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Image# 201508209000886453
PAGE 1 / 44
REPORT OF RECEIPTS
AND DISBURSEMENTS
FEC
FORM 3X
1.
TYPE OR PRINT
NAME OF
COMMITTEE (in full)
12FE4M5
Check if different
than previously
reported. (ACC)
2.
CITY
(b) Monthly
Report
Due On:
(Choose One)
80111
STATE
3. IS THIS
REPORT
C00033134
4. TYPE OF REPORT
(a)
CO
GREENWOOD VILLAGE
NEW
(N)
ZIP CODE
AMENDED
(A)
OR
Nov 20 (M11)
Feb 20 (M2)
May 20 (M5)
Aug 20 (M8)
Mar 20 (M3)
Jun 20 (M6)
Sep 20 (M9)
Dec 20 (M12)
Apr 20 (M4)
Jul 20 (M7)
Oct 20 (M10)
Jan 31 (YE)
(Non-Election
Year Only)
(Non-Election
Year Only)
Quarterly Reports:
April 15
Quarterly Report (Q1)
(c)
12-Day
PRE-Election
Report for the:
July 15
Quarterly Report (Q2)
Primary (12P)
General (12G)
Convention (12C)
Special (12S)
Runoff (12R)
October 15
Quarterly Report (Q3)
M
January 31
Year-End Report (YE)
in the
State of
Election on
July 31 Mid-Year
Report (Non-election
Year Only) (MY)
(d)
30-Day
POST-Election
Report for the:
General (30G)
Termination Report
(TER)
Runoff (30R)
Special (30S)
in the
State of
Election on
M
5.
Covering Period
07
01
2015
through
07
31
2015
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete.
Type or Print Name of Treasurer
Signature of Treasurer
Robert Balink
Robert Balink
[Electronically Filed]
Date
08
20
2015
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. 437g.
Office
Use
Only
FE6AN026
FEC FORM 3X
Rev. 12/2004
Image# 201508209000886454
SUMMARY PAGE
OF RECEIPTS AND DISBURSEMENTS
Page 2
07
From:
01
2015
To:
COLUMN A
This Period
6.
31
2015
802850.78
948134.22
764096.86
184037.36
2015
90043.33
295399.71
7.
111362.35
8.
184037.36
0.00
116398.89
145283.44
205356.38
.
.
This committee has qualified as a multicandidate committee. (see FEC FORM 1M)
FE6AN026
COLUMN B
Calendar Year-to-Date
9.
07
.
.
.
.
Image# 201508209000886455
Page 3
From:
07
01
2015
To:
COLUMN A
Total This Period
I. Receipts
11. Contributions (other than loans) From:
(a) Individuals/Persons Other
Than Political Committees
(i) Itemized (use Schedule A) ............
31
2015
COLUMN B
Calendar Year-to-Date
,
,
,
,
,
43450.00
,
,
,
,
,
62668.33
,
,
27375.00
07
.
14218.33
.
57668.33
.
0.00
.
5000.00
.
,
,
,
,
,
336759.00
,
,
,
,
,
432522.74
.
0.00
.
,
,
292055.00
,
,
.0.00
7960.14
.
90645.64
.
427404.64
.
.0.00
5118.10
.
,
,
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
.0.00
0.00
0.00
90043.33
802850.78
90043.33
802850.78
FE6AN026
.
70312.90
.
.
.
.
.
.
.
.
Image# 201508209000886456
II. Disbursements
21. Operating Expenditures:
(a) Allocated Federal/Non-Federal
Activity (from Schedule H4)
(i) Federal Share .............................
,
,
.0.00
.0.00
,
,
,
,
,
,
,
,
,
,
111362.35
.
111362.35
.
.0.00
0.00
.
0.00
.
,
,
,
,
,
,
.
0.00
.
0.00
.
,
,
,
0.00
.
0.00
.
0.00
.
,
,
,
0.00
0.00
,
,
,
0.00
,
,
,
0.00
111362.35
111362.35
23.
24.
25.
