Ansonia Republican Town Committee 2011 Campaign Finance

SEEC FORM 20
Itemized Campaign Finance Disclosure Statement CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Rev. 1/08
Electronic Filing
Office Use Only
Page 1 of 40
SUMMARY PAGE
1. NAME OF COMMITTEE
Ansonia Republican Town Committee
2. TREASURER NAME Title First

Jennifer
MI
Last
Jones
Suffix
3. TREASURER ADDRESS Street Address

145 Platt St
City
Ansonia
State
CT
Zip Code
06401
4. ELECTION DATE
5. OFFICE SOUGHT (if applicable)
6. DISTRICT CODE (if applicable)
7. CANDIDATE NAME Title First MI Last Suffix
8. TYPE OF REPORT
October 10 Filing - Original
9. PERIOD COVERED
Beginning Date
Ending Date
07/01/2011
thru
09/30/2011
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
Jennifer Jones
10/04/2011
4:02:53 pm
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 40
SEEC FORM 20
Itemized Campaign Finance Disclosure Statement CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Rev. 1/08
SUMMARY PAGE
TOTALS
NAME OF COMMITTEE
FILING DUE DATE
Original 10/11/2011
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 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 + C2) 15. Other Monetary Receipts (Section D-K) 16a. Total Small Food and Beverage Receipts at Fair (Section L1) 16b. Total Proceeds from Small purchases at Tag Sales, Auctions or Other Sales (Section L2) 16c. Total Purchases of Advertising in a Program Book (Section L3) 17. Total Monetary Receipts (add totals for lines 13-16c) 18. Subtotals (add totals in line 12 + line 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) 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) 25. Beginning Loan Balance 25a. + Loans Received (Section D) 25b. + Interest and Penalties on Loan(s) 25c. - Payments on Loan(s) 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)
$4,053.53 $1,438.00 $0.00 $0.00 $2,098.00 $0.00 $0.00 $3,536.00 $7,589.53 $2,238.94 $5,350.59 $0.00 $929.53 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
COLUMN B
Aggregate
$3,115.90
$3,538.00 $0.00 $0.00 $2,098.00 $0.00 $0.00 $5,636.00 $8,751.90 $3,401.31 $5,350.59 $0.00 $929.53 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Page 3 of 40
I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE FILING DUE DATE
Original 10/11/2011
A. Total Contributions from Small Contributors-Received this Period ONLY

(See instructions for definition of Small Contributor) Subtotal Section
$0.00
B. Itemized Contributions from Individuals

Last Name First Name MI Name of Employer
Marini
John
Tinley, Nastri, Renehan & Dost, LLP
Amount of Contribution
Residential Street Address
City
State
Zip Code
Principal Occupation
6 S Cliff St
Ansonia
CT
06401
Lawyer
Is contributor a lobbyist, spouse, or dependent child of a lobbyist? Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
X
_ 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? 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
X
Yes
No
Executive
Legislative Aggregate Contribution
Date Received Personal Check

_
Cash
Credit/Debit Card
Payroll Deduction MI
Money Order
07/07/2011
$128.00
$8.00
Last Name
First Name
Name of Employer
Stowe
Charles
Self Employed/Great Northern Excavating
City
State
Zip Code
23 Granite Ter
Ansonia
CT
06401
Excavating Contractor
Is contributor a lobbyist, spouse, or dependent child of a lobbyist? Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # 07312011a Method of Contribution
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/14/2011
$425.00
$25.00
Last Name
First Name
Name of Employer
Radin
Joan
Lear Pharmacey
City
State
Zip Code
198 Wakelee Ave
Ansonia
CT
06401
Pharmacist
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
07/14/2011
$300.00
$75.00
Page 4 of 40


Original 10/11/2011
Pyne
Warner
Philips Healthcare Informatics
City
State
Zip Code
162 Center Rd
Woodbridge
CT
06525
Sales Manager
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/21/2011
$25.00
$25.00
Last Name
First Name
Name of Employer
Tripp
Philip
Home Depot
City
State
Zip Code
27 Eagle St
Ansonia
CT
06401
Sales
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/24/2011
$25.00
$25.00
Last Name
First Name
Name of Employer
Cassetti
David
Birmingham Management
City
State
Zip Code
3 High Acres Rd
Ansonia
CT
06401-2951
Owner
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
07/26/2011
$485.00
$60.00
Page 5 of 40


