December 30, 2015 To City of Black Hawk Mayoral and Alderman Candidates: Administrative Services 201 Selak Street P.O. Box 68 Black Hawk, CO www

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1 Candidate Informational Packet City of Black Hawk, Colorado Regular Municipal Election Tuesday, April 5, Candidate Packet page 1

2 December 30, 2015 To City of Black Hawk Mayoral and Alderman Candidates: Administrative Services 201 Selak Street P.O. Box 68 Black Hawk, CO Office Fax Mayor David D. Spellman Aldermen Linda Armbright Paul G. Bennett Hal Midcap Jim Johnson Greg Moates Benito Torres City Attorney Corey Y. Hoffmann City Manager Jack D. Lewis City Clerk / Administrative Services Director Melissa A. Greiner Finance Director Lance R. Hillis Fire Chief Donald E. Taylor Police Chief Stephen N. Cole Public Works Director Thomas Isbester Community Planning & Development Administrator Cynthia L. Linker The enclosed materials have been prepared by the City of Black Hawk Clerk's Office for reference by Mayoral and Alderman Candidates in the City of Black Hawk s regular municipal election, which will be held Tuesday, April 5, Included are a summary of the basic requirements associated with the election, a listing of certain election dates, and forms required for participation in the election. The City of Black Hawk's regular municipal election will be conducted as a regular paper ballot election. The designated polling place for all precincts within the City's limits will be the Council Chambers located at 211 Church Street, with voting hours from 7:00 a.m. to 7:00 p.m. The ballot will ask voters to consider candidates for the Mayoral position and three Alderman positions. Nomination petitions may be picked up at City Hall on Tuesday, January 5, 2016 and may start to be circulated that same day. A minimum of ten signatures from registered voters residing within the City limits is required in order to establish candidacy. Completed nomination petitions, along with a signed Affidavit of Circulator form (included in Nomination Petition packet) and Acceptance of Nomination form are due in the Clerk s office on Monday, January 25, 2016 by 5:00 p.m. A drawing by lot will be held in the Council Chambers at 3:00 p.m. on Wednesday, February 10, 2016, to determine the order candidates will be listed on the official ballot. Either the candidate or a representative appointed by the candidate may be present. Regardless if a candidate chooses to accept outside contributions for campaigning purposes (resources other than candidate's personal funds), he/she must comply with the Fair Campaign Practices Act's reporting requirements which stipulate that the necessary forms be filed in the office of the City Clerk by the dates required as per State Statute and listed in this packet. This packet is intended for and provided as information only. The City Clerk's Office cannot and does not provide legal advice. Please consult your own attorney if you have specific questions about election laws. Thank you, Melissa Greiner City Clerk/Administrative Services Director 2016 Candidate Packet page 2

3 CITY OF BLACK HAWK MUNICIPAL ELECTION - APRIL 5, 2016 CANDIDATE PACKET 1. General Election Information. page 4 2. Qualifications to Hold Municipal Office page 4 3. Nomination Procedure page 4 4. Write-In Candidates page 5 5. Circulation of Nomination Petitions.. page 5 6. Voter Registration Information.. page 6 7. Ballots. page 6 8. Fair Campaign Practices Act (FCPA) page 6 9. Candidate Election Calendar.. page Election Related Forms.. page FCPA Forms page Candidate Packet page 3

4 1. GENERAL ELECTION INFORMATION The City of Black Hawk s regular municipal election will be held on April 5, At this election, eligible persons registered to vote, up to and including Election Day, will have the opportunity to vote for the Mayor and three Alderman positions. Qualified voters must have resided within the City s limits as of March 14, 2016 and be properly registered with the Gilpin County Clerk. Voter registration material is available at the City Hall. This election will be conducted as a polling place (walk-in) election, utilizing paper ballots. There is one polling place for the City of Black Hawk, located at the Council Chambers on 211 Church Street. The polls will be open from 7:00 a.m. until 7:00 p.m. on Election Day. The City of Black Hawk is a Home Rule City whose actions are governed by the City Charter. The City has adopted by reference the Colorado Municipal Election Code of 1965, Article 10 of Title 31, Colorado Revised Statutes (C.R.S.). A complete set of Colorado Revised Statutes and the Charter are available for review at City Hall. The Mayor and Alderman terms are non-limited. The terms commence at the first meeting held at least ten days from the canvass of votes of the election. Successful candidates will be sworn into office at the April 27, 2016 City Council meeting. All municipal elections are nonpartisan and nomination is accomplished by petition. The City of Black Hawk meets on the 2 nd and 4 th Wednesdays of each month at 3:00 p.m. in the Council Chambers. Special meetings and workshops are additionally scheduled throughout the calendar year. 2. QUALIFICATIONS FOR MUNICIPAL OFFICE CANDIDATE Persons wishing to run for City of Black Hawk municipal office must meet the following criteria: 1. U.S. citizen 2. At least 18 years of age for Alderman, 25 years of age for Mayor 3. Resident of Black Hawk at least 12 consecutive months preceding date of election 4. Registered elector 3. NOMINATION PROCEDURE Candidates for municipal offices shall be nominated at large, without regard to political party affiliation or geographic location. Municipal candidates are all nominated by petition. Nomination petitions must be filed in the City Clerk s office no later than 5:00 p.m. on Monday, January 25, Each nomination petition shall be completed with the name of the candidate as he/she wishes it to appear on the ballot, the candidate s place of residence, and the office being sought. Candidates may use a nickname, but may not use any title or degree designation with the business or profession of the candidate Candidate Packet page 4

