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HomeMy WebLinkAboutCOUCH SEMIANN04(2)Recipient Committee Campaign Statement Cover Page (Government Code Sectioos 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from "7/// Date of etectiont~fEap~:~i[~al~, (Month, Date Stamp COVER PAGE Page // of '~ For Official Use Only 1. Type of Recipient Committee: All CommErce- Comp~t~ Pa~ t, 2, 3, ar~ 4. j~ Officeholder, Candidate Controlled Committee State Candidate Election Committee Recall [] General Puq)ose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Comrnit~ee [] Ballot Measure Committee 0 Primarily Fen'ned 0 Controlled 0 Sponsored [] Ptimadly Formed Candidate/ Officeholder Committee 2. Type of Statement: [~semetection Statement i-annual Statement [] Termination Statemenl [] Amendment (Explain below) [] Quarterly Statement [] Special Odd-Year Repod [] Supplemental Preelechon Statement - Attach Form 495 3. Committee Information COMMITTEE NAME (OR CANDIDATE'S NMVIE IF NO COMMITTEE) STREET ADDRESS (NO P.O BOX) ~'¢ MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR PO BOX Treasurer(s) NAME OF TREASURER MAILING ADDRESS NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZiP CODE AREA CODE/PHONE OPTIONAL FAX I E /JAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I 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 ce~fy under penalty of porjaP/under the laws of the State of California that the foregoing is tme..~f~ect Recipient Committee Campaign Statement Cover Page -- Part 2 Type or print in ink. COVER PAGE - PART 2 Page ~' of~ 5. Officeholder or Candidate Controlled Committee OFFI~UGHT OR HELD (INCLUDE LOCATION ANO DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSiNESS ADDRESS (NO AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: List any commi~tees not included in ~his statement ~at are con~ll~ by you or e~ p~ma~ ~ to r~eive con~b~ons or make ex~ditums on behaff ~ your candida~. ~ME OF TR~SURER ~NrROLLED COMM*~EE? YES ~ NO COMMn-I'EEADDRESS STREET/I;~ESS (NO PO. BOX) CITY ~ STATE ZIP CODE AREA CODE/PHONE NAME OF TREASURER COMMr~FEEADDRESS STREET,~,~ESS (NO PO. BOX) STATE ZIP CODE 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO OR LETTER JURISDICTION ~OP~(~sERPORT Identify the controlling officeholder, candi~measure proponent, if any. NAME OF OFFICEHOLDER. CAN~PONENT OFFICE SOU~ DISTRICT NO IF ANY Primarily Formed Committee List names of officeholder($) or candidate(s) for which g~is commRtee is prfmarily formed. NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER or CANDIDATE OFFICE SOUGHT OR HELD l© sup~oJ OFFICE SOUGHTOR~ [] SUPPORT E]OPPOSE OFF. OUGHT [] SUPPORT OR HELD [~]OPPOSE OFFICE SOUGHT OR HELD Attach continuation sheets if necessary ED SUPPORT ~]OPPOSE FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASKAcPPC State of California Campaign Disclosure Statement Summary Page SEE tNSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. SUMMARYPAGE Page ~ of 7 NAME OF FILER Contributions Received 1. Monetary Contributions ...........................................Schedule A, Line 3 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Li~es I + 2 $ ~ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 ~ 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ ~' Expenditures Made 6. Payments Made ...................................................... Schedute E. 7. Loans Made ............................................................ Schedule H, Line 8. SUBTOTAL CASH PAYMENTS .................................... AddLines6*Z 9. Accrued Expenses (Unpaid Bills) ............................... Schedule~Line3 10. Nonmonetary Adjustment .......................................... Sc/,edule C~ L/ne 11. TOTAL EXPENDITURES MADE ................................ AddLines 8 Column A Column B Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summaty Page, Line16 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedu~ I. Line 4 15. Cash Payments .................................................. ColumnA, tine6ebove 16. ~CASH BALANCE If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule e. Pad 2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ Seeinstruct~onsonreve~e 19. Outstanding Debts ......................... AddLine2+LineginColum~Babove To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous poded amounts. If this is the first repeal being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any) ID NUMBER Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 Ihrough 8/30 7/1 to Cate 20. Contributions 2 {¢) ~ Received $ $ __ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Mad Date of Election 3 Date (mm/dd/yy) __] L___ $ __J.