec. 10 (2)(a), Colorado Constitution and 1-45-110, C.R.S.]
Please attach extra pages as necessary.
Mailing Address: _________________________ City: __________________ Zip:___________
Cell Phone: _____________________________ Home Phone:___________________________
Check () the appropriate response(s):
(New Candidates & incumbents)
This is my first filing as a
This amends my previous
List the source(s) of any income, including capital gains, whether or not taxable, of the person making disclosure and
such person’s spouse. (It is not necessary to list amounts.)
Recipient of Income (Individual receiving income)
Source of Income (Name of Employer)
Indicate any financial interest in excess of $10,000 in any business entity for you or your spouse.
Name of Business, Insurance Company or Trust
Who is the person with this financial interest?
List the legal description (as shown on the books of the county assessor) of all real property in Colorado (including an
option to buy) in which you or your spouse have a direct or indirect interest.
Legal Description of Property