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Colorado Secretary of State Elections Division 1700 Broadway, Suite 200 Denver, CO 80290 Ph: (303) 894-2200 Fax: (303) 869-4861 Email: [EMAIL REDACTED] Website: www.sos.state.co.us Below Space for Office Use Only Colorado Secretary of State Form CPF-10, Rev. 5/10/2013 This form may be saved Form may be submitted by Fax, E-mail, hand delivery, or postal service. The original is not required by this office please submit only once. Attach additional pages if needed. NOTICE OF MAJOR CONTRIBUTOR [1-45-108(2.5)] This report is mandatory for all committees and political parties for contributions of $1000 or more (monetary or non-monetary) received within 30 days immediately preceding a primary or general election. This report shall be filed with the Secretary of State within 24 hours after receipt of the contribution. Loans to committees are considered contributions Name of Committee Receiving Contribution: Address of Committee Receiving Contribution: Full Name of Contributor: Full Address of Contributor: Monetary Non-Monetary (item/s) Contribution Date: Amount of Contribution: $ Description of Non-Monetary Contribution: Print Registered Agent's Name: Registered Agent's Signature: Print Candidate's Name: Candidate's Signature: Date: Date: Save & Print