Ansonia DTC October 2015 Filing

Electronic Filing
SEEC FORM 20
Itemized Campaign Finance Disclosure Statement
CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2015
Do Not Mark in This Space For Official Use Only
Page 1 of 40
COVER PAGE
1. NAME OF COMMITTEE
Ansonia Democratic Town Committee
2. TREASURER NAME
First
James
MI
Last
D.
Hubbard
Suffix
3. TREASURER ADDRESS
Street Address
City
State
Zip Code
10 Harris Rd
Ansonia
CT
06401
4. ELECTION/REFERENDUM DATE
5. OFFICE SOUGHT (Complete only if Candidate Committee)
6. DISTRICT NUMBER (if applicable)
7. CANDIDATE NAME (Complete only if Candidate or Exploratory Committee)

First
MI
Last
Suffix
8. TYPE OF REPORT
October 10 Filing - Original
9. PERIOD COVERED
Beginning Date
07/01/2015
Ending Date
thru
09/30/2015
10. CERTIFICATION
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.
Electronic Filing
James Hubbard
10/03/2015 12:56:28PM
SIGNATURE
PRINT NAME OF THE SIGNER
DATE CERTIFIED
A Person who is found to have knowingly and willfully violated any provisions of the campaign finance statutes faces a civil
penalty or imprisonment or both.
Page 2 of 40
SEEC FORM 20
Itemized Campaign Finance Disclosure Statement
CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2015
SUMMARY PAGE TOTALS

NAME OF COMMITTEE (Provide Complete Name as Registered with Filing Repository)
TYPE OF REPORT
COLUMN A
COLUMN B
This Period
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
$4,110.48
12. Balance on hand at the beginning of Reporting Period
$4,970.48
13. Contributions received from Individuals (Section A and B)
$2,070.00
$2,515.00
14. Receipts from Other Committees (Sections C1 and C2)
$0.00
$0.00
15. Other Monetary Receipts (Section D through K)
$0.00
$400.00
16a. Total Proceeds from Small Puchases (Section L1 Subpart 1 + Subpart 3)
$0.00
$523.00
16b. Per Public Act 11-48, effective January 1,2012 Section L2 removed
16c. Total Purchases of Advertising - Program Book or Sign (Section L3)
$0.00
$0.00
17. Total Monetary Receipts (add totals for lines 13 through 16c)
$2,070.00
$3,438.00
18. Subtotals (add totals in Line 12 + 17 in Column A and in Line 11 + 17 in Column B)
$7,040.48
$7,548.48
19. Expenses Paid by Committee (Section P)

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 Donations not Considered Contributions - House Party (Section L5)
23. In-Kind Contributions Received (Section M)
24. Refundable Deposit to Telephone Company (Section N)
25. Loan Balance
$3,868.06
$3,172.42
$0.00
$0.00
$4,376.06
$3,172.42
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
25a. + Loans Received (Section D)
$0.00
$0.00
25b. + Interest and Penalties on Loan(s)
$0.00
$0.00
25c. - Payments on Loan
$0.00
$0.00
25d. Total Outstanding Loan Amount
$0.00
26. Campaign Expenses Paid By Candidate (Section Q)
$0.00
$0.00
$0.00
$0.00
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)
$0.00
$0.00
Page 3 of 40
I. MONETARY RECEIPTS (Section A-K)

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

(See instructions for definition of Small Contributor)
$390.00
Subtotal Section A
B. Itemized Contributions from Individuals

Last Name
First Name
Maffeo
Residential Street Address
City
7 Ford St
Ansonia
Principal Occupation
Yes
No
Is this contribution associated with an

event reported in Section L1?
If yes, list Event #
06252015A
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
No
If yes, indicate which branch or branches of

government the contract is with:
Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
Amount of Contribution
No
No
Legislative
Aggregate Contributions
07/07/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer
Is contributor a lobbyist, spouse,

or dependent child of a lobbyist?
Yes
No

06252015A
X
_

Yes
No
Is contributor a principal of state contractor or prospective state contractor?

