HomeMy WebLinkAboutHubka, Brenda - Candidate Statement of Non-Receipt and Non-Expenditure [REDACTED]City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ___________________________________________________________
Current Reporting Period: Through
Funds on hand at the beginning of reporting period (Monetary Only) $
6 Itemized Contributions $20 or More [C.R.S. 1-45-108(1)(a)]
(Please list on Schedule “A”)$
7 Total of Non-Itemized Contributions (Contributions of $19.99 and Less) $
8
9
Loans Received
(Please list on Schedule “C”)
Total of Other Receipts
(Interest, Dividends, etc.)
$
$
10 Returned Expenditures (from recipient)
(Please list on Schedule “D”) $
11 Total Monetary Contributions
(Total of lines 6 through 10)
$
12 Total Non-Monetary Contributions
(From Statement of Non-Monetary Contributions) $
13 Total Contributions
(Line 11 + line 12)$
14 Itemized Expenditures $20 or More [C.R.S. 1-45-108(1)(a)]
(Please list on Schedule “B”)
$
15 Total of Non-Itemized Expenditures
(Expenditures of $19.99 or Less) $
16 Loan Repayments Made
(Please list on Schedule “C”) $
17
18
Returned Contributions (To donor)
(Please list on Schedule “D”)
Total Coordinated Non-Monetary Expenditures
(Candidate/Candidate Committee & Political Parties only)
$
$
19 Total Monetary Expenditures
(Total of lines 14 through 17)
$
20 Total Spending
(Line 18 + line 19) $
DETAILED SUMMARY
All fields must be entered. Please put $0.00 if the amount is zero .
Committee to elect Brenda Hubka
08/20/2023 10/15/2023
0
454.99
0
630.00
0
0
1084.99
0
1084.99
1037.83
0
0
0
1037.83
1037.83
0
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person:
PLEASE PRINT/TYPE
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8.Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
1.Date Accepted 4.Name (Last, First): ____________________________________________________________________________________
5.Address: __________________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7. Description: ________________________________________________________________
8. Employer (if applicable, mandatory): _____________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
2.Contribution Amt.
$
3.Aggregate Amt. *
$
Check box if
Electioneering
Communication
* For contribution limits within a committee’s election cycle or contribution cycle, please refer to the following Colorado Constitutional cites: Candidate
Committee Art. XXVIII, Sec. 2(6); Political Party Art. XXVIII, Sec. 3(3); Political Committee Art. XXVIII, Sec 3(5); Small Donor Committee Art.
XXVIII, Sec. 2(14).
Schedule A – Itemized Contributions Statement ($20 or more)
[C.R.S. 1-45-108(1)(a)] A spreadsheet attachment may be uploaded if additional lines are needed.
08/20/2023
Victoria Cash
43369 spring cellar court,
25 Leesburg, VA 20176
24.07
donation
Tyler Technologies
Marketing Analyst
08/20/2023
Laurie Pierce
528 West 3rd St.
20 Oil City, PA 16110
19.52
donation
PennWest University
Nursing Faculty
Please see spreadsheet
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ________________________________________________________________
PLEASE PRINT/TYPE
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5.Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
1.Date Expended 4. Name: ___________________________________________________________________
5. Address: __________________________________________________________________
6.City/State/Zip: ___________________________________________________________________________
7.Purpose of Expenditure: __________________________________________________________________
Check box if Electioneering Communication
2.Amount
$
3.Recipient is (optional):
Committee
Non-Committee
Schedule B – Itemized Expenditures Statement ($20 or more)
[1-45-108(1)(a), C.R.S.] A spreadsheet attachment may be uploaded if additional lines are needed.