FE6AN026
COLUMN B
Calendar Year-to-Date
,
,
22.
Page 4
COLUMN A
Total This Period
,
,
,
,
.
0.00
.
,
,
,
,
,
,
,
,
,
,
741861.63
,
,
,
,
,
,
.
0.00
.
0.00
.
,
,
,
0.00
,
,
,
0.00
0.00
.
0.00
.
0.00
.
,
,
,
,
,
,
.0.00
.0.00
22235.23
.
22235.23
764096.86
0.00
0.00
.
741861.63
.
0.00
.
0.00
.
.0.00
0.00
.
0.00
.
0.00
.
.
.
764096.86
Image# 201508209000886457
of Disbursements
FE6AN026
Page 5
COLUMN A
Total This Period
COLUMN B
Calendar Year-to-Date
62668.33
,
,
,
,
,
,
,
,
.
62668.33
.
111362.35
.
0.00
.
111362.35
0.00
432522.74
,
,
,
,
,
,
,
,
.
432522.74
.
741861.63
.
7960.14
.
733901.49
0.00
Image# 201508209000886458
PAGE
OF
11a
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Date of Receipt
State
CO
07
31
2015
Transaction ID : SA11AI.9057
Zip Code
80222
6500.00
In-kind - rent
Occupation
Aggregate Year-to-Date
General
6500.00
B. Gerald Bader
Date of Receipt
07
State
CO
Zip Code
30
2015
Transaction ID : SA11AI.8747
Amount of Each Receipt this Period
80231
300.00
Receipt
Occupation
Partner
Aggregate Year-to-Date
General
300.00
C. Richard Billings
Date of Receipt
07
City
Lakewood
State
CO
Zip Code
80215
08
2015
Transaction ID : SA11AI.8238
1000.00
,
,
7800.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
1000.00
.
.
PAGE 7 / 44
Image# 201508209000886459
)(&0,6&(//$1(2867(;75(/$7('72$5(32576&+('8/(25,7(0,=$7,21
Form/Schedule: SA11AI
Transaction ID : SA11AI.9057
LLP contribution attributed to Mr. Walter A. Koelbel, Jr., 5291 East Yale Avenue, Denver, CO 80222
Form/Schedule:
Transaction ID:
Image# 201508209000886460
PAGE
OF
11a
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. June Bills
Date of Receipt
State
CO
07
31
2015
Transaction ID : SA11AI.8948
Zip Code
80303
250.00
Receipt
Name of Employer
Occupation
Homemaker
Receipt For:
Primary
Other (specify)
Homemaker
Aggregate Year-to-Date
General
250.00
B. Sue Cannon
Date of Receipt
07
City
State
CO
Lakewood
Zip Code
31
2015
Transaction ID : SA11AI.8917
Amount of Each Receipt this Period
80227
1000.00
Receipt
Occupation
Retired
Aggregate Year-to-Date
General
1000.00
C. Kristina Cook
Date of Receipt
07
City
Denver
State
CO
Zip Code
80206
20
2015
Transaction ID : SA11AI.8952
50.00
,
,
1300.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
Best Efforts
Receipt For:
Best Efforts
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
270.00
.
.
Image# 201508209000886461
PAGE
OF
11a
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Booker T. Graves
Date of Receipt
State
CO
07
09
2015
Transaction ID : SA11AI.8503
Zip Code
80013
50.00
Receipt
Name of Employer
Occupation
State of Colorado
Receipt For:
Primary
Other (specify)
Executive Director
Aggregate Year-to-Date
General
250.00
B. James E. Higby
Date of Receipt
07
City
State
CO
Arvada
Zip Code
30
2015
Transaction ID : SA11AI.8803
Amount of Each Receipt this Period
80005
100.00
Receipt
Occupation
Retired
Aggregate Year-to-Date
General
300.00
C. Kathryn Isenberger
Date of Receipt
07
City
Golden
State
CO
Zip Code
80401
20
2015
Transaction ID : SA11AI.8969
50.00
,
,
200.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
Ross-Lewis Trust
Receipt For:
Property Manager
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
250.00
.