Executive
Method of Contribution
X
City
90 N State St
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Merlone
MI
Carol
City
8 Shortell Dr
Ansonia
Yes
No

06252015A

Yes
No
Personal Check

Executive
X
State
Zip Code
CT
06401
Name of Employer

Cash
06401
Maureen
Zip Code
CT
First Name
Levine
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Elizabeth
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 4 of 40

TYPE OF REPORT

Last Name
First Name
Luxenberg
Manchester
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
10 Rockwood Ave
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Edmonds
MI
Shain
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
City
505 Beaver St Apt 15
Cash
06042
Christopher
Zip Code
CT
First Name
Phipps
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
45 Chatham Dr
MI
Geoffrey
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 5 of 40

TYPE OF REPORT

Last Name
First Name
Blake
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
158 Hodge Ave Apt 1
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Bottone
MI
Madeline
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
City
31 Webster Dr
Cash
06401
Linda
Zip Code
CT
First Name
Gentile
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
19 Birchwood Dr
MI
Kevin
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 6 of 40

TYPE OF REPORT

Last Name
First Name
Knapp
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
56 Locke St
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
St Jacques
City
16 Myrtle Ave
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
MI
Rita
Cash
06401
Diana
Zip Code
CT
First Name
Branch
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
3 Glen Dr
MI
David
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 7 of 40

TYPE OF REPORT

Last Name
First Name
Hunt
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
10 S Westwood Rd
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Madigosky
City
43 Holbrook St
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
MI
Howard
Cash
06401
Thomas III
Zip Code
CT
First Name
Clifford
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
6 Myrtle Ave
MI
Denice
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 8 of 40

TYPE OF REPORT

Last Name
First Name
Delucia
City
Murray St
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
City
6 Elliott Rd
Ansonia
Yes
No

06252015A

Yes
No

Executive
X
State
Zip Code
CT
06401
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Poehailos
City
20 Lawton Ter
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
MI
Donald
Cash
06401
Fran
Zip Code
CT
First Name
Digiorgi
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Anthony
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 9 of 40

TYPE OF REPORT

Last Name
First Name
Hubbard
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$25.00
$25.00
MI
City
28 Pinecrest Ave
Ansonia
Yes
No

06252015A

Yes
No

Executive
X
State
Zip Code
CT
06401
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$50.00
$50.00
First Name
Dellavolpe
City
198 1/2 Prospect St
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
MI
James
Cash
06401
Jo Lynn
Zip Code
CT
First Name
Flaherty
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
10 Harris Rd
MI
James
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$30.00
$30.00
Page 10 of 40

TYPE OF REPORT

Last Name
First Name
Kennedy
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$50.00
$50.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
159 Pulaski Hwy
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$50.00
$50.00
First Name
Macero
MI
Louis
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
City
55 Hubbell Ave
Cash
06401
Carmen
Zip Code
CT
First Name
Pitney
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
12 Jason Wright Dr
MI
Ilene
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$50.00
$50.00
Page 11 of 40

TYPE OF REPORT

Last Name
First Name
Lynch
City
15 Birchwood Dr
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$30.00
$30.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A

Yes
No

Executive
X
City
46 N Westwood Rd
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/07/2015
$25.00
$25.00
First Name
Kolakowski
City
14 Farrel Dr
State
Ansonia
Zip Code
CT
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
MI
Tara
Cash
06401
Joan
Zip Code
CT
First Name
Lawlor
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Anne
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/07/2015
$25.00
$25.00
Page 12 of 40

TYPE OF REPORT

Last Name
First Name
Lynch
Ansonia
Yes
No

06252015A
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/07/2015
$50.00
$50.00
MI
City
7 Ford St
Ansonia
Yes
No


Yes
No

Executive
X
State
Zip Code
CT
06401
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/10/2015
$10.00
$10.00
First Name
Caporale
MI
Ann
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

06252015A
X
_

Yes
No
Personal Check

Executive
X
City
26 Page St
Cash
06401
Elizabeth
Zip Code
CT
First Name
Maffo
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
15 Macntosh Ln
MI
Elizabeth
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/10/2015
$25.00
$25.00
Page 13 of 40

TYPE OF REPORT

Last Name
First Name
Kolakowski
City
14 Farrel Dr
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
X
City
26 Page St
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Lynch
MI
Anne
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
X
City
15 Birchwood Dr
Cash
06401
Ann
Zip Code
CT
First Name
Caporale
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Tara
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 14 of 40

TYPE OF REPORT

Last Name
First Name
Puro
City
28 Locke St
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
City
163 O'Neils Ct
Ansonia
Yes
No

07232015B

Yes
No

Executive
X
State
Zip Code
CT
06401
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Supp
MI
Lynda
Ansonia
State
Zip Code
CT
06401-2018
Name of Employer

Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
X
City
6 Kimberly Ln
Cash
06401
Florence
Zip Code
CT
First Name
Camilleri
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Jamie
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$10.00
$10.00
Page 15 of 40

TYPE OF REPORT

Last Name
First Name
Edmonds
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
City
6 Elliott Rd
Ansonia
Yes
No

07232015B

Yes
No

Executive
X
State
Zip Code
CT
06401
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$50.00
$50.00
First Name
Flaherty
MI
Jo Lynn
City
28 Pinecrast Ave
Ansonia
Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
X
State
Zip Code
CT
06401
Name of Employer

Cash
06401
Fran
Zip Code
CT
First Name
Digiorgi
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
505 Beaver St Apt 15
MI
Shain
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 16 of 40

TYPE OF REPORT

Last Name
First Name
Rios
City
121 Great Hill Rd
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
X
MI
City
48 Holbrook St
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Adamowski
City
19 Kathy Ln
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
_
MI
Edward
Cash
06401
Howard
Zip Code
CT
First Name
Madigosky
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Milagros
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 17 of 40

TYPE OF REPORT

Last Name
First Name
Shortell
City
19 Kathy Ln
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
X
City
2 Gracie Ln
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Branch
MI
Diana
City
56 Locke St
Ansonia
Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
_
State
Zip Code
CT
06401
Name of Employer

Cash
06401
Joseph
Zip Code
CT
First Name
Jeanette
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Brittany
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 18 of 40

TYPE OF REPORT

Last Name
First Name
Sheehy
City
130 Wakelee Ave
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
_
City
11 Dempsey Ct
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Williams
MI
Kan
City
2 Dogwood Dr
Ansonia
Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
_
State
Zip Code
CT
06401
Name of Employer

Cash
06401
Sean
Zip Code
CT
First Name
Rowley
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
James
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 19 of 40

TYPE OF REPORT

Last Name
First Name
Unno
City
13 Locke St
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
_
City
240 Prospect St
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Chellana
MI
Terrell
City
240 Prospect St
Ansonia
Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
_
State
Zip Code
CT
06401
Name of Employer

Cash
06401
Carlos
Zip Code
CT
First Name
Cosme
Cash
_
_
Date Received
Last Name
Cash
State
Name of Employer

MI
Louis
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 20 of 40

TYPE OF REPORT

Last Name
First Name
Gentile
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$25.00
$25.00
MI
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

07232015B

Yes
No

Executive
X
City
12 Jason Wright Dr
_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
07/23/2015
$25.00
$25.00
First Name
Knapp
MI
David
Ansonia
State
Zip Code
CT
06401-2911
Name of Employer

Yes
No

07232015B
X
_

Yes
No
Personal Check

Executive
X
City
3 Glen Dr
Cash
06401
Jeremiah
Zip Code
CT
First Name
Kennedy
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
158 Hodge Ave Apt 1
MI
John
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
07/23/2015
$25.00
$25.00
Page 21 of 40

TYPE OF REPORT

Last Name
First Name
Lynch
Ansonia
Yes
No

07232015B
X
_

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
07/23/2015
$50.00
$50.00
MI
City
45 Morningside Dr
Ansonia
Yes
No