Committee to elect Brenda Hubka
09/08/2023
Signal Graphics
5120 S Broadway Suite A
199.90 Englewood Co 80113
Door Hangers
09/21/2023
Signal Graphics
5120 S Broadway Suite A
183.69 Englewood Co 80113
Door hangers
09/28/2023
Signal Graphics
5120 S Broadway Suite A
237.71 Englewood Co 80113
Yard signs and stakes
10/5/2023
Signal Graphics
5120 S Broadway Suite A
157.76 Englewood Co 80113
printing of slides for candidate forum
8/24/2023
Signal Graphics
5120 S Broadway Suite A
237.71 Englewood Co 80113
Yard signs and stakes, design work
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: __________________________________________
LOAN SOURCE
Name (Last, First or Institution): __________________________________________________________
Address: __________________________________________________________________________
City/State/Zip: _____________________________________________________________________
Original Amount of Loan: $______________________ Interest Rate: _____________________
Total of All Loans This Reporting
Loan Amount Received This Reporting Period: $______________ Period: $ _____________
(Place on line 8 of Detailed Summary Report)
Principal Amount Paid This Reporting Period: $______________
Interest Amount Paid This Reporting Period: $______________
Amount Repaid This Reporting Period: $______________ Total Repayments Made: $_________
(Amount Repaid is sum of Principal & Interest entered on Detail Summary) (Sum of Schedule C pages, Place on line 16 of
Detailed Summary)
Outstanding Balance: $ ______________
TERMS OF LOAN: ________________ ___________________
Date Loan Received Due Date for Final Payment
LIST ALL ENDORSERS OR GUARANTORS OF THIS LOAN
Full Name Address, City, State, Zip Amount Guaranteed
LOANS - Loans Owed by the Committee
(Use a separate schedule for each loan. This form is for line item 8 and 16 of the Detailed Summary Report.)
[No information copied from such reports shall be sold or used by any person for the purpose of soliciting contributions or for any commercial
purpose. [Art. XXVIII, Sec. 9(e)] Notwithstanding any other section of this article to the contrary, a candidate’s candidate c ommittee may receive a
loan from a financial institution organized under state or federal law if the loan bears the usual and custo mary interest rate, is made on a basis that
assures repayment, is evidenced by a written instrument, and is subject to a due date or amortization schedule [Art. XXVIII, Sec. 3(8)]
Schedule C - Loans
Committee to elect Brenda Hubka
Brenda Hubka
3639 S Fox Street
Englewood, CO 80110
630.00 0
0 0
630.00
8/24/2023 12/31/2023
not applicable
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: __________________________________________________________
Returned Contributions
(Previously reported on Schedule A – Contributions accepted and then returned to donors)
PLEASE PRINT/TYPE
1.Date Accepted 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Purpose: ________________________________________________________________________________
2.Date Returned
3.Amount
$
1.Date Accepted 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Purpose: _______________________________________________________________________________
2.Date Returned
3.Amount
$
Returned Expenditures
(Previously reported on Schedule B – Expenditures returned or refunded to the committee)
PLEASE PRINT/TYPE
1.Date Expended 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Comment (Optional): _____________________________________________________________________
2.Date Returned
3.Amount
$
1.Date Expended 4. Name (Last, First): _________________________________________________________
5. Address: ________________________________________________________________
6.City/State/Zip: _________________________________________________________________________
7.Comment (Optional): _____________________________________________________________________
2.Date Returned
3.Amount
$
Schedule D – Returned Contributions & Expenditures
City of Englewood FCPA Filing Form - 2021
Full Name of Committee/Person: ________________________________________________________________
PLEASE PRINT/TYPE
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
1.Date Provided 4. Name (Last, First): _____________________________________________________________
5. Address: ____________________________________________________________________
6.City/State/Zip: _____________________________________________________________________
7.Description: ________________________________________________________________________
8.Employer (if applicable, mandatory): ______________________________________________________
9.Occupation (if applicable, mandatory): ____________________________________________________
10. Check box if Coordinated with a Candidate/Candidate Committee or Political Party. *
2.Fair Market Value
$
3.Aggregate Amt.
