SEEC FORM 20

COPY RECE

DN|E ,/ TIME:'4
TOWN

STJMMARYPAGE
.

NAIIE OF Cr}Nf]\TITTEE

iPaul Roy 2011

TP?^(rtpFp
Itde Nn1\fn
FEsl

Ldt

Sultx

Jeffrey
3. TREASTIRM.ADDRESS
Stleet .+(xEes

M
Crt]

Coe
State

80 Washington Ave.
.I.

Seymour
S
OIIFTCE SOTJGTIY {Comblat onlv if Ctndirl*e Committeel

CT
6. DISTRICTI\'LqIBER

06483

ELECTIONIREFRENDTAI DATE

inlr'dd}f})j

11t08t2011
T.

First Selectman
ottlv

CANDIDATE NAIUtr fcon ptds'

il

Cstditlate ot Expknofrrn, Cornntittee)

Trde

\fl

Lmt

iuttir

Paul
P Ta-pln ftF ESrLtIlT .lalaL

Roy

fka rl;v\

f.i

Januaq' l0

liling

{ f
f,

7th da1' preceding 30 da1's following

primaq' {" 7th da}- preceding ret-erendum r primary{*

.15

Initial Contributit.ru or Disbursement

(P.{Cs

O^Ll')
tcr

Ili April l0 tiling .fi

Julr-

dal's lbllorving

retbrendun .f

Arnerdment

l0

tiling tiling

7th da1'preceding election f Deficit

T1-pe.f Report:

f'

October l0

{l; l2th dal preceding election

(State Cedtml Committex

i*

Terminatioa

On\)

'-. indepentlent EsJrendinrre -''-t:eil"L,

?r-#;;;."-

J5

da1 s ibllorring electit'rn ntrt held in No'r ernber

o DI'Bf(lTt arffir?iuDft

Begrnning Date

Ending Date

a7rc1tz0fi

thnr

09/30/2011

IO. CIIRTTF"ICTITION

herebl' certih ancl state" under penalties of talse statement. that all of the intbrmation set tbrth on this ltemized Cnmpaign Finance

Disclosure Statement tbr tlre period cor-ered is true. accruate and complete.

Jeffrey iil. Coe

rT[
TRE.\STIRER (SIGN.{TIIRE)

lonilz0ll.
D.{TE (mm

PRINT N"\I\IE OF SIGNER

dd,lll

PEI.\LT|' FOR.II{ISE SZITE:}IENT IS PTNISIIIBLE BI- FI}{E

SLOOO, OR

TO EXCEED

^*OT I]IPFdSOiiJTEXT FOR );OT }IORE TE.4}' ONE T'8.1R, OR BOTH.

SEAC FORJ}I20
Itcm ized Crmpaign Flnance Disclosurc Statcm cnt
CONNECTICUT STATE ELECTIONS ENX'ORCEIIENT COMMISSION
Rev.

l/0l$

Page 2 of

l?

F,i

Ah,{E ]oF', aa}}vllrdf I"T!'ls

FI[;INtiIIIIE IIATF 1U11ftA11

Paul Roy 201 1

I

COLUMN A
Thic Ptriffl

COLUMN B
AEsresate $0.00

l.

Balanee on hand Januan- I of current 1 ear frrr Ongoing and Pag" Committees OR Balanc.e on haod Aom dal Committee nas ibnned lbr all other committees

12. Balance on hand at the beeinnhs of Reoortinc Period 13. Contributions received t-rom Individuals (Sections A and B) 14- Receiots from Other Commiftees (Sections Cl and C2) 15. Othor Monetan Receipts lSections D-K)

$0.00 $0.00 $0.00 $0.00 $6,631.00 $0.00 $103.00 $o.oo $388.00 $0.00 $7,122.00 $7,122.00 $2,908.00 $4,214.00 $822.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $187.00 $0.00

l6a. Total Small

Food and Beremge Receipts at Fair (Section

Sale s,

Ll

) Ttm,n Committees

O!\Ll'

$0.00 $0.00 $o.oo $0.00 $0.00 $0.00

16b. Total Proceeds from Small Purcbases at Tag

Auctions or Other Sales (Section L2)

l6c Total Purchass rrf Ar{r-ertisino in a Progranr BrnL- (Section |.11 Aommittea 0lif .l'
17. Total Monetary Receipts {add totals for lines l3-l6c)

llunicipal and Tmn

18. Subtotals{addtotalsinline12+linelTinColunnAandinlinell+lTinColumoB)
19. Expenses Paid bl"Committee {Section P)
20. Balance on hand at

clos

of Reporting Period isubtract line

19

fron line

18 in both l-olumns)

$0.00 $o.oo $0.00

21.In-Kind Donations not Considerd Contributions Receir.ed {Section L4)

22. In-Kind Coatributions Received (Section

M)
N)

2-3. Re&rndable Deposit to Telephone Companl- (Section

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

24. Receipts of Organization Expenditures (Section

25. Beeinnins Loan Balance

0)

25a.

Lc,ans Received (section

D)

25b. * 25c. -

InterestandPeaaltiesonLoan
Par-ments on Loan

25d. Total Otttstandins Loan Amount

26. Campaigo E:ipeoses Paid trv Caodidate (Section Q) 27. Espenses Incurred on Comnittee Credit Card iSection R) 28- Exoenses Incurred br- Committee Durins this Period but Not Paid {Section S)
28a. Total Outstanding Expenses Incurred b1'Committee

s0.00
$o.oo $0.00 $0.00

*ill

Unpaid (Section S)

L
IL{IV'EOFCOMMIrIEE Paul Roy 2011

I}IOFTETARYRICEIPTS (Sectftrnc A-I(l

IILINGIXIEDATE

Pase 3 of 17

A.
Lg$trle

'rCI$l Contributions from Small Contributors-Receiyed this Period ONLY

tnffiicttons

1A11n0/1
$

_($ae

fq

ddartfon dEnaII Contiktar)

Fl'st

Srbtotal Section.A
l\tr
:&r {,'!rile

0.09

B. Itemized Contributionc fmm Indlviduds

Thersa
hmrFalOereuion

Gonmy 171Skcd<orat St [s rsttriblltor a lobbli*L spousc. rdcpendeu c$ild of a lotbyi**

Minuts Clinic
NAnrd

.{mo{nt of C;attibsfion

l, ts
l.
No

Seyrsr

ol tsmilol'{

CT

0at&3

APRN

If co*bibdiol is in escers of $400 to e casdid*ecoamillee fora chief $ecuthe oficsr of a nunisigalig'docr co*ibrtor or busbess hc;she b l*soci*d rritt harr E eootrar* rrith srid onnicipalib.'vahed atmore thrn $5.0fi)? lr- r"es i. l.Io

lr

r|rie

contibotiol

assoiated 'lrith a

::'
:!

frndnising creot lisled in

$eclboll?

l's
No

k contibutor a prhr:ipal

of

shte

{fy'rr. lirtEleot*
Ill9hod of con$ibution: :': Cash l;, Pereoaolt'heck

dfw.indicaieniicbbrmchorbnr$b* ': of gotelmcat l&e coffacl b t'ith: , Erecuthe :- Legislath-e

reffittrd
!.'.J

co*rctor

or prorpesti\ e shte

solrtactof?
sggrggns

IJ

i.

Yes No

qrww{rD

;-' fredit'Dbitcdd i'. Pa-ro{tltedr*ion

Phit

Nloney0rder
N{I

97n7frn11
Fte*rPal {-r!s$t}an$

$100.00

$100.00
.lmount of

l,*t$laur

lMthdmy
116 maple

StFsinbndent of Operations
mt
:rp Lode Name ol

Cortriboiie

lmPlq'ir

St

Seymour

CT

o&183

Metrp-Nor*r

b corfih*ora lobbli*L spor*e, o'rdependenr cfiild ofa lobbl.bf

Is thb ,rontibotion assoiatsd n'ith a

Jl'

r,"es

ij' No
l'es No

Fcoatribotim h ir csc.ss of ${00

to a candidale conmittee lbr a chief ese,i$tire offieer of o

nudcipalitl'doer contr&utor or businers hetshe is lsEocintd rrith tor=

mlnfuipditr.r'ahedatmorclhan$5.000? 1 f'es 6'

I* eoatitutor
a

coffact rtith said

No

trudniring ereat listed h Sq:tiool,l? dfl'er. liatEtent+ 08/15/201 1

I\Iethod of conkib{ttion : :icnrh i,*l Pcrsosrtchc*

indbrte*'hichbntrc&orbnoehes of gor'mrnert &e costract is $ith: i'l Esecufirc :i. Legislath'*

{fler.
LIrc KCC'$CS

grincipal of

shte colbrclor or prospectir.e *tate

conErstor?
iggIgse

i'

i-

I Tes
No

l'" erdit''OeHtea.d :'lPcprollDcdrrfioa :.Nloncy0rdcr

t\ll

0il1ff2011
fuekryd (-'!'ctryaton

$40.00

$40.00
.{mount of

aflme

Wlhelmy

Maureen
)qR
alp Lllde

oist ltor
t 9l s[t[\ 5I

{lontribution

116llapla St
b rroahibutora

Seyrnour

bbblftL spolre.

il depcdnt child of I lot*1irft

':1'eg :i- No
'ta

CT

06483

ilsbo.North

lfcontibution ir ir grcerr af8400

to a cand&lale somrdtte for e chlferieculive offrccr ofa nunicip*lilv does contrbutsr or busins$ he/she is Nsocided niith harc a cofiroct rrith said '. ounicipalilr rahed st more than $J.00O? i Ye* :;. No

Is 6is ronfibution srosiatrd with a frndraising cr"cat ligtrd in $ectioa Ll?

l-d

No

b cintibutor a priacipal of a sbte sonba:tor or procpecth= eht* coabaetor? !l; Teg

of gor-ern*rt lte conbaet is

f1'cr. listBtent+ AAnSlzO11

I*'atiodicdcn'hiehbnnc&orbnrnhe* j" Etecuthe i. with:

t

:,No

Legiclatire
ag8rvgFrE

Iv*;thd of corbibution:

rilt &ecflgt(]

lr{rss

i{ Carh l*
$kurat

Personal

tacuk

:' . eredit DeUit C'!.d

!EAT

'';

Pa$olt Dulduc*i$n

ll

lr.Ionel' C}rder

aBng2a11
Prtncpal

lwt lIffia

\{
xile

$40.00

$40.00
Amounf of Clontribution

(.r'nmtrm

Rondd
.rb'

Regisbar
l!\tnllol.bmPlo]r

:rpl'oile

19 Glen Circls
Ir contibotor a lobb5tsl. spou*e.

Seyrpw
1es

CT
ig

If cohibution

es.cegr

of ${O0

Town ofSeyrnour b r card!:lobcommitee fora chbfexe-tth"e oflherof

06483

mdcpcnded clrild of
Is this

lotr63'bf

No

arunir:ipalit1'docr cortrbutor or burioess hsrshe b &rsocintd $itb hal s coffract n'ith s&id municipelitl'rahedrtnoretharS5.000? ;'". i-i No

tes

contihutim asgoeiatd rrith a fradniring event lhted is Ser:tionll?

i:

{fl'er.

tistEtut*

i*'

1es

Is

coatibutor

primipl of a state codator

or prosp+ctire *ht cort$stor?

:'-,l'es

No

0V'15/201

ofgoveuneltthecanlrac*ic$ith'j, Ltecuthe
t *c lteccFed
Credit'Dbit Cord

^f3rr. iadicate ntich bnnehor bnaches

Order

i'Legislath'e

rNo

lltet[od of conhibstior: ri: Ca$ i-l Persoml Check

i''

r'l Pelroll Deduction :-' Ilonqv

08r15f2011

i83rrSnFrwrffiE $,{o.m

$40.00 $220.00 $6,411.00 $6"631.00

SUBf,0TAL Sec8on B.lhlr Pngt TOTAL of edditioaal Section B Pages

TOTAL OF ALL C'ONTRIBTITION$ IIROII INDIVIDUALS {$ocdons
,1,

& B)

(Eater total

Line 13 of Ssrrmttw Papel

L
Paul Roy 291

MONETARYRECEIPTS Section B. Additional Pase

TY"T.O5,.REPORT 1w11t2811

LdNmc
VYisneski lwFtDgst-awcs

B. Itemb:ed Contributions fmmlndivifruals

Ftntt

htr
wtt

Itinsi*rl Crccumtion

Amoonl

of

Susan
.;1t)-

Human Resolrces Speciali$

!$
r-

Contributior

rNe

ftaE

rll EmP& CI

473 Rimmon Hill Rd

ls r:olrtitator a lobhli*t spou*e or dependeot child oin to6tyi.ti

"' T*r
'No

Bemn Fdls

CT

o&to3

State of CT

If contrihilios i* itr **ccs$ of $40O to r candidats commi8s for o chiet' executive olleer of a municipatiq does cootr&rlor of bu$iders helshe ie rsror:iated n'ittr hate a eoatmcl rtith caid nuahiralitqraHatmorettan$5.000? .-' -r'e .i. No

Islbisconbibutiqassociatedni$a':.;; l'er fundraising*r'entlistediaSstiorll? : . No

Iscoatitntuagrincipalofashtecodraetororpmsg*tir-e*trtecontactor?

Ifiu.

list Erent

08/15/201

Ifu.indicaferrhicbtreq:borbre$*s ofgovernrcnt&cconh"rctbnill: i-..Lrer:uli'r'e :

lriuc xsctf{l

i. :

r.'e*

No

Legishtite
-.g@tec{:Wl

L!*}odof coakibution:

lr. r'ash i.., P*rgonalChoii i

,.

(-redir.DebitC$d

i, hpollDedr*im :-'\looely(}rdlr !{ Frst

Jdrn .q
:IP

08r15fs11
krocjpal
Qs.e:upatlon

$40.00

$40.00
Amount of Contribrlrforn

Bums 9 ilominonood
Is cortibotor a lobbfist spousa or d?odd hild of a lobblirl?

Sales
L({

t' ,t

-r-es

No

05403 Beacon Falls CT If contributior h ia escerr of ${00 to a randidale commisee for a chfu{ exectth'e o$cer of a mnicipafirydoee cqr*ihrtoror bu$inels herefteb assoeiated rrithhare a cortrct rtilhscid

meorEmPt4-s Gabrieli Truck Sales

morbipelitvrahedatmrcthansS.00o? Istlb conributbn

fiullloiing cr-enl {f1*:. lirt Eteut
ssocisted rrith a lirtd h S.etior Ll?

ld f'er

:j5' No

l-.r
r-i No

IrcolbibotoraprbcipaloflstaterxntractororproslrectiTestatecost*tor?
of gorernnreot the coffact is

08/15/2001

ffter. indicatcniichblanchorhrilh*

:-, lcs

$ith:

.ii Ercr:sth'e l-l

l:

No

Legi*lathe
rE[drs:IirE

lvftrlod of corkiSutinn:

r,IE !trst
NII

Xrecrfa{l

t"i Cash if, Ptrsonnl Che{& i,'r t-reditrDebit Card i:. Prlroll Dedu*ioa [^; \looe-rOrder
Li$I\hma

0u15r2011 Plrqral C\.ruF6ton

$40.00

$40.00 .{nount of Coltribution

Coyne
alJwtilr Jucsa

Jamg

Attomw
;trte

-tuqG

-ls

51 lnca Drive

Ircoobibutoralobbyirlspousa t Is cdcpcndentchildofalobbyid? .i No
Is thir eolbibution assocfuted $ith a fridrairing ereni li*ted in Section L l?

0661 l Trumbull CT Goyne, von Kdln, Brady & Fries Ifcontrihfion is in escess of${00 to r candklatesomoitee fora chicfurecutir-e off*er ofl municipalitl'dors u:onk&stororbileiness her*lpis rsrorlisd lsi&hs\'a contract sith*oid

:p {l&le

xm

or !mF&t!.et

munhioditv$hsdrtrnotetian$5.000? ii.
Is

Ter . : No
i,

fcs
No

contihlor a trriacipal of o rtate codroetor

{tJ's. listEl'ent* 08/151201

Ifiw.

indicate

ntich hrancb orbsaches

or prospectire state

of goremmeot tlrt contnst h

$ith:

Ereeuth'e
1

-.

conbtstor? I ; l,.e* t : No
.

Legirlatire

lrlethod of contibotion: :"- rlcsh l;i Pereonal(,'he,*'.. C'reditDebitCad l-,

:IlSt

L|{lS KCe$rl

sEralBBc{ur|m*

hpollDedn*ion i'i

h.Ioney0rder lrtr

08/15/201 Retired

$m0.00

$200.00
.-Lmount of Cotrlribrtion

hmcrpal thcrmtrtm N06e ot E'nPlr}}'cr

Coe
s&i[

David
-{uq6\ FlLv

TGreatMeadowRd
k contrib{rtor
a bbbfist. spousa or d+pendent child olu

nucsr

toftl'#

i-'l

Sa-marr
If contribution b
foi esr:ess

lD6re

alp (.'(1de

ri:

r-es

Retired 06483 of $4{X} to t rtndidde somnittes for a cbief cxecuth'e oftir:er of a CT

e

N0

Ic tlis conbibution as*ocistedrtith a frn&ri*ing etent tigtd ir Sectiotl,l?

ll

so:itted rriti harc a conbact rrith ilid nuniciprtitrrafuedatmacthan$5.000? l-' :*E* til No Te* Ir contihtor a princfual of r sbte {sntaclor or pmsper:the rtate conhrclor? l- r-x
munieipalit-r docs r:ontribulsr or busines* hels$e is

{/t'c*. i-,

listEted* 0U15nA11
,i.l Per*oaal(hsji

'"1 No

of govemrcnt l&e contrilot CreA&OebitCard i"l

rrtrlt

fyys.indicaten'bichbranchorbr"aehc* {l Eserrrtite i- i Lcgi*trtir-e ii rri&:

lrew
Aggreg0E

il'

No

I\lslhod of contibdion:

con[$mrrE

Csh

ll

PrgollHuctioa -

Moae,.'Ordcr

08tt5n0t1
hre$at
i.{lllhe
!11

w.00

$40.00
-{mount

nll
)re
:rp L:od.

Qcqpau(lrr
.EmPlOt'{

Hain*
IWNDEGTSNffi

of

Frank
-:rq

Ralired
CT 06483

Contribltfun

I Castle SL
ordependent child

Ssvmour
ofa

b contrihutor a lotblist.

rpousclobbyisfl

,:: 1-cs l;r No

Retird If contribntkm is itr cnce*e of $,fi]O to a caldidats cosnitter for a chid esecutile ollcer ofa muoicipalit-t doer codributor or busisess helshe ir associatcd nith hn'e a coatn'act rti& said
mudeioalitr rahed atmore than $J.000?

;_'Ies ..'
r

No
e stale

Irtliscontibutionassocirtednidla l:' l'es

fuadrai*ing etent listed
J(fJ.*s.

listEr"ec* 08t15/201

ir Sertionll? ['r No
1

Is

coatilotor a prin+ipal of a strte colka:tor or prospctir ffw. indicatc rrtich bras,;h os bt rchcs
of gorernment the co$blst is

conbtctot?

l'ef
No

wilh:
IJa3i

: Er*uit'e ::i Legblatilr

*teglte co'lllruurora

Itle*hod of costibuticn:

xcefc

['.t

crsh ir. PergomlChs* : i ('rditjDbitcard ['-. Pa}rollfiedur*ioo F

lrtoncyorder

08/1512011

$50.m

$50.00 $370.00

SUBTOTAL Sectiqr &This Pae

Pnge

of '-

I. Paul

MONETARY RNCEIPTS Section B. Additional Pagq

TY?EOFREPORT
1A11/2911

Rcy2011 B.
Itemized Contributions from Individualc
IT
First

L*lilane

kir&-t{lat {:Lrlrpatisr

Bsnardhi t4 Kosev Lans

b contrilstor
or depedeu
a lobtr.r{st spou*c,

Cindy

Admin

contrihlion

.{norat of

fes
No

clitd of a lobbybf

jrtl rgltc Name {n rnrPrq'r fovvn ofSeymou 0648:l Sevmour CT If cmfibution ic in et':esc of $,100 to a modllatc coomi$ee &c r chMeri*atire dher of a noaicipalitl does corsibubr or businerr hclshe ia **ociated nith hare a ccrtrar:t with eaid qunhipalitytatuedetmrelhar$5.000? :-:l'cs i.'': No
No

ls thb coqhibrtioa *sociated n'ilh a f16{6iring el:nt listed in $ectfulq Ll?

:;;1'cs

f1u. lisrEvenl+

:-

Ir coatihtor a primipel of a slrte ':oabrctor or pro*pcctire strt oontactor?

08J15/2011

ofgoruaosntlheeotractbnit}: i*.8-recoth'e''
uat R6crse{l

I/;w. hdicate*hidrbraochorbran:b

i . l'e* .; No
$100.00 $100.00
.{mount

Legi*lath'e

il&sltod of eontbutiotr:

i*teSSesoKtME
l-}$crrF1oon

: . t'arh ,;, PcrsonalCledi i]. e.reditDebitCarrl

Fust

;..,h3tollDedoctim Roealie

l: UmeyO*er
N,II ruL

08t1s2011
[tlnc{al

sf

Averill
ffi)trett.+dfes
_:rD'

SalEs
4rr,.(u9
:{olle of EnFlfl'er

Contrlbrtioa

38 N. Bmham Lane
ls

Sepnour
Tes

CT

06483

Self-emdoyed

contribolor r bb$Jist spou**.

dcpearler* r:hiftl

cfa lot$lirt?

Nc

S40O to a caadidate comnifi* for I chief eiecuth'e ol]'icer of municlpalit-v doe* contribotor or bwitrss hetsh fo nssoebted nith hare coatract rrith said

If contributioft is in esc*ss of

I
1'es

munhioalih'rahedatmor,ethan$5.00tr1

.li Ycs liii

No

Il

thb eoabibution assotliatedrritt a frndrririq etant li*ted in Se$ionl,l?

I/l'eo. lirt Elen

:: [1 No

l-ea

O8l15fZA11
::-*'

Is conGibutor a priacigal ofe etats corh*:tor or prorpeetive stel {f;w. indicae

ofgolernmsnttheconhactislritfo: ti' Erecutir=

l'#swgNm
F-t

ntichbranchorbrmc[r*
lr.Ioney(Her

cotrtfl{*or? :-'
I
tg:8trRgilE

i No

l-.,Legielatirc
GmsrwRW

L!*lrod of conhibntioa:

ff Cssb :1. PersomtChe*

Coe
)reer,{o0f e$3

CrditiDebitCrrd flxs

i-..