07232015B

Yes
No

Executive
X
State
Zip Code
CT
06401-1311
Name of Employer

_
_
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Yes
Yes
No
No
Legislative
Date Received
Last Name
08/14/2015
$25.00
$25.00
First Name
Macero
MI
Louis
Ansonia
State
Zip Code
CT
06401
Name of Employer

Yes
No

_
X

Yes
No
Personal Check

Executive
X
City
55 Hubbell Ave
Cash
06401
Ronald
Zip Code
CT
First Name
Greski
Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
15 Macintosh Ln
MI
Elizabeth
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
Legislative
Date Received
_
Yes
Yes
09/04/2015
$25.00
$25.00
Page 22 of 40

TYPE OF REPORT

Last Name
First Name
Benjamin
Ansonia
Yes
No

_
X

Yes
No

Executive
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
Zip Code
CT
06401
Yes
Yes
No
No
Legislative
09/04/2015
$50.00
$50.00
First Name
Puro
MI
Jamie
City
28 Locke St
Ansonia
Yes
No


Yes
No
Personal Check

Executive
X
State
Zip Code
CT
06401
Name of Employer

Cash
_
_
Date Received
Last Name
X
State
Name of Employer

Cash
City
16 Birchwood Dr
MI
Mary
_
_
Credit/Debit Card
Payroll Deduction
Money Order
No
No
09/04/2015
$50.00
Total of Section B
TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS
(Sections A & B)
Legislative
Date Received
_
Yes
Yes
(Total on Line 13 of Summary Page)
$50.00
$1,680.00
$2,070.00
Page 23 of 40

TYPE OF REPORT
C1. Contributions from Other Committees

Name of Treasurer
Name of Committee
Address

Yes
No

City
State
Zip Code
Date Received
Total of Section C1

TYPE OF REPORT
NAME OF COMMITTEE

C2. Reimbursements or Surplus Distributions from other Committees
Name of Committee
Name of Treasurer
Address
Date Received
State
City
Zip Code
Amount of Receipt
Payment Type
Reimbursement for shared expense
Surplus Distribution
Expenditure # (if applicable)
Description
Total of Section C2
Page 24 of 40

TYPE OF REPORT
D. Loans Received this Period

Name of Lender
Source of Loan:
Bank
Street Address
Date of Receipt
Candidate
City
Individual
Other
State
Zip Code
Is there a cosigner or
Guarantor of this loan?
Yes
Name of Cosigner/Guarantor (if applicable)
No
Amount Received
Street Address
City
State
Zip Code
Total of Section D

NAME OF COMMITTEE
TYPE OF REPORT
E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLY)
Name of Entity
Street Address
Date Received
State
City
Zip Code
Amount Received
Total of Section E

TYPE OF REPORT
F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)
Date of Receipt
Is this transaction associated with an event

reported in Section L1?
Yes
No
Amount
Total of Section F
Page 25 of 40

NAME OF COMMITTEE
TYPE OF REPORT
G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)
Date of Receipt
Amount
Total of Section G

TYPE OF REPORT
NAME OF COMMITTEE

H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)
Date of Receipt
Method of Payment
Amount
Cash
Personal Check
Credit/Debit Card
Total of Section H
I. Monetary Receipts (Section A-K)

TYPE OF REPORT

J. Interest from Deposits in Authorized Accounts
Date Received
Name of Institution
Street Address
City
State
Amount
Zip Code
Total of Section J
Page 26 of 40

TYPE OF REPORT
NAME OF COMMITTEE

K. Miscellaneous Monetary Receipts not Considered Contributions
Name
Street Address
Date of Transaction
City
State
Zip Code
Description
Total of Section K
Amount
Received
Page 27 of 40
II. EVENT ACTIVITY (Sections L1 - L5)

