Ansonia DTC October 2013 Filing

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 35
COVER PAGE
1. NAME OF COMMITTEE
Ansonia Democratic Town Committee
2. TREASURER NAME First

James
MI
D.
Last
Hubbard
Suffix
3. TREASURER ADDRESS Street Address

10 Harris Rd
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
James Hubbard
10/03/2013
2:51:46PM
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 35
SEEC FORM 20
Itemized Campaign Finance Disclosure Statement CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION
Revised January 2012
SUMMARY PAGE TOTALS

NAME OF COMMITTEE
TYPE OF REPORT
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)
$4,440.80 $10,252.02 $5,645.08 $4,606.94 $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 $5,811.22 $4,440.80 $0.00 $0.00 $0.00
COLUMN B
Aggregate
$5,725.45
$4,941.80 $0.00 $25.77 $0.00
$0.00
$4,967.57 $10,693.02 $6,086.08 $4,606.94 $0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$0.00 $0.00
Page 3 of 35
I. MONETARY RECEIPTS (Section A-K)

NAME OF COMMITTEE TYPE OF REPORT
A. Total Contributions from Small Contributors-Received this Period ONLY

(See instructions for definition of Small Contributor) Subtotal Section A
$304.00
B. Itemized Contributions from Individuals

Last Name First Name MI
Pepe
Residential Street Address City
Fran
State Zip Code
165 O Neil Ct
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 # 09162013a Method of Contribution
X
Yes No
_ _
Yes
No
Executive
Legislative Aggregate Contributions
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/05/2013
$100.00
$100.00
MI
Last Name
First Name
Camilleri
Florence
State Zip Code
163 O'Neils Ct
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/05/2013
$50.00
$50.00
MI
Last Name
First Name
Caporale
Ann Marie
State Zip Code
26 Page St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/05/2013
$50.00
$50.00
Page 4 of 35


Last Name First Name
MI
Branch
Diana
State Zip Code
L CT 06401
56 Locke St
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Hunt
Denice
State Zip Code
R CT 06401
6 Myrtle Ave
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
St Jacques
Rita
State Zip Code
16 Myrtle Ave
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 5 of 35


MI
Crisco
Pat
State Zip Code
1205 Racebrook Rd
Woodbridge
Name of Employer
CT
06525
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Flaherty
Bartholomew
State Zip Code
R CT 06401
28 Pinecrest Ave
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Flaherty
Jo Lynn
State Zip Code
28 Pinecrest Ave
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 6 of 35


MI
Jeanette
Kay
State Zip Code
E CT 06401
2 Gracie Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Tonucci
Vincent
State Zip Code
26 Fairview Ter
Derby
Name of Employer
CT
06418
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Kolakowski
Tara
State Zip Code
L CT 06401
14 Farrel Dr
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 7 of 35


MI
Blake
Kevin
State Zip Code
M CT 06401
19 Birchwood Dr
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Kowalczyk
Susan
State Zip Code
L CT 06401
16 Kathy Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Siggars-Ford
Ralphine
State Zip Code
222 1/2 N State St

Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 8 of 35


MI
Nihill
Dawn
State Zip Code
M CT 06401
37 Berkshire Rd
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Hanaif
Saleh Gamal
State Zip Code
44 Buswell St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
D'Amico
Fred
State Zip Code
19 Wychwood Ln
Oxford
Name of Employer
CT
06478-1850
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 9 of 35


MI
Jeanette
Kay
State Zip Code
E CT 06401
2 Gracie Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Phipps
Nina
State Zip Code
M CT 06401
60 Rockwood Ave
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Phipps
Christopher
State Zip Code
W CT 06401
60 Rockwood Ave
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 10 of 35


MI
Macero
Louis
State Zip Code
R CT 06401
55 Hubbell Ave
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Degnan
Jonathan
State Zip Code
D CT 06611
87 Ochsner Pl
Trumbull
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Lynch
Thomas
State Zip Code
E CT 06401
15 Macintosh Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
Page 11 of 35


MI
Collicelli
Christine
State Zip Code
M CT 06401
10 Lingren Ter
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Fainer
Jerome
State Zip Code
M CT 06401
36 Cedar St
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Sharkey
Nancy
State Zip Code
H CT 06401
4 Pin Oak Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
Page 12 of 35


MI
Ives
Michelle
State Zip Code
M CT 06478-1463
7 Chestnut Tree Hill Ext

Oxford
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Silva
Janice
State Zip Code
E CT 06483
40 Bunting Rd
Seymour
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$25.00
$25.00
MI
Last Name
First Name
Hubbard
James
State Zip Code
D CT 06401
10 Harris Rd
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$25.00
$25.00
Page 13 of 35


MI
Bshara
Richard
State Zip Code
M CT 06401
20 Sobin Dr
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Vartelas
James
State Zip Code
P CT 06401
22 Holbrook St
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Pitney
Carmen
State Zip Code
T CT 06401
159 Pulaski Hwy

Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 14 of 35


MI
Digiorgi
Fran
State Zip Code
8 Elliott Rd
Ansonia
Name of Employer
CT
06401-2611
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Tracz
Mike
State Zip Code
Clark St
Ansonia
Name of Employer
CT
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Jayanthan
Jay
State Zip Code
K CT 06492
35 Turnberry Rd
Wallingford
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$250.00
$250.00
Page 15 of 35


MI
Maffeo
Joseph
State Zip Code
A CT 06478
6 Jensen Farm Rd
Oxford
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Lynch
Timothy
State Zip Code
E CT 06483
23 Charles Rd
Seymour
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Lynch
Patrick
State Zip Code
M CT 06401
15 Macintosh Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 16 of 35


MI
Bottone
Madeline
State Zip Code
H CT 06401
31 Webster Dr
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Jaskilka
Robert
State Zip Code
38 Greenfield Dr
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Gregono
Matthew
State Zip Code
30 Church St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
Page 17 of 35


MI
Pettinella
Stacey
State Zip Code
1 Poplar Dr
Seymour
Name of Employer
CT
06483
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Adamowski
Ed
State Zip Code
19 Kathy Ln
Ansonia
Name of Employer
CT
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Mangano
Ronald
State Zip Code
272 Hyland Terrance

Orange
Name of Employer
CT
06477
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 18 of 35


MI
Mangano
Maryanne
State Zip Code
272 Hyland Ter

Orange
Name of Employer
CT
06477
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Lynch
Danny
State Zip Code
15 Birchwood Dr
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Sampieri
Pauline
State Zip Code
54 Finney St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 19 of 35


MI
Pyro
Jamie
State Zip Code
28 Locke St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Marcnko
Peter
State Zip Code
100 Kathy Ln
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Shortell
Brittany
State Zip Code
14 Vose St
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 20 of 35


MI
Uvino
Louis
State Zip Code
13 Locke St
Ansonia
Name of Employer
CT
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$25.00
$25.00
MI
Last Name
First Name
Ahmad
Nasir
State Zip Code
347 Pinetree Dr
Orange
Name of Employer
CT
06477
_ X
Yes No
X _
_
Yes
No
X
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Burns
Peter
State Zip Code
F CT 06460
21 Melba St
Milford
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
Page 21 of 35


MI
Smith
Fonso
State Zip Code
L CT 06401
1 Unters Ln
Ansonia
Name of Employer
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$100.00
$100.00
MI
Last Name
First Name
Coughlin
Susan
State Zip Code
26 Birchwood Dr
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$50.00
$50.00
MI
Last Name
First Name
Tyszka
Francis
State Zip Code
18 Shortell Dr
Ansonia
Name of Employer
CT
06401
_ X
Yes No
X _
_
Yes
No
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$25.00
$25.00
Page 22 of 35


MI
Greski
Ronald
State Zip Code
45 Morningside Dr
Ansonia
Name of Employer
CT
06401
Treasurer
_ X
City of Ansonia
_ _ _
Yes No
_ X
Yes
No
Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$421.80
$421.80
MI
Last Name
First Name
Lynch
Elizabeth
State Zip Code
S CT 06401
15 Macintosh Ln
Ansonia
Name of Employer
Town clerk assistance

_ X
City of Ansonia
_ _ _
Yes No
_ X
Yes
No
Is this contribution associated with a fundraising event listed in Section L1? If yes, list Event # Method of Contribution
_
Yes No
_ _
Yes
No
Executive
Date Received
_
Cash
Personal Check
Credit/Debit Card
Payroll Deduction
Money Order
09/16/2013
$215.00
$215.00 $4,136.80 $4,440.80
Total of Section B
TOTAL OF ALL CONTRIBUTIONS FROM INDIVIDUALS
(Sections A & B)
(Total on Line 14 of Summary Page)
Page 23 of 35


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
City
State
Zip Code
Date Received
Aggregate Contributions
Total of Section C1

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 24 of 35


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

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)

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 25 of 35
I. MONETARY RECEIPTS (Section A-I)

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


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)


J. Interest from Deposits in Authorized Accounts
Name of Institution
Date Received
Amount
Street Address
City
State
Zip Code
Total of Section J
Page 26 of 35


K. Miscellaneous Monetary Receipts not Considered Contributions
Name
Date of Transaction
Amount Received
Street Address
City
State
Zip Code
Description
Total of Section K
II. FUNDRAISING EVENT ACTIVITY (Sections L1 - L4)


L1. Fundraiser Event Information
Fundraising Event #
Date of Fundraiser Letter
Description
09/16/2013
Location: Street Address
Meet and Greet Event

City State Zip Code
314 Main St
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.)
$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.)
$0.00
Total of Section L1
$0.00
Page 27 of 35

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


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 28 of 35
III. NONMONETARY RECEIPTS (Sections M - O)


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)


