HomeMy WebLinkAboutMCDERMOTT 405 (1) -;
Amendment to
Campaign Disclosure Statement
.. Type or print in ink
Date Stamp
This form must be used to amend statements filed pursuant to Government Code Sections 84200-84216.5, and must be filed with all
filing officers who received the statement being amended. NOTE: Do not use thisform toamend a Statement of Organization, Form
410, Candidate Intention, Form 501, or a Campaign Bank Account, Form 502. Use the actual Form 410, 501 or 502, respectively, to mak~
amendments. '
The information required in Part I must correspond to the information provided on the campaign statement being amended
I Name of Flier (See impor~ant information on reverse.) II Amendment Information
NAM OF F1LER ~/~F~"~ I,D. NUMBER C~
AMENDMENT
For Official Use Only
A. The following information amends campaign disclosure
statement, Form No. L{~ C)
executed on/D ' 2)' Q ~/' for the period z/~ ~ / ' ~2(~/' through/(:::) ' '~'} ' ~ ~
(MO, DAY, YR,) (MO, DAY, YR,) (MO, DAY, YR,)
B. The amended information affects items on the:
] Cover Page [] Allocation Page /~ummary Page
[] Schedule(s) [] Part(s)
C. Describe the changes below. Include in detail all information you v~ish to
become a part of your official campaign statement. Please attach a cover
page, summary pa e and/or appropriate schedule(s) to this Form 405 if
necessary for dariWceation. Include additional information on appropri-
ately labeled continuation sheets. (Number of sheets attached .)
Ill Verification (See important information on reverse.)
I haveused all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of m d the information containSrein and in the attached schedules is
DATE ~AND STATE By ~ SIGN ~ FIR' ' '
Officeholder, candidate, ~ate measure propon ee. responsible officerverffiutlon: I have used all reasonable dilige
DATE SlGNATU~ OF OFFICEHOLDE~ ~NDIOATE, ~ROffiNEffi. OR ~S~N$1BE OFFICER
Executed on
Executed on
Executed on
DATE CITY AND STATE
At By
SIGNATURE OF OFFICEHOLDER. CANDIDATE: OR PROPONENT
At By
DATE CiTY AND STATE SIGNATURE OF OFFICEHOLDER. CANDIDATE. OR PROPONENT
FOR INFORMATION REOUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977. SEE INFORMATION MANUAl. ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAt REFORM ACT.,_~
State of California Fair Political Practices Commission
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Contributions Received
Type or print in ink.
Amounts may be rounded
to whole dollars.
ColUmn A
TOTAL T~I$ I~RIOD
(FROM ATIACHED SCHEDULES)
1. Monetary Contributions ............................... Schedule A, Line 3 S
2. Loans Received ...................................... Schedule B, Line 7
3. SUBTOTAL CASH CONTRIBUTION5 ...................... AddUnes r + 2 $
4. Non-monetary Contri butions ......................... Schedule C Une 3
5. SUBTOTAL CONTRIBUTIONS:(Exclude Enforceable Promises) Add Lines 3 + 4 $
6. Enforceable Promises
(Exclucle Loin Guarantees, Line 18 below) ................... Schedule D, Une 7
7, TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnesS + 6 S
Sch edu/e E, Une 5 S
Schedu/e H, Une 7
Add Lines 8 + 9 S
Schedule F, Une 5
AddUneslO + 11 S
Expenditures Made
8. Cash Payments (Other than Loans Made) ............
9. Loans Made .............................................
10. SUBTOTALCASH PAYMENTS ............................
11. Accrued Expenses (Unpaid Bills) ........................
12. TOTAL EXPENDITURES MADE .........................
Current Cash Statement
13. Beginning Cash Balance .................. Previous Sumrnary Page, Line 17 $
14. Cash Receipts ......................................ColumnA, Line3 above
15. Miscellaneous Increases to Cash ........................Schedule l, Line 4
16. Cash Payments ....................................CoJumn A, Line 10 above
17. ENDING CASH BALANCE ..... Add Lines 13 + 14 .~ 15, then subtract Une I6 S
If this is a termination statement, Line 17 must be zero.
18. LOAN GUARANTEES RECEIVED .............. Schedule B, Patti, Column (b) $
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................ See instructions on reverse$
20. Outstanding Debts ................. AddLine2 + Line 11 inColumnCabove $
ENDtN~ CASH 8ALANG SHOUtD
NOT IE A NEGATIVE AMOUNT
i Zooo, c o
Statement covers period
through/LD ' ~- ) ' ~ ~//
Column B*
TOTAL PREVIOUS PERIO0
Column C
TOTAL TO DATE
$
$
s
t From previous Statement Summary Page, Column C. HOwever. if
this is the first reDoft filed for the calendar year, Column B should be
blank except for Loam Received (Line 2). Enforceable Promises (Line
6). Loans Made (Line 9). and Accrued Expenses (Line 11).
Summary for Candidates in Both June and
November Elections
1/1 through 6/30 7/1 to Date
21. Contrib tions
Recelve~ ....
22, Ex nditures
M~o~ ....... s