HomeMy WebLinkAboutROWLES AMEND97(1) mendment to
Campaign Disclosure Statement
?ypl Or print In Ink F]l~p
Thi~ form must be used to a mend ~tate ment~ filed pursue nt to Government Code Sections 84200-8a216.5, end m use be filed with
fihng officers who received the Statement being emended NOTE: Do not u~e this form to amend a Statement of Organization, Form
a 10.£and~date Intenhon, Form S01, or a Campaign Bank Account, Eorm S02 Use the actual Eorm al0, 501 or 502, respectively, to make
amendments
II
ZIP CODE
q
AMENDMENT
I Name of Filer (Seeimpo~antlnfm'matlonon,everse.)
NAME OF FI~ER
MAILINGqo AD(~ESS (~[/F ~'~C~ ~- L/~ ~ILER ~. (NO.~ AND ~J STRE ET)
CITY STATE
AREAC~E~AY~ME PHONE NUMBE~
A. The following informatiol3A~ends campaign disclosure
statement, Form No. qHL) .
e.ecutedon IO/~l/gQ for thep~rkxl lC)Ii / Q/~ through
B. The amended information affects items on the:
[] Cover Page
[]
NAME O~ TREASURER IF RECIpIENT COMMITTEE
P. ! clLd,
PERMANENT ADDRESS OF TREASURER: (IF APPLICA~J.E ~ (NO. AND STREET)
STATE ZiP CODE
A~[A CO~[~AY~IME PHON[ NUMBER
For Off icl.al Use Only
SCANNEE
C. Describe the changes below. Include in detail all information you wish to
become a part of your official campaign statement. Please attach a cover
page, summary page and/or appropriate schedule(s) to this Form 405 if
necessary for clarification. Include additional information on appropri-
ately labeled continuation sheets. (Number of sheets attached -- .)
III Verification (5eetml~o~fanflnfo~matlononrever~e.)
u~er ~n~hy ~f ~rj~ry ~nde~ the ~a~s ~f the ~tate ~f Ca~if~rni~ th~t the f~reg~ing is true ~nd ~rre~ ' ~ ~ ) ~ / ]
~ut~ o~ At By k
Executed on At By
Stltl of CJIlfocnla Flit Polltkal Practices Commission
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print in Ink.
Amounts may b~ ro4mded
to whole dollars.
· ootaaI
Statement covers ~,~ i ~,~
from Io l l lq(
SUMMARY PAGE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONT~I~LLE D COMMITTEE
Contributions R~ceived
1. Monetary Contributiom ............................... Seheo~/e A, Line
2. Loam Re¢eived ......................................... Schedule ~, Line
3. SUBTOTALCASH CONTRIBUTIONS ...................... Add Unes ! , 2
4. Non-moneta ry Contributions ......................... scheduleC, Llne$
S. SUBTOTAL CONTRIBUTIONSi(/xdud~ Enforceable Promises) Add Unes 3 + 4
6. Enforceable Promises
(Exdude Lnen Guarantees, Llne l m below) ................... ScheduleD, Uno7
7. TOTAL CONTRIBUTIONS RECEIVED ..................... A~UnesS, 6
Expenditures Made
8. Cash Payments (Other than Loam Made) ............ Sc~eduteE, L/neS $
9. Loam Made ......................... . .................... Sdmdule H, Uno 7
10. SUBTOTALCASH PAYMENTS ............................ AddUnesa, ~ $
1 1. Accrued Expenses (Unpaid Bills) ........................ ~hedmeF, UneS
12. TOTAL EXPENDITURES MADE ......................... AddUnes fO * Ff $
Current Cash Statement
13. Beginning Cash Balance .................. Prevlou~Summaq~Pogeo ~ne 17 $
14. Cash Receipts ...................................... CalumnA, Une3above
1S. MiKellaneous Increases to Cash ........................ ScheduleI, LIne4
16. Cash Payments .................................... Co~umnA, Uno tOabove
17. ENDING CASH BALANCE ..... AddLIne~ f3 + 14 + ~$, then zubtra~t Une 16 S
tf thls b a ee~mlnatlo~ statement, Llne 17 mu~ be zero.
18. LOANGUARANTEESRECEIVED .............. Schedulea, P~l, Cotumn{b) S
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................ ~e Instructlom on reverse
20. Outstanding Debts ................. A~Llne ~ ,~ Line 111nColumnCebove
Column A
$ S
S S
S $
S
S
S
S
· From previous Statement Summery Page, Column C. However. if
this is the first reDort filed for the calendar year. Column B should be
blank except for Loen~ Received (Line 2). Enforceable Promises (Line
6. Loans Made (Line g), and Accrued Expenses (L ne 11).
Summary for Ca.ndidates in Both June and
November Elections
111 th.rough 6~30 7/1 to Date
21. [ontribqtions
~ece~vea .... s
22. x nditures