___L $ __J___]___ $ ' 1, 2001. Amounts in this section may be amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toil-Free Helpline; 8661ASK-FPPC Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEEINSTRUCTIONS ON REVERSE Typ~ or print in ink. Amounts may be rounded to whole dollars. Statement covers period V ,h,o,,h Page SCHEEXJLE D 0,7 NAME OF FILER ID NUMBER NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMI~I'EE ~ Support [] Oppose [] Support [] Oppose TYPE OF PAYMENT Monetary [] Nonmonetary Contribution [] Independent Expenditure [] Monetary Contribution [] Nonmonetary Contribution [] Independent Expenditure [] Monetary Contribution [] Nonmonetary Contribution [] Independent Expenditure DESCRIPTION (IF REQUIRED~ AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR {JAN 1-DEC 31) PER ELECTION TO DATE (IF REQUIRED) [] Support [] Oppose SUBTOTAL Schedule D Summary 1. Contributions and independent expenditures made this period of $100 or more. (Include all Schedule D subtotals.) .............................................. $ /~"'~'-~" ~ 2. Unitemized contributions and independent expenditures made this pedod of under $100 ...................................................................................... $ 3. Total contributions and independent expenditures made this pedod. (Add Lines 1 and 2. Do not enter on the Summary Page.) .............. TOTAL $ FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period .... th ro.gh / CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Ch~ campaign paraphemalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations F]L candidate filing/ballot fees F-ND fundraising events I~D independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks t°OL polling and survey research professional services (legal accounting) PRT pdnt ads Page ~ of ~~''''' NUMBER e 'I/ qo PAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v, or cable airtime and production costs TRC candidate travel, lodging, and meats TRS staff/spouse travel, lodging, and meals TSF b-aris[er between committees of the same candidale/sponsor VOT voter registration WEB information technology costs (internet, e-mail) * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS .~! ~> (~,~, ¢~/ Schedule E Summary 1. Paymentsmadethispedodof$100ormore.(InctudeallScheduleEsubtotals.) .................................................................................................. $ ~/~,~::~,~, ~-~ 2. Unitemized payments made this pedod of under $100 .......................................................................................................................................... $_ 3. Total interest paid this pedod on loans. (Enter amount from Schedule B, Pad 1, Column (e).) ...............................................................................$ 4. Total payments made this pedod. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A, Line 6) ............................. TOTAL $ FPPC Fon-n 460 (Junel01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E (CONT,) Page ~' of ?_ ID. NUMBER C~ campaign paraphernalia/misc. CNS campaign consultants C~ contribution (explain nonmonetary)* CVC civic donations RL candidate filing/ballet fees FND fundraising events IXID independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MTG rne~tings and appearances PET petition circulating R-ID phone banks FOL polling and survey research POS postage, delivery and messenger services PRO professional services (legal. accounting) PRT pdnt ads PAD radio airtime and production costs ER:) returned contributions SAL campaign workers' salades ~ t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TS: transfer between committees of the same candidate/sponsor VDT voter registration WEB information technology costs (intemet, e-mail) NAME AND ADDRESS Of: PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUN I' PAID aymentsthatarecontribufionsor ndopendent expenditures mustaleo besummarizedon Scbedu eD. SUBTOTAL $ FPPC Form 460 (June/01) FPPC Toti.Free Hell)lire: 8661ASK-FPPC Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER v/ Type or print in ink. Amounts may be rounded to whole dollars, Statement covers period from t ,oug SCHEDULEI Page ~ of ~ DATE RECEIVED DESCRIPTION OF RECEIPT lA,' TE, ID NUMBER AMOUNT OF INCREASE TO CASH z Schedule I Summary 1. Increases to cash of $100 or more this period ........................................................................................................... $ 2. Unitemized increases to cash under $100 this period ............................................................................................... $ 3. Total of all interest received this period on I(~ans made to others. (Schedule H, Column (e).) ................................. $ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL $ FPPC Form 460 (Junel01) FPPC Toll-Free Helpline: 8661ASK-FPPC