.
Image# 201508209000886462
PAGE 10 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jacob Jabs
Date of Receipt
State
CO
Zip Code
80124
Owner
Occupation
Name of Employer
07
08
2015
Transaction ID : SA11AI.8381
10000.00
Receipt
Aggregate Year-to-Date
10000.00
B. Robert Jenkins
Date of Receipt
07
City
State
CO
Woody Creek
Zip Code
30
2015
Transaction ID : SA11AI.8867
Amount of Each Receipt this Period
81656
100.00
Receipt
Occupation
Construction
Aggregate Year-to-Date
General
250.00
C. Marjorie A Klein
Date of Receipt
07
City
Fort Lupton
State
CO
Zip Code
80621
10
2015
Transaction ID : SA11AI.8958
50.00
,
,
10150.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
Homemaker
Receipt For:
Homemaker
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
350.00
.
.
Image# 201508209000886463
PAGE 11 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Bruce W. Kopper
Date of Receipt
State
CO
07
30
2015
Transaction ID : SA11AI.8885
Zip Code
80904
10000.00
Receipt
Name of Employer
Occupation
Kopper Investment Mg
Receipt For:
Primary
General
Other (specify)
Aggregate Year-to-Date
10000.00
B. Merlin Kutz
Date of Receipt
07
City
State
CO
Parker
Zip Code
30
2015
Transaction ID : SA11AI.8923
Amount of Each Receipt this Period
80134
50.00
Receipt
Occupation
Clerk
Aggregate Year-to-Date
General
250.00
C. James Macek
Date of Receipt
07
City
Castle Rock
State
CO
Zip Code
80108
30
2015
Transaction ID : SA11AI.8883
500.00
,
,
10550.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
Coosemans-Denver
Receipt For:
President
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
500.00
.
.
Image# 201508209000886464
PAGE 12 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Marilyn Oden
Date of Receipt
State
CO
Zip Code
81650
Retired
Receipt For:
Primary
Other (specify)
Retired
Occupation
Name of Employer
07
11
2015
Transaction ID : SA11AI.8960
1000.00
Receipt
Aggregate Year-to-Date
General
1500.00
B. Joan Poston
Date of Receipt
07
City
State
CO
Denver
Zip Code
22
2015
Transaction ID : SA11AI.8537
Amount of Each Receipt this Period
80237
1000.00
Receipt
Occupation
Retired
Aggregate Year-to-Date
General
1050.00
C. Harry Schmidt
Date of Receipt
07
City
Littleton
State
CO
Zip Code
80121
22
2015
Transaction ID : SA11AI.8536
1000.00
,
,
3000.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
CPA
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
1000.00
.
.
Image# 201508209000886465
PAGE 13 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Patricia Somerville
Date of Receipt
State
CO
Zip Code
80209
Retired
Receipt For:
Primary
Other (specify)
Retired
Occupation
Name of Employer
07
30
2015
Transaction ID : SA11AI.8801
300.00
Receipt
Aggregate Year-to-Date
General
4300.00
B. Patricia Watson
Date of Receipt
07
City
State
CO
Greenwood Village
Zip Code
10
2015
Transaction ID : SA11AI.8506
Amount of Each Receipt this Period
80121
500.00
Receipt
Occupation
Homemaker
Aggregate Year-to-Date
General
500.00
C. Robert Watson
Date of Receipt
07
City
Greenwood Village
State
CO
Zip Code
80121
10
2015
Transaction ID : SA11AI.8504
9500.00
,
,
10300.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Name of Employer
Occupation
President
Primary
Other (specify)
FE6AN026
Receipt
Aggregate Year-to-Date
General
10000.00
.
.