5 Withdrawal from Election: Candidates may withdraw from the election by submitting a written affidavit to the City Clerk stating their withdrawal no later than 5:00 p.m., Tuesday, February 2 nd. 4. WRITE-IN CANDIDATES Write-in candidate votes will not be counted unless an Affidavit of Intent has been received. An Affidavit of Intent of Write-In Candidate must be submitted to the City Clerk no later than 5:00 p.m. Monday, February 1 st. 5. CIRCULATION OF NOMINATION PETITIONS The candidate may circulate his/her own petition or have others circulate a petition. Each nomination petition can only be circulated by one person. Nomination petitions cannot be left unattended by the circulator. The circulator must witness and certify by affidavit that each signature is the signature of the person whose name it purports to be, and that each signer has stated to the circulator that he is a registered elector of the municipality for which the nomination is being made. The nominating petition must contain 10 signatures of registered electors residing within the City limits of the City of Black Hawk. A registered elector residing in the City may sign an unlimited number of petitions for nomination of a candidate for the office of Mayor and Alderman. Each registered elector signing the petition must also print their name and physical address as it appears on their voter registration (no P.O. Boxes, please). A candidate may wish to obtain more than the required 10 signatures in the event a name is challenged, found to be ineligible or otherwise eliminated. Signatures will be verified by the Clerk. If signatures are eliminated by the Clerk resulting in fewer than 10 registered electors signing a petition, the petition circulator will have time in which to amend the petition. The last day to amend a nomination petition is Monday, February 2, First day petitions may be requested and circulated: January 5, 2016 Last day to file nomination petitions: January 25, 2016 Last day to amend nomination petitions: February 2, 2016 Please be aware that no campaign material can be placed within 100 feet of the polling place (Council Chambers) on Election Day, April 5, Candidate Packet page 5

6 6. VOTER REGISTRATION INFORMATION To be eligible to vote, one must be eighteen years of age, be a citizen of the United States, have resided in this State for twenty-two days and in the City of Black Hawk for thirty days, immediately preceding the election. Voter registration forms are available through any municipal or county clerk's office or in City Hall. The last day to register to vote in this election is March 30, BALLOTS The position of names on the ballot is determined by lot. The drawing of names for the position on the ballot will be conducted by the Clerk at the February 10 th City Council meeting at 3:00 p.m., to determine the order candidates will be listed on the official ballot. Either the candidate or a representative appointed by the candidate may be present. 8. FAIR CAMPAIGN PRACTICES ACT (FCPA) The reporting requirements of the Fair Campaign Practices Act apply to all Mayoral and Alderman candidates. All forms required by the Act must be filed with the City Clerk. It is the responsibility of each candidate to become familiar with, and meet, the reporting and filing provisions of the Fair Campaign Practices Act (FCPA). Forms necessary to complete this requirement are attached. Please review the documents thoroughly to proceed within these guidelines and submit all applicable forms to the City Clerk by the schedule shown below. 1. Candidate Affidavit, should be filed within 10 days of becoming a candidate, must be signed and notarized prior to submission. 2. Personal Expenditure Form, for use by a candidate who has not received any contributions, but has made expenditures of personal funds. 3. Candidate Statement of Non-Receipt of Contributions or Non-Expenditure of Funds, for use by a candidate that does not have a campaign committee and has not received contributions, nor made expenditures and no expenditures have been made on behalf of the candidate. 4. Committee Registration Form, every candidate, candidate committee, issue committee and political committee shall file a statement of organization with the City Clerk no later than 10 days after accepting or making a contribution or expenditure or 20 days prior to the election, whichever is earlier. 5. Detailed Summary Report of Contributions and Expenditures, including Schedules A, B, C, and D, is a financial report required for all committees that 2016 Candidate Packet page 6

