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SEEC FORM 20

Itemized Campaign Finance Disclosure Statement


CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION Revised January 2012

Electronic Filing

Do Not Mark in This Space For Official Use Only

Page 1 of 19

COVER PAGE
1. NAME OF COMMITTEE
Ansonia Republican Town Committee

2. TREASURER NAME First


Linda

MI
A

Last
Vaccaro

Suffix

3. TREASURER ADDRESS Street Address


515 Beaver St

City
Ansonia

State
CT

Zip Code
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

Ending Date

07/01/2013

thru

09/30/2013

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

Linda Vaccaro

10/06/2013 10:59:03AM

SIGNATURE

PRINT NAME OF THE SIGNER

DATE CERTIFIED

PENALTY FOR FALSE STATEMENT IS PUNISHABLE BY FINE NOT TO EXCEED $1,000, OR IMPRISONMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.

Page 2 of 19

SEEC FORM 20
Itemized Campaign Finance Disclosure Statement CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2012

SUMMARY PAGE TOTALS


NAME OF COMMITTEE
Ansonia Republican Town Committee

TYPE OF REPORT
October 10 Filing - Original

COLUMN A
This Period 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 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) 16b. Per Public Act 11-48, effective January 1,2012 Section L2 removed 16c. Total Purchases of Advertising - Program Book or Sign (Section L3) Municipal and Town Committees Only 17. Total Monetary Receipts (add totals for lines 13 through 16c) 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) 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 Contributions Received (Section M) 23. Refundable Deposit to Telephone Company (Section N) 24. Receipts of Organization Expenditures (Section O) OPTIONAL 25. Beginning Loan Balance 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) 28. Expenses Incurred by Committee During this Period but Not Paid (Section S) 28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)
$6,110.00 $9,993.45 $5,446.94 $4,546.51 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3,883.45 $2,310.00 $0.00 $0.00 $3,800.00

COLUMN B
Aggregate
$3,423.45

$3,532.50 $0.00 $0.00 $3,800.00

$0.00

$7,332.50 $10,755.95 $6,209.44 $4,546.51 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00

$0.00 $0.00

Page 3 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

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


(See instructions for definition of Small Contributor) Subtotal Section A

$0.00

B. Itemized Contributions from Individuals


Last Name First Name MI

Fers
Residential Street Address City

Patricia
State Zip Code

J CT 06401

28 W Brookside Ave
Principal Occupation

Ansonia
Name of Employer

Paralegal Specialist II
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

State of CT- Dept. of Childrens and Families


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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

08/21/2013

$190.00

$150.00
MI

Last Name

First Name

VITARIUS WAUGH
Residential Street Address City

JANET
State Zip Code

83 Prospect St
Principal Occupation

Ansonia
Name of Employer

CT

06401

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

_ X

Yes No
_ X

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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
X

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

08/21/2013

$10.00

$10.00
MI

Last Name

First Name

PYNE
Residential Street Address City

WARNER
State Zip Code

162 Center St
Principal Occupation

Woodbridge
Name of Employer

CT

06525

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

_ X

Yes No
_ X

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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/01/2013

$25.00

$25.00

Page 4 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


B. Itemized Contributions from Individuals
Last Name First Name

MI

Reed
Residential Street Address City

Irving
State Zip Code

14 Highland Ave
Principal Occupation

Ansonia
Name of Employer

CT

06401

quality control manager


Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

Materials Testing
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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/02/2013

$500.00

$500.00
MI

Last Name

First Name

VACCARO
Residential Street Address City

RONALD
State Zip Code

515 Beaver St
Principal Occupation

Ansonia
Name of Employer

CT

06401

EDITIORIAL DIRECTOR
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

NBC UNIVERSAL SPORTS


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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/02/2013

$500.00

$500.00
MI

Last Name

First Name

Vaccaro
Residential Street Address City

Lorie
State Zip Code

515 Beaver St
Principal Occupation

Ansonia
Name of Employer

CT

96488

Retired
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

none
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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/03/2013

$550.00

$500.00

Page 5 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


B. Itemized Contributions from Individuals
Last Name First Name

MI

Stowe
Residential Street Address City

Charles
State Zip Code

W CT 06401

23 Granite Ter
Principal Occupation

Ansonia
Name of Employer

Excavating Contractor
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

Self Employed/Great Northern Excavating


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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/05/2013