PalrottDeduetion

04n512011
te*rprl
\ame ol i-LictlFilt{Xt

$80.00

$80.00

[{l
ilite
-tp L

Loresr
_;rl1.

Retirsd
ru(

Cortribltiol

Amoult of

sletnilt

7 Great Msa&w Road

b contrihrtor a lobbvirl spolw. ord?erdd ciild nio fodb*e
Tes

Seymour
No monicip*litrdoer

CT

06483

loDlc!'rl Retired

If contribstioo b in ssc.ss of

nuni:ipaliryrebedatrmrcthan$5.$00{,..l r*c* ii,

\'e*
No

$:K)0 to a candidatccommitee for I dtidercrcuti\'. ot'icer of a contrilutor or b$siness ler'shc b $socistcd n-ilh hor:e a goatracd n'ith said

No

Irthiscolhibotionaesociatedrritha

irndniring srvot listed in $eetionll? {f}.d'- lirt El'ert * 08/15/201 1 Lldhod ofcontibstion: '
j".

r:

,'.

Iscortibotoraprincilnlofastdeos&&{ororprospe$h?siatcontractor?

r-

^fpr. indicdenhielrbra*:&orbru:her ofgoternneatlteconhactis$ith: i. Ese'Joth'e,".Legislatit'e

IffSSW

'r l'e* No
$/!0.00 $40.00
Amount of Contributiol

.-tgg!gae !'ontrtDuqffi

Clsh {'i

PEreonrl

Chedi

. CrcdilDetrit

{]ird j. Prrroll Dedu*ioa i 'i

brBl

}tone-v Order

08t15/2011
PlmcrFd QceuFilrcn

AI
Fulte
arp L-ode

Garofolo
(trlselElnl )Ireel .{alrlf es

Jamee
I-tq'

Professor
Nar$e oI .EmploJ's

163 Bunoay Rd
ls

coabihrtor a hbbyist. spousa

{
l!

Seymour
'l'es No

ot dcpendent child

ofa lobbf

ist?

Sulfpm CT State Univ. 08183 Iicontributiu is ir e*cerg of $dO0 to I candidate condiffeg for a chief secutir-c ollicer of n muniuipati$ doa eonbibutor or blshess hejsb b ltaociated n'ith barr a co$ract rith said
CT

nrudcioatirrrahedatmorcttan$5.{XX}? i:'Tes .$l

No

&thbconnib{rtbnssocinted$itha l': lcs ftadrdring etot listed in Sectioall? ' . No

I/J'er.

listR"entc 08/15J201
Pe,rronal

Is contibutcr a prinr:ipal of a sttte conilrrstor or pmslnctire state conhador? Iflus. iadicate ntieh brnnch or brm$e*

l-l
i:'

r*es

l.lo

olgorvnmtlbecontr.etifrrith:
lrloney Order I,II

lllErersrtir= i-lLegisl*h'e
iEEIElirEcwun]M
1

Ilethod of eonbibution:

t&B xec$e{l

i , Cgsh sl

Ch*,;k

i:l

CrediuDebit C.ard

i I Palroll Huction I
Saundra

08115/201
Pr$tcrpnl

$m'oo

$80.00
Aglotlnt of Coatrlbutiol

flIs

()cclpahst

Geeek
:is'

ReUrcd
iL1te .Sr

(_'ftle

Nsme $t.!,nrpln]'er

3TColonv Rd
b contributor a lobb-r.iat spoue"

'-' fes
a

Relired 0&$83 CT Seymour If contribrsiotr is in ercess of$400 to n candidatc r;omoittee fot e chl*

ndcpmdcd child of a lobbl.b8 Ir t&b contitutbn ssociated nilh

frrdraising
{fr.ds. list El'nl l'Bs

co*ih$or ot bnsinese he.trhs b ssochted rrithhate municipalit-vvahrcdrtmorethan$5.000?'rf' l'es ::;i No

munieigalig does
Is

crFcuth'e officer ofa a cortnct rrith said

er-ent listd in Sction L

l?

No

Oe11512011

conbihto aprincipal of a sltte r:o!iln:tot orP$sPecth'e {f;ur. indicate whie.h bra*h or bra:hc* ':-t
olgoremnent
the

strte ronhletor?
]i-r

'les
rNo

co8act

is

rrith:

Ese,nrth'e

Legishthrggreln& rarnsHffi

Itlc{rod of contibutisn:

lr{rg t{i:ctYgJ

[-t Ca*h

;; Perso!.11(te* :']'i trredit/Dthitcard [' PrlrollDc&ctim

[T lloneyorder

08t15I2011

$40.00

$40.00 $340.00 of

SU3trCITAL Sectim &'This Pap

Pnqe

L
Paul La*tNoe

MONETARY RECEIPTS
wreoiREroRT

Roy2O11 B.
!

19-11t2O11

Itemized Cmtributionsfrom Individuals

rsl

t{

Pttncipql C|is+otltttt

Grarde
-:rt-v

Cerct
ttale

Customer SenrbE
:|PL(U
Nane (rr tilFt(l}-er

Amortnl of Corrrihrtios

Main St. b contrlbnsor I lobbli*t *pouse c depedcnt ebild oia totb$d

347

Sdttl

Sayrow
t-es

CT

06483
brusines* he'she

OEM Contols
chid *ecuth'e offrcer of
a

If r:stribution is

il

errccss of $-lO0 to a candidals .:osrnitte for a t&an $5.000?

No

m*nicigatiS doc* u'odribrtor or

nunir:ipali{rrelu+d lt more

b axochted rrith bsts r r,'ontrct wi& said l-' Ye* i:., No

Isihb*oohihtionassociatedwi$a :;; l's

&ndrai*inger-er:tlistedio$o*bnLl?
I/.per. Ilsl Erent

i.

ls conbibutor

principnl of r Ebto so&a,{or or prospecth- stat

No

0811512011
-. CrcUitOeUltCard

hdicderrhieh branch or of gor.ernent ltre coohact is

flt-

branche ;'l- Execqth'e :* Legislatire $ith:

us xncerFe{l

llonbrqtor?
.{Sqrcgae

i- , tea
No

\Iethod of conbibution: :'.. CasS'i, Personrtt:hs'di :

L8'Nf,N

c(uulm(N
$40.{x} $40.00
.{mount of

l'. hlroltDcdnctiol l-'

H.

ilIoncy

ffier
\.fi
:rF

091s2011
Pfsrc{tal CL'ci$ttm

r!:r
Singh
irt}'

Pnet
rtluc

Researdl Ghsmist
Lode
(4 Ertrlrtl\

{lontribution

52Davis Rd
b c'oatibstor a hbblirl rpouse. ordfprndid child ofa lob&y'irP

Seyrnour

CT

0&183

Cytac

.i'"

r*es

l;r

No

Ifconbibution ir b *lrces3 of$400 !o a caadidate*ommifi.fo*a cbiefcsecslh'e officer ofa nudcipality does r'onbibutor or bosinlss hd# is n$ocisted lriitl har'. c contrast nith sdd I.i }'s lr5 No omfoipoli$tahed aroore rhar S3.008
l"eg

Is

ttb c'ortribntion

aseo,ehted

rrith

::

fuadnising o'eot listed

I/.14. lbt Evefr

ir $s:tion L l? * ggl15l201t

k coatibutor a principal

t"l No

lxam[es ;'.' Exe,:uthe ::-i Legistati\-e of gotemment the corfract is reilb:

t*er.
&dicnte rrhirfi bnnch or

orFa

etate coaira,lor or prospecth-e shte

conh*tor9 i ; Te*
,

;-' No

hlclhod of r'onbbution: [r r-esn .'i. Fcrsond Chedi l:'r CrediuDebit

I;lc

KeGll'eO

rggrryEREsFum
$80.00 $80.00
(lontribution
-dmount
Ctcupstrrn

Cud

i. hltoltDdo*ior fi

h.IoneyO.det
h,II

08/1mfi1
Pritrryil

rw
Gru&ias
t@KI
JUdt -1gWS

of

Richard
r'ls
itrte
ll{r
i- t1$e

29 Rimrnon SL
ls

$eymour

CT

05483

RElircd :aame (rMplo]'t Retired

'rontributor

lobblist, spours.

depqndnt child

ofa lobbl*fl

ilTes rl No

If conkibulion ir in escegs of $400 to a candirlatr comrnit*c for a ehief erccutive o$ser of a muaicipali$' doer codibttor or bnslress hlsh ir rssoeide{ sith hare l corkact rtith said monicioalih'rtbedetmorethac$1"000?,-lfe* l- No
Yes

Is ah& conhihf,tion assoeiated n-ith furdraising cr;elt listdd irr Section Ll? I/,ycr. list Etec Ogl15l2011

Ir contitntor a prhciral of

No

ofgortromrtthecor&actigrrilh: ii.Exc,xth'e
DAle fi$Ce$'ed
1

fyar"

indicaterrLichbranclrorbram&es
'll
tvlonc'y

state coafuactor or prospectirc shte

colrbrctor? l- ; Yes . No
ASCrl$lF COnqFrurts

:-.Legislath'e

I{eitod ofconhibutior :-. fa$h 'i; Pemonal Cher* : . CrcditDebit Crrd

FK

Dcdu*ion " Pagoll

Ords
Ntl

08/15/2011
ttb*rpal (,DcoDf,ton

$40,00

$40.00
.l.mount of

Smith
rKiuluers{ffi

Alloneo
t(-.u!'

Relired
l)6rc
"|8

Contribution

Hunters
a

Lana

b csatributor
or dcpmdent

lobbyist rpcuse.

ciild ofa lobhyist?

il

Savmour
If contribution is itr
esr:ess

l'Ne

Nrme t}I tsmplrlJ-er

CT

0a$3

Retirad

1'es

rt- No

of 3,100 b a candidate commitee for a chicf e$ecuth e o&icer of a municipaliry does codributor or burinss heishe b Ns$oci$ed nith let's I coo&*ct ri& *aid

nu$icipali{rnHatmorethaa$5-000{t
oigor:*nmat lS* contnct

f Tes
i-

iTl No

a s,1 l'ee findraising oent listd in Slctionl"l? .^. No Il;'c*. li.st Er-ent ; Ogl15l2D11
Is tl& coabibution associated n'ith IUetiod of contibution:

f,reonilibotoraprincipalorfartater:ontar:tororgrospctirestateconhactor?

fpw. indieatewhichhanchorbrancfis
fu

tjl les
.l
No

$ilh:

I Esq:oth'e

i'l

fegislnthe

Lx[ tf,i;c$.ac

A8ftgBe coll[n}u{rrIrs

i'I Carh Fl Pe*mel Cherji {':

Horbal

CrcditDebit Card ,-l Pa}roll Dedu,*iqr

Fnst

Ilo$ey Qrder
N{t

08f15t2011
PrurclFlt-[WA&on

$100.00

$100.00
.lmounl of Cortribution

Michael
1t]' xat
:lP (-rode

Lend Survwof
Nlnre otElr1Flo!'er

gwal

iueal.tut[8s
a

12 Oakwood Dr.
s conbibutor

$eynpur
fes
No

CT

06483

Sdf-erndowd

lobbfisl rpouse.

dcpendent cbild of a

lotrbl**

cxscsr of $400 to o ceudklate r:omnittee for a chif enecutie of icer of n monicipali5' doea coofoibutor or brrsioess her*he is tssocist*d $i& hate a cootract with said

If cmtribr*ioo is

il

muahipali8rahedatmoretlan$5.000? :a f-s :ia No

l'cs indicrterddch brarch or branches of gor'*rnnelt the controct is

Lg

thb colbibntion asrasiated $ih r fiurdraishg cvent li*tcd in Se'rtiol Ll?

h contibutr a priacipal of a sbte sotrfrctor ot ptospel'th-e

stnte conhactor?

Ii'cr.
[*r

lbt Er-e*

ril No

trts"

A8l 151201

n-ili:

'' Ese,:uth'e ]*i Legislathe

rgg.egirF

Tes No

illettod of coqtibntion:

L)iIId KECCtrd ::'

fagh

';:i Persornl Chedi

'

credit'Debit card

Prqoll Dedu,iiotr Ff \tuey Order

08il15n011

$40.fl)

$40.00 $300.00

SUBTOTAL $ecrim LThis Pas

Plge

of

L
PaulRoy2011 B.
LastNee
Fl'st
r.!-

MONETARYRECEIPTS Section B. ALditiond P?gg

TY}EOTREPORT

lU1ilz011 Itemized Contributions from Individuals

l\tr
Ittc
:lP L:t\t

hinciml tlqrrnalion

.lmootrt ef
Contnibotioa

Donna 7 Kozev Lane

ls eosbibstor

Secretrary
Nane or rmPFtcr

Sevmffn
Yes

CT
iB

06483

Town ofSeynow

lotrblisi. spouse. ordepeaded child ofr lobbl.irt?

If contrih:tiod

No :"1

candidate comrnitee for a chief csestti!'e ofrcsr of a ounicipaliq doer conhbutor or busiae*s helsh b arsociated n'ilh b*r l cortrart *'i6 sdd Yes No muabirditt' rahled at nore than $5.0{X}?
<seess of ${&0
a

&b contibEtisn ssociated with a fundniriag er.art listd io Sctiol Ll?

Is

j'.

l'ef
No

Is wabibutor

prhcipal

orf a state

{fJs.listEred* A&l1$EAfi
!rErt

I/3*r.iadicaferiichbroochorb:anches ofgorernmeirtdecodrEctirwith: -..Ese,wth'e ,Jde x3ce$'cd

conkactor or pmspectirc sttte

conhel*or? i . -t*x

'No

}Ictbod of conkibulion: i:,r--ach il PersoffilChe':k !..Credit0$itCardi,InayrollDednctiolril

Legi*Iatire tg8te8BEfl)ffiruw

lfoneyt}dcr
I\tr
JNG
:rP

08r1s2011
PrancFfll
:{anre

$40.00

$40.00
.{trroltnt of (:0ntribution

tlcnr,fi[on

Kulas
ffic:sllt Jreet*ffis
_'1tl"

Steven
L{u

Atbrmy
ot rmPr$}'cr

31 Skokoret

St

$eyrnow

& consitnrtorolobbyist

spou*c. i'

Ycs

ordepcndeotchildofalobbyhf?

.':;; No

May & Kulas PC If concibgis ir in err,less of S,lO0lo o candlldeeoolnitce fora hlf tel:util-e offr*rofa municipalilr doe* con*ibntor or busintt hC. *g b $cocinted rrith hlve a contract n ith said CT
06481:'

nuoicipditynbedatmre{rnn$5,000?
l-ea

.Lt;

I'es

.1.-i

No
state

Is thir coibibution asrociated $ith e listed in Scctionll? ftldrairing

nut

l'

lr

coaEihtor a priocipol of

atote corrlractor or

ptospictirc

{f;'e. listEr.*nt

[:.i No

I/16. indiqte$tichbranrhorbrmche*

conbtctod

-08/19?!1

of governrent $e conhaut is

n'itl:

j*l Esecrtire l, Legi"lathe '

' Yes i-r No

::

iltrelttd of contribution:
Lastl$i6e

lxlBK$6$!ed

sgregnERW|wu

ll c-ash ii. Pcnonal Check

Roy

3*r t--redit'Dcbit

Crrd t^. Pngoll De{uction [n \&as1" Order nm !{ Evelyn

:rN

aBt't5t2011 ttrlr$al
Nflme or {,}cupau$tr

w.00

$40.00
,{mount of

Rstitd
lnrFlq'tr

{:ontribution

RCA$telllal )Itee t -{\lalsg

TIG

:IF L

rut

80 Washinqton Ave,
h cortritnrtor a lohb$sl

Seymour
No

rdrpendentchildofalobbybt?';,
I* lhie conhibuticn
nsrociated $'ith a

spouse. ;"1 Yes

I'es No

0B+83 Ratiled CT If contribution is in txcss of $4{0 to a caadidlte rxmnitet for a *ief eseciltil'c officr of I nunicipalqv doer conkibutor or busini8s hpishe b associited rith hn"e a conFlct n'itb rdd

munhipalih'r.ahedltoorethan$3.000? l"l l.-e* :t, lilo

Is *olrtibetor
a

ftndraisfurg er-eot lbted in

f1'o. lirt Er-ent

Scctionll? ABnSlzOl 1

oiloteommt

{frw. indic*e xlic$

pdncipal of a sttie conkactor or Prospectire $hte bonch or brar*s

tbe coahact is

contmtcr:t
*EErtlsB

l*es

\rit&:

No

l*. f,tecutire i*. Legidathe

l\lrthod of con&ibltion:

llale lllcetsfrl

cwroK(E
$120.00 $120.00

i*. Cssh if, Penond Cher* ' .. CrsditiDebit Carrl l*, Payroll Nur*ioa
t

:l

trloney tlrder
A'I

08/1512011
httcFal i-tccr$ntotl

tBt

Asornl of
Coniributfua

Coe
$sl(Ktllilt 5tf*i,{ddtess

David
F:q'
l}jrtte
!.tP

Rstirsd
l
troe
Na$r

TGreat
Lr

MsadowRoad
sp,ousa
i-

ff Enlp&l'ef

Saymour

CT

06483

Retred

xdcpen&ntfildofa lotrhfisfl

contritntorl lobb-rirt

!l

1-es

It contribotion ir in tnces$ of$-l00 to a cnndirlate commifiee for a qhief aiecutir"* ofticer ofa
municipalit-r do*r con&ibutor or burire$s he/sle b associatd rrilh hare a contmct n'ith rnid

No
I

nunicipalityrahedatnoe&an$51)00? i:'
l's
No

\s

rrl

No i,,)

ls tlis conbihrtion $sociated $itl r &ndrairhg er"eat listerl in Se'ltiol Ll?

I/r'cr. listEr-ent *

Is eontitutor a prineipal oft stlte cootraclor orprolpectirr strte conhactor? Ifics. indicaierrhich branoh or braehe*
Ln& t(eeerFeo

oigor=ramenrlteconhaetiswith: i-lErecutire i-lLagislothe

o8r23u2011
Fltncpol {lcq$aeoft

'iNo

f.-ee

It.*dhod of coahibution:

.-l83re8BB OnElmJ$OrS

{i:('ash {'l

PcnonalCXrc* Cl t-'reditDebitcard ; I
l,'lrst

PayrcllMu*im - \Ione-vftdet
TII

$180.00

$140.00
.{mount of Clontribution

Averill
llwlucer.aws
tm Tes

Rosalie
*rta
4q L'odc

Sdes
Nere olEmplo)'dr

38N. Banham Rd Issolhibutoralobblistspourc. : -'

ordependeotchildofalotrbybt? :i! No

Sdf-emdoyd 0a$3 Se\rmour CT If contribution is b etcers of 9,100 to a candidete conmifce for a ghiefcsecutir e ofticer of a municipalitl.' do* costoib$br or bu*lres$ he;slrcis lEsocilted vith hare r csnlract n'itt gaid nuntiirati$'r'ohed atmorc thaa $5.{X)0? .';: t-es l;- No
Yes

Islhfocsohib{Dtbra$osiatdsitha,''.

fndni*ingerutlirtdinSectionll? l:t fJ'dr" ltut Evsot * 09/09/20'1 1

lrldhod of coq8ibmtioa:

Is contibutor a principal ofa stete r:otrh*)tor or Pros?cth-e sttte colbacior?

-l,.es

No

oigor.ergtrlnttle!$sEactislsitb: .'t Esee*h'e i-tlegidatit'e

udc ltscatved
isHrlgaE wrFlleqF

dJr;er- indicate s'hfuh hreoch or brrehes

No

I i (-lsh .i PeaonalCha* l.i cedit,Debitcard [f

PalrollDcdnctioa

lrlonc]'order

0st09nfi1

$111.00

$25.00 $365.00

SITBTOTAL Sectiral &This Pose Plge

of _-

I. MONETARY RECEIPTS seclionB.@

TEF
Paul Roy

2011

-,,.

..-

TYPE:OFREPORT
1W1112O11

B.
L:r*Nane
Filst

Itemized Contributlons from Indivirluals

I\tr
:,tF r-o(re

Ptinp'ualfJs'r:natirrn

Bemardini
.:lq'

Ciindv

Admh Assistant
lWC
OI

Aeo$nt of Contributftn

tmpln{'cl

14 Kozev Lane
Is contrib*or a lobbybl.

$eyrpur

CT

06483

Tmnof $eynotr

ordepeadentchildofalobb3:ir9

rpous*

r".

1*es

:i,

l,Io

If coahibutiol b io eeccers of $400 to a eandidate rcodalise fora chiof ess:ulh.e ofiicer ofa nsnicipalitl. does coatibulor or blsiness helshc is issociated 'nitb hare a eonhact witb said monhip.lit-r$tued atoole than 35.0O0? lf. f e* i;, No
Y3

Is this con&ihtiDn srs*hted a frndrairhg er"ent listsd in liestion L l?

rrlt

;.:

I/;'ds. Ibt El'!t

I\.trdfr od

.No

Ir coakibulor a priacipll of a *tate conb**or or proslncth

09/09/2011
;'.. Credit'Dcbitcard Ftst

ofgot*mdtheco*actisnith:
i,
httollDeduction

Ifnr.

iadicate

rr{ici bran& or brusk

e rtate

conba'itor?

ri.Executive .-. Legbleth'e

Yer No

; . c'ash :;; Pcrsomlfhe'i:

Blake
ffiil;ueel.{gdes 19 Blrchupod Dr.

of conkibutioa:

u0l KeceFnI

dgEr:gnacotrsrruw

i: I\ho:'fuq
T,II
rutrS

0910912011

$165.00

$50.00
Aoount of Conlriburho

Karen htf Ansonia

:rF{-ode

Prirpl Cl:rrryafrr:n Altormy

Nme or Emprq'er

contributor a lobblirt spouse otdepearle* child of r lotib$rt?

',rt

."

