Fillable REPORT OF CONTRIBUTIONS AND EXPENDITURES (City of Glenwood Springs)

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REPORT OF CONTRIBUTIONS AND EXPENDITURES (City of Glenwood Springs)

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REPORT OF CONTRIBUTIONS AND EXPENDITURES
The Report of Contributions and Expenditures is a financial report required for all committees or parties
that accept contributions or make expenditures to support or oppose a candidate or a ballot measure
seeking access to the ballot and/or a referendum placed on the ballot by a governing board. The first six
pages of the report must be returned to the City Clerk’s Office by the dates specified. The last two pages
are for your records. Complete the sheets after the Report of Contributions and expenditures and detailed
summary before filling out the Report or Summary.
Following is a description of each data sheet, including some basic instructions to help you complete and
finalize this report.
Report of Contributions and Expenditures: This is the first page of the report. It contains all of the
basic information about the committee, the type of report being filed and the reporting period, and a
summary of the contributions and expenditures for the reporting period.
Detailed Summary: The Detailed Summary is used to gather and calculate data from other worksheets.
In addition, it is the only place to enter your funds on hand from the previous reporting period and any
earnings on your bank account. This page needs to be included in the report filed with the City Clerk’s
Office. Complete this page form last.
Itemized Contributions: All monetary contributions of $20 or more, plus any loans received by the
committee should be reported here. Because certain loans are not subject to contributions limits, all loans
should be identified by placing a checkmark () in the designated column.
Contributions in Kind: The fair market value of all non-monetary gifts or loans of $20 or more should be
reported here.
Expenditures: All expenditures, regardless of dollar amount, should be reported on this form. By
definition, an expenditure occurs when the actual payment is made or when there is a contractual
agreement and the amount is determined (i.e. an obligation is made).
Contributions Returned: This form should be used to document any contributions, or portions thereof,
that have been returned during the reporting period.
Non-Itemized Contributions: This form, which is provided as a courtesy only, will assist committees in
tracking contributions received which are less than $20. The form does not need to be included in the
report filed with the City Clerk’s Office; however, the total amount of non-itemized contributions does
need to be included in the Detailed Summary.
Non-Itemized Contributions in Kind: This form is also provided as a courtesy only to assist committees
in tracking any contributions in kind received which have a fair market value of less than $20. The form
does not need to be included in the report filed with the City Clerk’s Office; however, the total amount of
non-itemized contributions in kind does need to be included in the Detailed Summary.
When filing the Report of Contributions and Expenditures, it MUST be received by the City Clerk’s office on
or before the schedule due date. Postmark dates are not recognized. A faxed report MUST be followed up
with the original document within seven calendar days.
REPORT OF CONTRIBUTIONS AND EXPENDITURES
Article XXVIII of the Colorado Constitution and Title 1, Article 45 of the Colorado Revised Statute (C.R.S.)
A fine of $50 per day will be assessed for late filings. [Art. XXVIII Sec 10 (2)(a)]
Full Name of Committee/Person: ____________________________________________________
(as shown on Committee Registration Form)
Name of Candidate (or NA): _________________________________________________________
(if not reflected in Committee name)
Reporting for
Current Period
1
Funds on Hand at Beginning of Reporting Period
(monetary)
$
2
Total Monetary Contributions
(line 10 on Detailed Summary)
$
3
Total of Monetary Contributions & Beginning Amount
(line 1 + line 2)
$
4
Total Monetary Expenditures
(line 16 on Detailed Summary)
$
5
Funds on Hand at End of Reporting Period
(monetary) (line 3 – line 4)
$
Type of Report:
Regularly Scheduled Filing
21 days before election day – March 21, 2019
Friday before election day – March 29, 2019
30 days after election day – May 2, 2019
Annual filing (start with day after last report)
Amended Filing, replacing prior report dated: _________________________________
Termination Report (Termination Reports MUST Have a Monetary Balance of Zero in Line 5 Below)
Reporting Period Covered: ____________________ Through ______________________
Date Date
Authorization
(Must be completed by either the Registered Agent OR the Candidate):
I hereby certify and declare, under penalty of perjury, that to the best of my knowledge of
belief all contributions received during this reporting period, including any contributions
received in the form of membership dues transferred by a membership organization, are from
permissible sources.
Printed Name:_______________________________________________________________
(Registered Agent OR Candidate Completing this Form)
Signature: __________________________________________ Date: __________________
DETAILED SUMMARY
Funds on Hand at beginning of reporting period (monetary):
7
Itemized Contributions
(monetary contributions of $20 or more and loans)
8
Non-Itemized Contributions
(monetary contributions of $19.99 and less)
9
Other Receipts
(interest, dividends, refunds, rebates, etc.)
10 Total Monetary Contributions
11
Itemized Contributions In Kind
(non-monetary contributions with value of $20 or more)
12
Non-Itemized Contributions In Kind
(non-monetary contributions with value of $19.99 and less)
13 Total Contributions
14 Expenditures/Obligations
15 Contributions Returned
16 Total Monetary Expenditures
ITEMIZED CONTRIBUTIONS
(Monetary Contributions of $20.00 or More and Loans)
Total Itemized Contributions: $
Contributor
(Individual or
Entity)
Address
(Including City/State/Zip)
Loans
()
Date
Contribution
Accepted
Amount of
Contribution
ITEMIZED CONTRIBUTIONS In Kind
(Monetary Contributions of $20.00 or More)
Total Contributions In Kind: $
Contributor
(Individual or
Entity)
Address
(Including
City/State/Zip)
Date
Accepted
Brief Description of
Contribution
Fair
Market
Value
Expenditures/Obligations
(Include all expenditures, obligations as referenced in the definition of “expenditure”, & repayment of loans)
Total Expenditures: $
Person/Entity to
whom Expenditure
or Obligation
was made
Address
(Including
City/State/Zip if outside
Glenwood Springs)
Date
Expenditure
or Obligation
was made
Purpose of Expenditure or
Obligation
Amount
Contributions Returned
Total Contributions Returned: $
Person or Entity
Whose
Contributions
Was Returned
Address
(Including
City/State/Zip)
Date
Originally
Accepted
Date
Returned
Reason for Return
Amount
NON-ITEMIZED CONTRIBUTIONS
(Monetary Contributions of $19.99 or less)
Total Non-Itemized Contributions: $
Source of Contribution
Description of Circumstances
Surrounding Contribution
Date
Received
Amount
NON-ITEMIZED CONTRIBUTIONS IN KIND
(Non-Monetary Contributions with Value of $19.99 OR less)
Total Non-Itemized
Contributions In Kind:
$
Source of Contribution
Description of Circumstances
Surrounding Contribution
Date
Received
Fair
Market
Value
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REPORT OF CONTRIBUTIONS AND EXPENDITURES (City of Glenwood Springs)

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Completed 23 January 2021

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