Image# 201508209000886466
PAGE 14 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Michael Williamson
Date of Receipt
State
CO
07
15
2015
Transaction ID : SA11AI.8955
Zip Code
80228
50.00
Receipt
Name of Employer
Occupation
Software Consultant
Aggregate Year-to-Date
250.00
B. Lester Woodward
Date of Receipt
07
City
State
CO
Denver
Zip Code
30
2015
Transaction ID : SA11AI.8806
Amount of Each Receipt this Period
80220
100.00
Receipt
Occupation
Attorney
Aggregate Year-to-Date
General
470.00
C.
Date of Receipt
Mailing Address
City
State
Zip Code
Amount of Each Receipt this Period
TOTAL This Period (last page this line number only) ...............................................................
,
,
,
,
Name of Employer
Receipt For:
Primary
Other (specify)
FE6AN026
Occupation
Aggregate Year-to-Date
General
.
.
43450.00
.
150.00
Image# 201508209000886467
PAGE 15 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Date of Receipt
State
CO
07
09
2015
Transaction ID : SA11C.9060
Zip Code
80124
C00525543
5000.00
Receipt
Occupation
Aggregate Year-to-Date
General
5000.00
B.
Date of Receipt
Mailing Address
City
State
Zip Code
Amount of Each Receipt this Period
Occupation
Aggregate Year-to-Date
General
C.
Date of Receipt
Mailing Address
City
State
Zip Code
Amount of Each Receipt this Period
TOTAL This Period (last page this line number only) ...............................................................
,
,
,
,
Name of Employer
Receipt For:
Primary
Other (specify)
FE6AN026
Occupation
Aggregate Year-to-Date
General
.
.
5000.00
.
5000.00
Image# 201508209000886468
PAGE 16 OF
11b
11c
12
13
14
15
16
44
17
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Date of Receipt
State
DC
07
01
2015
Transaction ID : SA12.9054
Zip Code
20003
C00003418
21500.00
Transfer
Occupation
Aggregate Year-to-Date
General
286180.00
Date of Receipt
07
City
State
DC
WASHINGTON
Zip Code
15
2015
Transaction ID : SA12.9055
Amount of Each Receipt this Period
20003
C00003418
5875.00
Transfer
Occupation
Aggregate Year-to-Date
General
292055.00
C.
Date of Receipt
Mailing Address
City
State
Zip Code
Amount of Each Receipt this Period
TOTAL This Period (last page this line number only) ...............................................................
,
,
,
,
Name of Employer
Receipt For:
Primary
Other (specify)
FE6AN026
Occupation
Aggregate Year-to-Date
General
.
.
27375.00
.
27375.00
Image# 201508209000886469
PAGE 17 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jose Alanis
Date of Disbursement
M
State
CO
Zip Code
80111
State:
10
2015
Transaction ID : SB21B.9040
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
665.06
General
B. Jose Alanis
Date of Disbursement
M
State
CO
Zip Code
80111
State:
14
2015
Transaction ID : SB21B.8990
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1143.54
General
C. Jose Alanis
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Travel- Mileage Reimbursement
07
Zip Code
80111
22
2015
Transaction ID : SB21B.9045
Candidate Name
Category/
Type
209.66
,
,
2018.26
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886470
PAGE 18 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jose Alanis
Date of Disbursement
M
State
CO
Zip Code
80111
State:
30
2015
Transaction ID : SB21B.9003
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1145.55
General
Date of Disbursement
M
State
CO
Zip Code
80222
State:
01
2015
Transaction ID : SB21B.9019
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
3246.25
General
Date of Disbursement
M
City
Denver
Purpose of Disbursement
In-kind - rent
07
Zip Code
80222
31
2015
Transaction ID : SB21B.9058
Candidate Name
Category/
Type
6500.00
,
,
10891.80
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886471
PAGE 19 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
14
2015
Transaction ID : SB21B.8988
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1600.73
General
B. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
14
2015
Transaction ID : SB21B.8989
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
50.15
General
C. Amcheck
Date of Disbursement
M
City
Denver
Purpose of Disbursement
Payroll Taxes
07
Zip Code
80207
14
2015
Transaction ID : SB21B.8995
Candidate Name
Category/
Type
2923.17
,
,
4574.05
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886472
PAGE 20 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
14
2015