Yer

No

Welch Teodosio Stand< & Blake h in cxces of $400 to r candidatc coomi$ce fora chiet'.:scsnth-e ollicer of n nrnicipllig doer cootributor or bleiner* Hshe b xsoci*ed rtiti h*t l corbact nith sakl CT 06401
U contribdion

muairipalih rabed
Is thb coabibnrtbu *sochted rtith a firndnfoing er.+nt listed in $ectionl,l?

at

mre

than

$5.{XX}?

Xi'

r*es j-,

No lr-, No

t/;'cl. li$tEl'eott Ogl09l201

lrle*lrod of conhihution;

ri

\es
No

Is coabihtor a principal of a stfite con8lqtor or pmspectire etate contstctor? ,''' tes of governnent the uonlnrt b

fgw.

indi*de nbich braruh or

brm:bcs n'ith: l'l Erer:nthre

,.rate

ia Legislath=
388legrGRnqmrffi

xaccli:e{

[-t

r-as] 'i.
Coe

Pcrsond cheeli i' ' f.rcditDehit card

'H .{g(ri}ss ! ,

i'.

Parrolt Dedscti$ l'-i lr{onc!'ordcr

ogtlgtzoll
Pn L'rF{rl

$2s.00

$25.00
.{mount

l\{I

{-\*r&oglm

of

David
iulle
:lI! t-{1de

Retircd
Na$c r]l lmtrh} cI

Contribatha

sxEISIil )geel

ltr
Saymour

7 Great Meadow Rd
[r conlributor a lobbfist. epouse. r dependent r*ild of a lobbl.bt?

CT

06483

Retired
a

'ti

l!'s

If contrihr$ion is in escest of $.ltl0 to a caadidatccossilte for r c$ief drelrrti\e offisr of

mudcipality doc* costributor or busiucss hsishc is rsssliafed rrith hare a conbaet n'idr soid l"l r*ea 11. lrto nunbipalib'r'alued atnrorc th*n

No

$5.000?

Is ddr cortibution a*sociated rritl a Sndniring event lirt*d in SectionLt?

fJ'cs. li*t Erer:s 09/09120't

Irlcdrod of gonbibutio$:
4".

q: Ys :-. No

I* canbibotor a principal of a sble cordrector or prospccth't

state

dflw"iadicaterhichbranchorbremfu i'. fl. Exurnth'" Legirtntir-e of gorernnrent dre eoatnr:t ig rrith:

HFffiGFR

sotrhsctor?

l-

Tes

No

cash ij Per*omlCbeck -. creditDebitcard J. hpollDeduction : iLlone.vorder

Conroy
!ltril Fnancis \,ll
lJrire
lrP

iggr8filll cotralFuNtrs

09/09/2011
Plucnal
NArb

$228.00

$40.00
Amount of {lontribrtion

LdNiuB
tr3sKrtElnr

{fmnatrrr Retired
ot!,mp!s:ef

loTskokoratst
a

)ueil.{diris

F,1$

tgcont.ibutoralobblirl.apou*e.
or

dcfodnr cbild of

LI 1,-es totrbl.irfl ii-' No

Saymour

lfrle

Refired 06483 If conbihtirm ia in esrcss of $d00 to I surdidntc commiter for a qhie'f executive ofiicer of a municigalilvdox conhibutororblsbess he/sheis n*sochted rrilbhalea corftact ririthsaid CT

municionlitrr.abedatnorethm$5.000? r-.
Ir conuiheltor
a

l'es nl No

ls tlis conFibution associntedsitr fiindmiaing erent listed ia Seetio{Ll?

$l leg l-' No

I$'cr. listEfcnit* 09/09/201

1-

oigorerlmentthecontrastis$ith: ill Ltecuth'e

lrflc
ltGcelveq

{fttr.

indicate

princigal orfa state conaar*or or Pr$pcth? $trte conhar*or? trticb bnrch orbramhes

{l i'

t..es

]\io

i-lLegislath'e
Sgge$llO clrnlnFuBolls

ltldhod of conbibution:
:

Cash {tl Persmal Chdadi Dioo

1,1

CrsditiDbit Card l.rst

.l

Palroll Deducion

Nlore-v Order
I\'tr

0ey09r2011
PnncFal {'}cupat({r

$40.s

$40.00
(lontribution
Amount of

Cvnthia
,:tt!

APEDIS
turtt
:rir L'r\le

Nrmc 0I lnrFh}'er

18 Caniaqe Dr
ccntrilnrtor a lobbf i*t spouse. ndegendent child of a lotrbl-ist?
Lr

Sevmour

CT

06483

L*com
r
.t':'

-' Ies it No

If ,:ontributiod is in csqdss of $4m b a caadllete u'ommitee &ra chi:f esecoth'e o,ffrcerof

municipdig
does contributor or blsiress h6;shs is rsociated with hale a conFael n-ith said

auniciiralityrohedotmorethro$5,000?

Yeg lii

No

&lhircontibntioaassocirtedrrilho :i l'cs
frndnising e\ent listed in Sectioll.l? [-r No

ls contsibalot

{/ye.

lial Event
::*d

+ 09/091201

Ifus.hdi.x*n'hichbnecborbraashes i '' &:ecuth'e oigorernnrent lhe codrlct is $iti:

udcKecqvd

principal of

a state

codrartot or prosp*:th= strte

cotrhilctor? i -t Tcs 1r No
.{sgrtEc {

:-i Legistlth? $25.00 $25.00 $180.00

Lldhod of sortributisa:

!'it-ffL

PersaaalChec& :;'i

(-leditDebiteild

[, pg1.rollfu&*ion Fhtoaqrorcet

09r0sr2011

S{]BTOTAL Scclim B'This Pffie

Pagc

of

--

I.
Paul Roy 201
1

MONETARY RECEIPTS

Secfion B. Additional Pase

i
10t1'l'2911

B,, Itemize{ Contributions frtrm llrulivitluals

LastNaile
Firsl IUI
ttate

kmrrpal Occuitauon

Amount

of

Fries
ilti

CollEgn
llp t.!tse
1\U

Attomev
Ot

Contribution

l$Plrl}Ci

107 Soruce St.

ls contributor a lobbfist. spouse
or deperdent child ofa lobbfst?

f;

Yes

Coyne, von Kuhn, Brady & Fries 06483 CT Seymour If contribution is io esees of $4O0 to a candidate eoarmitee for a ehiof esecutite oflreer of a
municipalitl' does coatributor or business he'she is associated n'ith har-e a coffrast n-ith said C Yes {, ttio municipalitr ralued at rnore than $5.000?
Yes

No

Ie this contibution assosiated \r ith a firndraising er-ent listsd in Seetioc Ll?

It''es" listE\-nt+ 09/09/2011

Nlethod of poaFrbution : cash Persoral Checli

iij .t

Is contibutor

No

If'eo. indicite n'hich branch or bra$ehes

the coobaet is

principal of

shte contraetor or prospectire state

conhacior? f.
Legislative

oiiovernment

n-ith:

{.

Executh-e
1

f.

fl

Yes

No

Date Kece*'etf,

.{eigregate conErDutsons

f.

f;

ii.

Credit'Debit Card i{. Palroll Dedu*ioa la, \Ioney order

09r09t201
hrlrryal

$100.00

$100.00
Amount

iLst
Garofolo
(slgufl JEeer.+dqs
,lq

James
CT

I
I

\tr

tlccupats(rn

of

Professor
lame oI Bmplq'er

Contribution

,rP L os

163 Bunoav Rd
ls aontributor a lobbli.st. spouse. or dependent child ofa lobbrisfi

Sevmour

06483

Southem CT State Univ.

Ies

li3, No

Il' conhibutioa is in excess of S-lO0 to a candidate committee tbr a chief esecutir"e offieer of a muoicipaliq'does contributor or business hershe is associoted n'ith hare a conhact rtith said lfi :*es ifr No nuniciiali* ralued at more than $5$00?
Is contibutor
a

Is tbis ,roqtibution associated $ith a frndraising er.ent listed in Sectionll? Ifi'es. list Er.ent * 09/09/201:l \.lethod of conEihution:

lfl les Ft No

prineipal of

state sonttactor or prospectil e sttte

Ifi'es.iodicitet'hichbranchorbranches .fl Executir-e lfi Legislative ol gor ernment the ,rontract is rr-ith:
Date Recen..ed

contactor'l f'

r*es

'fi

No

Ki Cash fl" Personal Clheck

LtrtNafte

lfl

Credit'Debit Card

f: PaFoll Ftrst
'rq'

Deductior

Nlone-v Order

o9/09t2011
hncrpal Occupauon

$120.00

$40.00
Amoutrt of Contributiol

Kulas
Ksrde$ral street,+dd$s

Steven
,tAte

I
I

Nx

Attomey
}lame lal EmPlq'eI

:rp Lod,e

31 Skokorat St.
Is cootributor a lobb5ist. spouse. or depeldent child ofa lobblist?

Seymour

CT

06483

May & Kulas PC

fl ;''

:*es No

for a chiet^ exeluth-e officer of a municipalilv does contributor or business hershe is assot)iated sith hare a Qonhact n-ith said municioalitv valued at more than $5"000? f. Yes f: No

If conhibution is in ericess of

$JOO to a candidate somtniftec

ls this conhibution associated with a

ftndraising e'rent listed in Sectionll? Igrer. listErent = 091091201 1

{: f.

res
No

Ls

contibutor a principal of

fes a state contractor or Prospscti\ts stlte *ontaclor? No indicate rvhich branch or Esecutir-e Legislatite oigovernnrent 6e conbact is .{ggreg:arw conurDwotr uate KecelYeq fy'er.

brancher n'ith: f,

{i f.

f.

og/09/20't

$&4.00

$40.00
-A.mount

Fust
Haines tsrdeilnl xrcet.+oqres 8 Castle

Frank
lJre

I ltfi
I arp

&inclpal Liccupstron

of

Retired
Jme
or lmPrQ] er

Contribution

St.
a

F.lt)

Seaour
Il:

eode

CT

06483

Retired

ls conhibutor

lobbfist. spouse.

ot dependent child ofa lotrbf isti

fl r!.

Yes No

iontitutioa ls in sreess of $4O0 to a caodidate qonmitee for a ,rhief executir-e officer of a municipalitv does ,rontributor or business he'she is associated n'ithhare a Qontact with said munieipalit-rr-aluedatmorethan$5,000? C: r*es f: No
Is conhibutor a prineipal of a state contractor or prosPecti\t state contactor? {.l Yes No f;'es. indicate s'hich branch or Legislatir-e Executire oigorernruent dre contract is -l8lega corurguEQ$ ute KseFec

Is this ,ronbibution associated rvith a fimdmising etent listed in SectionLl? I 'e$. list Erent * 09/09/201 1
IUethod of contibution: fi, t'ash {-l Personal Check

{il Yes i]]No fl

branches fl n-ith:

fi

{l

fl

CreditDebit Card

Pa}toll Deduction

fl

IUoney Order

09/09t2011
Prncrpal {-lcfirFatron

$e0.00

$40.00
.{monnt of

Mitter
KSSrUennAr Jtret

Fust Navnit
l1h

I \tr
I

Dir., Genetics Lab

Naare

Contribution

-{d(trcs

:P Lee

of Emplqer

77 Brookfield Rd
ls contributor a lobbf ist, spcuse. or dependeat child oiu totttl'lrti

.f lfi

Yes

Seymour If contdbution

CT

0a+83

Labcorp

No

is in esicess of $100 to a gandidate somrni$ee for a chief executire officer of a municipalilv does contributor or busisess he,she is associated nith harc a contract n-ith said No .'0 municipalib-rabed at more than

$5,000?

Yes i6

Is this conhibution a,cgociated $ith a fundraising er"ent listed in Section Ll? 09109/201 {f1'es. list Event

.'f; Yes

ltt

ls conbibutor a principal of a state contrtstor or prospDti\ state

No

indicate nhich branch or oigoremment the cootract is

f1'a,

braoches nith' f, Executive lfi Legislatir-e

Llate .K$en'eil

contactor',) f'

fi

t:es No

h.Iethod of

contibution:

.{ggregnle rlrnErDuBlrN

H"i Castr F. PersonalChech ',fi c'reditDebilCard

Pa-rrollDeductioa

Ntoael'Order

osr0g/2011

$25.00

$25.00 $245.00

.SUBTOTAL Setidl B-Tlrts Page

Page

of

--

I.
Paul Roy 201
1

MOI\TETARY RECEIPTS

Section B. Addifional Pase

B:
L#tNme Potash
K6lwat
Dqtrr -{qcs -rq'
FiIst

Itemized Contributions from lndividuals

\.fl
)hle
JtIr

?rurcrpal

0cupatql

Carmelita
!tE:

Retired
NAm Or EmPra5'er

.{mount of Contributiou

23 Glen Cirle
Is conhibutor a lobbrisl spouse. or dependent child of a lobbf ist?

Seymour

CT
i* i"

08+si

Retired

{'.

{.

Yes No

escess of $4O0 to a eandidate coomittea for a shief esecutive officef of a municipalitl.does contributor or business he.ghe is associated sith har-e a conhact nith said

"o"ttit*i*

municipalitr.vahredatmorethan$5"000?'f:
Is thir conkibutiol associated r-ith a furdraising event llsted in Sectionlt? fJ'es" list Evest + 09/091201 1 lrlethod of conhibution:
C. t-ash fil Personal Cherd; LNt Nilre

Yes f, f.

No

f] C

Yes

No

Is coatibutor a principal of a shte coakactor or prospe,ctire state cotrbactor? I/1o. indicate l'hich branch ol branches Legislatir-e Lxeeutire oiiovernment &e eonbact is

f. r*es {- No
$40.00

*-ith:

f.

IJaIe Kece$es

-tregare conqFuu(rs
1

. CreOit'Dehit Card C. Parroll Deduction l{- Nlonel'(Her

091091201

$40.m
.{mount of Contribution

Fiftt

I\{I
mre :lP

Prs,;lpal Ctccupa!0n

Roy
Kesldetaru )ueer -{utres

Paul
lib-

First Selectman
rlq
Name

ot bilpllrl'er

80 Washinoton Ave.
Is conhibutor
a

Seymour
Yes

CT

06483

Town of Seyrnour

lobblist.

or dependent child of a lobb-vist?

spouse, il
lS'

No

to a candidate sommi$ee for a ehief esecotite officer ofa municipalit-r does coatributor or husiness hershe is associated $ ith hare a contraet n"ith said No 3-' munieipalitv valued at more than

h'"""tttb"tir" ir in qrcess of$4S0

$5.000?
a

Yes :f'

Is this coahibution associated n-ith a fundraising er.ent listed in Section Ll?

Ifi'cr. list Erent

'.f Yes [fi No

ls

coatibutor a principal of

state conhactor or prospectir-e state

0910-91201

oigor-eroment the conkaet Credit'Debit Card F. Palroll Deduction

Fust

fJ6. hdi;te

$'hich bnnch or

branches is rvith' fi Executh:e lfi Legislative

l)ate Rerrved

con&actor',) {r
ngEltgdrc

'.fi No

Yes

Ilethod of cortributioo: Kl Cash f. Personal Cheeli

:i

F' \'Ione3'Order
\,II
;tate

09/09/201 Princioal

$170.00

$50.00
AmouBt of

[ast]il
Simpson
K6lderf$l
Sheet

?rincrpal rlcetpaton

James
]Ib'
3p

Contribution

-ld,f ess

Lde

\arue oI tsmplcler

4 Falbo Dr.
Ig soltributor a lobbfist. spouse. or depended child ofa lobbyist?

$eymour

if

Yes

tf

No
{31

""nttibutio municipalitl.doeg coahibutor or businEss heishe is associated $-ith ha\.e a contract n-it& said muni)ipalit\.'vahed at more thao $5.000? f. fes f, No
Is contributor a principal of a state conbaator or prospectire state conhactor? f1,es. indieate nliich branch or Legislative Executir-e oilor-emment the contract is

Town of Waterbury ir in excess of ${00 to a calrdidate committee for a chief executir-e offrcer of a CT 06483

ls this contribution associated with a fundraising event listed in SectionLl?

Yx

Ifi'er. listEvent # 09/091201

lNo

branche$ f. n'ith,
Uate Kece$ ed

f.

{, fe" f , No
$40.00 $40.00
Amount

Ir.Iethod of conhibution:

{ggregate canElDu[Qs
1

f.

Cash Si

Personal Check

{:

Ctedit'Debit (--ard
i

f,

Palroll Deduction

ll

lt{oney Order
N{l

09/09/201 Registar

rst

Principal Clccupation Name oI Empto,\-H

of

Skurat
Rsldenhnl

Ronald

Cmtributioo

Steet.\dte:s

19 Gln

Circle

t-)t]'

Ig eontributor a lobb3'ist spouse. or dependent child of a lobbf ist?

l
h.

Seymour
mudcipality

lJhte

LIP

LNC

CT

06483

Tmrn of Seymour

Yes No

If c"ntdb.tio i" in er*--

o? $d00 to a caadidate commi$ee for a ebief executi\-e o*icel of a does conhitrutor or busbess her'she is associated Jrith ha\''e a corhact rtith *aid

municipalitvraluedatmorethan$5.000?

f' Yes l*l

No

Is this contibution aqsociated $ ith a firndraising e'r-elt listed in Section Ll? It'(,r. list E ent *
N.Iethod of

{il

r*e.g

{*l

No

fl, Cash

contibutiol:
$':l Personal Checli

{,] Ies ts conhibutor a principal of a state *ontractor or prospectirc state contractor? No f.1'es. indicate rr-hich branch or brafirhes dll Esedsti\-e Legislatirr oi'ior-crnnent lhe conhast is lgxe8BE ct)nErDuq(rN Uate Kffel\-eil

sith:

fl

fl

ill

Credit'Detrit Card
rust

{) Payoll
Fred

Deduction

lrlonel'Order
IUl

09/09/201

$80'00

$40.00
.{mount of

hincrpal ctcupaurx

Stanek lsrdersrat $tet Aotres 22 N. Benham Rd

Is conhibutor a lobb5tst spouse. or dependent child ofa tobbf isti
Is this

Attomey
itsR
.rP

Contribution

.:rb.

rluc

Name ol

!r1pl$'6r

'{
i#t

Sevmour

CT

06483

Wech Teodosio Stanek & Blake

fes
No
{a

It'"*ttiUd*
l-es

is i" crices* of $4O0 to a candidate conrmiftee for a chif esesutir-e office{ of a nunicipaliq. does contributor or busioess heishe is associated rvith have a contract rvith said municipalit-rrahred atmore thaa $5"000? lf r*es lfl No
Is conhibutor a priacipal of a state contractor or prospecti-e state

contibution assosiated n ith a fundraising erent liste{ in Section L l? I/ler. list Event 0Si091201 1

No

fudicate which branch ot oi lor-erament the cootract is

flvs,

branches $ith: fi Eseeutive 'ii

Date Kecerved

contrsatot? f'
Legislatile

fi

Yes

No

lrlethod of conhibution: Ea Cash tr penonal Cheuk

AgglegaE conErBu[om

'fi

CreditDebit Card F- Palroll Deductioo

lrlonel'Order

09r0s12011

$25'00

$25.00 $195.00

SUBTOTAL Section BThis

Page

!19
_-

of "--

I.
Paul Roy 2O'11

MONETARY RECEIPTS

Section B. Additional Paee

ffiF
10t11t2s11
-lmount of Contributiotr
ot EnrprcS'el
a contracl

B.'
LastName

Itemfued Contributions from Indivfuluals

I\{l
'EIe
irP

Frsl

:nnclpal Occupatson

Stanek
Kestcel{$l JEei Aogress
.'rD

Karen
l.e
NAnre

Retired

22 N. Bneham Rd
Is contributora

ordepeadentchildofalotrbyist? {r, No
Is tbis conhibnrtion associated with a fundraising event listed in Section Ll?

lobblisl

spouse. C.

Yes

Retired CT 00483 Seymour If corbibution is in excess of $lO0 to a caldidate coarmittee for a shief esecutil'e officer of a
municipali!'does contfibutof or business he;she is associated r*'ith harc municipalit-vrahredatmorethaa$5.000? i", fes $, No with said

,:: Y*
.r. No

{/l'es. list Erent

09109/2011

Is contibutor a principal of a state contrastor or Ptospective state contaetor',) indicate ntich braneh or branches Etecutir-e {. Legislatirre olgovernment tle conbact is

fler.

i. I"t f* No
$55.00 $25.00
AmouEt

n-ith:

{.

Nlethod of contribution: Cash 6., Personal

flate KecerFed

-agelegate contrlbuafirs
1

i.

Chedi

l.

CreditiDebit Card lt*, purtoll *O,rclion

lli

lrlonel'Order
I\11

09/09/201

tffit

Stauffer
ilq'

Christine
tate
:rp Lrrde

lncpal Occupatson Realtor

iame

of

Contribution

oMPlo)-er

21 Briohtwood Dr.
Is contributora lobblist spouse, or dependent child ofa lobb-r'ist?

.f.

r"es

06525 self-employed CT Woodbridge If contribution is in eJrcess of $400 to a candidate conmitee for a chief esecuti\

16lNo

e officer of a orunicipalitl- does conhibutor or business hershe is asso,)iated n-ith harri a conFact rtith said muairipali&' r'alued at more than $5"000? f' le's lfr No Is cootributor a principal of a statc cootractor ot prosPectht state

Is rtris mntribution msociated q-ith a fuodraising event listed in SectionLl? 091091201 I fy'es. list Event

Yes

Ki

No

indiciten'hichbranchorbranches ilr Esecutive fi oigorernment &e contract is rtith:

f'.es.
Date K*rvo

con$astor? f' }*"*

lf'

No

Legislative
Ag-elegale comrouoQm

Nlethod of sontibution: Personal 61 Cash

ii

Che{k :l' Credit Debit Card Fl Palrolt Dedu*ion F' \{one1- order

0s/09r2011
krncipal (:iccupauoD

$50.00

$50.00
.lmount of Contributior

Fifft
Stelma tsxlefiat Jlrer.{d&ess 3 Oriole Lane
Is contributor a lobblist. or dependent child ofa
:lN

John
)uI9

I \tr
I
1rP LDale

Suoervisor
Nme 0l Smplc!'er

spouse. lobbtist?

r.: Yes
r5l

t)648i! GW lnd. Westem GT CT Seymour If cootribution is in oicess of $400 to a candidate comrnitee tbr a chief executive ofticer of a
municipalitl' does contributor or business hershe is associated rrith har-e a ,ronh&ct n-ith said f,; No munieipalitl- ralued at more than $5.000?