7 accept contributions or make expenditures. The reporting period ends 5 days prior to the filing date. Schedule for filing all FCPA forms: Deadline March 15 April 1 May 5 Reporting Period by 5:00 pm First Campaign Report due Second Campaign Report due Third and Post Campaign Report due *DO NOT FILE FCPA FORMS ELECTRONICALLY. All FCPA forms in this election are filed with the City Clerk. Failure to comply with the requirements of FCPA may result in enforcement action and the imposition of fines (CRS ). For more information on FCPA, please visit *Within 10 days of becoming a candidate, you MUST file the Candidate Affidavit. Failure to submit this form shall result in the disqualification of such person as a candidate Candidate Packet page 7

8 9. CANDIDATE ELECTION CALENDAR CITY OF BLACK HAWK REGULAR MUNICIPAL ELECTION APRIL 5, 2016 January 5 January 25 February 1 February 2 February 2 February 10 March 15 March 30 April 1 April 5 April 15 May 5 First day to circulate nomination petitions Last day to circulate nomination petitions, signed affidavit of circulator and acceptance of nomination due in City Clerk s office by 5:00 p.m. Last day for filing affidavit of intent for write-in candidates Last day nomination petitions may be amended to correct or replace signatures Last day candidates may withdraw from nomination Drawing by lot to determine order of candidates listed on ballot 3:00 p.m. at Council Chambers First Campaign Report due Last day to register to vote in April 5, 2016 election Second Campaign Report due Election Day Last day for Clerk to certify election results Third and Post Campaign Report due NOTE: These dates are determined according to the Municipal Election Code. Failure to meet a deadline could result in a candidate disqualification. If you are unclear on a deadline, please contact the City Clerk s Office Candidate Packet page 8

9 CERTIFICATE OF WITHDRAWAL FROM NOMINATION In accordance with the provisions of the Colorado Election Code, I, hereby decline the nomination for the office of for which office I was duly nominated by a Petition of Nomination filed in the office of the City Clerk on the day of, 20, and which nomination was duly accepted by filing my written acceptance of such nomination for said office with the City Clerk on the day of, 20, and hereby authorize my name to be withdrawn from the nomination for the office of to be voted on at the ensuing regular election of April 5, Signature of Candidate STATE OF COLORADO ) COUNTY OF ) Subscribed and sworn/affirmed to me this day of, 20. My commission expires. Notary Date: Time: By: Received in the Office of the City Clerk 2016 Candidate Packet page 9

10 To the City Clerk: AFFIDAVIT OF INTENT OF WRITE-IN CANDIDATE This is to certify that I, desire the office of and to the best of my knowledge and belief, will be fully qualified for said office on the date the term of office begins; that my place of residence is, and has been since, in the City of Black Hawk, County of Gilpin, State of Colorado and that my Post Office address is, Black Hawk; and that my birth date is. This affidavit is for the April 5, 2016 election. Signature of Candidate STATE OF COLORADO ) COUNTY OF ) Subscribed and sworn/affirmed to before me this day of, 20. My Commission expires. Notary Date: Time: Received in the Office of the City Clerk B y : 2016 Candidate Packet page 10

11 Candidate Affidavit Campaign Finance Forms Initial Filings Filed within 10 days of becoming a candidate Shall be filed electronically using the SOS online CPF filing system (TRACER) SOS Rule For Municipal Election - Must be signed & notarized prior to submission to the Municipal Clerk Section 2(2), article XXVIII of the Colorado Constitution; section (1), C.R.S. Voluntary Acceptance of Campaign Spending Limits Must be submitted at the SAME time as the candidate affidavit if candidate chooses to accept the limits Personal Financial Disclosure (PFD) Submitted within 10 days of filing the candidate affidavit (update is acceptable if full PFD is on record) Updates are due within 30 days of any change Sections (2)(a) & , C.R.S. Committee Registration Must be submitted & approved prior to receiving contributions Section , C.R.S. Ballot Access Documents For office qualifications and ballot access requirements, contact the Appropriate Filing Office or Designated Election Official CANDIDATE CAMPAIGN FINANCE FILING CHECKLIST State Candidates (Includes executive offices, State House & Senate, DA, RTD, CU Regents, State Board of Education, and Judges) File with Secretary of State must be submitted electronically using the TRACER online filing system File with Secretary of State Judges, and RTD candidates excluded File with Secretary of State RTD candidates excluded File with Secretary of State; may be submitted electronically at File with Secretary of State County Candidates* (Includes Special District and local School Board) File with Secretary of State must be submitted electronically using the TRACER online filing system Not Applicable Not Applicable File with Secretary of State; may be submitted electronically at File with the County Clerk and Recorder, or the Designated Election Official, as applicable Municipal Candidates* (Example: Mayor, City Council) File with municipal clerk Not Applicable Not Applicable File with municipal clerk File with municipal clerk The above checklist is intended to be a quick reference guide to initial filing requirements for campaign finance purposes and should not be considered legal advice. Other documents may be required. For campaign finance questions the campaign finance support team may be reached at cpfhelp@sos.state.co.us or ext For ballot access questions and information about what filings are required to access the ballot, please call ext For municipal campaign finance questions contact your local municipal clerk s office. For county or local ballot access questions please contact your local designed election official. References for Colorado s campaign finance laws: Article XXVIII of the Colorado Constitution; Title 1, Article 45 of the Colorado Revised Statutes (a.k.a. the Fair Campaign Practices Act), and the Secretary of State s Rules Concerning Campaign and Political Finance. *Please note: Home rule counties or municipalities may have their own campaign finance provisions which may supersede state campaign finance regulations. The Secretary of State s office will not provide legal assistance; should you require legal assistance you will need to contact legal counsel. Colorado Secretary of State 1700 Broadway, Ste. 200, Denver, CO Candidate Packet page Revised 11 11/2012

