Below Space For Office Use Only Elections Division Department of State 1700 Broadway, Ste. 200 Denver, CO 80290 Ph: (303) 894-2200 ext. 6383 Fax: (303) 869-4861 Email: [email protected] www.sos.state.co.us

NOTICE OF MAJOR CONTRIBUTOR [1-45-108(2.5), C.R.S.]

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.

Vote No on 301, Don’t Let Them Divide Broomfield______________________________ Name of Committee Receiving Contribution (Please type or print legibly)

1140 US 287 #400-267, Broomfield, CO 80020____________________________________ Full Address of Committee Receiving Contribution

Full Name and Address of Contributor: Colorado Petroleum Council 1660 Lincoln Street, Denver CO 80264

________________________________________________________________________________________________________

Check Only One:

x Monetary

Date Contribution Was Made: 10/18/17

Non-Monetary

Amount of Contribution: $75,000

Brief Description of Non-Monetary Donation: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________

Authorization (Must be completed by either the Registered Agent OR the Candidate) Print Registered Agent’s Name: Karen Nelson Registered Agent’s Signature: /Karen Nelson/

Date: 10/18/17

Print Candidate’s Name: __________________________________________________________________________________________ Candidate’s Signature: ____________________________________________________________ Date: _________________

Colorado Secretary of State Form Rev. 12/09