$575.00

$525.00
MI

Last Name

First Name

Czeczot
Residential Street Address City

Joanne
State Zip Code

M CT 06401

37 Morningside Dr
Principal Occupation

Ansonia
Name of Employer

SR ADMIN ASSIST
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

YALE UNIVERSITY
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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/05/2013

$75.00

$75.00
MI

Last Name

First Name

Fers
Residential Street Address City

Patricia
State Zip Code

J CT 06401

28 W Brookside Ave
Principal Occupation

Ansonia
Name of Employer

Paralegal Specialist II
Is contributor a lobbyist, spouse, or dependent child of a lobbyist?
_ X

State of CT- Dept. of Childrens and Families


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? Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:
_ _ _

Yes No
_ X

Yes

No

Amount of Contribution

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_

Yes No

_ _

Yes

No

Executive

Legislative Aggregate Contributions

Date Received
_

Cash

Personal Check

Credit/Debit Card

Payroll Deduction

Money Order

09/05/2013

$215.00

$25.00 $2,310.00 $2,310.00

Total of Section B

TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS

(Sections A & B)

(Total on Line 14 of Summary Page)

Page 6 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


C1. Contributions from Other Committees
Name of Committee Name of Treasurer

Address

Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event #

Yes

No

Amount of Contribution

City

State

Zip Code

Date Received

Aggregate Contributions

Total of Section C1

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

C2. Reimbursements. Payments. or Surplus Distributions from other Committees


Name of Committee Name of Treasurer

Address

Date Received

Amount of Receipt

City

State

Zip Code

Reimbursement for shared expense Payment for goods and services Surplus Distribution

Total of Section C2

Page 7 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


D. Loans Received this Period
Name of Lender Source of Loan: Bank Street Address City Candidate

Date of Receipt Individual State Other Zip Code Is there a cosigner or Guarantor of this loan? Yes No

Name of Cosigner/Guarantor (if applicable)

Amount Received

Street Address

City

State

Zip Code

Total of Section D

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLY)
Name of Entity

Street Address

Date Received

Amount Received

City

State

Zip Code

Aggregate Contributions

Total of Section E

I. MONETARY RECEIPTS (Section A-I)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)
Date of Receipt Is this transaction associated with a fundraising event listed in Section L1? Amount

Yes

No

If yes, list Event #

Total of Section F

Page 8 of 19

I. MONETARY RECEIPTS (Section A-I)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)
Date of Receipt Amount

Total of Section G

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)
Date of Receipt Method of Payment Cash Personal Check Credit/Debit Card

Amount

Total of Section E

I. Monetary Receipts (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


J. Interest from Deposits in Authorized Accounts
Name of Institution

Date Received

Amount

Street Address

City

State

Zip Code

Total of Section J

Page 9 of 19

I. MONETARY RECEIPTS (Section A-K)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


K. Miscellaneous Monetary Receipts not Considered Contributions
Name

Date of Transaction

Amount Received

Street Address

City

State

Zip Code

Description

Total of Section K

Page 10 of 19

II. FUNDRAISING EVENT ACTIVITY (Sections L1 - L4)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


L1. Fundraiser Event Information
Fundraising Event #
Date of Fundraiser Letter

Description

08/24/2013
Location: Street Address

Sale Event
City State Zip Code

1 High Acres Rd
Subpart 1: (All Committees) Was this fundraising event hosted at a personal residence?
X _

Ansonia

CT

06401

Yes No

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information for puchases made by host(s) for food, beverage and invitations.)

Did this fundraiser include items donated by a business entity of up to $100 or items donated by an individual of up to $100?

_ X

Yes No

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information.)

Was this fundraiser a tag sale, auction, or other sale of donated items with puchases from an individual of up to $100?

X _

Yes No

(If yes, enter Total Receipts here.)

$1,090.00

Subpart 2: (Town Committees and Municipal Candidate Committees ONLY) 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? Fundraising Event #
Date of Fundraiser

_ X

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.)

_ X

Yes No

(If yes, enter Total Receipts here.)

$0.00

Letter

Description

09/22/2013
Location: Street Address

Fair Event
City State Zip Code

French Memorial Park


Subpart 1: (All Committees) Was this fundraising event hosted at a personal residence?
X _

Seymour

CT

06483

Yes No

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information for puchases made by host(s) for food, beverage and invitations.)

Did this fundraiser include items donated by a business entity of up to $100 or items donated by an individual of up to $100?

_ X

Yes No

(If yes, go to Section L 4 In-Kind Donations not Considered


Contributions and complete required information.)

Was this fundraiser a tag sale, auction, or other sale of donated items with puchases from an individual of up to $100?