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14 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) Space Below For Office Use Only STATEMENT OF PERSONAL EXPENDITURES BY A CANDIDATE [ (1) & , C.R.S.] For use by a candidate who has not received any contributions (does not have a candidate committee), but has made expenditures of personal funds. Name of Candidate: Address of Candidate: City: State: Zip Code: Office: District No.: Elec./Yr.: Reporting Period: Beginning Date Ending Date Total amount of Non-Itemized Expenditures (19.99 or less): Expenditures exceeding shall be itemized and listed below. Date Expended Amount Name of Recipient Address City State Zip Comment / Purpose Date Expended Amount Name of Recipient Address City State Zip Comment / Purpose Date Expended Amount Name of Recipient Address City State Zip Comment / Purpose I certify to the best of my knowledge this Statement of Expenditures is true and correct. Candidate Signature: Date: Colorado Secretary of State Rev. 12/ Candidate Packet page 14

15 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) Space Below For Office Use Only CANDIDATE STATEMENT OF NON-RECEIPT OF CONTRIBUTIONS AND NON-EXPENDITURE OF FUNDS [ (1) & , C.R.S.] This form is for the use of candidates that do not have a campaign committee and have not received contributions nor made expenditures. No expenditures have been made on behalf of the candidate. Name of Candidate: Address of Candidate: City, State, Zip: Reporting Period: Beginning Date Ending Date CONTRIBUTIONS RECEIVED OR RECEIVABLE DURING THIS REPORTING PERIOD 0.00 EXPENDITURES MADE OR INCURRED DURING THIS REPORTING PERIOD 0.00 I,, affirm that no person received contributions on my behalf nor made any expenditures on my behalf. No contributions have been pledged to me nor on my behalf. I have not received any contributions nor have I made or incurred any expenditures on my own behalf during this election reporting period. Candidate Signature: Date: Colorado Secretary of State Rev. 12/ Candidate Packet page 15

16 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: Elections (303) Division ext Fax: Department (303) of State Broadway, Ste NEW COMMITTEE REGISTRATION FORM ( , C.R.S.) Please use this form if you are registering a new committee for Colorado campaign finance purposes. Select Only One Committee Type: Candidate Committee Political Party Small Donor Committee Below Space For Office Use Only Political Committee Issue Committee 527 Political Organization Federal PAC Committee Name: Committee Address (Physical): Committee Address (Mailing): Phone Number: Fax Number: Name should be descriptive. Include office, organization name, etc. Note: CO does not have PACs, only political committees. Alternate Phone Number: Web Address: Check Only One Jurisdiction: Federal State County Municipal Multi-County Other: Purpose/Office Sought (include party, office, district & election year, if applicable): Financial Institution Information: Institution Name: Institution Address: Agent / Contact Information: Name of Person Acting As Registered Agent: Under Colorado law, only the registered agent (or the candidate in the case of candidate committees) may file the committee reports. Phone Number: Alternate 1: Alternate 2: Authorization Registered Agent Registered Agent s Signature: Print Candidate Name: Candidate Address (include mailing): Candidate Signature: Date: Date: Colorado Secretary of State Form Rev. 1/ Candidate Packet page 16

