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HomeMy WebLinkAboutDICKERSON SEMIANN12(2)Recipient Committee Campaign Statement Cover Page ((' Dvemment Code Sections 84200- 84216.5) SEE INSTRUCTIONS ON REVERSE Statement from through 12 Type or print In ink. period Date of election if applicable: (Month, Day, Year) 1. Type Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Ajo Complete Part 7) 3. Committee Information I.D. NUMBEfiL -j L Z` MITTEE NAME (OR CANDIDATE'S NAME IF NO COMIOITTE ef MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Date Stamp 11 FEB -4 PM 1:58 1_1- _ _. -_ ,\LI \JI IL•.., 2. Type of Statement: selection Statement Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURE r COVER PA- Page I of G For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 CITY MAILING ADDRESS CITY STATE ZIP CODE AREA COOS /PHONE 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 ion con fined herein and in the attached schedules is true and complete. I certify under penalty of perjury under the aws of a State of California that the foregoing is true and correct. Executed on 2� l By Sign oilAssistant Treasurer 31 � Executed on 74C) I Oste By signatereofcorwolling omceiviclercandiclate. Sts PioponentorResponsibleow— of Sponsor Executed on Date By Signature of Controlling O1Noehokler, Candidate, 8181e Measure Proponerrt Executed on Date p Signahreot Controlling OlRcehdder ,C�ndidaM, Stab Measure Proponent FPPC Forth 480 (.ianuary105) FPPC Toll -Free Helpiine: 866 /ASK -FPPC (866/275 -3772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICES UGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page Z of BALLOT NO. OR LETTER JURISDICTION I [] SUPPORT ❑ OPPOSE 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 pehalf of your candidacy. COMMITTEE NAME I.D. NUMBER ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER NAME OF OFFICEHOLDER. CANDIDATE, OR PROPONENT 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 pehalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREET ADDRESS (NO P.O. BO)) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is pdmadly formed 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Fonn 460 (Januaryl05) FPPC Toll -Free Helpline: 86WASK-FPPC (866/275.3772) State of California Campaign Disclosure Statement Summary Page .uc rep. ,nT. -K10 n►1 OCVCRAP NAME OF FILER rives o:.-Av-,� S Contributions Received 1. Monetary Contributions ............ ............................... Schedule A, Line 3 2. Loans Received .:...... .............. ............................... schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... "Lines 1 + 2 4. Nonmonetary Contributions ..... ............................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ..... .•.• ..............••••AddL►nes3 +4 Type or print in ink. Amounts may be rounded to whole dollars. $ Column A TOTALTHIS PERIOD (FROMATTACHEDSCHEOUL'ES) r Expenditures Made 6. Payments Made ........................ ............................... Schedule E. Line 4 $ 7. Loans Made ...... schedule H, Line 3 ........................ ............................... 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ �- 9. Accrued Expenses (Unpaid Bills Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE .... ............................ Add Lines a + 9 + 10 $ Current Cash Statement — =L� 12. Beginning Cash Balance ....................... previous Summary Page, Line 16 $ 13. Cash Receipts .................... ............................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... schedule 1, Line 4 15. Cash Payments ................... ............................... Column A, Line 9 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ K this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ $^ Cash Equivalents and Outstanding Debts.- - 18. Cash Equivalents ............ ............................ see insm,ctions on reverse $ 19. Outstanding Debts ......................... Add line 2 + Line 9 in Column B above $ Statement /c ov rs period from throughf Coltmin S CALEMAR YFAR TOTALTO DATE r $ $ 6t $ 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 period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). SUMMARY PAGE age of I.D. NUMBER 1 13?-?t 1 Zi Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 711 to Date 20. Contributions Received $ - - -L�1� $ 21. Expenditures )�/� $ _ Made $ .��rYJ T.'�/ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd /yy) —.l ( $ I __ _/ $ 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275-3772) SCHEDULE B - PART 1 Schedule B - Part 1 ''r -' r " "` " Amounts may be rounded statement c ver period CALIFORNIA 4 Loans'Received to whole dollars. • FORM from 1 7i SEE INSTRUCTIONS ON REVERSE through age __4__ of NAME OF FILER I.O. NUMBER 6 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE A�q(O jNT RECEIVED THIS () AMOUNTPAID OUTST DING BALANCEAT INTEREST PAID THIS ORIGINAL AMOUNT OF CUMULATIVE CONTRIBUTIONS pFCOMMITTEE . ALSO ENTER I.O.NUMBER) pFSELFEhAPLOYEEMPL ENTER NAI&E OF BUSINESS) BEGINNING THIS PERIOD PERIOD OR FORGIVEN THIS PERIOD CLOSE OF THIS PE IOD PERIOD LOAN TO DATE • ©� ❑ PAID —7tV CALENDARYEAR s Z 4� j -�-- S S i DATER T_ DATE DUE ❑ PAID CALENDAR YEAR PER ELECTION ❑ FORGIVEN RATE to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s s s s DATE INCURRED s DATE DUE ❑ PAID CALENDARYEAR s s ss, s a ❑ FORGIVEN RATE PER ELECTION" t ❑IND ❑ COM ❑ OTH ❑PTY ❑SCC S • S S DATE INCURRED t DATE DUE SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received Oft period ..................................................................................... .................. ............. $ (Total Column (b) plus unitemized loans of less than $100.) 1 2. Loans paid or forgiven this perrod .........................................................................: ............................... $ (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.) ................................ ............................... NET $ �- aWSnumber) Enter the net here and on the Summary Page, Column A, Line 2. (May be a n•y 'Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. (Enter (e) on Sd*dLde E, Lino 3) 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 (January/05) FPPC Toll -Free Helpline: 866fASK -FPPC (866/275 -3772) Ze VAarl('DWWson ustice Freedom t I FOREVER 661- 101 C-- cl- tD I CO