No

f, res

Is this contibution associated r-it} a fuldraising er-ent listed in Sectioo L l? !fi'es" list Event; 09/091201 1

f
I

Yes

Is conhibutor

No

Ifi'es, inclicite n-hich branch or branches f. Esscuth'e oi'gotornrueat 6s contract is n-ith,

!)are Kecelv{

pdncipal of

a state conhastor or prospecti\-e state

conbastor? {:.

-l,-es

t-

No

f.

L"gi*lutit'.
.lgglegste contsrbutrons

\{othod of eontibution:

f.

t-'asn tr.

Personal Checli

i-

CreditDebit Card
I lrsi

f,

Partoll Deduction {-l

lrlone-v Order

09/09/2011
PnncrFal Occupatton

$25.00

$25.m
Amount

La$ Nanre

\II
lJtate lrp

of

Strumello
{srdedral
ls Street

Edward

Retired
LNe
lame !)t gmplo-\:er

Contribution

Atidss

188 Mountain

Rd
il-l

IJt}'

Sevmour

CT

06483

Retired

contributnr a lobbfist spouse. deperdeat child ofa lobbl'bt?

'l

tes
No

Ifr;ontribution is in ercess of$lO0 to a candidate committee for a chiefesecuti\-e ofriser ofa municipali$' does contributor oc business hershe is associated *-ith har-e a eontraat $-ith taid municipalitl'rahedatmorethan$5'000? fl Yes fil No
Yes

Isthisconbibutionassociated$itha
firndraising er-ent listed in Section Ll?

fi.]

{f}'er. list Elent + 09109/201

f.

No

ls conbibutor a principat of a state conbactor or prospecti\? state codEactor? C.l r*es {1l No I$'es. indicate w*ch branch or Legislatile Esecuti\e olgor-e,rnment the contract is

branches s'ith: fl
Date Recell'ed

f'

\Iedrod of contibution:

ugeRrE

Cash 6':l Personal Check Trybus

fl

Credit'Debit Card r*l Patroll Deduction

\IoneJ'Order

09109/2011
Pmcrpal L)!'cupa!on

$25.00

$25.00 of Contlibutio[
..Lmount

LastNane

Fffit
irN

Karl
J{ate

ll.tr
I lrP

lnstructor
!449
Na$e or lmProter

fwuel]B )rcgt.tgqgs

20 Old Ansonia Rd
Is contrihutor a lobbfist spouse, or dependent child ofa lobtrl-ist?

'il'

Yes

Sevmour tf contribution

CT

06483

Uconn

lffr No
:f, \-s ti-' No

ie in ericess of ${O0 to a candidate commitee for a chief esecutire officer of a mtnicipatit-r. does conhibutor or btrsiness he,she is associated n'ith hale a contraet *'ith said

ruunicipalitvralued atmore thao

Is this contibntion associated n ith a firndraising er-eat listed in Section Ll'? I/r'er. list BYent 09/091201 1 Is eonhibutor
a

$5"000? If' :r-es ',fi No

a state

tf'd.

iadi;te $iich branch or branches

principal of

soltractor or prospctile state

'1fi

conhaetot? f,' fes

oigoreroment the contract is

sith:

lfi

No

E:ieeutive 5i Legislati'e
lggregate conrlbuorxrs

L,fethod of contibutiotr: Fi Cash $- Personal Check

Date RtreFel,

lfl

e-redit'Dettit

card F

Pa5roll Deduction

lrtronel-

tlrder

09/0912011 SLTBTOTAL Sectim

$25.00

$25.00 $150.00 of

BThis PrgePage

I.
Paul Roy 201
1

MOh{ETARY RECEIPTS

Section B. Additional Pase

1U11t2011

B., Itemized Contributioas from Individualc

LastNme
Ftrst

l.tl
arp Llode

Prrrcipal Ocrrpation

Valeski
-1S'

Dawn

Asst. Public Works

'BIC L\Ug QMplq 9I

.{mount of Contribution

20 Osprev Dr.
Is conkibutor a lobbyis( or dependent child of a lotrb-visf?

Sevmour

CT

06483

Toan ofSeyrnour

spouse, f . lr,

r-es

No

eseess of $4O0 to a caadidate gommittee for a chief executire officer cf g municipalitl- does coatribulor or business he'she is associated rrith hare a contsact rtith said ouoicipali{. rrlue at qrore than $5.000? fl Yes !i, No

If contribution is in

Is thb conhibution associated $ ith a firndraisiag event listed io Section L l?

f,

Tes

yyel listEvert+ 09109/201 \lethod of ponhibution:

.f.

No

Iscoatibutoraprincipalofastatecontractororprospcctirestatecootactor? fy'es. indicate n-hich bran{rh or braocles

of govemment the coniract is

*-ith:

f. Erecuti'e f.
1

f. Tes f* No
$50.00 $50.00
-{mount

Legislatir-e
{gggatB conErDuuos

@r9KWgIro Credit'Debit Card

FUSt

f. Cash f

, Personal C.heck

i.

ii, Paltoll
Maureen

Dedur)tioo

]f. Irlonel'Order

09/09/201

Last Nane

rlt
ilare
.lI)

?nncrpal ocdrpabon

lMlhelmy
lq'

of

Dist Mqr
rgqc
lame ot bmFt(l}ir

Contributlon

116 Maole St.

Is cortn'butor a lobb1ist, spouse. or deperdent child ofa lobbr.ist?
-t,-es
3

,fr

CT 0B+83 Metro-North Seymour If conhibution is in sxcess of $.1O0 to a candidate commifiee for a chief sxecutive officer of a
municipali$' does conhibutor or business hershe is assosiated sith hare a contract n'ith said municipali!.raluedatmorsthao$5,000? Irt fes,fi No
Yes
Is contributor a principal of a state contlaetor or prospati\ state

No

Is thb conhibution associated n'ith a frndraising er.ent listed ia Section Ll',)

lfr

I*'er. list Etent

FNo

091091201

Ifizs.indicaten'hichbranchorbran*hes ji' lxecutive lfi Legislatir-e of gor-ernment the eoctraqt i$ rr-ith:

Ilate Kecelved

c$nkactor'.)
.tg*qrc,srE

f,

l*es

ifr

No

Nlethod of conhibutioa: E? Cash .{. Personal Check

ceurwqrTs

li

t-reditDebit Card F- Parroll Dsduction [fl Nlonev Order

:usl

o9/09J201

$s0.00

$50.00
Amount of

\{I
1lP L;lrde

Itulcrpal occupatron

Garofolo
Glmunl J&eet Ao&es 1&3 Bunsav Rd
ls conhibutor a
.rB

James

Professor
NAme or iJmptcS-er

Contribution

lobblisl

ordependentchildofalobhvist?

spouse, fi f,

Yss No

0648i:| Sevmour Southem CT State Univ. CT If contribution is in cncess of $lO0 to a candidate comrnittee for a chief executite offrcer of a municipalif'
Yes does contributor or business hetshe is associated rr-ith harc a rrontract $'ith said

municipalih ralued atmore than $5.000? Is this conkibution associated rvith a fitndraising elent listed in SestionLl? I/.1'es. list Event * _
IUethod of contibution: f. Cash dti Personal
Last Na$e

fl r*es {,

No

r
{t.

I*

No

'Jootibutor

principal of

a state gontractor of prospecti\ state conEactor',)

t.i I$

.If,es. indicate n'hich bratch or branchoe ol golernment the contract is nith:

l"r?lt

f.

No

i*- Esecutive f,. Legislatir-e

tIggldrg r(rtrul9uuQs
1

KeeIFelJ

Checli

{.

C--redirDebit Card

Partoll Deduction

f.

lr.Ionev C)rder

09/13/201

$420.00

$300.00
.{mount

!mt

\tr
IJtat

Principal (trupation

Simpson
lsuru *ee[ -{qqffi 5 Walnut

Judith
!-.lt)e'l Yes

Retired
:lp L:oft

of

St.

Sevmour
If conhibution is in

\ee

Contribution

or tsmPrct'et

CT

06483

Retired

coatributor a lobbSisl spouse or dependent chila oia totUrlrti

Lq

tr: No
a

ex'ress of $400 to a candidate committee for a chief executive officer of a municipalit-l' does contributor or business he.rshe is associated rr ith har-e a ,ronhact \$ith said No municipalitvralued atmore than

$5.000? f' Yes f,l branehes ill sith:

!/al Kecen etl

Is this coltibution associated

$idl

.t

firndnisirg event listed in Section L l?

; {*l

Ies No

f,'eJ. list Event: 09/30/2011

h'[et$od of conaibution: {, Cash Personal Check

Is contibutor a priacipal of a state contlactor or prcspeti1-e state corta,rtor? {f.r'es. iadicate *'hich btanch or Lxe,ruti\e . Legislatire of gorernnreat the contract is

f.l

:*es

ll-'

No

fl

fl

Credit:Dehit Card i*l Pavroll Deductioo

!

lrlone-v Order

o9t21t2011
kmcrpal O:cupatrm

$110.00

$s0.00
.{mount of Contribution

rst

III
*aIt
alp Lrode

Gridzias
tuguil JEet.aoqN

Richard
-lq'

Retired
Name ot llmpl0.Ter

29 Rimmon St.
Is contributor a lobb$sl spouse or dependent u'hild oin tolf3i*ti

?l'

Yes

Sevmour If contritr$ion

CT

0a+&3

Ratired

'.$r No

is in eicess of ${00 to a pandidate com"orittee for a chief executir-e offrcer of a municipalilv does cootributor or business heishe is associated with hare a conkact rrith said municipali!'r-alued at nrore than $5"000? ,r_r I gs .,.+ 1\o

Is this cootibution associated with a fundraising erent listed in Section L l?

Yes

{fi'er. list Er-eat $i Cash

fi,

No

Is conbihutor a principal of a shte conhactor or pro*pectir e state .Ifi,es. indicate s'hieh branch or

09/30/201

branches ofgovernrnentlhecontractis(-ith: fl Esecutir-e

I)aIe

conhactor',)

f' fes Ir No
$130.00 $90.00 $580.00

lfiLegislatir-e
AggIente cont rbudore

Ile*hod of contibutioa:

K$ered

fi

Personal

ChE*

.'f-r

Credit'Debit Card

[i

Parroll Dedu*ion

\Ionev Order

o9t21t2011

SLIBTOTAL Settiori B'This Pae

Page

of -

I.
Paul Roy 201 1

MONETARY RECEIPTS Section B. Additional Pase

i
10t11t201',1

B.
LastNase
Frrst

Itemiied Contributions from Indii'idual*

Ltr Pnncpal Ocrup*titrn

Welch
--I]

Tom
llrurs

Atorney
Qr EUPR-_a sr

-Lmount of contrib{tion

47 Old Shelbn Rd
Is eonhibutor a lobbfist. spouse or depeodent *hild oia lotb-visf

r'
i6,

Shelbn
Yes

No
Yes

Welch Teodosio Stanek & Blake If eontribution is in ur,Jess of ${OO to a candidate '}ommite for a chief esecutir-e oti rer of a

CT

06484

municipali$.'does contributor or business he''she is associated with hare a contract n-ith said 'f' Yes l, No nruaicipali!-r'ahred atmore than $5.000? Is conhibutor
a

lsthiscontibutionasso*iatedx-itha Sj
firndraising etent listed in Sectionll? If'a. list Event * 09130/2011
Nlelhod of contibrtion: Castr :tl Personal

f.

No

.t*es principal of a state eonhactor or prospectir-e state conbaqtor? fl . f No Ifi'ns- indicate rrLich branch or branJhes f. Executite f. Legistatire of gor-ernnent the contract is'n-ith:

Irate

l(sereo

{Iegate contrbuoons

f.

Chedi fl. CreditDebit Catd

nsl

Parroll Deduction

li. ltloner

Order
N.II

agt?1nafi
Plncrpal Occupanon

$100.00

$100.00
^{mount of

LLst Name

Coyne
jlt]'

Kevin Fairfield If conhibution CT 06825

Atorney
L\me or rlmProlq

C0ntribution

401 Davis Rd
le contributor a lobblisl spouse, or dependent ehild ofa lobbyisP

Coyne, von Kuhn Brady & Fries

r*es

,t.: No

is in encess of $.1O0 to a candidate comnri&ee for a dtief executir-e officer of a municipalit-v does sontributor or business hershe is associated \r ith hare a eontract n"ith said No municipalih'r'alued at more than $5.000? 'F,

Yes lir

Is lhis confibution associated with a frndraising er-ert listed in Section Ll?

Ifi'es. list Er.ent; 09130/201

\{ethod of conaibution:
LastNmre

'f; Yes FNo

Is conbibutor a priocipal of a state !-ontactor or prospecti\- state conhaetor',) f;'es. indicate n'hich branch or Lrecutir-e lfr Legislatir-e of gor ernmelt the contract is

btanches rtith: li
uare Kecereo

I' Ve. .fl No

$320.00 $320.00
Amount of

'fl, ffi Cash Penonal Ched; lfl CreditiDebit Card

l{sl

3*- Pa-rroll

Deduction f{: Nlone-v Order

N,U

09121/2411
PrmcFal {)ccuFaton

Stanek
KSlGnUat blreel .loflress

Karen

Retired
;late
:rtr Lrode

Contribution

}w r . les ior No

Nme ot !$ptc}'er

22 N. Benham Rd
Is contdbutor a lobbfist. spouse" or dependent child ofa lobbr.ist?

06483 Retired Seyrnour CT If contribution is in excess of $400 to a candidate tJommitee for a chief executir-e officer of a mulicipalif' does cortributor or business he;she is associated rrith hare a conhact with said
municioalitr valued at more &an

$5.000']

f. Yes fi

No

Is this contibution associated n ith a firndraising er-ent listed ifl SectionLl? Ifi'er. list Er.ent * 09/301201 1

fi. I'es C lto

\Iethod of *onbibution:
La$tNme

Yes Is confiibutor a principal of a state conhactor or prospcti\ stat conhactor? No {fi,es. indie*te n'hich branch or of gotemment thE conkaet is f,. Executive Legislatir-e tggregaG clrnEpwom HIEKrcST'R

branche$ $ith:

f.

{r f.

f, Cash Sl Personal Check {.

Twon
[qsilRr Ner.iqqs

Credit Debit Card 9*, Partoll Deducrioo

i.

\Ionel Order
a{l

o9t21t2Q11
krnclpal C]ecupabor

$145.00

$90.00
Amount of

![st

John

Retird
lmre
lIP L,NE
r

Contribution

2O Hotchkiss a lobblist. spouse. rr dependent child ofa lobbl.ist?

ls

Ten.

F-ts

ur suPru)

Ansonia

coatibutor

l.] fl

res No

Retired 06401 CT If sontribution is in ercess of $400 to a sandidate qom$ittee for a chief enecutive othcer of a ounicipalilr. does conkibutor or bsshess he:, he i, associated rrith harc a eonbact \rith said r- I es t!, l\o municipalitl'ralued at more than $5,000:)
Ls

Is thb coahibution associated n ith a firndraising errent listed in Section L l? Ifi'es. list Event = 09/30/2011

dil

fl

r*es

contibutol

principal of

state cortractor or pfospecti\-e state

No

indicate u'hich branch or branches of gor.ernment the t)onkact is

.fy'g.

'JonbactorJ

{-.i

$ith:

fl

fl

I es

No

Esecutive {1i Legislatir-e

r8SreeaE ulinq

\{ethod of conhibution:

Date

Ksel'ed

f' Cash $'l Personal Che,rk fl

LoPresti 35 Kalhv Dr.

Credit,Debit Card

fl

Parroll Deduction

fl

lrlonev Order

o9l2'u2911
ltnrclPal Cbcupaion

$45.00

$4s.00
.{mount

irst

\.ll

of

conkihutor a lobbyisl r*o*". rr dependent child ofa lobbl*ist?

ls

'f ..'

Yes No

'rf' Name or l]nprq'er .{, L.rus )BTC 06483 Retired Sevmour CT lf conbibution is in ericess of $400 to a sandidate committee lbr a chief esecutl'e offrcer of
municipatiq- does contributor or business he;she is associated nit$hare a contract n'ith said

Anthony

Retired

Contribntion

municipali!'raluedatmorethan$5,000?
Is this contibution associated n'ith a fundraising elent listed in Section L 1?

ifi Yes ltil No

.f

l-es

C, No

{/r'dr" list ErEnt + 09J30/201

Nleftod of contributiol:

Yes Is conhibutor a principal of a state contrastor or prospcti\ state cotrhactorJ l{1 No Ifi'es. indicate n-hich branch or Esecutive lfl Legislatir-e of gor-ernment the contract is

branctres $ith: ii
Date &ecesed

t:grggaF cQruouu!tr

F t'ash fi

Personal Check '.f, credirDebit Card

F' Palroll Deduction F \Ionel'order

a9121120'11

$4S.OO

$45.00 $600.00

SLIB?GTAL Srcttorr &,This Paec

Page

-_.-

of

L
Paul Roy 2011

MOTETARY RECEIPTS Section B. Additional Pase

19t11t2011

B,
LmtName Fkst

Itemized'eontributions from Individuals

NII
;trile :rp

Prircipal 0ccurratroa

Condon
tsroat JusI -aw$
-iR-

Kevin

Atomey !.re
l\U
Ot

-{mount of

Contribution

EmproJer

30 Laural Lane
Is c+ntributor a lobbl.ist. spouse, or dependent child ofe lobbf isP

fl

Yes

Condon & Smith o&72 Oxford CT If conkibution is in ercess of $ilOO to a eandidate committee for a ehief esEcutir-e officet of a
municipalit_v does conhibutor or business hershe is associated rrith hare a contract rsith said

fi. No

arunicipalig.raluedatmoretlan$5"000?
Is this contibution associated with a foadraising er-ent listed in Section L l? ti'er. list E\-ent * 09/30/201 1
Nlethod of contibution: fi, Personal Check C:

l-. Yes f:

No

q; 1-es .f. No

Is eontributor a principal of a skte cosbaetor or prospectis state If'es. iadicite s-hich bransh or branches

contactor? f
Legislath-e

{*

. Yes No

oiioverument

the coabaet is

n'ith

t.

Executh'e

f.

l.)ate

!{setred

{:8Iee3E COnErouqLrD

clsl

f,

Creait'Debit Card
t

f,

Pat'roll Deduction

lf. Nlonel'Order
l\II
;tate

a9/2112011
Prncrpal Cha:pattrn

$50.00

$50.00
.{mo*nt of

Est

Phelan
(slctrIlta Jusr -{wes 19 Cedar Dr.
Is sonhibutor a lobbvist, spouse or depeadent child ofa lobbybti
Is this

Marie
irq'

Atomey
:{l UNE
or grPru) sr

contIibution

Killingworth

CT

06419

Pullrnan & Comley

res
No

lsl

It' itonhibution is in qicess of $.100 to a caadidate commifiee for a chid esecutire officel of a municipalitl' does eontributor or business hsshe is associated rtith hal"e a contract n ith said l,' No nrunicipalitl' r'alued at more than $5.000? if-' te
Is cootibutor

conhibutiol asso,Jiated n-ith a frndraising er.ent listed in Section Ll? In'er. listErerts 091301201 1

fi YEs FNo

{f1es. indieiten'hichbraachorbranches f' Esecutirr; ol gol'ernoent the coatract is rtith:

!)ate Kecelved

principal of

a state

codrastor or prospecti\

e state

contactor? {'
Legislative

Yes

:fl No

lfl

Nlethod of contribution: Cash if. Personal Chec& F.l Credit Debit Llard

3l Patrotl Deduclion
Karl

fi

\loney Order
AT
xaae

09t21t2011
tmcrpal !)ccupatrsl

$45.m

$45.00
Amount

LastNme

[St

of

Trybus
slgcrunt nrser.aNN
2O Old
'rtl

lnstructor
,!p!]e
\ame ot lJlnprq'er

Contribution

Ansoflia Rd

Seymour
Yes

CT

06483

Uconn

Is contributor a lobblist.

ordependentchild

spous*. {*l ofa lobbyist? f,

No

Il- contritrution is in ericess of $.1O0 to a candidate committee for a chief executive ofti,Jer ofa municipalig.' does contrihutor or business hershe is associated with hate a conEact rvith said

mnnicioalitr"rahred atmore tftan Is this contitlution associated n ith a fiindmising elent listed in Section Ll? {fi'sr. listEr-ent + 09130/201 1
Ir.fethod of

$5,000?
ofa

A Yes F, No f,

f;l

les

Is conhibutor a prinuipal

CNo

state conkactor o{ prosPeltive state contraqtor? Ifi'es. indicate n-hic$ braneh or bratches Legislatirc Eseoutirre olgovernment &e contract is

lij

f".

res
No

$ith:

f.

i Ca* frj Personal Chedi

Coe

contibution:

Date Rwe*'ed

igElcEgtc u([u&,uaus

{-ll CreditrDebit Card

F

f,

PaFoll Deduction

fl

Nlore-v Order

o9t2lna11
ltrncrpal ()c$rpauon

$70.00

$45.00
-\mount

lrsa

l\il
lJare
4rP

of

David
F:l['
r*es
Lllrde

Retired
Nele
or .ErDproJ'et

Contribution

K$roenlnl ilrcet j\o&ffi

TGreatMeadowRd
h contrihutor a lobbS.ist, xdependentchildofa lobbf

Seymour

CT

06483

Retired

spouse" f,:l ist? l

No

$4O0 to a candidate commifiee lbr a chief esecuth'e officer ofa orunicipalig' does contributor or business heishe is associated n-ith harrE a contra,rt \Tith said C'Yes 6l No municipalit-r'ralued at more than $5,000?