17 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Phone: (303) ext Fax: (303) REPORT OF CONTRIBUTIONS AND EXPENDITURES 2010 Revised Reporting Forms 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 an initiative seeking access to the ballot and/or a referendum placed on the ballot by the general assembly. The report is comprised of 7 basic data entry pages along with several informational and instructional pages. The data entry forms consist of the Report of Contributions and Expenditures with the Detail Summary, Schedules A, B, C, D and the Statement of Non-Monetary Contributions. Completion of Schedules A, B, C, D and the Statement of Non-Monetary Contribution forms should be done prior to completion of the Report of Contributions and Expenditures and Detail Summary pages. Listed below are brief descriptions of what each data entry page accomplishes to help you complete and finalize this report. Report of Contributions and Expenditures (page 1) A summary page of the committee or party name, address, financial institution, registered agent and the contribution/expenditure totals for a specific reporting period with the Detailed Summary page (page 2) that summarizes totals for all other data entry forms. Complete this 2-page form last. Schedule A This form is used to report monetary contributions received by the committee or party that exceed (Money received into the committee/party.) Schedule B This form is used to report expenditures paid out by the committee or party that exceed (Money expended/paid out by the committee/party.) Schedule C This form details loans received and repaid by the committee/party. (Money received by committee from a financial institution and/or repayment of a loan to a financial institution.) Schedule D This form allows the committee/party to account for either a contribution or expenditure that has been made and is being returned to the committee/party. Statement of Non-Monetary Contributions This form details contributions received that are tangible and can be assessed a fair market value. Expenditures on behalf of a candidate that are coordinated with or controlled by the candidate, candidate s agent or the political party shall be counted as a contribution to and expenditure by the candidate committee or the political party. If filing the Report of Contributions and Expenditures manually, it MUST be received by the appropriate officer on or before the manual due date. Postmark dates are not recognized. A faxed Colorado Secretary of State Form Rev. 12/ Candidate Packet page 17

18 report MUST be followed up with the original document within seven calendar days. If you wish to file electronically, please log onto our web site at and select Campaign Finance and then select Campaign Finance Filing and Inquiry. Instructions for electronic filing may be found on the Campaign Finance page. The candidate and/or registered agent are responsible for the content and accuracy of the report. Other items available on the Secretary of State website are: Electronic filing instructions, Campaign and Political Finance forms, filing calendars and the Campaign and Political Finance FAQs (Frequently Asked Questions) fact sheet. Please note the Microsoft excel spreadsheet version of the report is no longer available. State and county committees requiring assistance should contact the Secretary of State s Campaign and Political Finance Support Team at ext Municipal committees should contact their municipal/town clerk for assistance. Thank you Colorado Secretary of State Form Rev. 12/ Candidate Packet page 18

19 Instructions for REPORT OF CONTRIBUTIONS AND EXPENDITURES DETAILED SUMMARY Reference Colorado Revised Statute: Who uses this form? Purpose of form: Is this form required? When do I file this form? , C.R.S. All Committees This form is used to summarize the information from all other forms. Yes This form must be received by the designated election official on or before the filing due date for the reporting period. Postmarks are not accepted. COMPLETING THE FORM This form uses information contained on other forms; all other applicable forms must be completed prior to filing this summary form. STEP 1. Completely fill out the Report of Contributions and Expenditures page until you reach Line 1. Print or type the full name of the committee Print or type the address of your committee. Print or type the city, state and zip code of your committee. Print or type the name of the financial institution where the committee funds are deposited. [ (1)(a)(IV)(b), C.R.S.] Print or type the address of the financial institution including city, state and zip code. Print or type the Secretary of State-issued committee number. This is the committee ID number that was mailed to you shortly after registering with the Secretary of State. If you registered with an election official other than the Secretary of State, you do not file with the Secretary of State s office. Determine what type of report is being filed. Regularly Scheduled Filings are normal reporting periods as required in & , C.R.S. (These dates are available through the Campaign and Political Finance manual, your local election official, the calendars provided and the Secretary of State web site Amended Filings are reports that correct a previously filed report. Termination Reports are filings that close a committee, indicating the committee is no longer in existence. You must report a zero balance on line #5. (Art. XXVIII, Sec. 2(3), , C.R.S., and the Rules Concerning Campaign and Political Finance 3.3) Check ( ) the appropriate box next to the type of report filed. If this report is an amended filing, print or type the date of the originally filed report being amended. Print or type the Reporting Period being covered. (The beginning and ending dates) Colorado Secretary of State Form Rev. 12/ Candidate Packet page 19

