REPORT OF CONTRIBUTIONS AND EXPENDITURES
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1 City Clerk's Office Lakewood Civic Center 480 S Allison Parkway Lakewood, CO Phone: Fax: TDD: REPORT OF CONTRIBUTIONS AND EXPENDITURES Full Name of Committee Address of Committee City, State & Zip Code Committee Type Bill Furman 4 Lakewood 814 S. Lewis St Lakewood, CO Candidate Committee Name and Address of First Bank Financial Institution th St, Denver, CO Type of Report Regularly Scheduled Filing Amended Filing This amends previous report filed on (date) Submit changes or new information ONLY Sept 5th, 2017 Termination Report (Termination Reports MUST have a monetary balance of zero in Line E) Report Period Covered from August 2, 2017 through August 30, 2017 Page 1
2 Full Name of Committee Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) TOTAL CONTRIBUTIONS 1, (total amount is calculated based on the entries below) Amount Name Address City/State/Zip Employer 1 8/26/ Laurie Mayer 12 S. Lexington Ave 504 Ashville, NC None Retired n 2 8/26/ Roman Mayer 12 S. Lexington Ave 504 Ashville, NC None Retired n 3 8/27/ Gillian Nevers 2022 Jefferson St Madison, WI None Retired n 4 8/27/ Nicole Mayer 814 S. Lewis St Lakewood, CO None n/a n 5 8/27/17 1, Bill Furman 814 S. Lewis St Lakewood, CO Jacobs Architect n Page 1
3 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 2
4 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 3
5 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 4
6 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 5
7 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 6
8 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 7
9 ITEMIZED CONTRIBUTIONS STATEMENT (more than 20.00) Amount Name Address City/State/Zip Employer Page 8
10 STATEMENT OF NONMONETARY CONTRIBUTIONS Full Name of Committee Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 TOTAL CONTRIBUTIONS (total value is calculated based on the entries below) Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) Page 1
11 STATEMENT OF NONMONETARY CONTRIBUTIONS Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) Page 2
12 STATEMENT OF NONMONETARY CONTRIBUTIONS Fair Market Value Name Address City/State/Zip Description Employer (if applicable, mandatory) (if applicable, mandatory) Page 3
13 Full Name of Committee Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 ITEMIZED EXPENDITURES STATEMENT (more than 20.00) TOTAL EXPENDITURES 1, (total amount is calculated based on the entries below) of Expense Amount Name Address City/State/Zip Purpose of Expenditure 1 7/25/ Wix.com 235 West 23rd St, 8th Floor New York, New York, Web Site n 2 7/25/ Wix.com 235 West 23rd St, 8th Floor New York, New York, Domain Registration n 3 7/25/ Wix.com 235 West 23rd St, 8th Floor New York, New York, n 4 8/16/ Customink 2910 District Avenue Fairfax, VA, Tshirts n 5 8/26/ Ram Run W Green Mountain Dr Lakewood, CO Race Entries n 6 8/22/ Club Flyer 2300 NW 7th Ave Miami, FL Flyers/mailers n 7 8/26/ Fed Ex Kinkos 105 Wadsworth Blvd A Lakewood, CO Flyers/mailers n 8 8/30/ Fed Ex Kinkos 105 Wadsworth Blvd A Lakewood, CO Flyers/mailers n 9 8/30/ Cheap Signs 9200 Waterford Center Blvd Austin, TX Yard Signs n Page 1
14 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 2
15 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 3
16 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 4
17 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 5
18 of Expense ITEMIZED EXPENDITURES STATEMENT (more than 20.00) Amount Name Address City/State/Zip Purpose of Expenditure Page 6
19 Full Name of Committee LOANS Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 TOTAL OUTSTANDING LOANS 1, (total amount is calculated based on the entries below) LOAN SOURCE Name Address City/State/Zip Loan amount at the beginning of the reporting period Amount received this reporting period LOAN AMOUNT Amount repaid this reporting period Loan balance at the end of the reporting period Bill Furman 814 S. Lewis St Lakewood/CO/ , , Page 1
20 CANDIDATE COMMITTEE FUNDS TRANSFER FORM This form is used by candidate committees established by the same committee for a different public office intending to transfer existing funds from an existing committee as defined by the Lakewood Municipal Code. Full Name of Committee Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER FROM Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer TRANSFER TO Full Name of Committee Address (physical) Mailing Address (if different from physical) Phone Num Fax Num Address Total Amount of Transfer Page 1
21 DETAILED SUMMARY Full Name of Committee Bill Furman 4 Lakewood Reporting Period 08/02/2017 through 08/30/2017 Loans Outstanding Balance, 1, Funds on hand at the beginning of reporting period (Includes Candidate Contribution Funds Transferred) 1 Itemized Contributions more than , Total Monetary Contributions 3 1, (Total of lines 1 & 2) 4 5 Itemized Expenditures more than , Total Expenditures 7 1, (Total of lines 7 & 8) A Total of NonItemized Contributions (Contributions of or less) Total NonMonetary Contributions Total of NonItemized Expenditures (Expenditures of or less) Funds on Hand at the Beginning of Reporting Period (Includes Committee Funds Transferred) TOTALS DETAILED SUMMARY B Total Monetary Contributions (line 3) 1, C Total Contributions & Beginning Amount (line A + line B) 1, D Total Expenditures (line 7) 1, E Funds on Hand at the End of Reporting Period (line C line D) Print Registered Agent's Name OR Print Candidate's Name William Furman William Furman I understand that campaign finance activities are governed by Chapter 2.54 Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and the Lakewood City Clerk Rules and Regulations regarding campaign finance. I further certify that I have read and understand the provisions of Chapter 2.54 Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and the Lakewood City Clerk Rules and Regulations regarding campaign finance. The City Clerk shall impose a penalty for each day a report is filed late per Chapter (C) Campaign and Political Finance in Municipal Elections of the Lakewood Municipal Code and Rule 13 of the City Clerk Rules and Regulations. By submitting this form, you are signing this Contributions and Expenditures electronically and certifying the above information to be true and correct, to the best of your knowledge. Page 1
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