If conhibution is in espess of

fu rhis conhibution associated with a ixrdraising er-ent listed in Se,)tioa L l? 09/301201 1 r1'gr, |tu1f,1'ga1

6l

fl

Yes

No

Is contibutor a principal of a state contractor or prospecti\? state coltactor? Ifi'er" indicate rrhieh branch or branches f.l Esecutir-e {ll Legi.slatile oi gor-ernment the conkact is n

ith:

f.l fl

Yes

No

\{et6od of contibution: {*, Crsh trl Personal Check

Date

Rsesed 091281201
1

-{SelegAte crlntrlDunom

fl

t-redit Debit

Csd
Fust

fl

pa'r'roll Deduction

fl

Nlonel' Order
Ntr

$328.00

$100.00
.{mount of Contribution

Prncipal Occupatnn

Wsneski 1e$rgerfl at xr*r -{odess 473 Rimmon HillRd

[s coatributor a lobblist. spouse or dependent child ofa lobbl-isP Yes No

Susan
.lS'

Human Resource Specialist

:$ L:Oft
Name (rl

lnlplotor

Beacon Falls If contributiotr ia itr

municipalitl
Yes Is

CT

06403

State of GT

encesg of ${00 to a candidate eommittee for a chief executi\-e office'r of a does conhibutor or business hershe is assoeiated $ ith have a uontract s"ith said

municipalit-vraluedatmorethan$5.000?
Is this conkibution associated n'ith
a

r*es

3a No
!"-*' r*es

findnising er-ent listed in Section Ll? Ifi'es. fist EIent = 091301201 1

Nlethod of conhibution: Personal &i Cash

:f
tl
J

No

contibutor a principal of a shte coohactor or proslleqtive state sontaator? fy,es, ildiciten'hichbranchorbranchs lfi Ese,Jutile 5i Legislative oigoleroment the contract is $ith:
!)ate

"f

lfi

No

Kserfec 091281201
1

.{ggregaB cotrErouuotB

fi

Cherk '-fi Credit"Debit Card F Paltoll Deducfioa F \tone1'order

$85.00

$45.m
$285.00

SIIBTOTAL $ectim BThis Pasc

Page

of

L MONETARY RECEIPTS Section B. Additional Pace

:

Paul Roy 20'l

1011 1/201

B. Itemized Coniributions
LstNmr
tgemar DEst First

from Individuals
Pnncg,al (:hcupatlon

\,II
fiale
::P

Theresa
-+ws
.:rq'

Minute Clinic
LNE
Nme ol !mprc5's

.\mount of Contribution

177 Skokorat St. Is conhibutor a lobhlisl spouse.

or dependent child ofa lobbf irt?

r'

Ys

APRN 0a+83 Seyrnour CT If cootributior is in ercess of $dOO to a candidate ,rommittee tbr a chiefeiecutire oftieer ofa
munieipati['does co$tributor or busioe*s he'she is assorriated $ith hav" a conhact n-ith said 'i', Yes f: No municipalit-vrahred atmore ftaa $5.000?

fr: No
{E
a

Is this eontibution associated x'ith a fundraisiog event listed in Seetion L l'l I/;.es. list Etent + 09130/2011 lile{hod of conhibutior:

fes
No

Is coahibutor

a principal of a shte cotrhactor or Prospectir-e state contador? .f}.as" hdicate rrhich branch or branches f. E:recutir-e f Legislatil'e olgor-ernment the contract is rr'ith:

l. f

Yes

No

Date Keees-ed

tggregate conE lbunons

1

ii, Cash ti:

Personal

Chedi

{1. CreAit'DeUlt Card

Fust

if

Pawoll Deductioo 'I-. Irlonel'Order

09128/201

$235.00

$135.00
Amount

{l
*ate :E cod

hmcrpalOcmption

of

Fries
K$lcefflal ilIet -{geffi

Colleen
Ittt'
Nanre

Afiomey
oI !,mFro)-{

Contribution

107 Spruce St.

Is contributor a lobbrist. spouse, or depeodent child ofa lobbyirf?
Is tftis conhibution associated rrith

Seymour

CT

06483

Coyne von Kuhn Brady & Fries

C
n
1

r*es

If

lO

l.io
',1i Tes F No

contribution is in excess of $4O0 to a candidate committee for a chiet- esecutire oficer of a municipali$. does eontributor or business heishe is associated rr-it,h har-e a cootract rvith said municipalitvrahred at more than $5"000? lfii Yes .fi No Is contibutor t*es a state ,rontraqtor or prospecti\ state colrhac*cr? No branch or i{' Executir-E lfi Legistatite o?gotemment the eonlraet is {ggregac conErDuEoN Date Rwere.i
a

princigal of

fundraisinger-enttstedinsectionll?
.I/)'.'s. list E\-ent * 09130801
Nfethod of contibution: F Cash Personal

Ifi'es. indicite n'hich

branches with:

fi ifi

f.

(Aedr '.fl

CreditDebit Card
t,ret

C Payoll Deduction F' hlore!'order

Ntr :rp L.Nc

o912u2011
hurcrpal Occupaton

$187.00

$55.00
.{mount

L6t

NXIne

of

Demmino
lgwl Dg9et.tqqc$ .'ltl'

Mary
'AI

Educator
)

Contribution

0l lJmPrq'et

100 Walnut St.

Is cortributor a lobbl.isl spouse or depeldent child ofa totbvi"t?

q; No

Yes

Seymour Bd of Ed. 06483 CT Seymour If contrihution is in excess of $400 to a candidate sommiftee for a chief executil-e ofti:er of a
municipaliq'dox conkibutor or
municioalitt'ralqed
at orore

business hershe is associated'rvith hale a coatract

n'iti

said

thal

$5,000? f, Yes f.

No

Is this conhibution aqsociated n-ith a ftrndraising e'r'ent listed in Section Ll?

{3
t"

Yes

No

fyer" listBlent * 09130/201

Is contibutor a principal of a state conhactor or prospecti\-e state contactor? !r.1'o" indicate which braoch or branehes

r ; lgs f- No
compuuoN

oigolernnrenttheeontractisrtith, f.Executive
!)ate

f.Legislatir-e

It'fetlod of eonbibution:

Ksered

:tggle8nte

It Curtr fl

Personal Cheak C, Crcdit Oebit Card

f,

Parroll Deduction

ll

lvlooel'Order

ost28t2011
hmcipal t)qcurtatron

$s0'00

$50.00
,{mount of Contributiotr

f-st

\{I
lJerE
llP Lfr]e

Gesek
tesloerural >treet

Szudra

Retired
lame ol Empl.r)'er

-{doress

37 Colony

Rd

F.rq

Is colkibutor a lobbfisl spouse. or dependert child of a lobbf ist?

ft
h_.

Seymour

CT

06483

Retired

Yes

No

I1'contribution is in ercess of $.1O0 to a qandidate corumi$ee for a chief executir-e offieer of a municipalitl' does contributor or business hershe is assoeiated rtith hate a contract s'ith said municipali{'raluedatmorethaa$5.000? i]. Yes i-{ No No

Is this cnnhihutinn associated *'ith a ftindraishg er-ent list*d in Sectioa Ll? tt]'cs. list Elent n 09130/201 1
lvlethod of coabibution: {-: Cash *il Personal
LastNam

S-] Yes

{-'

C] r"es Is conhibutor a princigal of a state cootracto! or piosperti\ e state contartor? t_. l\o f1m. indicate shich branch or braaqhes Executir-e {11 Legislative oi- gor-ernment dre contract is r\gtr.aG cm[DuuQD Lrate K*etreo

with:

f;l

Cherk !]l CreditDebit Card

F$st

fl

PaFoll Deduction

fl

ilIooe1'[hder

09t2f]/24fi
Pmcpal Clcmpahon

$93.00

$45.00
.{mount

\tr
*ale
:ry

of

Conroy
Ke$deilru )ueet.-tooress

Anna
lltr
spouse"

Retired

Contribution

lwe

)'lanre

lrl lmPlcl'el

167 Skokorat $t. Is sonhibutor a lobblisl

Yes

Seymour ff coniribution is ir

CT

08483

Retired

or dependent child ofa lobbv.ist?

lfri No
'{1- l'es

escess of $dO0 to a candidate committee tbr a chief executite officer of a municipalitl' does contributor or btrsiness hershe is associated n-ith hale a contract n ith said municipalit-vvaluedatmorethat$5,000? i* Yes F, No
Ls

Is this conhibutiol associated rr ith a

&rndraising event listed in Section L I?

Ifi'es. list Er-ent

F-i No

coctib{rtor a princigal of a state corrhactor or prospectir-e f1'es, indicate n-hich braach or branchos
o?lorernnrent the co$kaet is

state conhactor?

f'Yss

09/30/201

$ith:

fi

Executive lli Legislatise

1

fr

No

Nle*hod of conbibution: personalClhe,r;k .'{i Credit,Debitcard SlCash

J-)ate

Kecefeu

-tegnE uQnElw[eD

fi

lfl Pa]rollDeduction Fltlonel'Order

09/281201

$90.00
PaEe

$e0.00 $375.00 of

SIIBTOTAL Sctim FThir

Pase

I.
raur t(oy
LutNme
First

MONETARY RECEIPTS S"

1W111201'l

\fi
jtate

lPrmrpal (rccuP

lrene
lib-

Retireo
trase of Emplc5's

Contributior

GliffiafSt*t.\ddress 28 Northstar Dr.

Is coahibutor
a

Scvmartl

cT l0e+e3
,

lzlPu(M

tetired
r a chief esecuti\-e officr of-a conhact $ith said

hbhfist. sPousa

r:
a l'l

-r-es

or deperdent cbild

ofa lobb1'ht?

s, No

ffiilitill";*
l-es
Is

",.:;;:bfy:.."".".:,l;;X,0."0.

"n1*lli*oo**j^=
{'

"

Is thb aoatibution assosiated Ttith irndraisine ereat listed in Section L

Ifi'es. lisi Etent

tr n

* !9/30/201
-r-L--rf

f.

No

contibutor a PrinciPal of a st rte )oohactor of prcspecta-e Ifies. indicate shich branc hor braruhes
of gor-ernnrent the contracl I

$tate gonIracrori

fNo
$20.00
Amount of

th:

Executire f'. Legislatir-e

\sseeate conElbuaoos

\le{hod of coatibution:

'

.erd lil parroll Deduction

t

,'{-.

I[oney Otder

09t28/2011
?fincFal OccuPabon

$20.00

ust

Blaze

Jane
litv

Fletirerl

Contribution

ffiffiISilAil&ess
21 Glen Girc,le

itate

Sevmour
-t,"es

cr

lZlF

L o,J

Natre ot

gnplq'r

I oe+e3

Retired
lb.
i* ussociated with har-e '.ff No .!'fr t'x
a chief executhe ofllcer oJ a a contrast n ith said

I-*"tit t*"ttttfist.sPouse' t'. or depeodent ,:hild oi a lotrblist? :f'

Is this contsibotion associatEd with frndraising er-ent listed in Seetion L

No

tt-contribution rs ln excesl municipaliq' does conhibt ltor or bt ,*Lo"

<

E.ffifffi.-tt*
{x}o'l

l"t*L

rr.,-

a l")

Yes

Is eonbibutor

u.i u,---t

C'

No

f}Or"nr?O{

"ii'-Ll-l"iu"#;;;;lh,
f.
Pa5rollDeduc*ion

If

rc-

principal of a shte contractor or p(ospdstr\3 state inclicate n{rich branch or branqhes

a

s}ntracror;

' rs

r,

s*"fr'"

l{*' No

nL:ttu
\gg:egate clrntrrDuBw

Date Reclved

"SCJ-'r-.p:;;;;ic,",*
lr'{ethod of conhibutionl

lfr credicDebitcard
First

[fi \'rosevorder
\,tr
-lp L.mle

091281/2011
Pnncrpal OccuPaton

$100'00

$100.00
.{mount of lontributiol

-=------4

Bernardini GlFntial Street Aditess 14 Kozev Lane

llinr{v
CT 06483

Admin Asst.
SanJ-I-Enpl))u

iltl

Seymour d*l

Town ofSeYmour

ffiu6bb-t'i*tipoo*.. or depeadent child oia lobbf i*tt

f,,

Yes

No

or a 0 to a candidate comoifiee for a chief esecutn'e o$rcer Ifcontributron $ m qxcel rrith har-e a goilract n-ith said municipalitl' does contril rlltor or t*iu"*t n"g. it associated q5 oool r*l Yes -f, No or ptospeetirc state contractor ls coatributor a principal of a state contractor

Is this ,rontibution associated n-ith a frrndraisine event listed in Section L l?

Ifi'es. lisiEr-ent= 09/30/201

lrle{hod of conhibution: -

Yes

No

"ii"-;il"t
lart
iust

lfrrss.indicaterthichbranchorbranuhes f' n.t""tl'' *t"*tt Ji,"tttt'

a9l2a2u1

': fl

I e$ No

i- curn fi,

personal Che"g C. cr, .'lir,I)Phir

{-- Parroll Deduqtion trl N'loney Order

$255.00

$90.00
Amount of

ffiffici"""p;tt;
lJure

Bilodeau

Marcia
F:tr)'

[ffiffiISEeet.rd*s
14 Momingsiar Dr
[s contributor a lobb-r'ist' spouse a.p."O."i"ftifO oi' u tot Ulire

lp

alode

ffiIEFFtr
USPS

Lettor Canisr

Contribution

Anso nta

cl

Yes

r!. No

f*;"hief exec$tive offtcr of a If gontfltrutlol ls s o"*o ,. *'" gontrnst $ith said or br rsbess hetshe is associatd $'ith hare a municioalih'does conhibutor then $ t 0tx)? C'Yes No -rl^r:i-,--r,-.t .r ---'

CT

06401

"TidG;ffi;

-nrr

iil

Is this contibution associated t"ith a fundnising ercnt listed in Section Ll? f1.ar. list Er-ent * O9/3Cl/201 1 itlethod of conhibution:

{il Ies f' No

ritC ard
brst

or prospctl'e state 'Jonralxol Is contibutor a principal of a state colhactor

r-r r s

indicateshichbranchorbranehes f: E= ' "ii".='"*""io.;ot"o-,,; "ttn'

Ifres.

fl

No

ii

Cash ff] Personal Check

C-' Credit'Det

fl

Paltoll Deducrion

Nlooey Ordet

09t2u2A11
PrrnclFal ClccuPatlon

$45.00

$45.00
Amount of

Moher

Michaet
1rh

ffiiEFfSFI.\d':kes
163 Brent Hill Rd.
ls coatributor a lobbf ist. spouse. oi' u totuui,ti

ttate

1{r (-ode

C!arrmnt

CT

06483

AttomeY FffiEiIFPL1'er Daniel Skuret PC

executir-e officer

Contribu6oa

; ;-";;.J

.'f

ofa

r-es

'.{tr No

;#$;t$+l;+fbf::.-::f
uo

"htld

i'ffiX

heshe

is-rssociateqJ''*l^"'

contract with said

Is thb contibution asscciated with a frrndraising evect listed in Seetion Ll?

{a ltr

i't

ls eolhibutor a prilcipal of a state contractor or ltrla$. hdicate $tich branch or branches . .rr i* *ith, ;i:":;;;e.-;;;.i

prospeetive state coltraetor

t-' I s " 'fl No Esecuti'e in L"si'lut"'\&segate contsrbutloN

'JJ
lvtethod of contibution:

Eie
PersonalCheck :{i (--reditDebitCard

Reeived

-F|?;i-'fl

Pa5'roll Deduction

fi

\Ione5'Order

0!|/2812011

$100.00

$100.00 $355.00
of

SUBTOTAL Section FThis P1g1

Pnge

I.
Paul Rov 201
LdtNme Potash
K6rdenflal steet
1

MONETARY RECEIPTS Seetion B. Additional Pase

1A11nOfi

8., : ftemi:zcd Contributfuns frqm Indivirluals

First

lf

Pnncrpal Occupaaon

-{mount of

Daniel
Jrq'

Assembler
jlale
,lP

Contributioa

A(ktes
Yes
i..

!.rus

Name ot Smplq er

23 Glen Circle
Is cootributor a lobblist. spouse.
or dependent child

Seymour If *rt ib"tir" i" i"

CT

0e+83

Thule, lnc

ofa lobbyist?

No fr.. Yes

of $,100 to a candidate commitee for a chief executh'e offreer of a municipalit5.'does contributot or business hershe is associated qith har-e a conhact with said i. Yes f, No -..'-'--muoicipalitl- ratued at more than $5.000?
Is eonbibutor
a

*"*s

Is this eontibution associated

*ith l

principal of

state qonhaetor or prospectire state

coctactor? f.

firndraisinger.entlistedinSectionll?

Ifu, listEventii 0S/3q?Qlj-

f.

No

oiiovernmeottheconfactisrtith: l.Lrecutive i:Legislatir-e

DateRsered
-igg:egate contlbunola
1

fy:r.indicitentichbranchorbranches
09/28/201

Yes

No

Nlethod of conhibutiol: C: Casn , PersonalChecli C. CreditDebitCard

f,

PalrollDeductioo .'f. Nlone1'Ordet

N'II

$'15'00

$45.00
ADrount

Fffit

Itinclpal Qccupaton

of

Potash
lB$leilral street.{d{trs

Carmetita
]rt''
tta!
,IP

Retird
L{M

Contribution
er

Nme ot .Emplq

23 Glen Circle
Is conhibutor a lobblist spousa or dependent ehild ofa lobbyist?
Is

Seymour

CT

06483

Retired

Ies
:n No
a

ffi"ti*
Yes

of $4o0 to a ctndidate commisee for a chief eswutir-e offiser of a i" i" does conhibutor or business he,she is associated with hare a cootract rvith said muoicipalit-v ralued at more than

.\--t.

municipali['

$5'000?
a

ttb contibution a*sociated with

'.f
Si

l{i Yes Q !! ''=.Esecuth'e

Is contsibutor

principal of

state consactor or prospectil-e state

*on&actor? f'

Ves

fundraising er-eat listed in Section

Ll?

No

I/;'es. listEvent+ 09/301201

Nlethod of conhibution:

oiiorernment

fym" hdicatewhichbranchorbranehes 'fl

the contraet is

*-it&:

fi L3gqt",i*-

lft

No

Date Rrcesed

,{ggtegati l'onEloullolls

('iCash F.

personalChe,li

lfl

CreditDebitCard CPa3rollDeductioa Fi \.lme1'Order

First

09128t2011
Prirnrpd rlccupanon

$130'00

$90.00
Amount

\{I
MI
:rP (:otle

of

Richard (sr(telltlal ;teet.{d(res 4 Emerv $t.

Is conhibutor a lobbfist. spouse, or dependent child ofa lobbl:isfl

Crystal
-lt}-

Sbn Maker
I

Contributiol

otgBplcT'er

fi f,

Yes

No

0a$3 Nu-age DesiEns, lnc CT Seymour If *"ttitr"ti"r ir i" s.l"*s of $400 to a candidate commitee tbr a chief exeeutir e officer of a municipali$' does coatributor or busin*s heishe is asscciated rdth hare a contract rlith said
muni,:ipalitv vahred at more than

$5"000? fl r*es f:
a

No

Is this eonbibution associated n'ith a firndraising etent listed in Section Ll?

{f1.'es. list Er-ent

l'es
No

09/301201

state contractor or prospectire state conhsctor'J Is eontibutor If,es. indicate n"hich braneh or braachet Executile oigoternment fte cootract is
a

principal of

l.le8 {No

$ith;

f.

f.I.:gftutl:

Irle*hod of contribution : cash trj Personal Chsok

Dat Rece$ed

AggIegA: C(rnrtouuoffi

{.

CreditiDebit Card
Ftrst

f,

PaFoll Deduction

fl

lrloae!'order
l\[
lrP LOse

0gt28na11
hrn rpal()ccrFaton

$90.00

$90.00
.{mount of Contriblltion

lesiiLntinl 1OO

steet.{d&e*

Charmel

Patrick

Pres. & CFO

ls:ate

W. Meadow

Rd

Is eonhibutor a lobblist, spouse or dependent child of a lobblxti Is

fl
l!

Hamden
ffi

t}-

Nme oI lrsployer

CT

06518

Grifnn HosD.
for
a

Yes

a candidate commi$ee

chief exe')utive offtcer of a

a contraet n"ith said

No

muricigalitl. does contributor or business her she is asso,riated with har-e municipalitrtalued atmore than $5.000? f Yeg fl No

tlis contibution

associated n-ith a

*i-t Yes

fundraising elent listed in Section {fy'es. list Er-ent * 09301201

Nlethod of ,ronkibution: f , Cael f,'J Personal Che.Ji
LastName

Ll?
1

fl

No

Is conbibutor a prineipal of a state contractor or prospectir $tate contactol? Ifius. indicate rr-hicb branch or Legislotire Executive oilosernment the conbact is

Cl

branches {l nith:
D*te Kecered

fl

fl lto

Yes

+SIegnte

{:l

CreUit OeUit Card

Ftrst

fl

Pa!'roll Deduction

fl

\{one-r Order \,II

o9t28t2011
?trncrpal Occupattrn

$90.00

$90.00
Amount of

Weaving
(esr'Jentral litseet Arl{tress

:R spouse. 'f Yes lobb-rist? l,t' No

If

Jason

&vns
lstate
ir it

I GetUsedParts.com LLC

Contribution

12 Eleanor Rd

seymour

b coohibutor

a lobbf ist, or dependent child of a

of $d00 to a candidate eomndltee for a chief sse'Juti\e oftter of a ""rhibr"r.r muoicipaliq- does conkibntor or business he,she is associated rvith hali- a ,:ontract rtith said nunicipalilr'r'afued at more thar $5"000? lfr tes F No
Is conbibutor a priocipal of a state cotttsactof or pfospectil'e state

*"t*t

lcr

lztP L'od

){dne oi Emplq er

loo483

self-employed

Is thb contribution associated n'ith a irndraising etent listed in Section Ll?

Ifi,es" list Etent

F Ie" fiNo
(f

contradof? {]'

091301201

indicate nhlich branch or oiiorernment the contract is

fys.

branches 'fi fresuti\ t-ith:

I)at KeceFed

'3'i

LeSilllt!1-

fi

r*es

No

Itlethod of cootibution:

+tegaE coNrou(lN

fi

Cash R

Personal Check '.fl CreditDebit Card

Payoll fleducrioa

hlone.r'Order

a9t28t2911
STTBTOTAL Section

$45.00

$4s.00 $360.00

BThis
Page

$g

of *

L
aO1!{L,llTTFrE,:'
I 'l
l

MONETARY RECEIPTS
10/11/20',t

Section B. Additional Page1

Parrl Rov 201

llrr :

R'

lr!'i

:riprn$iprt Cnntritrutions'from Indivfufuals '

- T{I
.ry

!f

LstNme

Fk$t

PrncEal (Jcspanm

-{mount

of

Wallaca
Resrde$$l Ste.t Addrffi

Stanley

Mail CaniBr

Contribution

13'l lnwood Rd
Is contributor a lobb;-isl sPouse, or dependent child ofa lobbl'bt?