20 Print or type the Declared Total Spending Limit if applicable. (Art. XXVIII, Sec. 4) This is only for candidates that have accepted the Voluntary Spending limits. STEP 2. Skip Lines 1-5 and the Authorization portion of the Report of Contributions and Expenditures page (page 1) and go to the Detailed Summary page (page 2). STEP 3. On the Detail Summary page of the Report of Contributions and Expenditures form completely fill out the header information and lines 6 through 20. Line #6 Enter the total amount from Schedule A. Line #7 Enter the total amount of contributions received this reporting period that were or less. Line #8 Enter the total amount of all loans received this reporting period. (Schedule C) Line #9 Enter the total amount of all other receipts. (Example: Interest, Dividends) Line #10 Enter the total amount of all expenditures returned or refunded to the committee. (Schedule D - money coming back to the committee). Line #11 Enter the sum of Lines #6 through #10. Line #12 Enter the total amount of all Non-Monetary Contributions from the Statement of Non- Monetary Contributions form. Line #13 Enter the sum of Line #11 and #12. Line #14 Enter the total amount from Schedule B. Line #15 Enter the total amount of all Expenditures or less. Line #16 Enter the total amount of all loan payments paid this reporting period. (Schedule C) Line #17 Enter the total amount of contributions returned to the donor. Example: A contributor exceeded contribution limits and the amount exceeding that limit must be returned. (Schedule D - money going out of the committee). Line #18 Enter the total amount of expenditures by a third party that are controlled by or coordinated with a candidate, candidate committee or political party. (Statement of Non-Monetary Contribution form) Line #19 Enter the sum of Lines #14 through #17. Line #20 Enter the sum of lines #18 and #19. [Art. XXVIII, Sec. 5(3)] STEP 4. Return to the Report of Contributions and Expenditures form and complete Lines 1-5. Line #1 If this is your first Report of Contributions and Expenditures as a committee enter zero (0). If you have previously filed enter the ending balance from line #5 of your most recently filed report. Line #2 Enter the total amount from Line #11. Colorado Secretary of State Form Rev. 12/ Candidate Packet page 20

21 Line #3 Enter the sum of Lines #1 and #2. Line #4 Enter the total amount from Line #19. Line #5 Enter the difference of Line #3 minus Line #4. STEP 5. Complete the Authorization portion of the Report of Contributions and Expenditures form by printing the name of the registered agent and then sign and date the report. Colorado Secretary of State Form Rev. 12/ Candidate Packet page 21

22 Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO Ph: (303) ext Fax: (303) REPORT OF CONTRIBUTIONS AND EXPENDITURES ( , C.R.S.) Space Below For Office Use Only Full Name of Committee/Person: Address of Committee/Person: City, State & Zip Code: Committee Type: Name and Address of Financial Institution As Shown On Registration SOS ID NUMBER (state and county committees): Type of Report Regularly Scheduled Filing. Amended Filing. This amends previous report filed on (date) Submit changes or new information ONLY Termination Report. (Termination Reports MUST Have a Monetary Balance of Zero in Line 5) Check this box if this Report Contains Electioneering Communications Information Reporting Period Covered: Declared Total Spending (if applicable) [Art. XXVIII, Sec. 4(1)] Date Through Date Totals Detailed Summary Page 1 Funds on Hand at the Beginning of Reporting Period (monetary only) 2 Total Monetary Contributions (line 11) 3 Total of Monetary Contributions & Beginning Amount (line 1 + line 2) 4 Total Monetary Expenditures (line 19) 5 Funds on Hand at the End of Reporting Period (monetary) (line 3 line 4) The appropriate officer shall impose a penalty of 50 per day for each day that a report is filed late. [Art. XXVIII Sec. 10(2)(a)] 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 or 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. Print Registered Agent s Name: Registered Agent s Signature: Date: Print Candidate Name: Candidates Signature: Date: Colorado Secretary of State Form Rev. 12/ Candidate Packet page 22

23 DETAILED SUMMARY Full Name of Committee/Person: Current Reporting Period: Through Funds on hand at the beginning of reporting period (Monetary Only) 6 Itemized Contributions 20 or More [C.R.S (1)(a)] (Please list on Schedule A ) 7 Total of Non-Itemized Contributions (Contributions of and Less) 8 9 Loans Received (Please list on Schedule C ) Total of Other Receipts (Interest, Dividends, etc.) 10 Returned Expenditures (from recipient) (Please list on Schedule D ) 11 Total Monetary Contributions (Total of lines 6 through 10) 12 Total Non-Monetary Contributions (From Statement of Non-Monetary Contributions) 13 Total Contributions (Line 11 + line 12) 14 Itemized Expenditures 20 or More [C.R.S (1)(a)] (Please list on Schedule B ) 15 Total of Non-Itemized Expenditures (Expenditures of or Less) Loan Repayments Made (Please list on Schedule C ) Returned Contributions (To donor) (Please list on Schedule D ) Total Coordinated Non-Monetary Expenditures (Candidate/Candidate Committee & Political Parties only) 19 Total Monetary Expenditures (Total of lines 14 through 17) 20 Total Spending (Line 18 + line 19) Colorado Secretary of State Form Rev. 12/ Candidate Packet page 23