_ X

Yes No

(If yes, enter Total Receipts here.)

$0.00

Subpart 2: (Town Committees and Municipal Candidate Committees ONLY) 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?

_ X

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.)

X _

Yes No

(If yes, enter Total Receipts here.)

$2,710.00

Total of Section L1

$3,800.00

Page 11 of 19

II. FUNDRAISING EVENT ACTIVITY (Sections L1 - L4)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

L3. Purchases of Advertising in a Program Book or on a Sign (Municipal Candidate and Town Committees ONLY)
Name of Purchaser Purchase Made By: Business Entity Sole Proprietorship Street Address City State Zip Code Individual

Date Received

Event #

Aggregate Purchases for All Events

Amount of Program Ad Purchase

Amount of Sign Purchase

Total of Section L3

II. FUNDRAISING EVENT ACTIVITY (Sections L1 - L4)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


L4. In-Kind Donations Not Considered Contributions
Name of the Donor

Street Address

City

State

Zip Code

Donation Given by: Business Entity Individual Sole Proprietorship

Description of Donation

Fair Market Value of Donation

Date Received

Event #

Aggregate value for this event

Total of Section L4

Page 12 of 19

III. NONMONETARY RECEIPTS (Sections M - O)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


M. In-Kind Contributions
Name

Street Address

City

State

Zip Code

Type of Contributor:

Committee Other Yes No

Date Received

Aggregate contributions

Description of In-Kind Contribution

Individual / Sole Proprietorship Is Contributor a lobbyist, spouse, or dependent child of a lobbyist?

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
Is contributor a principal of state contractor or prospective state contractor? If yes, indicate which branch or branches of government the contract is with:

Yes No

Fair Market Value of this Contribution

Is this contribution associated with a fundraising event listed in Section J1? If yes, list Event#

Yes No

Executive

Legislative

Total of Section M

III. Non Monetary Receipts (Sections M - O)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


N. Refundable Deposit to Telephone Company
Last Name of Individual

First Name

MI

Date Deposit Made

Residential Street Address

City

State

Zip Code

Amount of Deposit

Name of Telephone company

Street Address

City

State

Zip Code

Total of Section N

Page 13 of 19

III. NONMONETARY RECEIPTS (Sections M - O)


NAME OF COMMITTEE TYPE OF REPFORT
October 10 Filing - Original

Ansonia Republican Town Committee

O. Non-Monetary Receipts of Organization Expenditures Made By Legislative Leadership, Legislative Caucus, and Party Committee - OPTIONAL See Public Act 11-48
Name of Committee (Legislative Leadership, Legislative Caucus, and Party Committees ONLY) Name of Treasurer