16 Tirmhutl f. r,
Tes

1state

!,wr

ffiifiIE$pEs
USPS
executile ofticer ofa

lCf

06611

No

*.,*elputitl,.ao",conkibutororbusioesshelsheis$soeiatedsithhar.eacontrsctrtithsaid .r.'ara tten S5.O00? 'f . fes : No

----r-r'--r:i-.,^r,-t
Ifvas.

Is tiis eonkibution msociated rrith a firndraisinc ercnt listcd in Section L t?

tr..*

r;.i c,-**

= n0ran/?nl 1
{-h*l- f'

fl: l.

les
No

Is contsibutor

! Iw state eooracror I a princigal of a state coltractof or PfosPeltn-e tr No hdicaterrtichbraoshorbranches { Executite f Legislativo , ,, ..' Ag-qegaie contrbuu!1ns "iir.=t"-*iU""ootu,rtito'ith' Receivdd Date
lrlooev Ordet

\Iethod of ,:ontibution: '1* iti D-*^-.r

^-..t

r-."AitiDebit lard
[,trst

arroll Deduclion

o9t2a2011
Prmcrpal QccuPaton

$4s.00

$4s.00
Amount of

Sawicki, Sr.

Gr

alStretAd&ess

13 Lantem Dr.
ls cortributor a lobbltst' spouse Yes
.t..'

Wlliam ]b' qavm.)lr

No

CPA
;tate

CoBtribution

,IPL]e

ffiETsplo't's
Maranm, LLP

CT

0a[83

- a-.p*4..t-ftifa rr.,-

oia toUt-virti

contributor or business ;;"ip.lil;;* -. ..L,---L-^J-r-.^--*.-et{VM?

Yes
ls coltributor a principal of
a

esecutive ofticer ot-a heishe ieassosiated*ith hare a conlra.)t $-ith said

.t{i Ye

?n No

Is this conkibution associated $'ith a frndraisins er-ent listed in Sestion L l? li"; Fr.Fnt nqr3nf7ol 1
#

P.

state cootractor or prospectil'e state

contagtor? ! I

r es

$-' No

lfles.

"ii"..t
Fint
---=----r-r-

indicatewhiehbranchorbranehes -*lo"".on"*it*1tl' fi E*""otu

Date Reserved E*'

No

"fi fl:fblfi c0nEltluuoN \seggte

$45'00
$45.00
loutribulioa

N[ettod of confibttion: "fr;[f -.S.

t.*"*icL".:tc. lf

Credit'Debit Card 3*. Pa*oll Deduction

\Ione.v ordEr

0912812011
lPrinclpal ()ccupatlon

Kozey

Donna

ffiffiia=l$Ft.{d*es
7 Kozev Ln

th
Yes

spouse. f I ordependentchildoialot'bfist? f.
I"

*ntibtt *

t"ttbjitt,

No

Seymour IGT ffiili1il *il:;:i":bf::L::b*?fiXhershe

"ontract
is

Ptate

I :p ti* 06483 I
Ls

\tr

Secretarv
Lrt

lName

lmplq

el

TownofSeymour
a ehit^esecutir-e oflrcor

associat't

]ltl^= '

of qontnct.ith said

Isthiseontibutionassosiated$iths'i,
frndraisine e,;ent listed in Sectiou L

Yes

prospective state Is conkibutor a principal of a state contractor or

corrha')tfl
Lesislati\',e"
Asgregst

rr..,"

ti"i

rr-*r =

l?

f.

No

ffrss- indicite which braoch or branches

O9/30/201

lr{ethod of sonbibutioo:

f ..."r f;'p*^-"lclre"t {.
Kalako
steet.ld&es

CreditiDebit

"ii".=#*"iit,'ard f, nrroll Dedustioa f

Just

trith:

il'

Eseeutir-e

f^

itj lf ' I\o

$65.00 $25.00
.{mount of Contribution

..-,."..--.

Date Recel\'ed

Nlone-t Ortler

ost2u2a11

ffiGcupaA;Barista

Melanie
l-jlD

Glffiial

lJBre

7 Third Ave.
lg *oqtributor a lobbf ist. spouse. or dependent rhild ofa lobbvist?

{l
i!

Yes

9eymo ur If contributiol s ln

No

ffitiveoffirerofa sisess with hare a contract n'ith snid munieipaliq'does conhibutor or bu siness he, she is assoeiated ,----: -:l--r:*..--k,J .r mne thrn S' i_000? ft Yes l No
state coltractor Is contibutor a principal of a state contractor or pro$pectire Ifree, indicate *-hich braoch or branches

:rpsue 06483 CT or lrrru

SAitEtEnpryaStarbucks

ls this eonhibution

asso,liated with

a
1

S] lts

{-

' r6
$4s.00
.{mount

fundraisingerentlistedirSectionLl?

I/-ac

lict Ftenf

* n0/lnltnl

fl

No

#;;;;;d.;*"t'

Dat Receri'e,J

iggregnte conEmalrD

\{ethod of eontitrution:
LastNarue

*' n--r l D*^-.r

Harmeling

aki,'L- frt t-*,tit,Debit Crd {'l ?alroll Deduction

l'fst

Ir'Ione-v

Order

091301201 t
PrrncrFal OccuPanon

$45.00

of

I
I

Kristen

Vhe-Pres.
lstate
:qr L:oile

Contribution

ffifsrtral Street -{d,tess 27 Patrick Dr.

Ig contributor a lobb1ist" spouse. or dependeat child of a lobb,rist?

ilsavmorrr
Yes
'.m

ffi;EEmp$er
Hanhon GrouP
executh'e officer of'a a contract with said

lCf

06483

No

;*'*[l ::i:]"::1*f"x'"ffi
Is con&ibutor
a

* *'

T#.,y:.*.,1''$]'*
snbacto{'l i-' I s

this conhibution associated s'ith a firndraising erent listed in Section Ll?

lf 1-es l{ llo
[r

principal of

state contractor or prospective state

I/r.as.

iodieate'$-hichbranchortrranches -.
Date

'fi

No

Fr

"i!.''!'"-*id "'
Pagoll Deduciirro

R*enetl
0913012011

.{ggregnle

c$rrDuus
$420.00 $45.00 $205.00

\lethod of contibution: Fi";t ls, ienonalChecli

crcdit'Debitcard "f'

F \Ione1'otder

SSBIOTAI.Sq{ FlldsPas
Page

_.__ -of-

L
Paul Roy 201 1

MONETARY RECEIPTS Section B. Additional t

1U1112011

from Indivitlu

Amount of Contributiol

Is"oanibutorolobbfislspouse" I:
I'iith

32 Smith St., APt. 3G

ordependentchildoialobbyist? f,.
Is

Yes

No
Yes

;;6;ttt;"*
No

a chiefexecuth-e officer ofa s-ith said conhibutor or bwiaess hershe is;ssoeiated withhar-e a conha':t 'fi r*es No r-il"uii'i"ft.a at more tbaa

$5-000?

f''

trj a frndraisinc erent [sted il Sction]-l? iIf,es. lisi Event = 09/30i201 1

ttis conbibdtion
associated

state ccnbactor? Is eontibutor a prineipal of a state colhaetor or prospective nhich branch or branches lfrer. indicate i* rir

i".=tt-*ia.
l:

";;"t "@

hlethod of conbibution: '

A.61[f,-

e^.

F"*"*f Cfr""t

!-,. Cr"AitOetit Card

5. Palroll Deduction

Irtoney Order

$50.00
Amount of

Contribution

t bbl*t' sPouse' l' Yo " or ".ttihrt- child ol a lobb;'ist? lfl No dependent

b
Is this eoatibution associated with frndraising er-ent listed in

;;"rp"lild"*
Yes
Is

p!{" ratuedatmorethan$5'000?'J-' Ies

Ifrss. indicate

r a chief eseeuti\ e officer of a with said contributor or businese hErshe i$ as19':iatefvil\hare a coatract
a state conbactor or pfospesti\ rtate conbactor? n hich branch or branches Legislative Erecutive contraet is

Ifi'a.

listEvent

a F Sectionlll fl'
1

contibutor a principal of

No

09/3Cl/201

"ii..=t"-"tit"

rtith:

fi

Ntethod of confr ibution: -n '

F";i-

p"r."""f Cftuck :fi CreditDebit Card 'fl. Pa'oll Deduirtion

F-' trIotrey Order

$85.m
Amount of

Contribufion

spouse. fl f* ordependertchildoialobbviqt? f, No
Is sontributor a lobb1ist.

ee

for

chief erecutite ofticer of

a conhact s-ith said

;;;;li$;;;;;ontributor.or
i"il.ri*.rfu"a
Yes

blsiness heahe is

at more than

$5"000? f, tes f
t*ittt'

associate$ri{fare
No

Is this contibution associated \r ith a frndraising event listed in Sectionll?

{; f.

No

stnte conbsclor? Is conbibutor a prineipal of a state consactot or FfosPe':tile If indi,:ate rrhich braoch or branches

!!.es. lisiEreat* 09l/30/201

lc. ;i [;.eirnreni,il

*rrrtu-t i*

f ' Esecuth'e f

' Legislath'e

$50.00
.dmount

of

Contribution

347 Scuth Main Is conkibutor a lobblisl

St.
sPouse

Seymour
a
S]
\'e$

C.t
contibutor or business heishe isrssoeiated with hare
No

or dependent child ofa lobbS'isti

ii" ;;$;ft].. ;".-

executile officer ofa

a consact n-ith said

;ilffii';;heJaimorethan$5$oo? f Yes rl
No

Is this contibution associated rtith

firndraisinger-e*tlistedinsectionlt? fl If'es. listB'r-ent * 09/30/201 1

e state coabactor? Is eonhibutor a princlral of a state coltractor or ProsPectil I^'cs. indicate shich branch or brun"htt ..

"ii"-"-"Ja;;;"*",

b"tft'

^, E f: -

$90.00
.{mount of Cotrtrib$tion

Is conbibrtor a lobbJ-ist. spouse. dependent child of a lobb-r-ist?

i ;;"tp.ttil;*;nhibutor-or
Sj
No

chiefexesuti$ officerofa
brsiness he she
u corrbact $-ith said

isrssoci:rttlJ'tl^= lS No i"i'""rit-'r"f,t"dutmorethao$5.000?

IsthisconbibutionassociatEdnitha'F \s
irndnising event listed in Seetionll? Ifi'es. listEvent+ 09/301201 1
Ir.te$od of conhfuution: '.f. Personal Checli K] Cash

prospcth-e state Is conhibutor a principal of a state codractor or Ifr'es. indicate n'hich branch or branches

"$r-es ^-L-^*.k-.

coatraclor? f' fes

lfi

No

"ii"t'.tr*""it"-";*;"tth,
F
\tone--s Order

{'E**'i-"
SUBTOTAL Sectisr FThis

fr

CreditDebit Card &* Palroll fleductioa

?r

I,
Paul Roy 201't

MONETARY RECEIPTS
1A11n011

Section B. Additional P

Indtviduals
.\mount of

Contributiol 193 White Hallow Rd Nafls and Young Engineem, lnc

Yes

lsconbibutoralobbfist,spouse. f, ordependentchildofa lotbvisP f,

Is this eonEibution associated with fundniring er-ent listed in Seetion Ntethod of conbibution:

ffi
Yes

No

for a chief executir-e oftlcer of a municipaliS.does cootributor or busiaess he,sbe is associated $ith ha\e a contraet rrith said municipatq ratued atmore than $?O
t'o a eaodidate comodgee

16'r.listE\-ent* qqBQr2q]l

a Ll?

f'

'il.

Is contributu a principal of a state conbactor ot prospectir-e state

No

- If;;.Aaitit""tti"t tmn"trorbranehes oii-'.ror**tecosfractis$ith: f,E*""@

it, Payoll Nuction
l{-i

eonbactorl i*.

Yes

No

f.in*l

s., i*rsonat check F*. Credit'Debit Card

\Ione}'order

$320.00
Amount of

Contributiotr

111 Great Hill Road

lobbf ist, spouse, or dependont child of a lobbyist?
[g

Welcfr Teodosio Stanek & Blake

'ronhibutor

C'

-fes

'O

ffi

Uo

a candidate committee for a chief esecutir-e officer of a nruoicipal!.' does coakibutor or busiless hershe is associated,sith hare a conkact rvith said ioatinvahredatmorethan$5"000? [F' Yes i' No

Is this

fuadraising event listed in Section Ifi'es. listEr-ent 09/30/20't

'rontibution

associated

$ith

Ll?

Is coobibutor a principal of a state conhactor or prosPecti\-e $tate contactor? /f yes" indicate nhirh brasch or Legislative Eseeutive oi Lo.-ernment the conlract is

branches 'f' $ith:

fi

f' fe* 'ft No

$?00.00
Amount

il lethod

n C*l-

of contibution:

F, Per"onal check

fl

creait'Debit card

C PaFoll Deduction Fl Irlouey Ordet

of

Contribufion

Is cootributor a l,obblist.

ordependentchildoialo6tyist: f,
Is lLisqontsibution associated n'ith a firndraising er-ent listed in Section I.l1 f1'er, list Er-ent 09130/201 1

spouse" {-l

Yes

; for a chiefexeeutive ofticer ofa

mudcipali6
Yes

No

iciiralitrtaluedatmorethan$5.000? f. Yes f,

does cootributor.or blsiless hEishe is associated :rithbar-e a contract lr-ith said

No

fi,

fNo

Is contibutor a principal of a state contraetor or prospesti\- stat conkfictor"r fy'e*. indicate which bnnch or branches Legislative Esecutir-e oiiol-.n"** O" contract ie

with:

f.

f.

\,lethod of contsibution : f. C"rn {tj iersonal Che,}k

{.

CredirDebit Card

f.

Pa$otl Deduction

|l

\Ione,v Order

$45.00
Amount of

Confiibution

4 Falbo Dr. Iscoatributoralobbfist.spouse.

ordependettchildofalobbvist? l
Is this contibution associateds-ith a firndraising er-ent listed ia Seetion L l? Ifi'rs" list E\-rnt * 0S130/201 1 Nlethod of conhibution: cash Sl Personal Che,rli

fl

Yes

No

committee for chief executire ofticEr of $4O0 to a candidate commrttee toI a cblet execuln'e olltcer oI a n ith said munieipalit-v does eontributor or business he,she is associated,rritlr harc a contract No municipalit-v'rahred at more than

If conhibution is in arcess of

$5"00{?

f tes l

fil Yes f I No

principal of a state contractor or prospectise state cotrtactor? Ls conhibutor {f;'es. indicate which bralch or branehes ill Esecutite fll Legislatirc oiior.ntru.ot U. contract is nith:
a

fl

i:l

Credit'Debit Card

t'l Paltoll

Deduction

lrlone-v

(hder

$107.00
.{mount of Contribution

coanibutor

lobb-r'ist. spo$se. dependert ehild of a lobbf ist?

a

ffi 5.
res

,;andidate comnriuee for a chi"f executive officer nf a tloes contributor or business hershe is associated:rith harrr a coffact rtith said municipalit-v ',ft No iciialin talued at more than ''f'

$5$00?

Tes

Is this contribution associated rvith a fundraising event tisred in Section Ll? dfJ'es. list E\-ent + 09/30/201 1

F-l No

* 'fi*. Is contibutor a princigal of a state conhactof

i"ai"i"
,irtiich branch or

oig*=.nm*t6tcontractisrvith: iil
Pa]roll Dedustion

branches

of prospectfis state

eontaclol? !f'
"

'fi

Yes

No

Executir-e

I}L*gislative
$60.00

Itlethod of cortribution: -

Ki

curt lf. Personnl chec&.

'fi

creditDebit card [fl

lrlone:- order

I. MONETARY RECEIPTS Section B. Additional Paee

i,F.fii:illilidiir
Paul Rov 201 1 1At11t2911

S.
LastNamc F$st

Itemized Contributions froq-Il4nrdgql*

t\{I
itate

bncrpal Occupatitur

Amount of

Richard iesrftd$l Stteet Adftes 4 Emery St.

Is contributor a lobbf ist" spouse, or dependent child ofa lobbfist? Is
{

Crystal
lttl' Yes

Sign Maker
.4 !-Ne
Na$e ot Emplq'd

Contribation

Seymour If

CT i" i"

06483

Nu-age Designs, LLC

No

for a chief esecutic officer of a "f ""lkibtti"t mudcipaliq.'does contributor or business he:she is associated $ith hale a contract rvith said
$4OO to a candidate committee

*".-t
a

municipalih'vafuedatmorethan$5.000?

f Yes f,l !{o.--'..._--

ttis conhibutiou associated n'ith a firodraisiag er-ont listed in Sectiol Ll? f1.er. list Event + 0gl3O/2O11
Nlethod of conhibution:

irj

Yes

Is conbibutor

lC No

l,

principal of

state coohaeto{ or prospcti3 state

conbactor? {.' ls

ii"t.indiclten-hichbranchorbranches t -g"t" f. e'r.*,1* foiior-ernment te contreet is $ith:

Date RqJesed

No

.lggegate c0nE ltruilom

1

h Ca$ fl

PersonalCheck

lli

Cr.ditD"UitCard
Frst

Pa3totlDeductiou

f-

Irloney0rder
T{I
;tatc

091301201

$243.00

$153.00
Amount

Prrncpal (tcrpaaon

of

Niezelski
(e$cettnl JtIee[ Aqcres

Joe

Sales CT
ot lnpkYer St. Anthont's Book /Gifts to acandidatecommitteefora shief executi\-e officerof

Contribltion

:lpllre

)'lame

't30 Skokorat St.

Is contributor a lobbl*t spou*e, or depeodent child ofa lobbyist? Is thb contibution associated with

Seymour

08+83

)es

Itr a

ffi
Yes

No

munieipatirl- does sonkibutor or bBiness heishe is associoted n'ith har-e a contract rvith said icr No municioalitr tahred at more than

$5'000?

lf Yes

'f,'

Is conhibutor a princigal of a state cotltastor or prospeti'|-e state

ftradraisinger-entlistedinseetionll?

Ifi'c.
K1

listEved

No

0g[30j-2Q11

- lfl*.indie;en-hichbranchorbranches if' Exer:utire lllt Legislath-e oig.to.t* Os cootract is $ith:

flate RecrYd

eolEaclor? f'

fl

I.es No

{ggregale coll[rwBrlm

lrlethod of confribution:

Cash lf.
Roy

Personal ChecL

'fl

CredirDebit Card Fi6t

f.

PaFoll Deduction F' h{oaeJ'Order

0913l/2011
hmcrpal Ctctpatnm

$126.00

$126.00
Amount of

[asaffi-Resldenhal s:tet .{{l([ess

Itr
}Ialc

Evelyn
-]lti

Retird
!p Lo{e
Name ofEmployu

Contribution

80 Washington Ave.
Is soahibutor a lobblist, spouse, or dependent child ofa lobbvist?

Seymour
i-'l Yes
No

CT

06483
a caadidate

Retired
commitee for

a chief esecutir"e offieor of a municipaliq. does contributor or business hejshe is associated n ith ha\.e a contract rrith said fl tes f, No mulricipalih. valued at more than $5'000?

ffito

Is this conkibution assoeiated $ith a firndraising etent listed in Section L l?

fr: \es

iNo

Is conhibutor a -fii,er,

f.

princigalof

shtecontractof of pfospecth'estatesontactof?

Ifi.es. listEr-ent* 09/30201

Nlethod of eontibution : Ca"tr f,j Persoaal Chesk

oiiorernrnentfrecontractiswith: (.Executise
I)ate Kserved

aioi"it .r*ch

branch or

braoches

ilj

f.

r*es

No

l!g$q:- clrNlruulrs Aggleg$E

$315.00 $75.00
.{mount of Contribution

f,

{-

Credit'Debit Card

Parroll Deduction {*l lvtoae-v Order \.tr

PErc
4lp

09130/201

FEt

Prmcrpal t]ccupaton

Valeski
Rsidedial SSet.\d,iess
K.rb

Dawn
Lse

Asst Public Works

Name

ot EnPlc')er

20 Osorev Or
Is eontibutot a lobbSisl spouse. or depordent child of a lobbf ist?

Seymour

CT

06483

Town of Sevmour

lll f,l

Yes

ffi
Yes

No

,Jindidate eoormi$ee for a chief ese,:uti\ E officer of n municipaliq' does contributor or business he'she ia assopiated nith har-e a conha.)t n'ith said municipali!.vafuedatmorethan$5.000? f' fes ffl No
Is conbibutor a

Is this conhibution assooiated n'itb a firndraisiag el-ent listed in Section L 1? 09/30/201 1 {f}.es. list Elent

r]

r::

No

oigol'ernnrent the co!*ract is

fl,es,

princiral of a state conhaetor or prospective state uonbartor? indicate *-hich branch or branches

L, les

rr-ith:

fl EseTtive-fl
1

fl

No

I-3gis!:tile
\gregate

l\lethod of contibution:

llate Rece$.ed

i. Ca"n fl

Personal Check

fl

t-redit Debit Card FIst

fl -

Paltoll Deduction

Nlonel' Order

09130/201

$105.00

$55.00
.{mount of

LstNrm
lesldeDtnl Stseet A$tess

\fl
itate [Z$
Ltrile

Prncrpal tl}tcup:um

Contribution
N[frEoiFplc-r'er

;rt\

ls

conhibutor

rr dependent child of

lobb-visl spouse. a tohb.r'isfi

'f' lfi

Yes

No {.
tes

a caadidatecommitteefora chief erecutive officerof a municipalitl'does conhibutor or business he'she is associated rvith hare a contrret rrith said ',$ r*es if: No muoicipalitvtahed atmore thao $5'000?

ffito

Is thb conhibution associated $ith a firndraising er-ent listed in Seetion Ll?

f}'es.

list Er-ent

in

uo

Is conaibutor a principal of a state coltractor of prospeetive state cotrtrftctor? Ift'es. indicate n{rich branch or branches Legislatir"e la Esecutive oi io. ernment &e eontra,rt is

iF fes

ir

No

n'ith,

lrlethod of son$ibution: fri*fr 'F, persoml

Date ReceiYed

"f"l

Aggre8ie conttbuuom

Che,*

'.{"i

Credit'Debit Card

Pagoll Dedu,;tion

Nfonel'Order

SUB?OTAI Se*tiort BThis PrgP'

Page

$409.00 of

t"r.{ug
a.

