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Home My WebLink AboutDICKERSON 460 SEMIANN22Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE from. throw ''Z 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2; 3, and 4. [x"'Officehotder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee O Recall O Controlled (Also Complete Port5) O Sponsored (Also Complete Par! 5) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Pofitical.Party/Central Committee (Also Compiete Part 7) 3. Committee Information I.D. NUM NO MMITTE ) C:Zjk STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and certify under penalty of perjlfyu der the laws of the State of California that the fon Executed on to Executed on ate !� ^� By COVER PAGE Date Stamp Date of election if applicable: Page tl of — (Month, Day, Year) For Official Use Only A 2. Type of StoSgMpt� i C L iJ 1L' i I 'r, C[ (_ ❑ Preelection Statement ❑ Quarterly Statement ES' Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file 6:Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) t��NAME OF TREAStI CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS of my knowled i�lformation contained herein and in the attached schedules is true and complete. I to and cores / or �omwnin9 ........ rruponent or rw5pu-1— uincer or sponsor Executed on By Dale Signature of Controlling Officeholder. Candidate, Stale Measure Praponent Executed on By Date signature. of Controlling Officeholder, Candidate, State Measure Proponent 'P>` FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/775-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICE OLDER OR CAN rIDATIE OFFICE SOUGHT OR HEL[)(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.U. BUX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMI I I EE? ❑ YES ❑ NO COVER PAGE - PART 2 Page of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnamesof officeholder(s) or candidate(s) for which this committee is primarily formed. i COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary NAME OF OFFICEHOLDER O CANDIDATE SOUGHT OR HELD IFFICE O� SUPPORT 1 ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Y V' t Amounts may be rounded to whole dollars. Stateme f co,prs period from — e throw .-�, • jW SCHEDULE E w Page_ ,,.._•._ of CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)" OFC PET office expenses circulating SAL TEL campaign workers' salaries t.v. or cable airtime and production costs CVC FIL civic donations candidate filing/ballot fees PHO petition phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supportinglopposing others (explain)` POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID sa." 1-N2:1 l - � * CIIRTO Al $ Payments that are contributions or independent expenditures muss also be summarized on Schedule D. a b Schedule E Summary p 1. Itemized payments made this period. Include all Schedule E subtotals..........••...•.......•..••...................•••••.......••.......••• $ 2. Unitemized payments made this period of under$100...........................................................................................................................I....I......... $ �7 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)........................... TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 Vtowho{edollars. 1 �'OV, S_ erioc 460 Loans Received from —,`r "`�' If , • - SEE INSTRUCTIONS ON REVERSE through 2� Page of NAMEOF FILER I.D. NrUUMBE}Rf 0 1. FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE AMOUNT RECEIVED THIS AMOUNT PAID OR FORGIVEN OUTSTANDING BALANCE AT INTEREST PAID THIS ORIGINAL AMOUNT OF CUMULATIVE CONTRIBUTIONS (IF COMMITTEE. ALSO E TER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD PERIOD THIS PERIOD • CLOSE OF THIS "'RIOD PERIOD LOAN TO DATE �*�f ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION ' ` RATE 2 t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED DATE DUE ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION- RATE t❑ IND ❑ COM ❑ OTH ❑ PTY [:I SCC $ $ $ $ $ DATE DUE - DATE INCURRED t ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION; RATE DUE DATE INCURRED tEl IND ❑ COM ❑ OTH El PTY El SCC }DATE SUBTOTALS $ $ $ Schedule B Summary 1. Loans received this period.......................................................................... (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period............................................................... (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............................. Enter the net here and on the Summary Page, Column A, Line 2. 'Amounts forgiven or paid by another party also must be reported on Schedule A. "` If required. .......................................$ —� .......................................$ �lJ' NET $ �`` (May be a negative number) icn�o, ink vn au,cwiv �, uuu o� tContributor 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