Original 10/11/2011
Nimons
William
Naugatuck Valley Savings and Loan
City
State
Zip Code
85 Pulaski Hwy
Ansonia
CT
06401
Vice President
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/28/2011
$250.00
$250.00
Last Name
First Name
Name of Employer
Reed
Irving
Materials Testing Inc.
City
State
Zip Code
14 Highland Ave
Ansonia
CT
06401-2518
Quality Control Manager
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/28/2011
$135.00
$30.00
Last Name
First Name
Name of Employer
Marini
John
City
State
Zip Code
11 Hawley Dr
Ansonia
CT
06401
Lawyer
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
07/30/2011
$168.00
$40.00
Page 6 of 40


Original 10/11/2011
Henri
Cheryl
Sinclair Insurance Group Inc.
City
State
Zip Code
16 Harris Rd
Ansonia
CT
06401
Commercial Account Executive
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/31/2011
$25.00
$25.00
Last Name
First Name
Name of Employer
Carroll
Randolph
Unknown
City
State
Zip Code
40 Fourth St # 10
Ansonia
CT
06401
Unknown
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/31/2011
$55.00
$15.00
Last Name
First Name
Name of Employer
Norman
Edward
Qwest Communications Inc..
City
State
Zip Code
51 Grove St
Ansonia
CT
06401
Sr Sales Engineer
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
07/31/2011
$15.00
$15.00
Page 7 of 40


Original 10/11/2011
Fers
Patricia
State of CT- Dept. of Childrens and Families
City
State
Zip Code
28 W Brookside Ave
Ansonia
CT
06401
Paralegal Specialist II
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
07/31/2011
$150.00
$20.00
Last Name
First Name
Name of Employer
Valentine
Nancy
Yules and Yules LLC
City
State
Zip Code
18 Farrel Dr
Ansonia
CT
06401
Legal Assistant
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
08/04/2011
$200.00
$100.00
Last Name
First Name
Name of Employer
Stowe
Charles
Self Employed/Great Northern Excavating
City
State
Zip Code
23 Granite Ter
Ansonia
CT
06401
Excavating Contractor
Is contributor a lobbyist, spouse, or dependent child of a lobbyist? Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_
_ X
Yes No
_ X
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
09/01/2011
$485.00
$60.00
Page 8 of 40


Original 10/11/2011
Valentine
Nancy
Yules and Yules LLC
Amount of Contribution Principal Occupation
City
State
Zip Code
18 Farrel Dr
Ansonia
CT
06401
Legal Assistant
Is contributor a lobbyist, spouse, or dependent child of a lobbyist? Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # 09292011A Method of Contribution
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$380.00
$180.00
Last Name
First Name
Name of Employer
Reed
Irving
Materials Testing Inc.
City
State
Zip Code
14 Highland Ave
Ansonia
CT
06401-2518
Quality Control Manager
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$235.00
$100.00
Last Name
First Name
Name of Employer
Stowe
Deirdre
Yale
City
State
Zip Code
23 Granite Ter
Ansonia
CT
06401
Business analyst
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
09/29/2011
$60.00
$60.00
Page 9 of 40


Original 10/11/2011
Fers
Patricia
State of CT- Dept. of Childrens and Families
City
State
Zip Code
28 W Brookside Ave
Ansonia
CT
06401
Paralegal Specialist II
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$175.00
$25.00
Last Name
First Name
Name of Employer
Bruchal
Richard
Retired
City
State
Zip Code
13 Murray St
Ansonia
CT
06401
Retired
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$20.00
$20.00
Last Name
First Name
Name of Employer
Radin
Joan
Lear Pharmacey
City
State
Zip Code
198 Wakelee Ave
Ansonia
CT
06401
Pharmacist
_
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
09/29/2011
$458.88
$40.00
Page 10 of 40


