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Home My WebLink AboutCOUCH SEMIANN99(1) -Officeholder, Candidate, and Controlled Committee Campaign Statement -- Long Form Type or print in ink. (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Check one of the following boxes to indicate the type of statement being filed: [] Pre-election Statement DSupplemental Pre-election Statement (Attach a completed Form 495 to this statement ) Special Odd-Year Campaign Report Semi-annual Statement Termination Statement (Attach · completed Form 41S to this statement.) I "Officeholder Candidate. and Controlled Committee Included in tt~is Statement NAME OF OFFICEHOLDER OR CANDIDATE O~F ICE SOUGI-rr OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL OR IUSlN[SS ADDRESS /(NO AND STREET) AREA CODE/DAYTIME PHONE I,D. NUMIER 9'Sz/gD ZiP CODE AREA CODE/DAYTIME PHONE A~A (~AYtlM[ CITY STATE ZIP CODE COMMITTEE NAME F ,e..,J5 o/a b,,,,,,;,i COMMII1EE ADDRESS (NO. AND STREET) 7~a5' Fea 7~e,e f,~e~ CITYSTATE NAME OF TREASURER PERMANEN1 ADDRESS O~ TREASURER (NO. AND STREET) 33o A/5raeeT, ,~o, te Z CITY STATE ZIP CODE 8a le e e 5 ~r, e lJ III Verification Date Stamp Statement covers period ,,o~ ////9~ ,h,o.0h Oateofele,ztionifapplkable: 9C~ AUG -? ~H 9: ~? (MOnth. Day, Year) ~AKERSF';LLL; C~i ~' Ci,~:ikr, COVER PAGE - LONG FORM FOr Official Use Only HqO Other Committees ~lot Included in this Statement: ust ,ny ot~er committees not included in this consolidated statement that are controlled by you and any committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. COMMITTEE NAME I I,D. NUMBER NAME Of TREASURER (ONIROLt[D COMMITTEl7 COMMrrTE[ ADDRESS (NO, AND STREET) CITY SLATE ZiP CODE AREA CODLtDAYIIME PHONE I~O NUMIER I CONTROtLED COMMITTEE? COMMITlEE NAME NAME Of TREASURER COMMrrrEE ADDRE$S (NO AND STRF~ET) CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE Attach additional information on appropriately labeled continua tlon sheets. I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my k nowl e the information contained herein and in the attached schedules true end complete. I certify under penalty of perjut under the laws of the State of California that the foregoing is true orrect~,,,~t ~ Executed on 7 JD/fq At ~;~' ~/~.t/d~- LfC_~ ey~ DATE CITY AND ST~fTE SIGNATURE Or An officeholder or candidate who controls a committee must Ilso verily the campaign statement I have used all reasonable d' ence and to the be of my k nowledge the treasurer has used all ':'!::"'' '";" :::':'",:o. Executed on At By DATE (ITY AND $1ATE SIGNAI UR[ Of CANDIDAIE/OI Executed on At By DA I E CITY AND SI AlE $1GNA I URI OI lANDIDA I Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE Contributions Received 1. Monetary Contributions $ 2. Loans Received ......................................... 3, SUBTOTALCASH CONTRIBUTIONS .................... S 4, Non-monetary Contributions ......................... 5. SUBTOTAL CONTRIBUTIONS(Exclude Enforceable Promises) $ 6. Enforceable Promises (Exclude Lomn Guarantees, Line 18 below) ................... Schedule D, Une 7 7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnesS, S S ............................... Schedule A, LIne 3 Schedule B, Line 7 Actd Unes I , 2 schedule C, Line 3 Add Lines 3 ,, 4 Expenditures Made 8. Cash Payments (Other than Loans Made) ............ schedule E, Une S 9. Loans Made ............................................. Schedule H, Une 7 10. SUBTOTAL CASH PAYMENTS ............................ AddLines8 ~ 9 11. Accrued Expenses(Unpaid Bills) .................. ScheduleF, UneS 12. TOTAL EXPENDITURES MADE ......................... AddLines tO · tl Current Cash Statement 13. Beginning Cash Balance .................. Previous Summary Page, Line 17 14. Cash Races pts ...................................... Column A, Line 3 above 15. MiKellaneous Increases to Cash ........................ Schedule I, Line 4 16. Cash Payments .................................... Column A, Line 10 above 17. ENDING CASH BALANCE ..... AddLines 13 , 14 , 15, then subtract Une 16 ff this IS a termination statement, Line 17 must be zero. 18 LOAN GUARANTEES RECEIVED .............. Schedule e, Patti, Column(b) Cash Equivalents and Outstanding Debts 19. Cash Equivalents ................................See instructions on rever~e 20. Outstanding Debts ................. Addline 2 , Line If inColumnCabove Type or print in ink. Amounts may be rounded to whole dollars. Column A TOIAL THIS PERIOD A~ACHED f~HEDULES) -0' -O' -O' -0' -O' -O' '787."' -D' s 3,7o9."' ENDING CASH IALANfE SHOULD MOT IE A NEGATIVE AMOUN/ Statement covers period ,,0, th.ou,h /so Col umrl Be TOTAL PREVIOU$ PERIOD (~EE NOT[ IELI3NV) SUMMARY PAGE i.D. NUMBER Column C TO1AL TO DATE (ADD CO{UMNS A , I) _ s 7~?.°~ .D- s s 7E?. * From previous Statement Summary Page, Column C. However, if this is the first report filed for the calendar year. Column B should be blank except for Loans Received (Line 2), Enforceable Promises (Line 6), Loans Made (Line 9). and Accrued Expenses (Line 1 I), Summary for Candidates in Both June and November Elections 1/1 through 6/30 7It to Date 22. ~ap3~d!!.Ur.e! S Schedule E Payments and Contributions (Other Than Loans) Made Type o~ print in ink. Amounts may be rounded to whole dollera. SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE CODES FOR CLASSIFYING EXPENDITURES Statement covers period ,,o- SCHEDULE E Page 3 I.D. NUMBER If one of the following codes accurately describes the expenditure, ou may enter the code and leave the 'Description of Payment' column blank, Refer to the back of Schedule E-Continuation Sheet for detailed explanations of Y;ach category. 'C* - MONETARY AND IN-KIND (NON-MONETARY) CONTRIBUTIONS TO OTHER CANDIDATES AND COMMITTEES '1° - INDEPENDENT EXPENDITURES 'L'- LITERATURE NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION (IF COMM~TI!, ~ ADOff~N TO COIAMR'IIE'5 NAME AND ADDRESS, IN~ER I.O. NUMIER O~ ff NO I.O. NUMIER HAS lIEN A$$~NID, ENTER TREA$URER'$ NAME AND ADORE$S) '9' - BROADCAST ADVERTISING 'N* - NEWSPAPER AND PERIODICAL ADVERTISING 'O' - OUTSIDE ADVERTISING 'S' - SURVEYS, SIGNATURE GATHERING. DOOR-TO-DOOR SOLICITATIONS 'F' - FUNDRAISING EVENTS 'G' - GENERAL OPERATIONS AND OVERHEAD 'T' - TRAVEL, ACCOMMODATIONS AND MEALS (MUST BE DESCRIBED) °P' - PROFESSIONAL MANAGEMENT AND CONSULTING SERVICES CODE IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON LINE 4 OF THE SUMMARY SECTION BELOW. OR DESCRIPTION OF PA'IrMENT ,OdveeTl.Se,,-,e,dT ,:.1 Pt'~a~ L,~b~n. Ze,,d,,c oI~ 7ze Y'e,,~ AMOUNT PAID 25'5. Im rtant: Contributions and expenditures made out of campal n funds to or on behalf of other on ~f~*c;holders, candidates, commsttees, or ballot measures must ;~o be entered on the Allocation Page, Part I, Payments and Contributions Made Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals,) ............................: ......................... $ 2. Payments made this period of under $100, (Do not itemize,) ....................................................................... $ 3, Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part II, Column (d).) .............................. $ 4, Total accrued expenses paid this period. (Do not itemize. Enter amount from Schedule F, Line 4,) ..................................... $ 5. Total payments made this period, (Add Lines !, 2, 3, and 4, Enter here and on the Summary Page, Column A, Line 8) ........... TOTAL $ SUeTOTAL $ 39 .o"/ 3?'/, or,' -O' Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE Type of Ixlnt in ink. Amounts may be rounded to whole dollars. Statement covers period f,om DATE FULL NAME AND ADDRESS OF SOURCE RECEIVED 0F coMMrrrEk. IN ADOPTION TO COMMmEE~ NAME AND AODRISS. ENTER l.O. NUMBER DESCRIPTION OF RECEIPT ORe If NO I.D. NUMIER HAS IEEN ASSIGNED, ENTER TREASUle,~R'S NAME AND ADDRESS) C,r'l e~.e /~ kea.sfl'/~'/j ~?et,,,,~d ~,/~ ~,~ / Attach additional information on appropriately labeled continuation sheets. SUBTOTAL Miscellaneous Increases to Cash Summary 1. Increases to cash of $1OO or more this period ............................................................. $ 2. Increases to cash under $1 O0 this period. (Do not itemize.) ................................................. 3. Total of all interest received this period on loans made to others. (Schedule H, Part II (b).) .................... $ 4. Total miscellaneous increases to cash this period. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Line 15.) ....................................................................... TOTAL $ ' ,,.. ,./ ,,, ,./ I,D. NUMBER AMOUNT OF INCREASE TO CASH s ,,7o ~. oo/