TYPE OF REPORT
L1. Event Information

Event #
Date of Event
06/25/2015
Letter
Description
Was this a fundraising event?
Dinner Event
Yes
No
Location: Street Address
City
State
Zip Code
557 Wakelee Ave
Ansonia
CT
06401
Subpart 1: (All Committees)
Yes
No
Yes
No
Yes
No
Was this event hosted at a personal residence?
Did this fundraiser include goods or services donated by a business entity of

up to $200 or items donated by an individual of up to $100?
Was this fundraiser a tag sale, auction, or other sale of donated items with
puchases from an individual of up to $100?
(If yes, go to Section L5 In-Kind Donations not Considered

Contributions Associated with a House Party and complete required
information for any puchases made by host(s) for food, beverage and
invitations.)
(If yes, go to Section L 4 In-Kind Donations not Considered

Contributions and complete required information.)
$0.00
(If yes, enter Total Receipts here.)
Subpart 2: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)
Were there purchases of advertising space in a program book or on a sign associated
with this fundraiser?
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass gathering held
within the state with this fundraiser?
Event #
Date of Event
07/23/2015
Letter
Yes
No
Yes
No
(If yes, go to Section L 3 Purchases of Advertising Space in a Program

Book or on a Sign and complete required information.)
$0.00
Description
Was this a fundraising event?
Party Event
Yes
No
Location: Street Address
City
State
Zip Code
557 Wakelee Ave
Ansonia
CT
06401
Subpart 1: (All Committees)
Yes
No
Yes
No
Yes
No
Was this event hosted at a personal residence?
Did this fundraiser include goods or services donated by a business entity of

up to $200 or items donated by an individual of up to $100?
Was this fundraiser a tag sale, auction, or other sale of donated items with
puchases from an individual of up to $100?
(If yes, go to Section L5 In-Kind Donations not Considered

Contributions Associated with a House Party and complete required
information for any puchases made by host(s) for food, beverage and
invitations.)
(If yes, go to Section L 4 In-Kind Donations not Considered

Contributions and complete required information.)
$0.00
Subpart 2: (Party Committees, Municipal Candidates and Political Committees other than Exploratory Committees)
Were there purchases of advertising space in a program book or on a sign associated
with this fundraiser?
Subpart 3: (Town Committees ONLY)
Did your committee sell food or beverage at a fair or similar mass gathering held
within the state with this fundraiser?
Yes
No
Yes
No
(If yes, go to Section L 3 Purchases of Advertising Space in a Program

Book or on a Sign and complete required information.)
$0.00
Page 28 of 40
$0.00
Total of Section L1

TYPE OF REPORT

L3. Purchases of Advertising in a Program Book or on a Sign
Name of Purchaser
Purchase Made By:

Business Entity
Other
Individual/Sole Proprietorship
Street Address
Date Received
City
Event #
Aggregate Purchases for All Events
Zip Code
State
Amount of Program Ad Purchase
Amount of Sign Purchase
Total of Section L3

TYPE OF REPORT

L4. In-Kind Donations Not Considered Contributions
Name of the Donor
City
Street Address
Donation Given by:
State
Description of Donation
Fair Market Value of

Donation
Business Entity
Individual
Date Received
Zip Code
Event #
Aggregate value for this event
Sole Proprietorship
Total of Section L4
Page 29 of 40
II.EVENT ACTIVITY (Sections L1 - L5)

TYPE OF REPORT
L5. In-Kind Donations Not Considered Contributions Associated with a House Party
Is this event supporting more than one candidate or committee?
Name of the Host
Yes
No
If yes, complete Itemization in

Addendum L5
City
Street Address
State
Description of Donation
Zip Code
Fair Market Value of

Donation
Event #
Aggregate value of this Event - all hosts
Aggregate value of all Events - this host/candidate
Total of Section L5
III. NONMONETARY RECEIPTS (Sections M - O)

TYPE OF REPORT

M. In-Kind Contributions
Name
City
Street Address
Type of Contributor:
Committee
Individual / Sole Proprietorship

Is Contributor a lobbyist, spouse, or
dependent child of a lobbyist?