Original 10/11/2011
Cassetti
David
Birmingham Management
City
State
Zip Code
3 High Acres Rd
Ansonia
CT
06401-2951
Owner
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$585.00
$100.00
Last Name
First Name
Name of Employer
Tripp
Philip
Home Depot
City
State
Zip Code
27 Eagle St
Ansonia
CT
06401
Sales
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$85.00
$60.00
Last Name
First Name
Name of Employer
Scarlata
Vincent
Self-Employed
City
State
Zip Code
199 Pulaski Hwy
Ansonia
CT
06401
Cabinet Maker
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
09/29/2011
$40.00
$40.00
Page 11 of 40


Original 10/11/2011
Carroll
Randolph
Retired
City
State
Zip Code
40 Fourth St # 10
Ansonia
CT
06401
Retired
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Money Order
09/29/2011
$75.00
$20.00
Last Name
First Name
Name of Employer
Marini
John
City
State
Zip Code
11 Hawley Dr
Ansonia
CT
06401
Lawyer
X
_ X
Yes No
X _
_ _ _
_ _
Yes No
X
Yes
No
Executive

_
Cash
Credit/Debit Card
Payroll Deduction
Money Order
09/29/2011
$188.00
$20.00 $1,438.00 $1,438.00
Total of Section B
TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS
(Sections A & B)
(Total on Line 14 of Summary Page)
Page 12 of 40
I. MONETARY RECEIPTS (Section A-I)


C1. Contributions from Other Committees
Name of Committee Name of Treasurer
Original 10/11/2011
Address
Is this contribution associated with a fundraising event listed in Section L1? State Zip Code Date Received
Yes No
If yes, list Event #
City
Aggregate Contributions
Total of Section C1
Page 13 of 40


C2. Reimbursements. Payments. or Surplus Distributions from other Committees
Original 10/11/2011
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 14 of 40


D. Loans Received this Period
Name of Lender
Original 10/11/2011
Source of Loan: Bank
Street Address
City
State
Zip Code
Is there a cosigner or Guarantor of this loan? Yes
Amount Received
Candidate Individual
Name of Cosigner/Guarantor
Other Committee
No
Street Address
City
State
Zip Code
Date Received
Total of Section D
Page 15 of 40


E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLY)
Name
Original 10/11/2011
Street Address
Date Received
Amount Received
City
State
Zip Code
Aggregate Contributions
Total of Section E
Page 16 of 40

Original 10/11/2011
F. Amount Transferred from Affiliated Business Treasury (Business Entity Committees ONLY)
Is this transaction associated with a fundraising event listed in Section L1? Yes No If yes, list Event # Date of Receipt Amount
Total of Section F
Page 17 of 40

Original 10/11/2011
G. Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Organization Committees ONLY)
Date of Receipt Amount
Total of Section G
Page 18 of 40


H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY)
Date Received Amount Method of Payment Cash Personal Check
Original 10/11/2011
Credit/Debit Card
Total of Section H
Page 19 of 40


I. Anonymous Contributions
Date Received $ 1 bills $ 5 bills $ 10 bill coins
Original 10/11/2011
Amount
Total of Section I
Page 20 of 40
I. Monetary Receipts (Section A-I)


J. Interest from Deposits in Authorized Accounts
Name of Institution Date Received
Original 10/11/2011
Amount Received
Street Address
City
State
Zip Code
Total of Section J
Page 21 of 40


K. Miscellaneous Monetary Receipts not Considered Contributions
Name Date of Transaction
Original 10/11/2011
Amount Received
Street Address
City
State
Zip Code
Description
Total of Section K
Page 22 of 40
II. FUNDRAISING EVENT ACTIVITY