$
Check box if
Electioneering
Communication
* Note: If coordinated, then contribution must also be reported as a non-monetary expenditure on Detailed Summary. Art. XXVIII, Sec. 2(9) states: “…Expenditures
that are controlled by or coordinated with a candidate or candidate’s agent are deemed to be both contributions by the maker of the expenditures, and expenditures by
the candidate committee.”
Statement of Non-Monetary Contributions
Statement of Non-Monetary Contributions
[Art. XXVIII, Sec. 2(5)(a)(II)(III) & Sec. 5(3) & 1-45-108(1), C.R.S.]
ocessed Da e ype Desc pt on Donat on Da e G oss Amount Net Amount Anedot ee i st Name ast Name Add ess ine 1 Add ess ne 2 C ty State Z p Count y Sou ce ype B l ing ZI Ca d ype Ca d ast 4 Ca d Exp Date hone Email Dono ype employe occupat on Comments Re e e UR Sou ce Code und In e nal ID und Name Wi hd awal D und ype
Dona ion Donat on om sa Gu h ie 2023-10-09 $50 00 $50 00 $50 00 $2 40 $47 60 isa Gu h ie 4485 S De awa e St Englewood CO 80110 US c ed t_ca d 80110 v sa 3551 02 2030 3038862371 ndividual 1001 Gene al und wc925d17c3a508480c1ec A SE A SE RUE $2 40 $52 40
Dona ion Donat on om V cto a Cash 2023-09-30 $20 00 $20 00 $18 90 $1 10 $17 80 Victo a Cash 43369 Sp ing Ce la Cou t eesbu g VA 20176 US paypal ndividual ma ke ing ana yist 1001 Gene al und w19e4 40e97ddeb34983a A SE A SE A SE $0 00 $20 00
Dona ion 2023-09-16 $25 00 $25 00 $23 70 $1 30 $22 40 Wi l am Wa d aw 3912 Sou h Washington St eet Englewood CO 80113 US c ed t_ca d 80113 mas e 7391 12 2025 ndividual 1001 Gene al und w8d97 d587d8b57b9894d A SE A SE A SE $0 00 $25 00
Dona ion 2023-09-03 $40 00 $40 00 $40 00 $1 98 $38 02 Mel ssa Adams 4810 S ea l St Englewood CO 80113 US c ed t_ca d 80113 v sa 8493 11 2025 ndividual eti ed 1001 Gene al und w99e50d 3113d32bb724a A SE A SE RUE $1 98 $41 98
Dona ion Donat on om David Ca o l 2023-09-01 $50 00 $50 00 $50 00 $2 40 $47 60 Dav d Ca oll 4307 S Jason Ct Englewood CO 80110 US c ed t_ca d 80110 mas e 6396 11 2025 13035870905 ndividual 1001 Gene al und w9bc cde80e4576e 457b A SE A SE RUE $2 40 $52 40
Dona ion Donat on om K m Howa d 2023-08-29 $40 00 $40 00 $40 00 $1 98 $38 02 K m Howa d 10555 West Jewe l Avenue akewood CO 80232 US paypal 12068502883 ndividual sel p op ieto Wa lpape company 1001 Gene al und wd3e915cd a511 64cd2 A SE A SE RUE $1 98 $41 98
$222 60 $11 16
Donation Amoun Re e e to o m W thd awal Se t e Communicat onsCommun ca ionsDono Cove ed Dono Cove ed otal Donat on A
2023 10-09 17 0 l sagu h ie@kw c 2023 10 10 16 4
2023 09-30 12 3 vic o ia cash@co yle echno ogie 2023 10 03 16 2
2023 09-16 22 1 Donat on om Wi l am Wa dla w l iam wa d aw@ 2023 09 19 16 2
2023 09-03 15 3 Donat on om Mel ssa Adam cmnadams@gm 2023 09 05 16 3
2023 09-01 11 3 dlc1165@gma l 2023 09 05 16 2
2023 08-29 15 1 cadencekayhow 2023 08 31 16 2
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