If yes, list Event#
Date Received
Aggregate contributions
State
Zip Code
Description of In-Kind Contribution
Other
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
than $5000?
Yes
No
Yes
No

Fair Market Value of this

Contribution
Yes
No
Executive
Legislative
Total of Section M
Page 30 of 40
III. Non Monetary Receipts (Sections M - O)

NAME OF COMMITTEE
TYPE OF REPORT
N. Refundable Deposit to Telephone Company

Last Name of Individual
First Name
City
MI
State
Date Deposit Made
Zip Code
Name of Telephone company
Street Address
City
State
Zip Code
Total of Section N
Amount of
Deposit
Page 31 of 40
IV. EXPENDITURES (Sections P - T)

TYPE OF REPORT

P. Expenses Paid By Committee
Name of Payee
Date of Payment
Molto Bene Resturant
07/01/2015
Street Address
City
557 Wakelee Ave
Ansonia
Purpose of Expenditure
(by code)
Method of Payment
X
Check #
Debit Card
1247
State
CT
Description
EFT
06401
Amount
Event #
FNDR *
Zip Code
06252015A
Expenditure #
(if applicable)
Type of Expenditure ( Itemization in Addendum P Required unless "None of the below" is checked)
$450.00
None of the below
Coordinated with reimbursement sought (joint expenditure)
Independent
Coordinated without reimbursement sought (in-kind contribution)
Organization
Name of Payee
Date of Payment
Eliabeth Lynch
07/07/2015
Street Address
City
15 Macintosh Ln
Ansonia
(by code)
Expenditure #
(if applicable)
D
Method of Payment
X
Check #
Debit Card
1248
State
EFT
Zip Code
CT
Description
POST
06401
Event #
Amount
Stamps envelpoes
$93.67
None of the below
Independent
Organization
Name of Payee
Date of Payment
DSCC
07/07/2015
Street Address
City
30 Arbor St Ste 404
Hartford
(by code)
D
Method of Payment
X
Check #
Debit Card
State
CT
Event #
Description
Misc *
1249
_
EFT
Zip Code
06106
Amount
Voter File Access
Expenditure #
(if applicable)
X
$442.00
None of the below
Independent
Organization
Page 32 of 40

TYPE OF REPORT

Name of Payee
Date of Payment
Elizabeth Lynch
07/07/2015
Street Address
City
15 Macintosh Ln
Ansonia
(by code)
Expenditure #
(if applicable)
Check #
Debit Card
1250
State
EFT
Zip Code
CT
Description
A-NEWS
Method of Payment
06401
Amount
Event #
Caucus meeting
$139.51
None of the below
Independent
Organization
Name of Payee
Date of Payment
Bank of America
07/13/2015
Street Address
City
Main St
Ansonia
(by code)
D
Method of Payment
_
Check #
Debit Card
State
EFT
Zip Code
CT
Description
Event #
Amount
BNK
Expenditure #
(if applicable)
$3.00
None of the below
Independent
Organization
Name of Payee
Date of Payment
Molto Bene
07/23/2015
Street Address
City
557 Wakelee Ave
Ansonia
(by code)
D
Method of Payment
X
Check #
Debit Card
State
CT
Event #
Description
FNDR *
Pizza Party
1251
_
EFT
Zip Code
06401
Amount
07232015B
Expenditure #
(if applicable)
X
$600.00
None of the below
Independent
Organization
Page 33 of 40