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 29 of 35
III. NONMONETARY RECEIPTS (Sections M - O)

NAME OF COMMITTEE TYPE OF REPFORT
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 30 of 35
IV. EXPENDITURES (Sections P - T)


P. Expenses Paid By Committee
Name of Payee Date of Payment
Method of Payment
_ X
Bank America
07/11/2013
Check # Debit Card Zip Code
Street Address
City
State
Main St
Purpose of Expenditure (by code) Description
Ansonia
CT
Event #
06401
Amount
BNK
Expenditure # (if applicable)
Type of Expenditure (if applicable) Itemization in Addendum P Required

_
_ _
Coordinated with reimbursement sought

_
Coordinated without reimbursement sough
Independent
Organization
$3.00
Name of Payee
Date of Payment
Method of Payment
X _
Molto Bene
07/22/2013
Check # Debit Card
1217
Street Address
City
State
Zip Code
Wakelee Ave
Ansonia
CT
Event #
06401
Amount
FOOD

_
_ _

_
Independent
Organization
$150.00
Name of Payee
Date of Payment
Method of Payment
X _
Olderman
07/26/2013
Check # Debit Card
1219
Street Address
City
State
Zip Code
400 Main St
Ansonia
CT
Event #
06401
Amount
OVHD
Insurance

_
_ _

_
Independent
Organization
$854.96
Name of Payee
Date of Payment
Method of Payment
X _
Hong Tran
08/06/2013
Check # Debit Card
1220
Street Address
City
State
Zip Code
East Main St
Ansonia
CT
Event #
06401
Amount
OVHD
payment for Headquarters

_
_ _

_
Independent
Organization
$1,500.00
Page 31 of 35


Method of Payment
X _
Ansonia Cultural comm
08/06/2013
Check # Debit Card
1221
Street Address
City
State
Zip Code
Main St
Ansonia
CT
Event #
06401
Amount
FNDR *
October Fest Table main st

_
_ _

_
Independent
Organization
$50.00
Name of Payee
Date of Payment
Method of Payment
_ X
Bank of America
08/12/2013
Street Address
City
State
Main St
Ansonia
CT
Event #
06401
Amount
BNK

_
_ _

_
Independent
Organization
$3.00
Name of Payee
Date of Payment
Method of Payment
X _
Eileen Krugel
09/06/2013
Check # Debit Card
1223
Street Address
City
State
Zip Code
36 Cedar St
Ansonia
CT
Event #
06401
Amount
A-SIGN

_
_ _

_
Independent
Organization
$450.41
Name of Payee
Date of Payment
Method of Payment
_ X
Bank of America
09/06/2013
Street Address
City
State
Main St
Ansonia
CT
Event #
06401
Amount
BNK

_
_ _

_
Independent
Organization
$3.00
Page 32 of 35


Method of Payment
X _
Antonios
09/06/2013
Check # Debit Card
1222
Street Address
City
State
Zip Code
Main St
Ansonia
CT
Event #
06401
Amount
FOOD

_
_ _

_
Independent
Organization
$1,375.00
Name of Payee
Date of Payment
Method of Payment
X _
Jo Lynn Flaherty
09/16/2013
Check # Debit Card
1216
Street Address
City
State
Zip Code
28 Pinecrest Ave
Ansonia
CT
Event #
06401
Amount
A-NEWS

_
_ _

_
Independent
Organization
$175.50
Name of Payee
Date of Payment
Method of Payment
X _
Eileen Krugel
09/27/2013
Check # Debit Card
1224
Street Address
City
State
Zip Code
36 Cedar St
Ansonia
CT
Event #
06401
Amount
A-SIGN
Signs/cell phones

_
_ _

_
Independent
Organization
$1,080.21 $5,645.08
Total of Section P
Page 33 of 35

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

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
Description
Event #
Amount
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 34 of 35
IV. EXPENDITURES

S. Expenses Incurred By Committee but Not Paid During this Period
Name of Creditor
Date Incurred
Street Address
City
State
Zip 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
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
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 35 of 35

Ansonia DTC October 2013 Filing

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Ansonia DTC October 2013 Filing

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SEEC FORM 20

Itemized Campaign Finance Disclosure Statement

Do Not Mark in This Space For Official Use Only

2. TREASURER NAME First

3. TREASURER ADDRESS Street Address

5. OFFICE SOUGHT (Complete only if Candidate Committee)

6. DISTRICT NUMBER (if applicable)

PRINT NAME OF THE SIGNER

SUMMARY PAGE TOTALS

$4,941.80 $0.00 $25.77 $0.00

$4,967.57 $10,693.02 $6,086.08 $4,606.94 $0.00 $0.00 $0.00 $0.00

$0.00 $0.00 $0.00

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

B. Itemized Contributions from Individuals

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

222 1/2 N State St

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)

Ansonia Democratic Town Committee

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

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

Legislative Aggregate Contributions

I. MONETARY RECEIPTS (Section A-K)