24 NOTE: In addition to the reporting requirements of , C.R.S., please note provisions for specific Committee type, as follows: Candidate, Issue, Political Party and Political Committee (PC) Required to disclose occupation and employer for all 100 or more contributions made by natural persons. (Art. XXVIII, Sec. 7) Small Donor Committee Accepts contributions of no more than 50 per year, FROM NATURAL PERSONS ONLY. [Art. XXVIII, Sec. 2(14)(a)] Electioneering Communications Reporting Reporting required by persons spending 1,000 or more on Electioneering Communications, Required to disclose occupation and employer for all 250 or more contributions made by natural persons. (Art. XXVIII, Sec. 6) Corporate and Labor Organization funding are prohibited. (Art. XXVIII, Sec. 6) Candidates: Schedule A Instructions Contribution Limits State Candidates (Art. XXVIII, Sec. 3) 525 Primary, 525 General if nominated to general election ballot Gov*, Gov/Lt. Gov**, Secretary of State, Attorney General and State Treasurer 200 Primary, 200 General if nominated to general election ballot State Senate, State House of Representative, State Board of Education, CU Regent, and District Attorney. Note: Candidates may receive the primary and general election contributions at one time, the contributor must note that the contribution is for both the primary and general election contribution. Candidates must note both contributions on their report. It is preferred that each contribution be given separately; one check written for the primary and one check written for the general, and so noted by the contributor on the check and by the recipient on the report. Political Committees (State, County, District & Local): 525 per House of Representatives Election Cycle Political Party (From any person other than Small Donor): 3,175 per year no more than 2,650 to state party. Political Party (From Small Donor): 15,900 per year no more than 13,250 to state party. Prohibitions on next page. Please refer to Article XXVIII, Section 3 of the Colorado Constitution for complete contribution limits and prohibited contributions. * Primary Election ** General Election Contribution Limits reflect adjustments made by CPF Rule 12 pursuant to Article XXVIII, Sec. 3(13) of the Colorado Constitution. Colorado Secretary of State Form Rev. 12/ Candidate Packet page 24

25 PROHIBITED CONTRIBUTIONS [Art. XXVIII, Sec.3 & C.R.S ] No candidate's candidate committee shall accept contributions from, or make contributions to, another candidate committee. No person shall act as a conduit for a contribution to a candidate committee. It shall be unlawful for a corporation or labor organization to make contributions to a candidate committee or a political party, and to make expenditures expressly advocating the election or defeat of a candidate; except that a corporation or labor organization may establish a political committee or small donor committee which may accept contributions or dues from employees, officeholders, shareholders, or members. No candidate committee, political committee, small donor committee, or political party shall knowingly accept contributions from: Any natural person who is not a citizen of the United States; A foreign government; or any foreign corporation that does not have the authority to transact business in this state pursuant to article 115 of title 7, C.R.S., or any successor section. No candidate committee, political committee, small donor committee, issue committee, or political party shall accept a contribution, or make an expenditure, in currency or coin exceeding one hundred dollars. No person shall make a contribution to a candidate committee, issue committee, political committee, small donor committee, or political party with the expectation that some or all of the amounts of such contribution will be reimbursed by another person. No person shall be reimbursed for a contribution made to any candidate committee, issue committee, political committee, small donor committee, or political party, nor shall any person make such reimbursement except as provided in subsection (8) of this section. [Art. XXVIII, Sec. 3(8)] Contributions from professional and volunteer lobbyists to any member of or candidate for the general assembly, or the governor or candidate for governor are prohibited during regular legislative session. Political Committees may contribute to a legislator during session, unless the political committee employs, retains, engages, or uses, with or without compensation, a professional or volunteer lobbyist. Colorado Secretary of State Form Rev. 12/ Candidate Packet page 25

26 Schedule A Itemized Contributions Statement (20 or more) [C.R.S (1)(a)] Full Name of Committee/Person: WARNING: Please read the instruction page for Schedule A before completing PLEASE PRINT/TYPE 1. Date Accepted 4. Name (Last, First): 2. Contribution Amt. 3. Aggregate Amt. * Check box if Electioneering Communication 1. Date Accepted 2. Contribution Amt. 3. Aggregate Amt. * Check box if Electioneering Communication 1. Date Accepted 2. Contribution Amt. 3. Aggregate Amt. * Check box if Electioneering Communication 1. Date Accepted 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 4. Name (Last, First): 2. Contribution Amt. 5. Address: 6. City/State/Zip: 3. Aggregate Amt. * 7. Description: 8. Employer (if applicable, mandatory): Check box if Electioneering 9. Occupation (if applicable, mandatory): Communication * For contribution limits within a committee s election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art. XXVIII, Sec. 2(14). Colorado Secretary of State Form Rev. 12/ Candidate Packet page 26