Transaction ID : SB21B.8996
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
55.25
General
B. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
30
2015
Transaction ID : SB21B.9001
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
2159.59
General
C. Amcheck
Date of Disbursement
M
City
Denver
Purpose of Disbursement
Payroll Processing Fees
07
Zip Code
80207
30
2015
Transaction ID : SB21B.9002
Candidate Name
Category/
Type
51.85
,
,
2266.69
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886473
PAGE 21 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
30
2015
Transaction ID : SB21B.9008
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
5497.11
General
B. Amcheck
Date of Disbursement
M
State
CO
Zip Code
80207
State:
30
2015
Transaction ID : SB21B.9009
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
60.70
General
Date of Disbursement
M
City
Lansing
Purpose of Disbursement
Insurance
07
Zip Code
48909
23
2015
Transaction ID : SB21B.9033
Candidate Name
Category/
Type
1473.00
,
,
7030.81
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886474
PAGE 22 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Centennial Bank
Date of Disbursement
M
State
CO
Zip Code
80112
State:
02
2015
Transaction ID : SB21B.9029
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
139.10
General
B. Centennial Bank
Date of Disbursement
M
State
CO
Zip Code
80112
State:
03
2015
Transaction ID : SB21B.9030
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
282.16
General
C. Jack Cutter
Date of Disbursement
M
City
Highlands Ranch
Purpose of Disbursement
Travel- Mileage Reimbursement
07
Zip Code
80129
06
2015
Transaction ID : SB21B.8980
Candidate Name
Category/
Type
201.91
,
,
623.17
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886475
PAGE 23 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jack Cutter
Date of Disbursement
M
State
CO
Zip Code
80129
State:
17
2015
Transaction ID : SB21B.8981
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
271.18
General
B. John Cutter
Date of Disbursement
M
State
CO
Zip Code
80111
State:
14
2015
Transaction ID : SB21B.8991
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1159.84
General
C. John Cutter
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Payroll
07
Zip Code
80111
30
2015
Transaction ID : SB21B.9004
Candidate Name
Category/
Type
1161.84
,
,
2592.86
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886476
PAGE 24 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Date of Disbursement
M
State
FL
Zip Code
33762
State:
01
2015
Transaction ID : SB21B.8976
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
2403.45
General
Date of Disbursement
M
State
FL
Zip Code
33762
State:
27
2015
Transaction ID : SB21B.8977
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
10000.00
General
C. Dropbox
Date of Disbursement
M
City
San Francisco
Purpose of Disbursement
Online software
07
Zip Code
94107
08
2015
Transaction ID : SB21B.8978
Candidate Name
Category/
Type
75.00
,
,
12478.45
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886477
PAGE 25 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Fedex
Date of Disbursement
M
State
IL
Zip Code
60094
State:
27
2015
Transaction ID : SB21B.9036
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
81.88
General
B. FLS Connect
Date of Disbursement
M
State
MN
Zip Code
55128
State:
27
2015
Transaction ID : SB21B.9024
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
7000.00
General
C. Jordan Gascon
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Travel- Mileage Reimbursement
07
Zip Code
80111
02
2015
Transaction ID : SB21B.9020
Candidate Name
Category/
Type
244.35
,
,
7326.23
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886478
PAGE 26 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jordan Gascon
Date of Disbursement
M
State
CO
Zip Code
80111
State:
14
2015
Transaction ID : SB21B.8992
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1298.84
General
B. Jordan Gascon
Date of Disbursement
M
State
CO
Zip Code
80111
State:
15
2015
Transaction ID : SB21B.9021
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
206.51
General
C. Jordan Gascon
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Payroll
07
Zip Code
80111
30
2015
Transaction ID : SB21B.9005
Candidate Name
Category/
Type
1300.85
,
,
2806.20
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886479