Street Address

Date Notice Received

Fair Market Value of Donation

City

State

Zip Code

Aggregate Donations

Description of Donation

Purpose of Expenditure A B C D E

Total of Section O

Page 14 of 19

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


P. Expenses Paid By Committee
Name of Payee Date of Payment

Method of Payment
X _

ANSONIA CULTURAL COMMITTEE

09/01/2013

Check # Debit Card

129

Street Address

City

State

Zip Code

Main Street
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06401
Amount

FNDR *

ANSONIA HARVEST FESTIVAL

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$50.00

Name of Payee

Date of Payment

Method of Payment
X _

NAUGAUTIC VALLEY HEATLH DIST

09/16/2013

Check # Debit Card

130

Street Address

City

State

Zip Code

98 Bank St
Purpose of Expenditure (by code) Description

Seymour

CT
Event #

06483
Amount

FNDR *

FOOD LICENSE

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$72.00

Name of Payee

Date of Payment

Method of Payment
X _

BJ'S WHOLESALE

09/21/2013

Check # Debit Card

131

Street Address

City

State

Zip Code

DIVISION STREET
Purpose of Expenditure (by code) Description

Derby

CT
Event #

06418
Amount

FOOD

FOOD & BEVERAGE FOR PUMPKIN FESTIVAL

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$304.48

Name of Payee

Date of Payment

Method of Payment
X _

STOP & SHOP

09/22/2013

Check # Debit Card

132

Street Address

City

State

Zip Code

BANK STREET
Purpose of Expenditure (by code) Description

Seymour

CT
Event #

06483
Amount

FOOD

FOOD ROLLS AND NECESSARY ITEMS

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$28.88

Page 15 of 19

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


P. Expenses Paid By Committee
Name of Payee Date of Payment

Method of Payment
X _

KIRK PRODUCTS COMPANY INC

09/22/2013

Check # Debit Card

133

Street Address

City

State

Zip Code

1 Rimmon St
Purpose of Expenditure (by code) Description

Seymour

CT
Event #

06483
Amount

FNDR *

FIRE EXTINGUISHER

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$30.00

Name of Payee

Date of Payment

Method of Payment
X _

LORIE VACCARO

09/23/2013

Check # Debit Card

134

Street Address

City

State

Zip Code

515 Beaver St
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06401
Amount

FNDR *

FOOD FOR PUMPKIN FESTIVAL

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$390.59

Name of Payee

Date of Payment

Method of Payment
X _

GIANCARLO CEFALU

09/23/2013

Check # Debit Card

135

Street Address

City

State

Zip Code

EAGLE STREET
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06401
Amount

FNDR *

FOOD FOR PUMPKIN FESTIVAL

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$48.44

Name of Payee

Date of Payment

Method of Payment
X _

VINNIE SCARLATA

09/23/2013

Check # Debit Card

136

Street Address

City

State

Zip Code

BENZ STREET
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06401
Amount

FNDR *

SIGNS FOR PUMPKIN FESTIVAL

09222013P
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$25.52

Page 16 of 19

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


P. Expenses Paid By Committee
Name of Payee Date of Payment

Method of Payment
X _

THE HARTFORD INSURANCE COMPANY

09/25/2013

Check # Debit Card

137

Street Address

City

State

Zip Code

301 Woods Parks Dr


Purpose of Expenditure (by code) Description

Clinton

NY
Event #

13323
Amount

Misc *

HARTFORD INSURANCE POLICY

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

_ _

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$425.00

Name of Payee

Date of Payment

Method of Payment
X _

EVER READY PRESS

09/25/2013

Check # Debit Card

138

Street Address

City

State

Zip Code

78 Clifton Ave
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06401
Amount

A-SIGN

LAWN SIGNS AND PALM CARDS

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

_ _

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$4,020.03

Name of Payee

Date of Payment

Method of Payment
X _

NAUGATUCK VALLEY HEALTH

09/25/2013

Check # Debit Card

139

Street Address

City

State

Zip Code

98 Bank St
Purpose of Expenditure (by code) Description

Ansonia

CT
Event #

06483
Amount

Misc *

FOOD LICENSE FOR THE HARVEST FESTIVAL

09222013R
_ _

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum P Required


_

Coordinated with reimbursement sought


_

Coordinated without reimbursement sough

Independent

Organization

$52.00 $5,446.94

Total of Section P

Page 17 of 19

IV. EXPENDITURES (Sections P - T)


NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Q. Campaign Expenses Paid By Candidate


Name of Payee (Name of vendor who candidate paid directly) Date of Payment Is Reimbursement Claimed? Yes Street Address City State Zip Code No

Purpose of Expenditure (by code)

Description

Event #

Amount

Total of Section Q

IV. EXPENDITURES
NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


R. Expenses Incurred on Committee Credit Card
Name of Issuing Institution Type of Credit Card: Visa Other Name of Vendor Master Card

Discover

American Express

Date of Transaction

Street Address

City

State

Zip Code

Purpose of Expenditure (by code)

Description

Event #

Amount

Expenditure # (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum R Required Coordinated without reimbursement sough Independent

Coordinated with reimbursement sought Organization A B C D E

Total of Section R

Page 18 of 19

IV. EXPENDITURES
NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee


S. Expenses Incurred By Committee but Not Paid During this Period
Name of Creditor

Date Incurred

Street Address

City

State

Zip Code

Purpose of Expenditure (by code)

Description

Event #

Amount Incurred (Estimate or Actual)

Expenditure# (if applicable)

Type of Expenditure (if applicable) Itemization in Addendum S Required Coordinated without reimbursement sough Independent Organization :

Coordinated with reimbursement sought A B C D E

Total of Section S

IV. EXPENDITURES
NAME OF COMMITTEE TYPE OF REPORT
October 10 Filing - Original

Ansonia Republican Town Committee

T. Itemization of Reimbursements to Committee Workers and Consultants


Last Name of Worker/Consultant First MI Date of Payment Method of Payment Check # Debit Card Secondary Payee

Street Address

City

State

Zip Code

Purpose of Expenditure (by code)

Description

Event #

Amount

Expenditure #

Type of Expenditure (if applicable) Itemization in Addendem T Required Coordinated without reimbursement sough Independent

Coordinated with reimbursement sought Organization: A B C D E

Total of Section T

Page 19 of 19

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