L1. Fundraiser Event Information
Location: Street Address City
Original 10/11/2011
Fundraising Event #
Date of Fundraiser Letter
Description
State
Zip Code
07/31/2011
Picnic Event
18 Farrell Dr
Ansonia
X _
CT
06401
Subpart 1: (All Committees) Was this fundraising event hosted at a personal residence? Did this fundraiser include items donated by a business entity of up to $100 or items donated by an individual of up to $50? Was this fundraiser a tag sale, auction, or other sale of donated items? Subpart 2: (Town Committees and Municipal Candidate Committees ONLY) Were there purchases of advertising space in a program book associated with this is fundraiser? Subpart 3: (Town Committees ONLY) Did your committee sell food or beverage at a fair or similar mass gathering held within the state?
_
Yes
No
If yes, go to Section L 4 If yes, go to Section L 4
Yes
No
Yes
No
If yes, go to Section L 2
Yes
No
If yes, go to Section L 3 If yes, enter Total Receipts

from small purchases
$0.00
Yes
No
Fundraising Event #
Description
Location: Street Address
City
State
Zip Code
09/18/2011
Fair Event
French Memorial Park
Seymour
_ X
CT
06483
X
Yes
No
Yes
No
Yes
No
Yes
No

from small purchases
$2,098.00
Yes
No
Fundraising Event #
Description
Location: Street Address
City
State
Zip Code
09/29/2011
Dinner Event
70 Main St
Ansonia
_ X
CT
06401
_
Yes
No
Yes
No
Yes
No
Yes
No

from small purchases Total of Section L1
$2,098.00 $0.00
Yes
No
Page 23 of 40


L2. Proceeds from Tag Sale, Auction, or Other Sale of Donated Items
Original 10/11/2011
Name of the Purchaser Last Name
(Individuals ONLY)
First Name
MI
Method of payment: Cash Personal Check Date Received Credit/Debit Card Event #
Aggregate Amount of Purchases
City
State
Zip Code
Items Purchased
Total of Section L2
Page 24 of 40


L3. Purchases of Advertising in a Program Book (Municipal Candidate and Town Committees ONLY)
for All Events
Original 10/11/2011
Name of Purchaser
Business Entity Yes No State
Event #
Date Received
Amount of Purchase
Street Address
City
Zip Code
Aggregate Purchases for All Events
Total of Section L3
Page 25 of 40


L4. In-Kind Donations Not Considered Contributions
Original 10/11/2011
Name of the Donor
Donation given by: Individual Business Entity
Fair Market Value of Donation
Street Address
City
State
Zip Code
Aggregate value for this event
Description of Donation
Date Received
Event #
Total of Section L4
Page 26 of 40
III. NONMONETARY RECEIPTS


M. In-Kind Contributions
Original 10/11/2011
Name
Type of Contributor:
x
Cassetti David
Street Address City
Individual Committee Other
Fair Market Value of this Contribution
3 High Acres Rd
Ansonia
State
Zip Code
CT
06401
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
_ x
_ _
Yes No Yes No Date Received
Is Contributor a lobbyist, spouse, or dependent child of a lobbyist?
Yes No
Is contributor a principal of state contractor or prospective state contractor?
_ x
07/14/2011
Aggregate contributions
Is this contribution associated with a fundraising event listed in Section J1?
Description of In-Kind Contribution

X _
Yes No
60 pre-printed tickets for fundraiser $15.00 $15.00
If yes, list Event#
07312011a
Name
x
Valentine Nancy
Street Address City
18 Farrel Dr
Ansonia
State
Zip Code
CT
06401
_ x
_ _
Yes No
_ x
07/31/2011

X _
Yes No
use of home for picnic fundraiser $100.00 $25.00
If yes, list Event#
07312011a
Page 27 of 40


Original 10/11/2011
Name
x
Radin P Joan
Street Address City
198 Wakelee Ave
Ansonia
State
Zip Code
CT
06401
_ x
_ _
Yes No
_ x
07/31/2011

X _
Yes No
food and beverages for picnic fundraiser $349.29 $49.29
If yes, list Event#
07312011a
Name
x
Valentine Nancy
Street Address City
18 Farrel Dr
Ansonia
State
Zip Code
CT
06401
_ x
_ _
Yes No
_ x
07/31/2011

X _
Yes No
If yes, list Event#
07312011a
plates, napkins, condiments and plasticware
$100.00
$10.00
Page 28 of 40


Original 10/11/2011
Name
x
Radin Kathy
Street Address City
214 Roosevelt Dr
Seymour
State
Zip Code
CT
06483
_ x
_ _
Yes No
_ x
09/18/2011