PAGE 27 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Gotocitrix.com
Date of Disbursement
M
State
CA
Zip Code
95054
State:
17
2015
Transaction ID : SB21B.9017
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
99.00
General
B. Harland Clarke
Date of Disbursement
M
State
TX
Zip Code
78249
State:
22
2015
Transaction ID : SB21B.8975
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
54.49
General
C. Tyler Hart
Date of Disbursement
M
City
Greenwood Villiage
Purpose of Disbursement
Payroll
07
Zip Code
80112
22
2015
Transaction ID : SB21B.9044
Candidate Name
Category/
Type
2582.69
,
,
2736.18
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886480
PAGE 28 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Tyler E Hart
Date of Disbursement
M
State
CO
Zip Code
80112
State:
30
2015
Transaction ID : SB21B.8998
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
4037.60
General
B. Kristian Hemphill
Date of Disbursement
M
State
CO
Zip Code
80111
State:
14
2015
Transaction ID : SB21B.8993
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1333.21
General
C. Kristian Hemphill
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Payroll
07
Zip Code
80111
30
2015
Transaction ID : SB21B.9006
Candidate Name
Category/
Type
1335.22
,
,
6706.03
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886481
PAGE 29 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Home Depot
Date of Disbursement
M
State
CO
Zip Code
80112
State:
27
2015
Transaction ID : SB21B.9028
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
205.23
General
B. iDonate
Date of Disbursement
M
State
CA
Zip Code
92007
State:
02
2015
Transaction ID : SB21B.8979
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
270.00
General
C. Intuit
Date of Disbursement
M
City
Seattle
Purpose of Disbursement
Computer Support
07
Zip Code
98124
06
2015
Transaction ID : SB21B.9037
Candidate Name
Category/
Type
31.20
,
,
506.43
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886482
PAGE 30 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Intuit
Date of Disbursement
M
State
WA
Zip Code
98124
State:
29
2015
Transaction ID : SB21B.9038
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
21.56
General
B. Jimmy John's
Date of Disbursement
M
State
CO
Zip Code
80111
State:
13
2015
Transaction ID : SB21B.9016
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
309.68
General
C. Ian Lindemann
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Payroll
07
Zip Code
80111
14
2015
Transaction ID : SB21B.8986
Candidate Name
Category/
Type
829.09
,
,
1160.33
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886483
PAGE 31 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Ian Lindemann
Date of Disbursement
M
State
CO
Zip Code
80111
State:
23
2015
Transaction ID : SB21B.9011
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1896.65
General
B. Ian Lindemann
Date of Disbursement
M
State
CO
Zip Code
80111
State:
30
2015
Transaction ID : SB21B.8999
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
451.67
General
C. Owen Loftus
Date of Disbursement
M
City
Denver
Purpose of Disbursement
Strategy consulting
07
Zip Code
80211
01
2015
Transaction ID : SB21B.8982
Candidate Name
Category/
Type
6432.00
,
,
8780.32
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886484
PAGE 32 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. MailChimp
Date of Disbursement
M
State
GA
Zip Code
30318
State:
06
2015
Transaction ID : SB21B.9018
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
85.00
General
B. McCauley Associates PC
Date of Disbursement
M
State
UT
Zip Code
84101
State:
23
2015
Transaction ID : SB21B.8973
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1500.00
General
C. Megapath
Date of Disbursement
M
City
Dallas
Purpose of Disbursement
Phone Expense
07
Zip Code
75312
21
2015
Transaction ID : SB21B.9031
Candidate Name
Category/
Type
2070.00
,
,
3655.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886485
PAGE 33 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Megapath
Date of Disbursement
M
State
TX
Zip Code
75312
State:
31
2015
Transaction ID : SB21B.9032
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
5150.00
General
B. Anne O'Donnell
Date of Disbursement
M
State
CO
Zip Code
80111
State:
01
2015
Transaction ID : SB21B.9039
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
593.10
General