TYPE OF REPORT

Name of Payee
Date of Payment
Elizabeth Lynch
07/25/2015
Street Address
City
15 Macintosh Ln
Ansonia
(by code)
Method of Payment
X
Check #
Debit Card
1252
State
CT
Description
EFT
Zip Code
06401
Amount
Event #
POST
Expenditure #
(if applicable)
$29.40
None of the below
Independent
Organization
Name of Payee
Date of Payment
Elizabeth Lynch
07/25/2015
Street Address
City
15 Macintosh Ln
Ansonia
(by code)
D
Method of Payment
X
Check #
Debit Card
1253
State
EFT
Zip Code
CT
Description
Event #
Amount
OFFICE
Expenditure #
(if applicable)
$25.07
None of the below
Independent
Organization
Name of Payee
Date of Payment
Hong Tran
08/04/2015
Street Address
City
East Main St
Ansonia
(by code)
D
Method of Payment
X
Check #
Debit Card
State
CT
Event #
Description
OVHD
1254
_
EFT
Zip Code
06401
Amount
Campaign Headquaters
Expenditure #
(if applicable)
X
$600.00
None of the below
Independent
Organization
Page 34 of 40

TYPE OF REPORT

Name of Payee
Date of Payment
Olderman& Hallihan
08/05/2015
Street Address
City
400 Main St Ansonia
Ansonia
(by code)
Expenditure #
(if applicable)
Check #
Debit Card
1255
State
EFT
Zip Code
CT
Description
Misc *
Method of Payment
06401
Amount
Event #
Liability Insurance
$877.84
None of the below
Independent
Organization
Name of Payee
Date of Payment
Alzheimer's Assoc
08/10/2015
Street Address
City
200 Executive Blvd # 4B
Southington
(by code)
Expenditure #
(if applicable)
D
Method of Payment
X
Check #
Debit Card
1256
State
EFT
Zip Code
CT
Description
Misc *
06489
Event #
Amount
Memory of Pauline Sampieri
$25.00
None of the below
Independent
Organization
Name of Payee
Date of Payment
James D. Hubbard
08/10/2015
Street Address
City
10 Harris Rd
Ansonia
(by code)
D
Method of Payment
X
Check #
Debit Card
State
CT
Event #
Description
Misc *
1257
_
EFT
Zip Code
06401
Amount
Flowers to Madeline Botton
Expenditure #
(if applicable)
X
$26.57
None of the below
Independent
Organization
Page 35 of 40

TYPE OF REPORT

Name of Payee
Date of Payment
Bank of America
08/11/2015
Street Address
City
Main St
Ansonia
(by code)
Expenditure #
(if applicable)
Check #
Debit Card
State
EFT
Zip Code
CT
Description
BNK
Method of Payment
06401
Amount
Event #
check Service
$3.00
None of the below
Independent
Organization
Name of Payee
Date of Payment
The Vinci Group
08/31/2015
Street Address
City
54 Robert Rd
Manchester
(by code)
D
Method of Payment
X
Check #
Debit Card
1259
State
EFT
Zip Code
CT
Description
06040
Event #
Amount
CNSLT
Expenditure #
(if applicable)
$500.00
None of the below
Independent
Organization
Name of Payee
Date of Payment
Ansonia Cultural Comm
09/02/2015
Street Address
City
253 Main St
Ansonia
(by code)
D
Method of Payment
X
Check #
Debit Card
State
CT
Event #
Description
FNDR *
1260
_
EFT
Zip Code
06401
Amount
basket sale
Expenditure #
(if applicable)
X
$50.00
None of the below
Independent
Organization
Page 36 of 40

TYPE OF REPORT

Name of Payee
Date of Payment
Bank America
09/10/2015
Street Address
City
Main St
Ansonia
(by code)
Method of Payment
_
Check #
Debit Card
State
CT
Description
EFT
Zip Code
06401
Amount
Event #
BNK
Expenditure #
(if applicable)
$3.00
None of the below
Independent
Organization
$3,868.06
Total of Section P

TYPE OF REPORT
Q. Campaign Expenses Paid By Candidate

Name of Payee (Name of vendor, Person or Entity who candidate paid directly)
Date of Payment
Is Reimbursement Claimed?
Yes
(by code)
State
City
Street Address
Description
Event #
No
Zip Code
Amount
Total of Section Q
Page 37 of 40
IV. EXPENDITURES
TYPE OF REPORT