X _
Yes No
Hamburgers, buns and onions $706.29 $637.89
If yes, list Event#
09182011A
Name
x
Radin P Joan
Street Address City
198 Wakelee Ave
Ansonia
State
Zip Code
CT
06401
_ x
_ _
Yes No
_ x
09/18/2011

X _
Yes No
ice for coolers $418.88 $39.59
If yes, list Event#
09182011A
Page 29 of 40


Original 10/11/2011
Name
x
Radin P Joan
Street Address City
198 Wakelee Ave
Ansonia
State
Zip Code
CT
06401
_ x
_ _
Yes No
_ x
09/18/2011

X _
Yes No
fire extinguisher rental $418.88 $30.00
If yes, list Event#
09182011A
Name
x
Radin Kathy
Street Address City
214 Roosevelt Dr
Seymour
State
Zip Code
CT
06483
_ x
_ _
Yes No
_ x
09/18/2011

X _
Yes No
bottled water $706.29 $68.40
If yes, list Event#
09182011A
Page 30 of 40


Original 10/11/2011
Name
x
Diotalev Gene
Street Address City
51 D Wedgewood Rd
Stratford
State
Zip Code
CT
06614
_ x
_ _
Yes No
_ x
09/18/2011

X _
Yes No
cheese for burgers $54.36 $54.36
If yes, list Event#
09182011A
Total of Section M
$929.53
Page 31 of 40


N. Refundable Deposit to Telephone Company
Original 10/11/2011
Last Name (Individuals Only)
First Name
MI
Date Received
Amount of Deposit
City
State
Zip Code
Name of Telephone company
Street Address
City
State
Zip Code
Total of Section N
Page 32 of 40


O. Non-Monetary Receipts of Organization Expenditures Made By Legislative Leadership, Legislative Caucus, and Party Committee
Original 10/11/2011
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 33 of 40
IV. EXPENDITURES

P. Expenses Paid By Committee
Name of Payee Date of Payment Method of Payment
X Check # 0001
Original 10/11/2011
Amount
Ansonia Rotary: Harvest Festival Committee

Street Address City
07/08/2011
State Zip Code Purpose of Expenditure (by code)
PO Box 575
Description
Ansonia
CT
06401
Misc *
Debit Card Event #
Booth Fee for the Harvest Festival

_ _
Type of Expenditure (if applicable)

_ _ _ _ _
Candidate(s) Name (if applicable)
Office Sought
Supported Opposed
Coordinated with reimbursement sought Coordinated without reimbursement sought Independent Organization (see Instructions) A
_
E Date of Payment Method of Payment

X Check # 0002
$50.00
Name of Payee
Amount
Seymour Pumpkin Festival

Street Address City
07/14/2011
PO Box 860
Description
Seymour
CT
06483
FNDR
Debit Card Event #
Booth Fee for the Seymour Pumpkin Festival on 9.18.11

_ _
09182011A
Candidate(s) Name (if applicable) Office Sought Supported Opposed

_ _ _ _ _
_

X Check # 0003
$175.00
Name of Payee
Amount
American Heart Association

Street Address City
07/27/2011
PO Box 417005
Description
Boston
MA
02241
CHAR
Debit Card Event #
Charitable donation in memory of a member's father

_ _

_ _ _ _ _
Office Sought
Supported Opposed
_
$50.00
Page 34 of 40
IV. EXPENDITURES

X Check # 0004
Original 10/11/2011
Amount
Naugatuck Valley Health District

Street Address City
08/04/2011
98 Bank St
Description
Seymour
CT
06483
FNDR
Debit Card Event #
Temporary food permit fee for Seymour Pumpkin Festival Booth

_ _
09182011A
Office Sought Supported Opposed

_ _ _ _ _
_

X Check # 0005
$50.00
Name of Payee
Amount
Nancy Valentine
Street Address City
08/05/2011
18 Farrel Dr
Description
Ansonia
CT
06401
RCW
Debit Card Event #
Reimbursement for food and ice for picnic fundraiser on 7.31.11

_ _
07312011a
Office Sought Supported Opposed

_ _ _ _ _
_

X Check # electronic
$62.09
Name of Payee
Amount
The Hartford
Street Address City
09/01/2011
Hartford Plaza
Description
Hartford
CT
06115
OVHD
Debit Card Event #
Yealry insurance premium