:[ (-uulllxrrwr
Name ol lfeasrer
ot

Nme

r :
Is th is

:;;ll:-!Ilil]
$0.00

rd&ess
Jtate

fund raising er-ent listed in SectionL

contibution

asso cAtedn'ilh a

f. fs l/;s'

lis'

lp GT

Code

Ete

ecCn ed

\ggega*ruuruswr

f, No=El.Tt.i.T_
$0.001

list

ilili'culmrttee
Ad,te$
li1 Tes l/}'s' list this coDttbuton asso( ,iated n-ith No radraising er-ent I rcted: n Sectionl-l?'fi ::l: Flliltlii-'" r:
r
I

-^--t

af flnntrihution

Eren11.,....$o.oo

lib'

lcr

State

tz*i lode
rteRNeNed

I
a

-lggrsSdrs

$0.00

Ndre of L--{$mrttee n-ith s this go raibutior ! agso eiated

itate

a, -l-es

-td,*ess

11, i,radraisi w event listed in Se*tiool-l?

lzrp coae

:fifaueTTctm;tttee

GT

l*

No EI*:-:=

Ifi

s' list

-^--r

nf (.nntributioD

:eived

l.{gIe8:aE I uruuuqqD

: I :il--.

$0.00

so.oo
I

ffi
nt\

'ess

lls thi"

conbihution assoei ated

lstate

lcr
.r

I
I

6'cffi

lfitttataoiog etent listed FFeCeived

xilh a ir r sectionll?

fl Yes Invt' list {:' No E\-ent =

$0.00

ldount

.:::

of Contributron

\gEIEdF

$0.00
4

ffi-f taffi,tt* ia$-es-,iated rrith b this contitrution asso( frrndraising event I sted r nsectionll'?

a f, Yss l/.1ss' list

C: No Ertnt=
.cggregaK

^f

{'ontribution

5ir$ame olCwtmrttee

Itate

lzlP L(

66Eect n'ed
i

=,r,.:::f
$0.00

$0.00

CT

{ame

\d,tes
:'.t\.

this fundraisi
[s

co rtsibutior i AggC
I1g

lsurte

lcr

Cu l' l4r
I

x[fxtl ;*nftnt ,nt*-nr,SttT n*

I
,liated

event listed
eived

$ith a C, Yes dfu'es' list in Sectionll? C No Er-ent=

:= : i::::: --l-{ggtegaF !urupquq-

-^--r

nf Cnntriblltloll

::

::

$0.00

to'oo eommitteer l'

, ":' ''

ni*friiiidd*srmir';tt'*r
of Trexwer

'Tmre

)ate ReceNed

.{mount of ReceiPt

ffi

1t\'
$ame ot Uommrllee

I I
I

CT

E"i**t*"-"nt tbr *hared . il;;;;;;sasdsenlco

,Iame

espense

-il

Surplus

$0.00

Distribution

of Treasucr

Date

RseNed

-\mount of ReceiPt

Ad,$es

Irb'

lSifr.

lcr-

lZrp tlrrle

?-' Reimhursenelt for shared

il#;,f*;J**a""i"."

eloense { ' )urTru

$0.00

Distrib ution

$0.00 $0.00
t

loNTRI

ffi Lii fi'of$n?rfr,efl'

Pns'il

$0.00

PTS
$ l f, t[ r}tr frfll\' fl\ ITTTIIE

(Sections

A-K)
{T.INGI}LIEDAIE 10t11'2411

Paee 5 of

li

Paul Roy 201

I). Loans Receir:q4$!!-tgri04

'Ime of lender
iEet -ldftess ,Iame of C(x lgner'Gurutmtor

Source of Loan:

ln

,rp L'ode

i, Bank

3t. Candidate

CT

lf lndiliduat'f t)*r.r
Conmittee

Is there o Cosig!r or Guarrtrtor of this loan? 'il Yes f/.r'es IFt raw mda&ess of Cosigrerfruaret r)

"{mount Receir-ed

INo

$0.00

itret.\ddres
ofJ-ender

llh'

lrp Lltde

Dateoffmp
Source of Loan:

CT
'Jame

itreet "{dffess
$ame ol Ctxtgner'(iuaranttrr

.'$

llp

Llrrde

l. gant

;:l

Is there r Cosiger or Guarantor of

Candidats

-{mosnt Receired

this loan?

CT ir. Indi\.idual C O*rer

,:tt\:

'f'Yes
?-t No

16.r'estl*

nane atdad&ess

C6igneflGualettol)

$0.00

r-nmrnis+

Street,{dftess

lip

L-*1e

Kecelpr

CT

':

Total Ser'tiqr D:

0.00

n
{me
of Bnah

D.irii-rc.f.*r,rr I'ntitir.c n*hertiien Indivlduals oI: Other COmmittees (&eterenifuryCofrtinittb* ONLI] ,'

\g-segate

C(utrlbutl(s

$0.00

I
I

$0.00

Nme

of Enhn

CT

r
lp

$0.00

$0.00

$o.oo $0.00

CT

TofalSectiurEls
Date of

0.0O

Receipt
hansa,Jtion associated

-{'mount

Date of

Receipt

.{mount

Total Transfers

$0.00
I* this

$0.00
ls this trarsaction associated $ith

nith a f,' fundraisinger-entlistedinSectionLl? {l

fes If yes,lb'. No Erent#

^

firndraisingeventlistedinSestionLl?S

a f: I"r lfi'es, list No Et'ent+Trpisrrn

0.00

-z '
Date ofReceipt

'pi! ,a-,i r ^i^:

ir-:^;

^; frat.;;J il;;nlzoi*nr
Date of Receipt

lf'hoa*i.trtioa fommjncix0Tif.lll
Total lrnnslers

lmount

$0.00

$o.oo
-{mount

$
(Coildidare Cqtttr?iree's

0.00

If
Dateof

- personal Funtls of the Cirndidate Reteivetl this Period

lrledrod of pal'ment:
1

O.\ZI? ,

\Iethod of palment:
Date of Receipt

.{mount Received

Receipt

09/28i201

t_. Cash

$90.00
-{mount

Personal {lheck Credit'Debit Card

Amount

$0.00

lr

Cash

Personal Check r_l L-redit'Debit Card

$

90.00

i-ffiffiRY
Paul Roy 201 1

REcEIPTS (sections A-rQ

iffTN{l r)I'iF DATF,
1At1112A11

Prge 6 of 17

t- Anonvmour Contributions
)ate Recese,l

tspecifv itolls am$nt otthe

bjw
so.oo
s:

-lmount

Datc

Raerved

I sr(1m

09/30/201
$r

$13.00

I otal .{mount Received

uit

$3'00

$:

uills W bitl
t
$10'00

g1

coirs $0.00
Date Rece$'ed

$ro

6;x, $0'00 coins go.oo

uru*

$0'00 $o'oo

slo

bil

$
$o.oo

13.00

r
$0.00

trnn ftanocifc in Ar*horized AccountS

Total .{nount Receir-ed Nme otlts'btuhm

ffiffiffim
Str*t.{dlles
iState Zrp L-ode

lcr

Lrih'

State

Zrp Code

CT

0.00

rt
Nme
Stset,{illres

114icretlenenrrs Mcnetarv Recefu)t$ nOt Conskleretl

Coqtribution$
lati
of Trma".trcn

'

,lmount Received

Lrrq

Zb

L-ode

CT $0.00

flesdFi$l
$
Date of Transactm

Nme
1b-

.{mount Received

Zp

L--od

S8eet -\,llress

CT
$
l

D*uiF*1d1

$0.00

;i:::

::?

ii::::::;::=

Narne Zrp c$de

.{mount Receired

Street Addres

lllt)'

CT $o.oo 0.00

D*-trptrd
$

Tofal

SettimK

$
0.00

Summary of OtherMoneJarf Receipts (Se*tionlD-K) ''r.l

(section E) Iotal Receipts from Entities odrer lhan Inrlhiduals or odrer cmmittees
(Section Total -\mount Transferred from -\frliated Business Treasurl'

F)

-'''---

: :

0.00 0.00 0.00 90.00 13.00 o.00 0.00 103.00

n'.-t {-^-'-rT--*-t^*-'rr-^-

Lrftli4ts'llehorllnionorOtherOremiuationTreasur'l'(SectionG)
(Secti'on

+
+

E''..lo nf rlre f'mrlidate Receit-ed thiq Periorl

Total -{mormt of .\nurlmous Contributiurs (Secfion I)
-

tI)

+
+ +

---r

^. l-.^-*]

e^-

n^-^-ik

ih I

rrrhotired lcmrrnts {Scction O

n.-otlrnmus 1\lmefan, Receints not {lonsidererl Contributions (Section []

s
)*--t-7*ttw.

(Add Scctions D'K)

z*-t cl4-t

^- t t--

l1 nf ttstwrmr

Paspl

10/11/2011

Pae

Aggregare Amount of Purchases

$12.00
lggregate
Amount of Purchsres

$25.00 $187.00 $201'0(

Section
Darrl Pnv?Ol

t2. A
l'-.''

1
!4r I tUlBUt
I

porr
I

lruu

.rri*
tBb

oti _---.--ar*'rirrn,, Y-Yr

{are
_ap

or:
I\'Il

f}fhcr Sale of 'Dotfattd ltems

Nlethod of parment
d3.

riame of

i,n6'i.xilxzrt Wlhelmy
Resrdenhal lEeet -{nrJles

h.uclnser Lct

Nue

ttl'

* .

nnit
Code

Cash'

PersonalCheck

)ate Rserred

to"*"

CreditDebitcard

,{ggregate Amount of
Purchases

116 Maple St.

itmsFrchsied

Saymour

CT

06483

og/30i2011

$25.m

Beer and wine Asst.

iffiiildrss-tastt't"me rlt it iihtalsoi\Lt) Grande

ffiffial
Saeet.{ddress

Io* I

IiI
Card
arp
I

\Iethod of palment:
Dtte RceFed

i Cash' , Personal Che{:k *

Aggreg*te
Credit Debit Card -Amount of Purchases

347 S. Main St.

S"rtou.,
"*.
:tt\

uoce

jrent:

CT

06483

ogt3o12o11

io. e,o

- John J. sullivan's Restaurant' 2 bot{ex wn

$46.00

{*.f P*cl*"et - Lmt}lnnP ROY Inil'iituatsz|lLn

80 Washington Ave'
-teNPurchased

\{I Evelyt
daa9

Irlethod of Palment: - -d' Cu*l' 'fi Penonal Check

tat Rseivd

creditiDebit Card
1

.{ggregate Amount of
Purchases

4p Ll1qe

lvent =

Seymour

CT

064&i

09/30/201

$50.00
Ftrst

Mexican basket, N
l\{I

ffiil"ttotr-LmtNanre

tnitnituatsz*Ll]
ffiffimlSiteet -\ddress 4o1 Devis Rd
Items Pwchased

GOyne :ll\

Kovin Seymour
'6I
1rP

--
F

Nlethod of pa1'nent:

born' b

Persoaalcheck
areni =

.\ggregate Credit'Debit'!111

.{mount of
Purchases

tode

Reen'ed

CT

0&{83
tl

09R012011

$20.00

Bracelet

\I*""fRt"t*"r LastNaoe g*dnilaatsoliLl) Harmeling

REilFtal Stmt.{d&ess 27 Patrick or
Items Pwchtrsed
lrtT

\tr

Kristen
l6t

rlethod ofparraent: -:$Cn*h' -

Aggregate

PersonalCheck

i{i

CredittDebitcard

Amo[Dt of
Purchases

Seymour

CT

iings I
\,II

lgretf=

oei3cy2o11

$30.00
lethod of oarment: -.f, Personal Curn'

\Mne basket w/ glasses

LastNam

6Jofhlr"ha".t
27 Patrick Dr
#
ltems Ruclms,J

tnitiriil*atsolrLl)

Harmeling
.lq

Kurt
)EIF

Checg

FSFntral Steet.{dffe$s

,{t

uode

Fte

Received

Ever$

ii Credrfielrt'llj!
og/go/zo1
1

Aggregate Smount of
Purchases

Seyrnour

CT

06483

$30.00
LmtName 'Itl'
Fust itrte
:rp Cld

Wne basket wl cftocolate

lrlethod ofpalurent: -'&

6iof-P*"t*"*

tndfiiitualsA*LD

f Cash

PersonatChe"k Cjsent

C-4rtE!{C*!

Aggregate Amount of
Purchases

>tteRseNed

tms hrchNed

tl*" .t'P*"-l**t

Last Nnme

Fst

Itlethod ofpal'rnent: '8

tnilhiilueb AliLi)

C; Ca*n'

PersonalCheck
E\.erf =

fl Ctdit&bitcard

Aggreglte
Amount of
Purchases

}h

lEte

crl crl

[Zp t't{e

)ate Rserved

iiffi'ffiE?il

$0.00
Ir{ethod ofpa-rrnent:

ffi.'ffit"t
Tnilititftiak

O\LI}

r*tNi'
]ltl-

Frnl

f.Cash C' Per ronalCheck {]

Ssent

CreditDebitCard

itate

lzlp l-ode

Date RecelretJ

Aggregate Amount of Purchrses

ltms

Pwchased

$o.oo

SIIBTOTAL Sction l2-This Page

$201.00

Paae

of

'o11

rO

of

ry;-tx;
{

\1 ,*"tE
)o\
F*?]5'i
$ ).00 I
\tate

*' ,.00
nt
o'

Lls

io.( r0
runt of
rcha se

reE.glY

tor -{r

-..".tr
$0.00 \

sbte

Lffit
l.\cg.e

$t ,.00
nou trt o{
'urC Il&se

r'or

\sel

f il-AllE(ents I
$o.l

$0.00 \

t0.00
Am, )unt

of

Pu rchtse

State

r@-

jrerf

)o\

$0.00

*J:lT'; ncb,{ renb

Fent*

Gount ot
Purchase

CT

#ffiff--...N

{l

P*"to*t

State

$ ).0t
I

$0'00

q*H.ff*\

Fount

of

Purchase

CT

\g
\
State
ed

$0.00

:Y:,-lt+;;
1

G-tootof
Purchase

$o'or

$0.00
,A.mount {

il"g:,X.'H1

Purchas

-'*

$0. A$oun

ffiH.*-""\

Purch

I
Stnt

so.oo

$
,\nor ?urt

CT

eiva

TAJ
f.. It6o

mI

Page l0 of 17

$71.00 $751.00

$s22.00

rT TUITONUSING EVENT ACTTVITY

'en

oution

br-; fi
value

fi'nAir-iaual
Business Entih'
thrs erent

Fegate

fd

iJr*rotn,

cheese, cookies, candY' rdls' wine

gisenbv: f'

BusinessEntit]'

Name of

r)onor

Kristine Bourret

Sir=ot-t, f'

BusbessEnti$'

ffiii[i---f,udi.iauol
uir-enbY: 0

BusinessEntib'

for th$ vent

$132.00

Appetizers and bottle of wine

Nmc
r1f

DLrnc{

Karen Stanek

Name

otDonu

gi-;Ut,
Rosalie Averill

ft

BusinessEntit-t
evgnt

ibrth$

$131.00

Cheeselpepper tray, 6 dozen cookies

$egate
salue for thrs esent

NAt{Ii oii

rr}I\rMrrTFF.
, ! !

,,, I
.
| ! | !l !!
.

T'ltJilinifill tffil*****************
'

itial.'?-L+::ln

r0t1112011
' ' l!' rf

Paul Rov2011 -

.,.
Nafi e of Donlrr

r. r ri:t :-3l llii-o+inirc.Rlnl {lonsiflefe il Contribu tions .u-!.!ll|.]lEE !t

ll

.krlith Simoson

G .r5ilil
i
t/Valnut St.

F ffi

il
:it]-

i-T crl

lffiiiii-Floai.ioual lgh'er br': C' Business Entit]

|,\ggregate value

Fair llarke{
'alue ofDonatior

Zrp Code

06483
Date KseN*e{

iu tns

etent

gro.oo
09/091201',|

$10.00

Eser$:
1

dpticn of donahon

c JOK|es
Evelyn Roy
-\ddles
itate

09/091201

)onation rlndiridual
rh'en b-v: fr
.4lF L.wc

Busi*e*sEntitl''

Feir luarket \.rlue of Donatlon

SQate

talue l'orthis evenl

Shet

80 Washington Ave'

qavmf)trl

CT

06483
fhte Rece$ ed

$40'00

$40.00

Dffi;Iffiron
ftoldes,
rolls, wne
Nme of Domr

Fffi=
09109t2011

09/09/2011

Donatios Qlndilidual

Fair 1\larLet
Yalue ofDonation

Judith SimPson
_rit} JutIE

givenby: fi

BusinessEntiq'

ffi]Tffiess5 Walnut St.

D6qrDtrm ot dmtrDn , : ^ tt. -.^ .^ L^^i-r -I aole, rrll(;luwave \twr
ratlae\

ggregate value t'i:r this event

Seyrnour

CT

06483
Jurt

$10'00
Evrf
1

$10.00

Kg:ereq

I
Fair l\Iarke*
\:alue ofDonatioa

09/09/201

ffi

Kristen Harmeling

ffi

27 Patrick Dr,
Dewlr{rm .lt
Nme
donatkln

iSevmour

srI

ponation {Tlndiridual gh.eoby: S BusinessEnti\-

CT

Tz@ I oo+e3
:.]at

.A,ggregate

rslue tor thls s-ent

$200.00

$200.00
Eied
=

llervvs

plates Gaterer, water, soda,alcohot & paper

of

09/09/2011

09/09/2011
Fair \Iarket
alue ofDonation

Donation 'Indi\idual

l)ontr

Anna ConroY

givonb1: S
lrtl
Seymour
JUIId

BosinessEntig'

FE;ISK
167 Skokorat St'
Desariptnn ofdonatron

\ggregate value tbr this erent

CT

0e$3
)ate Rcerve,f,
E-r.ent

$50'00
=
1

$50.00

Music box, Gifl cert. Towsr Sg' Diner' or

Nane r:f Doncr

09/30/201

09/3012011

oo*tioo
givenby-:
XR'
I

QlodiriAuat

Fair l\'Iarkd
Yatue of Donation

Manrntain Rd Wine &

Lhuor
$eymour

fi

BusinessEntiqtils
evnt

SleEffiS253 Wsst St.

lcr

state

Zrp-t5de

.{ggregate valw tbr

0e483
Date

$30'00
1

$30.00

F-i6imof
Nme

Rsen'ed

domtton

Wne basket & chocolate

trf Dtrncq

09/301201

0st301201

Donatior llndi\"idual
gh-enby: fi
$egate
Ese* =

Fair \larket
Value of Donation

BusinessEntiS

Antonio's Restiaurant
StrJiEEi.

kess--

}q'
Ansonia CT

f4'Ge-06401
)aie Kecel\'eo

value t'or thls eYe.nt

$20'00
0w3t)/2011

$20'00

314 Main St.

Faor6rexrof donaton

Wne Basket and glasses

Nameofllons

09,30/2011
gir-en
--rt]'

nooutlo"

{:'Indi\idual Entitr

Fair I\Imhet
\:alue ofDonation

Antonio's Restaurant

br': G Business

.{ggregate falue for this erent

f&ee-i$fiess314 Main St'

Ansonia

CT

06401
Date RE;eFed

$20'00
09130/2011

$20.00

ffiooof $fl) Gift

dt-mtron

cert. Antonio's Restaurant

09130/2011

,ir*r"p"r'

$380'00

Page

-of -

n run-snqc
6d

EYENT

acrrYITY

norraiions Not Coqiuereit

contriuulllH,

D"".ti* {E lndiridual givenbl-: Ci BusinessEntih'

$50. Gifi cert. Antonio's Restaurant

gSO'gltt cett J J Sullivan

R""t'!-t & *in" "*L

NameafDonu

gir-enb1-: fJ
H. Preet singh

BushessEntiq'

Nme tf Donw

Si.;"U.,
Vera WlhelmY

f-r BusinessEntih

32 Smith St., APt' 3G bracelet Bracetet, Necklacen earlings &

Siou-doo {i' Inditidual

givenbl': fi
$egate

BusinesrEntiS'

talue tix ths esent

m NOI\{MONETARYRXCEIPTS
$ALr'ilE'r.r1ldi'frTTTg r'.. ..
.:,

PagelloflT 10ll
11201
1

.'

]'? InJi': f'ITF NATF."

Paul Roy 201 1

$ame

iate
ls contributor a lobbyist.

ordepeldentchildofalotrbfist? {*'
)ate Rrceir-ed

spoure, li

Yes

No

a chief esecuth-e ofhser ofa q'ith har-e a contract r-ith said municipalilv does contributor ot bnsinms hershe is associated fl' Yee f , No municipalitf'r'alued at more than $5.000?

crl

lt

Il,pe ofContributor: f,r lndiridual

f f

Committee

Fair I\Iarket Ydne of this Contrihrtion

Oher

("lpplicab,e srb' to Referendum Comwittee$

iommitee for

s this contibutioo msoliated $-ith a irndraising event listed in Section Ll? {ft'as^ list Er-ent =

fl fes 3No

Desurptrm of In-I;urd ConhbutNn

agrwaR

$0.00
Type ofContributor:

$0.00
li'air 1\larf,el Value of this

$me
]treet^L:':res
'rh'
Julle
4Ip L otle

CT
Is qootribrtor a lobbfisl spouse o, A"p.na*t *nila oia toUtf irti
)ate Re{erved

'S li fi

Indir-idual
Committee Other figplicable onll' to Refren&tm Committees)

Contribution

'O
iJ

Yes
NO

a cardidate commitee for a chief eseeuti\ e officer of a rvith said municipalit-v does coohibutor or business he'she is associated rvith hare a contract O C' No municipalig'valued at more than

ffi

$5.000?

Ies

Is this ,:oobibotioq associatsd $'ith a

f'

trndraising ocnt listed in SectionLl?

f1'rs)trame

li$t E\-ent

e,

Yes

Deselptrtu of In-Knd Ll(rdtrlbutFn

{ggIcg"l!

No
T5.pe ofContributor:

$o.oo

$0.00
li-air luerx.t Value of ttis

Fstldffiss
Iscontributoralobhfist.spouse.
or dependert
)ate Received

'lh'

)Bre

arp C(lde

CT

f f; f,, $5'000?

