HomeMy WebLinkAboutTATUM PREELECTION20(1) AMENDRecipient Committee
Campaign Statement
t Cover Page
SEE INSTRUCTIONS ON REVERSE
from
Statement covers periodI Date of election If applicable:
-7 / — :26) 2- (Month, Day, Year)
through
2,jZo //- 3 20211
1. Type of Recipient Committee: All committees — complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
O State Candidate Election Committee Committee
Q Recall O Controlled
(Also Complete Part 5) O Sponsored
(Also Complete Pad 6)
❑ General Purpose Committee
O Sponsored
O Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
MITTEE NAME (OR CANDIDATE'S NAME IF N
❑ Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
I.D. NUMBER N 3 0 7 n
STREET ADDRESS (NO P.O. BOX)
CITY
U." COVER PAGE
Date Stamp i , '
•
.-
Page_; of
DEQ,' 22 AN .I f: E 6 For Officia Use Only
.J Z77
2. Type of Statement:,, t' ' �j
Preelection Statement
❑ Quarterly Statement
Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
tA Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
kr;S# a. w b ; " r. ; IN
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
�
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS
S t7w>, e RS jj save Al /,A -
CITY STATE ZIP CODE AREACODE/PHONE CITY �STATE ZIP CODE AREA CODE/PHONE
Alllq.�
l
OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and In the attached schedules is true and complete. I
certify under penalty of peq'u;y under the laws of the State of California that the foregoing is true and correct.
Executed on <3O By
Dd0 ate Signatur f Treasurer or Treasurer
Executed on 3 By
Date Signature of Controlling Officeholder. Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder, Candldale, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, Slate Measure Proponent
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule A Amounts may be rounded SCHEDULE A
Mo6etary Contributions Received ro wnoie uonars.
Statement covers period
from - 2 0.2 ®'
FORM
2J 2 o
SEE INSTRUCTIONS ON REVERSE
through
Page of
NAME OF FILER SEP jo TM 3: 38
I.D. NUMBER
DATE
FULL NAME, STREETADDRESS AND ZIP CODE OF
CONTRIBUTOR
VUAL, ENTER
IFAN INDIID
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
RECEIVED
CONTRIBUTOR
CODE *
OCCUPATION AND EMPLOYEIK
..
RECEIVED THIS
CALENDAR YEAR
TO DATE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
- •
(IF SELF-EMPLOYED, ENTER NA E� �
PERIOD
(JAN. 1 -DEC. 31)
(IF REQUIRED)
j m i s/e V-
1 IND
❑ COM
_
PTY
El SCC
T%r� C✓� s/e t
a oo • 0
/�
/ � e,en L S�c�„�I /°/}- G
[:1 IND
❑ COM
❑ PTY
❑scC
v``oo•a�
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL $
Schedule A Summary
Amount received this period — itemized monetary contributions.
(Include all Schedule A subtotals.).........................................................................................................$
2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $
`Contributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov