Notice Of Independent Expenditure In Excess Of One Thousand Dollars - Colorado Secretary Of State

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Colorado Secretary of State
1560 Broadway, Suite 200
Denver, CO 80202
(303) 894-2680
(303) 894-7732 Fax
NOTICE OF INDEPENDENT EXPENDITURE IN EXCESS OF ONE THOUSAND DOLLARS
($1000.00)
[CRS 1-45-107(1)]
This report is due within 24 hours after obligating funds for such expenditure. Each independent expenditure shall require the delivery
of a new notice CRS 1-45-107(1). This notice shall be delivered to all candidates affected.
Name of Person Responsible for Independent Expenditure (Please type or print legibly)
Full Address of Person Responsible for Independent Expenditure
Was this notice delivered to all candidates in the affected race?
________Yes _________No
Please print the name of the candidate the independent expenditure is intended to support or oppose.
Was independent expenditure used to: Support __________ Oppose _________
Name and Address of Vendor/Person Receiving Payment:
__________________________________________________________________________________________
__________________________________________________________________________________________
Detailed Description of the Independent Expenditure:
__________________________________________________________________________________________
__________________________________________________________________________________________
Date Funds Were Obligated: ___________________ Amount of Expenditure: $_________________________
I, ______________________________________, certify that I have examined this Notice of Independent
Expenditure and to the best of my knowledge and belief it is true and correct.
__________________________________________________________________________________________
Printed Name of Disclosing Individual
Signature of Disclosing Individual
Date
Colorado Secretary of State Form Rev: May 2000

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