Individual
Committee Other (4pplicabte n 4' to Referenitum Cmm,tteed

Contribution

p child oia lottt-r';st: *

Ie

Yes tqo

ateaommiceefora chief executive ofiicerof a does conhibutor or business he:she is associated n'ith hare a conhact with said nrunicipalitl'"

iir*"ii,Jtq't"r"ed

atmor than

f' Tet f'

No

conhibution associated $'ith a fundraising event listed in Section Ll? f;l'ec, list Erent *

fis

hN"

{ t lEs

Descriptirn of In-K{rd Corsntntron

gIcEaE

$0.00
T3'pe of Ccnhibutor:

$0.00
.l'air l\Iarltet \:alue ofthis

{me
tust Adjrss
s contributor a lobbf ist. sPoue. >r dependent child of a lobhf ist?
)ats Receivod Is this

ilt\

1rp Cl)de

CT

f fl. f.

Indisidual
Committee

Contribution

O&er (4pplicabte Mb' to Relermifum Cawittees)

fi Yes f'No

*uni"iputiq.'aoo co$hibuto. or bBsiness he'she is

ir"i"ii,ofitl","f"ed
rrith
Yes

atmore thar

$5^000? i' t'es ft

omnoittee fot a chiefesecuth-e ofticer ofa assoeiated with har-c a contract rdth said

No
{Egrega to[trrouuQlD

contibution

fundraising
$ame

a fi er-ent listed in Section L l? lfi

associated =

Descnptron of In-Kind Llortntutron

No
T-'l'pe

$0.00
of Conhibutor:

Ifi'es. list Event

W;eiTI&ffi

rt\

iure

1ip ('ode

GT

f Inditidual f- cor-itt* f, Other (lpplicable @t4' to Refren&tm

Value of this

Contributior
Committes)

comruisee for a chief executi\-e officer of a Yes Iscontributoralobbfist a"* contsibutor or business he'sbe is associated *-ith hare a contract rvith said No dependent ,:hild oia lobb-vist? or "to*"ipnfitt }'Io municipali*rahedatmorethan$5.000? lgglegaK Descryrtrtrr of In-Xmd Llruklbutron Yes )ate ReceiYed associated sith a Is this contibution No fundraising event listed in SectiorLl? In'e$. list Event =

spou*e, f; i*'

ffitdate

{' Yes fi

fr
f'

$0.00

$0.00 $o.oo $0.00 $0.00

$trBToT?lt'wtion.1lL'rms*Page

:.:....:.:..:]j:]:.].,]:.l.',:ToT.lNLof,'.'il.lifioit.lsGctsiMPdss
ffity ro

&{{tqBr of dep$ Wial\qtlsts Jtry l i&;i*a: not 7ai6bt'*isne ri the in aidtae

Last

\{I
CT
telephone compml'

I Date Dposrt

\Iade

.\mouot of
Deposit

$0.00 CT

,.. r Total:gisfrxlN(Er**ldalq LinsE

$0.oo

III.
Oar rl Elnrr ?11'l 'l

NOI{MONETARY RECEIPTS
rffrlrrrtrT$TF

Page 12 of

l7

flitil
1At1112011

@ip,
iFeetA,:ltes

O;. Non'Monetarl', Rgceipts, of orgQnizatiotr- $xpefinru rs.E+a.trF D.! f ,roielilire f ,eedeirshln Lcdslath'e Caucus'and IAXE Comriitts NaneTE;asuel I*gistat*e caueus, anil Part! cs,'mittees QNL l)
Date

.,

Notice Rece$'ed

Fair l\Iarket Value ofDonation

lil'
CT
Desmrtlln of Donatrm l-mmftee (Legislath'e Latlenhip, I*gisbfi'e Cau&s,
and Par4'L Mmttrees

Z,p ca{e

\ggresaiB Donahons

$0'00
Ptlltr\)se

f.r lf'B fic nD f.E

u:\Ltt
{me of Treasrxer
Date Nc,tice

ol g\Pendltue Pes

trsw@o6,t

$0.00

Name (rf

itret-\dtes
llbZrp Code

RslYed

Fair l\Iarket Yalue of Donathn

\ggreg"b &rnatlons

CT
Descnpbm ofDonatron
Pwpose

$0'00

Ci.lfBncflDClE
anil Pdfi! Co'nmittees O^LV
Name of Treasuftr Date NL:drce Recex'ed

tf

Expendinre {see in*rattions)

$0.00

iEet-ldAess
ZrpC.ode

Fair 1\Iarket Yalue

ofDonation
\ggrate Donatons

Irq' ).scrr$lm
(rf DonatNn

CT

$0.00
Purps of E\pndrfirc (see ifistructtorls)

f-.r 'f's fic f:D *E

caacu s, and Partl' c omai'te6

$0.00

@lifi'e
ilret Ad&ess

o\z't)

Name ofTreasurel

Date N,rtice Rmened

Fair 1\Iarket \-alue

afDonation
Zrp Code \ggregate Donatlors

.'lt-l'

CT
lrrp..p of Eyonditure

$0.00
(see inlfr,rctions)

)esarptrur of Donatrtrn d Par4' Cunmitte$

f,.r fl'B lc PD frE

ffite Notice
Recen'ed

$0.00

O^Lt

Nme of Treasuer

Fair ilIarket Value ofDonation

liB'

Zrp L:rrJe

\ggegate Donatlotr

GT
)esmptr(x ot Lbmtr(\n

$0'00
Purpo* of Expendinre {see insfitetions)

C-r dl'B f c fiD

FG Nt*rie teceived

f,'E

$0.00

anl
Iteet -\d&es

anil Par ' Commiftes

A^Lt)

ffieETrcasrm
Fair l\Iarket Vulue of Donation

_iitl'

Zrp L--ode

\grgate Donahons

CT )ewiprmof Domuon

$0'00 lrpos

h'r flB f.c glD lE

Date Notrce Recen-ed

of Expendrtwe (see instra$iaile)

$o.oo

lkw
r!! t

Fair

llarket Vdue

of Donrtion
State

llt\'
)escnFtlon ofn\natron

Zrp cltde

\ggregate Donahons

CT
lnrpose of

$0'00

Cr

Erlrndihre

(see

infiilctions)

C,B

{ic frD

if'E

$0.00 $o.oo

W. n)(PENDITI]RES
iri r*f nr ra n t.TIl

Page 13 of 17

,.T?Yl
Name of Pa].e

,RoI

291

J.,,,,,.,,,,,,,,,,
cit.

,,',
cr I

,.'

P.IExncnsesPnidbr:

,,,,, ,, ,,'l ,, Cgumittee''.','' .'

)ate ofPa)'men!

'tot't1t2011
,

hlethod of Palment

-lmount

Barone's sporfs cafe

ttri.{dfies

48 Wakelee St.
PwpN

n5'.o:"i

ot E\Tiendrhre

Seynnur ffiiotrm-r!*Hrr\rr
ATT

lzp t Ne 06483

8i1&fz0fi

f;

Cbeck r- 101 dl. Debit Card

Kick ofi party for re'election of Paul Roy for 1st Seled

0a15/2011

lvpe of Espenditure Qf opplicable) : f . C*rainuteO n-ith reimbursement sought f Coordimted rtithout reimbursement sought

6f @ielbte)

E E

Supported opposed

f,Otg*izution

Independent

@nr.t**igns,
;bet Ad;kss

f;.r

(see Inctrt diottc)

C,B {:,c rl o
LLC

..e
late ot

480.00
l.aJn*I lle&od of Pa.rment
.{moutrt

llh

itate

132 Silvermine Rd

Seymour

cr I

lzrPLN oo+s3

9f22n011

G check

+-

102

fl

Debit Card

lilmF

tt .o:er

ol lr{Fenolurg

ffiint1-n-/L'!r'!u('l
--

E{ent

*
Eopposed

AOTH

Redeclion sbns (100) & various other election signs

!)$roe J!1ugff

[r-pe of Expenditrne ft!aPdicade): C Coordinated n-ith reimbursement soug&t C; Coordinated *'ithout reimbursement sought C Independent

tlalrdilati:t

li Nane (ifapplicable)

C 0rganization (see Insttudions)

Nme of hr-ee
Sheet,{dlrcss

f:r CB l-'c f.o f'r

--ltl
itate ap uode

$
)ate 0t ltr):ment

868.00

'

v'lelhod ot PaJrrretrl 6p

Colleen Fries

9p,zna1l

ghggl *, 1 03

107 Spruce St. PrmN of Erondrurle

ffi
POST

Seymour

CT

064&3

C' Debit card

U\.ent =

rb.''"odei

'!r!rrPq\zr

Stamps, lnvites & envelopes for auction held at Villa B

09/30/2011

Ivpe of Expenditure (if @ieaue):

Cmdrdat {s} Name

f: fi fl fl

Coordinated with rei.arbursenent sougbt Coordinated without reimburssment soughl Independent Organization (sce Instructions)

(i!appliuble)

opposed

130.00
ff
oI ra)-_ug& l!.lethod

ffie-tffi--- Bianca ' Villa

Stet.{d&ess

f;,

r {,B f.c fl o lfir

l$Seymour
lffidm

otYalment

AEounl

itate

312 Roosevelt Dr.

hfn)se of E\Dendtwe

cr [

lZtP c{r'l

980/2011

Bcheck* 104
SDetitcard
Event 4

06483

tbrjcodet

ATT

Silent auction and buffel

Llmdrdate(s) Nmre

09130/201

I1'pe of Erpenditure G! applieble) : r.0 Coordinated n-ith reimbursement sought ,rS Coordinated n-ithout reimbunenrent sou glrt l{T Indepeodent

f{qptimble)

E opposed

Fl Organ4ation
Name of Pa\ce

f r f o fin

{see

Iu snaoion s)

f1

n f.r
)ate of Pa.v$er$

s
\'[ethod of Palment
-.p l\1de

1,430.00
-{mouDl

ttreet.tdlles
P|llnse ol.Experulrtuf

x\CT
)escnpttctr

f ft

Check

+_*

Debit Card

Event

lb!

code) Cmdrdatets)

[-rae ofEspendittue 6f apficaue): fll Coordinated n-ith reinbursement sougfit '{J Coordinated s ithout reimbursenrent songht S Indepeadent 'fi Oreanrzation (sec Instructions)

Nme

(ifapplicoble)

flopposed

I]T fiBT.i C CDCE

0.00 $2,908.00

$0.00
_

I .-, ,'i .rY

nnr*in t'g'tfi"t; tuniJiioisa'n'i P"s4

$2,908.00

IV. NXPENDITURES
frtlt
trar rl Flnv 2O1
1 :rr

l"n:
ntg.
10t11f?.911

11 "111

@piitilirectg
itret -.\(Eres

)ate o{Pa}ment

Is Reimbursement Claimed?

.lmount

Sbples
llt]' :{r r,.Ne

a7/23t2g11
ti\.ent a

f'Yes
{!} No

3 Armstrong Dr
Pwtrns ot.b\:pDarnre

{b}'coJei

Shelton Dsflpfim POST

x'ho

CT

06484

$7e.00

lnvitations, blac* ink-iet cartridge & labels

Date lrf Pa,r'ment

N*t..f P.i* P-'"t" r/l'enitor

Jteet -{d&ess

undiihte

piil
irt!

ilirectls)

US pOSt O{fiCe
:lp u)de

ls Reimbursement Claimed?

.dmount

a$ftzzarl
$;nt]ate ot falmenr

fr ro
'No

91 Main St.
Prnpose ot Br?endmre

Seyrnour
DscrrDucn

CT US Flag

oa$3

$44.00

{b'codei

GIFT

'

;eles
Steet.{ddrs
rrq:

Is Reimbursemetlt Claimed?

Amount

4IP L:!{e

0tt1st2011
EvIf

{:
*

res $64.00

3 Armstrong Dr
PuqDs ot EsPndrnre

Shelton

CT

08184

SNo

femrtrtu
POST
dnditute piddnecfl))

tb code.t @o

Labds, color ink-iet cartridge

Date

of Pal-lrent

Ls

Reimbursement Claimed?

.Amount

F-rEffi-Frpos of Espendture iby code)

'lB'

1lp Clade

{'Yes
{-r l\o Bve$:

CT
)scnFtiofl

$0.00

Amount

Sbeet-TdlF
Rxpsse (rt EliQmdrtue

rlb'

ZrF Ctr1e

O les

CT
Desrlpttrn
Date

Fno

$o.oo

isent

(bj'codel
ot lAlmenl

Is Reimbursement Claimed?

Amount

SEeet

-{d&es

litv
Desorptieu

liate

crl

lZrp Code
EYent :

{^, Yes

fNo

$0.00

Rrpose of Eryen&tul
{by code)

Date of Pa,vnrent

Is Rel$hunement Claimed?

.\nount $0.00

ItreetAidiess Parflos
!1t

ci6'
Descriptrern

)IAIE

Zlp C.ode

'ft tes

GT
-BxPendrare

f*
F-ent:
)ate of Payment

No

ibv cojei

Is Reimbursement Claimed?
{ Yes

\mounl

F-rTffms
flulLrse ot E:iPendrtue

artj
Dmentrtion

jtale

Zp

L-ode

GT

f'No
Stelrt a

$0.00

ft'cute)
Nme
trf ?a]-ee

(\ a n e of

I'en dor

t*

c9 n

di date

paul ar

e c n )'

I
iAI
Zry Crrde

I)ate,rf Pa]-mEnt

Is Reimbursement Claimed?

Amouni

ffiFdesffiofEspendttue
(t't'code)

]h'
Descnptlm

CT
Event =

(-,Ies SNo

$0.00

$187.00

$0.00
$187.00

TV. E}PtrF{DITI]RES
!'t

Fage 15 of
Eilr l.'t'}a.r:fJTili:Tt :t

l7

j:a,:fq

Al! fli:rhtf,]n'Pllgs.

TF,

Paul Roy 201 1

10t11n411

Card
Neme of Issuing Instifution

Type ofCredit Card:

5. \-isa

Nlaster

Card f:

Discover ll'.{merican

ExPress

f.
Nme cf \-mdor }p

other
Date of TrascL-trotr

.\mount

ffiEEGs,s
Rxpose ofE:penditure

Crh'

)6I

Code

CT
)esx1ptu6

Uril

t
TnNactim

$0.00

ib}'cole) rlme of \-endor (lrt]

Jtate

Date of

.{moutrl

Street.\ddrN

lp

Crrde

CT
R:rpos ofExpendrhre

Elent:
Dat oiTransaatLn

$0.00

t\.code)
Amounl

Sbeet Adke$s

City

itate

Zip Code

CT
Rrpos
of E:gendrnre iby codei

FGffi-

El'erll

$0.00

Nme of \:endor
cih''
Jtate

Date of Tram{ctron

-dmortnt

SheetAdches

lp

L-ode

CT Rrpo*
of ErAenditue t14. c*de)

)es!T$t(n

Erenl +

$o.oo

$me of \-md(.r
Citv Jhte
,4r Code

Date of Tra$actlcn

.\mount

Steet.{ddress

CT
Rupose ofEr?endrurre
{qnr

EurEM

Event

$o.oo

coje)
Date of TraNact[Yl

f{ame of Vendcrr

^{mount

Street AdJress

c1R'

XAI

}p taile

CT
R[pose oflxpendtturo ib:'co.Jei
Name of

$0.00
Ererf =

)6cnptrr'n

lendor

Date ofTra0sactron

Amounl

St eet -\ddress

C1h

Jtate

Zip Code

CT
Purpose ofErpendinre (.bf code) Name of \.endor

)csrlFlm

E\.ent

$0.00

Date of Trmsaction

Amount

Stret -{d&ess

citi' )smpEm

Jtate

lp

Cerje

CT
Erent

$0.00

Pr,rpose of Erlendtture

{b1'ctrdei

$0.00

i''':
......., . . ,,,

..

"''

?o|fAllofiilAifiomrseadotRF.egg', -. !
lt

$0.00 $0.00

!-

IV.
rI

E)(PEIYDITI]RES
;lr
.TN.]. r}rlB,

Page 16 of 17

tMF :f lI' {:tii}i'!i;ff

TTF"E

t|{TF
1W11t2011

Paul Roy 2011

S.' Eroenses tncurrcC bv Commi*ec but Not paiC

Nme of
L-reditor

nurinc

this. Period
Amount Incurred lEstimdte ot.ldaal)

Date Incurred

)u&r-{wes
crqState 4lo L.ode

Er$t

landidateisi Nme 1tl

alplicable)

Otbce Sougld

CT
rwl4s !
!_v ceJe j

ftpe of Expenditure Qf appli u N e) : (- Coordinated * ith reimbmsement sougfit

f:

)estrrptrm

f.

Coordinated rr-ithout reimbursenent sought Independent tlsanization (s ee Instruaions)

'Cr.r fis f-.c i-,D

C,E

f'fpp.xed

Ilsuppt'roa
)ate Incwed

$0.00
Amount Incurred
(Eslimate otActual)

Nme

rrf Llredrtor

Slr*t-\dlles
CiE.
Siat

Ecelf *

lp

CoJe

lardidate{sl Narae

lil apptiebte)

Office Stryfu

CT
'Urpw
lrl E:qEnOilue l1'pe of Expendihre (if aplicable):
b1- code )

C
Jesmptld

f,

{-.

f.
Naure ofCredrtor

Coordinated with reimbursement sought Coordinated rrithout reimbursement sought Independent

OgagizitioA{see

llstnt$ns) {'A r,Bt-.C i_Dt.;E

'frsryporao fr;ppmed
)ate Incured Everf 4

$0.00
.{mount Incurred
Estimate

orAarcl)

kmt.{ddres
citv
4rp Llo{te

]mdidate(s)Name

f/alryIicable)

{-)!llce SougJf

CT

a[Iw

or !\Penqrure

Il?e

\"cuJe)
)e$cnptill

Coordinated n'ith reimbwsement sought Coordinnted rrithout reimbursement sought C: Iadependent

f. f.

of Espendinre Sf ayp{i mWe) :

*uifi'.1,.F*;"

rtYT,l, .,

C,Suppl.dsd

fii-)ppse.l
Date l-*:urred

$0.00
Amount Incurred
(Estinate or.4ctaal)

Nme

of

Credts

SEst.lites
--ltj'
jrnposo ot lJxpesorere
State

E\-qf =

,4r Clode

Jmdidatet.s) Naule

{fappliofilel

Otbce Soug$l

CT
bf'ctriei )6ixlp&dr

Ilpe of Expendihrre fifappliuWe): {i,Indepetrd*t

Ji. Coordinated n-ith reimbursement sought il: Coordinated *ithout reinrbursement sought

f,

Orsmization /see Instntdions) -f'-r

f B C'c C D C

| ,_)pFsed lupputed

$0.00 $0.00 $0.o0 $0.00

Prttiirylt*b

fiipiiri,thiirn6:ind*dtto.gx1
Line
2E a

$0.00 $0.00

af Sttmmarv Paeej

TV. UGE}{DITIJRES
\IttrlE lfF eClllo*{IFrFF:: Paul Roy 201
1

Page 17 of

l7

llr.r*,1rs*; T)iTlE 1gt1ilz011

T. Itemization
"mt
Name of l4iorkerconsulbDt

of Reimbursements to Committee Workers and Consultants

Ftst \tr
)ste of Pa!'nent

N{ethod of Palment

Imount

Fclrum-ra\-d
Jttfrt -{dilres
Desfiryhi,n

'utrs$ or t\fEr b'csJel crq

f;
C
,p

Check*
Code

Dbitcar;-

CT

Tlpe of E:pendibte

ll {: L

Af apdi cabl e) : Coordinated rr-ith reimbursement soudt Coordiaut d *ithout reimbursement soug&t lndependent

Candrdate{$} Name

t'itlce

Soughl

f!aq*limblel

fi

Supported ()pposed

! - Organization
Lmt

f:a e:R flr

(see Instrurrions)

:i:n:r]n
Ftrst

$0.00

Nme ol\\iorhuiComukurt

vll

Date oiPa:$mmt

llethod ofPa"wrent

.{nou[t

Jccnda$' tb:'ee

1trpw

or L\pensrNe

$
stet Air(lfes
L,IE'

cule)

f,
GT

Cheek+Debit card

Zlp O)de

L)scrrytrlxr

rype of Expndihre (ifappli&bl|.

CmdirJatetsi Nane

O$ice Sougl$

l{ *t
L

Coordinated n-itL reimbursement sougfit Coordinated rithout reimbursement sought Independent

6f awlieablel

f,. Supported f,Opposod

.r Organ2ation (see lustntctions)

'

nrf

nfic'{^,nf.n
FGI

$0.00
.{mourrt

*t Nme

of

1\'orkertonqltnt

r{l

)at ofPavment

Nlethod of Paprent

xcmm'raiai
Street -{dfiess L:rE'

irpos

0I

uErnaMe

bn-cuii)

ifi'check+S Debit card

lF
Ccde

CT

T-qn of Expendihue fil.t$icaWe):

l

Jand&te(s)Nme
8f appliuble)

Ollice Sought

{]lSupported

f; f, fl

-1

Coordinated s ith reimbursement sougfit Coordinated without reimburseme,nt Jought

r'Opposed

Indemdent

Org*rzutioo (see Insmtuiotts) -

.f-,r f_B flc

*rD rip
Fnst

$
r{l
Date of Pavmmt

$0.00

Last Name ot l\'larkerr Consulf anl

lt{ethod of Pa-rment

Amount

ECmOm'fa\'?i

i{plrs

or E}])Fnqrwg

bl.ccrie)

fi Chech*.-_f'uebitCard
Zlp t-ode

Jtret -{dlles

C-rt1'

Jtate

Ds4tuon
Candrdab(s)Nme

T-r,pe of Espeodihre 6f appli cad

e)

'S Coordira0Ed rith reimbrusement sousht

Otfrce Sougtrt

ffqpliuble)

Coordinated rr ithout reinrbursement

iugnt

{lil Supported I -()pposed

ft

hdependent

0rganizrtion

F'r lc p, i-:r.

(see

Instrudions)

1.

D '.'F

$0.00 $0.00 $0.00

TOTAL OFALL RTIIIBLIRSEI\TENTS TO COIII\ITTTEE II'ORKTRS AND C:ONSLJLTAIITS

$0.00