C. Anne O'Donnell
Date of Disbursement
M
City
Greenwood Village
Purpose of Disbursement
Payroll
07
Zip Code
80111
14
2015
Transaction ID : SB21B.8987
Candidate Name
Category/
Type
1505.89
,
,
7248.99
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886486
PAGE 34 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Anne O'Donnell
Date of Disbursement
M
State
CO
Zip Code
80111
State:
23
2015
Transaction ID : SB21B.9050
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
330.91
General
B. Anne O'Donnell
Date of Disbursement
M
State
CO
Zip Code
80111
State:
30
2015
Transaction ID : SB21B.9000
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1507.89
General
C. Polstar Strategies
Date of Disbursement
M
City
Denver
Purpose of Disbursement
Political Strategy Consulting
07
Zip Code
80205
01
2015
Transaction ID : SB21B.8983
Candidate Name
Category/
Type
10000.00
,
,
11838.80
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886487
PAGE 35 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Date of Disbursement
M
State
IA
Zip Code
50309
State:
23
2015
Transaction ID : SB21B.9062
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
645.26
General
Date of Disbursement
M
State
CO
Zip Code
80111
State:
21
2015
Transaction ID : SB21B.9052
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
3357.25
General
Date of Disbursement
M
City
Greenwood
Purpose of Disbursement
Insurance
State
CO
07
21
2015
Transaction ID : SB21B.9053
Candidate Name
Category/
Type
2547.64
,
,
6550.15
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
PAGE 36 / 44
Image# 201508209000886488
)(&0,6&(//$1(2867(;75(/$7('72$5(32576&+('8/(25,7(0,=$7,21
Form/Schedule: SB21B
Transaction ID : SB21B.9062
Reimbursing Iowa GOP for shared travel expenses. Hotel room fees at Capitol Hill Hotel, 200 C Street, SE
Washington, DC 20002
Form/Schedule:
Transaction ID:
Image# 201508209000886489
PAGE 37 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Paulo Sibaja
Date of Disbursement
M
State
CO
Zip Code
80111
State:
14
2015
Transaction ID : SB21B.8994
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
2077.81
General
B. Paulo Sibaja
Date of Disbursement
M
State
CO
Zip Code
80111
State:
30
2015
Transaction ID : SB21B.9007
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
2079.81
General
C. Sprint
Date of Disbursement
M
City
Carol Stream
Purpose of Disbursement
Utilities
07
Zip Code
60197
21
2015
Transaction ID : SB21B.9034
Candidate Name
Category/
Type
70.38
,
,
4228.00
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886490
PAGE 38 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Sprint
Date of Disbursement
M
State
IL
Zip Code
60197
State:
21
2015
Transaction ID : SB21B.9035
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
350.38
General
B. Targeted Victory
Date of Disbursement
M
State
VA
Zip Code
22202
State:
23
2015
Transaction ID : SB21B.8974
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
600.00
General
C. Jefferson Thomas
Date of Disbursement
M
City
Greenwood Villiage
Purpose of Disbursement
Payroll
07
Zip Code
80112
23
2015
Transaction ID : SB21B.9047
Candidate Name
Category/
Type
1746.48
,
,
2696.86
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886491
PAGE 39 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Jefferson Thomas
Date of Disbursement
M
State
CO
Zip Code
80112
State:
23
2015
Transaction ID : SB21B.9051
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
1746.48
General
B. USPS
Date of Disbursement
M
State
CO
Zip Code
80112
State:
28
2015
Transaction ID : SB21B.9022
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
500.00
General
C. Webconnex
Date of Disbursement
M
City
Sacramento
Purpose of Disbursement
Online software
07
Zip Code
95814
28
2015
Transaction ID : SB21B.9014
Candidate Name
Category/
Type
19.00
,
,
2265.48
TOTAL This Period (last page this line number only) ...............................................................
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
.
Image# 201508209000886492
PAGE 40 OF
44
21b
22
23
24
25
26
27
28a
28b
28c
29
30b
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
A. Webconnex
Date of Disbursement
M
State
CA
Zip Code
95814
State:
28
2015
Transaction ID : SB21B.9015
Category/
Type
House
Senate
President
District:
Candidate Name
Office Sought:
07
Disbursement For:
Primary
Other (specify)
59.00
General
B.
