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2. This form can only be used by a candidate who has no committee, has not accepted or received any contributions or contributions in kind, but has made expenditures of personal funds.

   Items marked with an asterisk (*) are required.

4. Name of Candidate
6. Address of Candidate
8. City
9. State
10. Zip
14. Reporting Period Covered
    Reporting Period Covered Start Date

    —

    Reporting Period Covered End Date

    Expenditures exceeding $20.00 shall be itemized and listed below:

16. Full Name of Recipient, Address and Purpose of Expenditure
18. Date of Expenditure
    Date of Expenditure
19. Amount
23. Full Name of Recipient, Address and Purpose of Expenditure
25. Date
    Date
26. Amount
30. Full Name of Recipient, Address and Purpose of Expenditure
32. Date
    Date
33. Amount
37. Full Name of Recipient, Address and Purpose of Expenditure
39. Date
    Date
40. Amount
44. Full Name of Recipient, Address and Purpose of Expenditure
46. Date
    Date
47. Amount
51. Total Amount of Non-Itemized Expenditures ($20.00 or less)
52. Amount
54. I certify to the best of my knowledge this Statement of Expenditures is true and correct.
56. Signature of Candidate*
57. Date
    Date
59. Note: Submission of false, erroneous, or incomplete information may be subject to sanctions in accord with the Greenwood Village Municipal Code.
61. Filing Requirements
    Chapter 2, Article 1, Section 130

    For the purpose of meeting the filing requirements for candidates or committees under the Village’s Fair Campaign Reporting, electronic copies shall be accepted; provided that original documents are received by the City Clerk within five (5) days from the date of the electronic filing pursuant to Chapter 2, Article 1, section 130 of the Village’s Municipal Code. Reports/ Forms required are deemed timely if received by the City Clerk no later than 5:00 p.m., local time, on the designated day for filing.
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit Submit and Print

* indicates a required field