_ _

_ _ _ _ _
Office Sought
Supported Opposed
_
$425.00
Page 35 of 40
IV. EXPENDITURES

X Check # 0006
Original 10/11/2011
Amount
Ansonia Commons, LLC

Street Address City
09/01/2011
14 Davis Rd
Description
Woodbridge
CT
06525
OVHD
Debit Card Event #
cost of having a Republican Headquarters for three months

_ _

_ _ _ _ _
Office Sought
Supported Opposed
_

X Check # 0007
$1,000.00
Name of Payee
Amount
Ansonia Rotary/ Harvest Festival

Street Address City
09/12/2011
PO Box 575
Description
Ansonia
CT
06401
A-OTH
Debit Card Event #
Having a booth at the Harvest Festival- not a fundraiser

_ _

_ _ _ _ _
Office Sought
Supported Opposed
_

X Check # 0010
$50.00
Name of Payee
Amount
Massimino's Pizzeria
Street Address City
09/29/2011
70 Main St
Description
Ansonia
CT
06401
FOOD
Debit Card Event #
Pizza and soda for fundraising event

_ _
09292011A

_ _ _ _ _
_
$264.50
Page 36 of 40
IV. EXPENDITURES

X Check # 0008
Original 10/11/2011
Amount
Joan Radin
Street Address City
09/30/2011
198 Wakelee Ave

Description
Ansonia
CT
06401
FNDR
Debit Card Event #
Soda for Pumpkin Festival

_ _
09182011A

_ _ _ _ _
_

X Check # 0009
$64.58
Name of Payee
Amount
Kathy Radin
Street Address City
09/30/2011
214 Roosevelt Dr
Description
Seymour
CT
06483
FNDR
Debit Card Event #
Decorations for the booth

_ _
09182011A

_ _ _ _ _
_
$47.77
Total of Section P
$2,238.94
Page 37 of 40
IV. EXPENDITURES

Q. Campaign Expenses Paid By Candidate
Name of Payee (Name of Vendor who candidate paid directly) Date of Payment Purpose of Expenditure (by code)
Original 10/11/2011
Is Reimbursement Claimed? Yes No
Amount
Street Address
City
State
Zip Code
Event #
Description
Total of Section Q
Page 38 of 40
IV. EXPENDITURES

R. Expenses Incurred on Committee Credit Card
Name of Issuing Institution Type of Credit Card: Visa Other Name of Vendor Purpose of Expenditure (by code) Date of Transaction Master Card Discover
Original 10/11/2011
American Express
Amount
Street Address
City
State
Zip Code
Event #
Description
Total of Section R
Page 39 of 40
IV. EXPENDITURES

S. Expenses Incurred By Committee but Not Paid During this Period
Name of Creditor Event # Date Incurred
Original 10/11/2011
Amount Incurred (Estimate or Actual)
Street Address
City
State
Zip Code
Purpose of Expenditure (by code)
Description
Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent Organization (see Instructions) A B C D E
Office Sought
Supported Opposed
Total of Section S
Page 40 of 40
IV. EXPENDITURES

T. Itemization of Reimbursements to Committee Workers and Consultants
Name of Worker/Consultant Date of Payment
Original 10/11/2011
Method of Payment Check #
Amount
Secondary Payee
Purpose of Expenditure Debit Card
Street Address
City
State
Zip Code
Description
Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent Organization (see Instructions) A B C D E
Other Candidate(s) Name
Office Sought
Supported Opposed
Total of Section T

Ansonia Republican Town Committee 2011 Campaign Finance

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Ansonia Republican Town Committee 2011 Campaign Finance

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SEEC FORM 20

2. TREASURER NAME Title First

3. TREASURER ADDRESS Street Address

5. OFFICE SOUGHT (if applicable)

6. DISTRICT CODE (if applicable)

7. CANDIDATE NAME Title First MI Last Suffix

PRINT NAME OF THE SIGNER

FILING DUE DATE

I. MONETARY RECEIPTS (Section A-K)