Date of Disbursement
M
Mailing Address
City
State
Zip Code
Purpose of Disbursement
Amount of Each Disbursement this Period
Candidate Name
Office Sought:
State:
Category/
Type
House
Senate
President
District:
Disbursement For:
Primary
Other (specify)
General
C.
Date of Disbursement
M
Mailing Address
City
State
Zip Code
Purpose of Disbursement
Amount of Each Disbursement this Period
Candidate Name
Category/
Type
TOTAL This Period (last page this line number only) ...............................................................
,
,
,
,
Office Sought:
House
Senate
President
State:
FE6AN026
Disbursement For:
Primary
Other (specify)
General
District:
.
111040.09
.
59.00
Image# 201508209000886493
OF 44
41
PAGE
LOANS
Transaction ID : SC/10.8226
State CO
60000.00
0.00
60000.00
TERMS
Date Incurred
M
01
12
Date Due
Y
2015
Interest Rate
Y
01/08/2016
Secured:
3.25
Yes
(apr)
No
Name of Employer
Mailing Address
City
Occupation
State
ZIP Code
State
ZIP Code
Amount
Guaranteed
Outstanding:
Name of Employer
Mailing Address
Occupation
State
ZIP Code
Amount
Guaranteed
Outstanding:
Name of Employer
Mailing Address
City
Occupation
City
Name of Employer
Mailing Address
City
Amount
Guaranteed
Outstanding:
Occupation
State
ZIP Code
Amount
Guaranteed
Outstanding:
,
,
,
,
.
.
60000.00
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
FE6AN026
Image# 201508209000886494
OF 44
42
PAGE
LOANS
Transaction ID : SC/10.8228
State CO
10312.90
0.00
10312.90
TERMS
Date Incurred
M
02
26
Date Due
Y
2015
Interest Rate
Y
01/08/2016
Secured:
3.25
Yes
(apr)
No
Name of Employer
Mailing Address
City
Occupation
State
ZIP Code
State
ZIP Code
Amount
Guaranteed
Outstanding:
Name of Employer
Mailing Address
Occupation
State
ZIP Code
Amount
Guaranteed
Outstanding:
Name of Employer
Mailing Address
City
Occupation
City
Name of Employer
Mailing Address
City
Amount
Guaranteed
Outstanding:
Occupation
State
ZIP Code
Amount
Guaranteed
Outstanding:
,
,
,
,
.
70312.90
.
10312.90
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
FE6AN026
Image# 201508209000886495
PAGE
(Use separate
schedule(s)
for each
numbered line)
Excluding Loans
43
OF
44
9
10
PO Box 11181
City
State
Chattanooga
Zip Code
TN
37401
Transaction ID : SD10.9064
.0.00
4012.01
0.00
City
State
33762
FL
Transaction ID : SD10.9063
0.00
9659.83
0.00
State
Saint Paul
9659.83
Zip Code
55128
MN
Transaction ID : SD10.9065
City
FLS Connect
Mailing Address
4012.01
Zip Code
Clearwater
.0.00
Outstanding Balance at Close of This Period
7071.33
,
,
20743.17
2) TOTALS This Period (last page this line number only) ......................................................
,
,
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
,
,
,
,
FE6AN026
7071.33
.0.00
.
.
.
.
Image# 201508209000886496
PAGE
(Use separate
schedule(s)
for each
numbered line)
Excluding Loans
44
OF
44
9
10
State
Zip Code
CO
80211
Transaction ID : SD10.9068
.0.00
1000.00
0.00
City
State
80250
Transaction ID : SD10.9070
0.00
1000.00
Zip Code
CO
PO Box 100382
Denver
PSI
Mailing Address
24342.82
0.00
24342.82
Mailing Address
City
State
Zip Code
.
Outstanding Balance at Close of This Period
,
,
25342.82
2) TOTALS This Period (last page this line number only) ......................................................
,
,
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
,
,
,
,
.
116398.89
.
FE6AN026
.
.
46085.99
.
70312.90