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Home My WebLink AboutMCDERMOTT 405 (2)Amendment to Campaign Disclosure Statement Type or print in ink Date Stamp This form must be~sedt~amendst~tementsfi~edpursuantt~G~vernmentC~deSecti~ns842~~~84216~5.andmustbefi~edwitha~~ filing officers who received the statement being amended NOTE: Do not use this form toamend a Statement of Organization, F(~ 410. Candidatelntention. Form S01, or a Campaign Bank Account, FormS02. Use the actual Form 410, 501or S02, respectively, to~nake amendments, The information required in Part I must correspond to the information provided on the campaign statement being amended. Name of Flier (See important information On reverSe.) I.D. NUMBER (IF APPtlCAILE) II Amendment Information A. The following information a~,.r~nds campaign disclosure statement, Form No. z_) ~ C-~ , AMENDMENT AREA For Official Use Only executedon/,P '5' ?~fo, the.e,,od __ th,oug. (MO, DAY, YR.) (MO, DAY, YR.) (MO, DAY, YR.) B. The amended information affects items on the: [] coy., P.g. [] .,,oc.t,o. P.g. j~.mm.,,, P.g. C. Describe the changes below. Include in detail all information you Wish to become a pa~ of your official campaign statement. Please a~ach a cover page, summary pa · and/or appropriate schedule(s) to this Form 405 if necessary for clari~ation. Include additional information on appropri- ately labeled continuation sheets. (Number of sheets a~ached .) has used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the ..... rue and complete. I certify Ex.uted on z/s / ,, DATE AI"JID STATE SIGNATURE OF OFFICEHOLDER' CANDIDA"r[, PROPONENT. OR R[SPONSlIL[ OFFICER Executed on At By DATE CITY AND STATE SIGNATURE OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Executed on At By DATE CITY AND STATE SIGNATURE OF OFFICEHOLDER, CANDIDATE, OR PROPONENT FOR INFORMATION REQUIRED TO BE PROVIDED 10 YOU PURSUAN1 TO THE INFORMATION PKACTICES ACT OF Tg77, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT. State of California Fair Political Practices Commission Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Contributions Received 1. Monetary Contributions ............................... .Schedule A, Line 2. Loans Received ......................................... S<hedule 9, Line 3. SUBTOTAL CASH CONTRIBUTIONS ...................... ,addUnes ~, 4. Non-monetary Contributions ......................... Schedule C, Line 5. SUBTOTAL CONTRIBUTIONS:(Exdude Enforceable Promises) Add Unes 3 · 6. Enforceable Promises (Exclude Loin Gulrlnfees, Line 18 below) ................... Schedule D, Une 7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnesS ~ Expenditures Made 8. Cash Payments (Other than Loans Made) ............ Schedule E, Une 5 9. LOans Made ............................................. Schedule H, Une 7 10. SUBTOTAL CASH PAYMENTS ............................ AddUnesa ,, 9 11. Accrued Expenses (Unpaid Bills) ........................ S<hedule F, Une S 12. TOTAL EXPENDITURES MADE ......................... AddUnes ;0 ·, Current Cash Statement 13. Beginning Cash Balance .................. Previous Summary Page, une ;7 14. Cash Receipts ...................................... Column A, Line 3 above 15. Miscellaneous Increases to Cash ........................ Schedule ~, Line 4 16. Cash Payments ....................................Column A, Line I0 above 17. ENDING CASH BALANCE ..... AddLines 13 + 14, ;5, then subtractUne I6 ff this is a termination Statement, Line 17 muSt be zero. 18. LOAN GUARANTEES RECEIVED .............. Schedule B, Partl, Column(M Cash Equivalents and Outstanding Debts 19. Cash Equivalents ................................ SeeYr~trudlonsonreveae 20. Outstanding Debts ................. AddLine 2 ,, Line l; inColumnCabove Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period ,,o, 0-; )-fi / through ~J SUMMARY PA'~E Column A Column B* Column C TOTAL THIS PEmOD TOTAL I~VIOU$ ImERIOO TOTAL TO I)&'T~ ffROM ATIACHED M}IEDULES) (SEE NOTE IILONV) f (ADD COLUMI~ A · l) $ $ /~5'~. ~ Y s ~ _. s /~w. ~ ~ /~o o · e ~ s _ s /~d~- ~ /~D., ~ s s /~- ~ s /~, ~ s _ s /~, ~ / o o o . o12) ENDING CASH IALAN(:~ SHOULD NOT IE A NEGATIVE AMOUNT * 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 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 I/1 through 6/30 711 to Date 22. i~apo%nd!!.u.r. et s Schedule, E Payr~ents and Contributions (Other Than Loans) Made Type or print in tnk. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE R., . ~' c~CODES FOR CLASSIFYING EXPENDITURES Statement covers period q - t - ,h,ou.h io'l- SCHEDULE E Page_ of '1 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 o{Yecach category. 'C'- MONETARY AND IN-KIND (NON-MONETARY) CONTRIBUTIONS TO OTHER CANDIDATES AND COMMITTEES INDEPENDENT EXPENDITURES - LITERATURE · B' -' 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 NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION (~F COMMITTEE, IN ADDITION TO COMMITr[E'$ fiAME AND ADDRESS, ENTER I.D. NUMBER O1~ IF NO LD. NUMBER HAS BEEN ASSIGNED, ENTER TREASURZR'S NAME AND ADDRESS) 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. CODE OR DESCRIPTION OF PAYMENT Important: Contributions and exp, enditures made out of campaign funds to or on behalf of other' officeholders, candidates, committees, or ballot measures must also be entered on the Allocation Page, Part !. SUBTOTAL $ 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 ad~ount from Schedule F, Line 4.) ..................................... $ 5. Totalpaymentsmadethlsperiod. (AddLinesl,2,3, and4. EnterhereandontheSummaryPage, ColumnA, LineS.) ........... TOTAL $ AMOUNT PAID Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE Type or print in Ink. Amounts may be rounded to whole dollars, Statement covers period throu0h C) FULL NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER DATE (~F COMMR'TEE, IN ADDr~ION TO COMMrrTEE'S NAME AND ADDRESS, ENTER I.D. NUMBER(IF SELF-EMPtOYED, ENTER RE CE IVE D oe. iF NO LD. NUMBER HAS BEEN ASSIGNED, ENTER TREASURER'S NAME AND ADDRESS)NAME Of BUSINESS) SCHEDULE A SUBTOTAL $ Monetary Contributions Summary 1. Amount received this period -- contributions of $100 or more. (Include all Schedule A subtotals.) ......................... ' ............................................................................ 2. Amount received this period -- contributions of less than $100. (Do not itemize.) ....................................................................................................................... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) ......................................... TOTAL Page__ I.D. NUMBER AMOUNT CUMULATIVE TO DATE RECEIVED THIS CALENDAR YEAR PERIOD (JAN. 1 - DEC. $ $ $ CUMULATIVE TO DATE OTHER (IF APPLICABLE)