R. Expenses Incurred on Committee Credit Card
Type of Credit Card:
Name of Issuing Institution
Visa
Master Card
American Express
Discover
Other
Date of Transaction
Name of Vendor, Person or Entity
City
Street Address
(by code)
Expenditure #
(if applicable)
State
Description
Zip Code
Event #
Amount
Type of Expenditure ( Itemization in Addendum R Required unless "None of the below" is checked)
None of the below

Independent
Organization
Total of Section R
IV. EXPENDITURES
TYPE OF REPORT
S. Expenses Incurred By Committee but Not Paid During this Period

Date Incurred
Name of Creditor
City
Street Address
(by code)
Expenditure#
(if applicable)
Description
State
Amount Incurred
(Estimate or Actual)
Event #
Type of Expenditure (Itemization in Addendum S Required unless "None of the below" is checked)
None of the below

Independent
Coordinated without reimbursement sought (in-kind contribution
Organization :
Zip Code
Total of Section S
Page 38 of 40

TYPE OF REPORT
T. Itemization of Reimbursements and Secondary Payees

Last Name of Worker/Consultant
First
MI
Date of Payment to Vendor, Person or Entity
Payment to Reimburse Committee Worker/Consultant as reported in Section P
Name of Vendor, Person or Entity Paid by Committee Worker/Consultant
Check #
Street Address of Vendor, Person or Entity Paid by Committee Worker/Consultant
(by code)
Expenditure #
Debit Card
City
State
Event #
Description
None of the below

Independent
Organization:
Total of Section T
Section L5. ADDENDUM

NAME OF COMMITTEE
TYPE OF REPORT
L5. In - Kind Donations Not Considered Contribution Associated with a House Party - Addendum
Event #
Name of Candidate or Committee
Zip Code
Amount
Type of Expenditure ( Itemization in Addendem T Required unless "None of the below" is checked)
EFT
Page 39 of 40
Section P. ADDENDUM
TYPE OF REPORT
NAME OF COMMITTEE
P. Expenses Paid By Committee - Addendum

Expenditure #
Supported
Amount of Expenditure
Opposed
Office Sought (if applicable)
Cost Allocated to Candidate or Committee
Section R. ADDENDUM
NAME OF COMMITTEE
TYPE OF REPORT
R. Expenses Incurred on Committee Credit Card - Addendum

Expenditure #
Supported
Opposed
Section S. ADDENDUM
TYPE OF REPORT
NAME OF COMMITTEE
S. Expenses Incurred by Committee but Not Paid During this Period - Addendum
Expenditure #
Supported
Opposed
Page 40 of 40
Section T. ADDENDUM
TYPE OF REPORT
NAME OF COMMITTEE
T. Itemization of Reimbursements and Secondary Payees - Addendum

Expenditure #
Supported
Opposed

Ansonia DTC October 2015 Filing

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Ansonia DTC October 2015 Filing

Caricato da

Copyright:

Formati disponibili

Electronic Filing

Do Not Mark in This Space For Official Use Only

5. OFFICE SOUGHT (Complete only if Candidate Committee)

6. DISTRICT NUMBER (if applicable)

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

PRINT NAME OF THE SIGNER

SUMMARY PAGE TOTALS

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)

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

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)

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)

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

October 10 Filing - Original

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

B. Itemized Contributions from Individuals

Is this contribution associated with an

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

If yes, indicate which branch or branches of

Is contributor a lobbyist, spouse,

Is this contribution associated with an

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

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

Residential Street Address

Is this contribution associated with an

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

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

Is contributor a lobbyist, spouse,

Residential Street Address

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

Is contributor a lobbyist, spouse,

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals

Is this contribution associated with an

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

If yes, indicate which branch or branches of

Is contributor a lobbyist, spouse,

Is this contribution associated with an

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

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

Residential Street Address

Is contributor a lobbyist, spouse,

Is this contribution associated with an

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

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

505 Beaver St Apt 15

Residential Street Address

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

Is contributor a lobbyist, spouse,

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

October 10 Filing - Original

B. Itemized Contributions from Individuals