27 Schedule B Itemized Expenditures Statement (20 or more) [ (1)(a), C.R.S.] Full Name of Committee/Person: PLEASE PRINT/TYPE 1. Date Expended 2. Amount 3.Recipient is (optional): Committee Non-Committee 1. Date Expended 2. Amount 3.Recipient is (optional): Committee Non-Committee 1. Date Expended 2. Amount 3.Recipient is (optional): Committee Non-Committee 1. Date Expended 2. Amount 3.Recipient is (optional): Committee Non-Committee 1. Date Expended 2. Amount 3.Recipient is (optional): Committee Non-Committee 4. Name: 5. Address: 6. City/State/Zip: 7. Purpose of Expenditure: Check box if Electioneering Communication 4. Name: 5. Address: 6. City/State/Zip: 7. Purpose of Expenditure: Check box if Electioneering Communication 4. Name: 5. Address: 6. City/State/Zip: 7. Purpose of Expenditure: Check box if Electioneering Communication 4. Name: 5. Address: 6. City/State/Zip: 7. Purpose of Expenditure: Check box if Electioneering Communication 4. Name: 5. Address: 6. City/State/Zip: 7. Purpose of Expenditure: Check box if Electioneering Communication Colorado Secretary of State Form Rev. 12/ Candidate Packet page 27

28 Schedule C - Loans Full Name of Committee/Person: LOANS - Loans Owed by the Committee (Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.) [No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial purpose. [Art. XXVIII, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidate s candidate committee may receive a loan from a financial institution organized under state or federal law if the loan bears the usual and customary interest rate, is made on a basis that assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 3(8)] LOAN SOURCE Name (Last, First or Institution): Address: City/State/Zip: Original Amount of Loan: Interest Rate: Loan Amount Received This Reporting Period: Total of All Loans This Reporting Period: (Place on line 8 of Detailed Summary Report) Principal Amount Paid This Reporting Period: Interest Amount Paid This Reporting Period: Amount Repaid This Reporting Period: Total Repayments Made: (Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16 of Detailed Summary) Outstanding Balance: TERMS OF LOAN: Date Loan Received Due Date for Final Payment LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN Full Name Address, City, State, Zip Amount Guaranteed Colorado Secretary of State Form Rev. 12/ Candidate Packet page 28

29 Schedule D Returned Contributions & Expenditures Full Name of Committee/Person: Returned Contributions (Previously reported on Schedule A Contributions accepted and then returned to donors) PLEASE PRINT/TYPE 1. Date Accepted 2. Date Returned 3. Amount 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Purpose: 1. Date Accepted 2. Date Returned 3. Amount 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Purpose: Returned Expenditures (Previously reported on Schedule B Expenditures returned or refunded to the committee) PLEASE PRINT/TYPE 1. Date Expended 2. Date Returned 3. Amount 1. Date Expended 2. Date Returned 3. Amount 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Comment (Optional): 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Comment (Optional): Colorado Secretary of State Form Rev. 12/ Candidate Packet page 29

30 Statement of Non-Monetary Contributions [Art. XXVIII, Sec. 2(5)(a)(II)(III) & Sec. 5(3) & (1), C.R.S (1)] C.R.S.] Full Name of Committee/Person: PLEASE PRINT/TYPE 1. Date Provided 2. Fair Market Value 3. Aggregate Amt. Check box if Electioneering Communication 1. Date Provided 2. Fair Market Value 3. Aggregate Amt. Check box if Electioneering Communication 1. Date Provided 2. Fair Market Value 3. Aggregate Amt. Check box if Electioneering Communication 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. * 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. * 4. Name (Last, First): 5. Address: 6. City/State/Zip: 7. Description: 8. Employer (if applicable, mandatory): 9. Occupation (if applicable, mandatory): 10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. * * Note: If coordinated, then contribution must also be reported as a non-monetary expenditure on Detailed Summary. Art. XXVIII, Sec. 2(9) states: Expenditures that are controlled by or coordinated with a candidate or candidate s agent are deemed to be both contributions by the maker of the expenditures, and expenditures by the candidate committee. Colorado Secretary of State Form Rev. 12/ Candidate Packet page 30