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Home My WebLink AboutCOUCH PREELEC98(1)Officeholder, Candidate, and Controlled Committee Campaign Statement - Long Form (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Check one of the following boxe~ to indicate the type of ~tatement being filed: Pre-election Statement Supplemental Pre-election Statement (Attach a completed Form 495 to this statement.) ~J Special Odd-Year Campaign ReDors [] Sea -annual Statement r~ Termination Statement (Attach a corn pleiad Form 415 to this statement.) ~)~ceholder..Candidate. and Controlled Committee Included in this Statement NAME OF OFFICEHOLDER OR CANDIDATE O~1~ %OL~HT OR HELD (INCLUDE LO~AT ION AND reST IUC[ NUMIIER ff At~II-IC~IL[ ) COMMITTEE NAME Type or print in ink. Statement covers period thro.h Date of election ff applicable: {Mo~t h. Day. Year) II COVER PAGE - LONG FORM Date Stamp ~ " ~: ' 9~) OCT -5 PH 12: -~ B~K£RSFI'~LD CLlYI'~K / ~ ~ ''" ~ ;2 For Official Use Only FILE C01 Y Other Committees [Sot Included in this Statement: Usta.yo~h., committees of which you have knowledge that are primaHA/ formed to receive contributlor~ or to make exDenditures on bahaft of your cand/dacy. CO~NTROLLED Aff~ch ~-J;Gon~l Informatiod~ on epprop~leteA/ labeled con~nuatlo~ shee~ III Verification .... I have used all reasonable diligence in preparing this statement. i have reviewed the statement and to.the best of my k ~ow?.~_ ___ the mformet~onfonta,ned herein and in the attached ~chedules true and complete. I certify under penalty of perjury under the laws of the State of Ciliforme that the toregoing · t r~le~or rect:~' _ Executed on /a/."~'/c/9 ' At ~sa/~:e ~-~ reasOnlb · d li<]ence in preparing this statement. I nave revlewea the staxamen, .,,u .v.,,w ~.. v . · . ~. ""['"'-7 - complete. I certify under penalty of perjury under the laws of the.St/ate of California that the foregoing is true ano tort .e~r ......... ~ OATS CITY AN~ STATE PAT! CnY ANO STATE Executed on At By Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE Contributions Received 1. Monetary Contributions ....................... 5chedu/e A, Une 3 2. Loans Received ......................................... S~edule R, Une 7 3. SUBTOTALCASHCONTRIBUTIONS ...................... AddU~esl +2 4. Non-monetary Contributions ........... ~heo~/e C, Line 3 5. SUBTOTALCONTRlBUTlONSi6-CxcludeEnforceableeromlses) AddUnes3 +4 6. Enforceable Promises (Exclude Loan Guerantee~, LIn~ !8 below) ................... 5chedu/e D, Une 7 7. TOTAL CONTRIBUTIONS RECEIVED .................... AddUnes5 * 6 Expenditures Made 8. Cash Payments (Other than Loans Made) .......... Schedule £, Une s 9. Loans Made ............................................. 5d-~,du/e H, Une ? 10. SUBTOTAL CASH PAYMEN.TS ............................ ~ddUnese + g 1 1. Accrued Expenses (Unpaid Bills) .................... Schedu/e ~, Une S 12. TOTAL EXPENDITURE5 MADE ......................... ~dUne$10 + ~ Current Cash Statement 13. Beginning Cash Balance ................. Pcevtous Summery Page, L~ne17 14. Cash Receipts ...................................... ColumnALIne3ebove 1 5, Miscellaneous Increases to Cash ........................Schedu/e I. Uoa 4 16. Cash Payments .................................... ColurnnALInelOabove 17. ENDING CASH BALANCE ..... AddL/~el ~3 * 14 + ~5, then subUact Une 16 If th~ b a tecminaffo~ Jtatement, Ltne 17 mu~t be zero. 18. LOAN GUARANTEES RECEIVED .............. 5chedules, Partl, ColumnCbJ Type o~ print in ink. Amount~ may be rounded to whole dollars. SUMMARY PAGE L~ ': ~ Column A Column B* Column C s 17,579 s s /7,~77 s 17,~79 s s s /'1, ~79 s s /7,~77 s I1~ '-1o5 s II,HOZ~ s I I, ~Yo~ s s Cash Equivalents and Outstanding Debts _~_ 19. Cash Equivalents............................. ~ I~ ~ ~W~ S 20. O~tstanding Debts ................ AddUne2 ,, Line ~t,'nCo~umnCebove S s s /1, ~/0 S s s / 1, s s 1/, '-/~_~ · From Dreviou$ Statement Summary Page, Column C. However, if] this is the first report filed for the calendar year. Column B should be blank except for Loans Re(Rived (Line 2), Enforceable Promises (Line 6), Loans Made (Line g), and Ac~ued Expenses (Line 11 ). Summary for Candidates in Both June and November Elections 1/1 through 6fJ0 711 to Date 21. (~ontribqtions ~ecewea .... $ 22. ~a/~end ! t..u.,.~ $. Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE FUL~ N~ME AN~ ADDRESS OF CONTR~RUTOR ? / Monetary Contri~ut10r~s Summary I. Amount received this period -- contributions of $100 or more. Type or print in ink. Amounts may be rounded to whole dollars. OCCUPATION AND EMPLOYER Statement covers period SCHEDULE A AMOUNT CUMULATIVE TO DATE RECEIVED THIS CALENDAR YEAR PERIOD (JAN 1-DEC CUMULATIVE TO DATE OTHER (IF APPLICAg LE) SUBTOTAL (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 I.) TOTAL $ / 7~ / S-o I '7, ~7~. Schedule A (Continuation Sheet) Monetary Contributions Received Type m print in ink. Amounts may be ;DUndeal to whole dollart. NAME OE OEE~CE.OLDE" O" CANDIDATE A"D CONT"OLLED COMM'TTEE FULL NAME AND ADDRESS OF CONTRIBUTOR ~. Ce~Tae p~r~ ,,Yeua~ ~,~ . ~ Statement covers period ,ro~°d~ //~ OCCUPATION AND EMPLOYER AMOUNT (ff ~[L[~MI%OYED, I[NTEl~ RECEIVED THIS SCHEDULE A (cont.) I.D. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN !-DEC 31) SUBTOTAL CUMULATIVE TO DATE OTHER (I; APPLICABLE) Schedule A (Continuation Sheet) Monetary Contributions Received Type o~ print in ink. Amounts may be rounded to whole dollarm, NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE FULL N~,ME AND ADDRESS OF CONTRIBUTOR O~CUPATION AND EMPLOYER Statement covers period SCHEDULE A (cont.) NUMBER AMOUNT CUMULATIVE TO DATE RECEIVED THIS CALENDAR YEAR PERIOD (JAN 1-DEC 3t) SUBTOTAL CUMULATIVE TO DATE OTHER (!~: APPLICABLE) Schedule E Payments and Contributions (Other Than Loans) Made Type o~ print In ink. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF OFFICE HOLDER OR CANDIDATE AND CONTROLLED COMMITTEE COOLS FOR CLASSIFYING EXI~NDITURES Statement (overs period ,tom Eh,o.0h SCHEDULE If one of the following codes accurately describes the expenditure,you may enter the code and leave the "Description of Payment' column blank. Refer to the back of Schedule E-Continuation Sheet for detailed explanations of each category. 'C'- MONETARY AND IN-KIND (NON-MONETARY) CONTRIBUTIONS TO OTHER CANDIDATES AND COMMITTEES 'l' - INDEPENDENT EXPENDITURES 'L' - LITERATURE 'B' - BROADCASTADVERTISING 'N'- N EWSPAPE R AND PERIODICAL ADVERTISING 'O* - OUTSIDE ADVERTISING 'S*- S U RVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SO LICITATIONS 'F' - FUNDRAISING EVENTS *G'- GENERAL OPERATIONS AND OVERHEAD 'T'- TROVE L, ACCOMMODATIONS AND MEALS (MUST BE DESCRIBED) 'P' - PROFESSIONALMANAGEMENTANDCONSULTING SERVICES NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION D u/d Cooc CODE Important: Contributions and expenditures made out of campaign funds to or on behalf of other · officeholde~andidates, co_mmtttees, orbal_lotmeasures.mustal~o be entered_on theAIIocati~_Page, Patti. SUBTOTAL $ Payments and Contributions Made Summary 1~ Paymentsmadethisperiodof$100ormore. (Include all Schedule E subtotals.) ...................................................... $ /~7~ 7'~/ 2. Paymentsmadethis 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).) ............................$ ' O - 4. Total accrued expenses paid this period. (Do not itemize· Enter amount from Schedule F, Line 4.) $ - O - S. Total payments made this period. (Add Lines l, 2, 3, and4 EnterhereandontheSummaryPage, ColumnA, Line8) ' TOTAL $ ,I,I, D3 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. OR DESCRIPTION OF PAYMENT AMOUNT PAID Schedule E (Continuation Sheet) Payments and Contributions (Other Than Loans) Made SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE 'C° - MONETARYANDIN-KIND(NON-MONETARY) CONTRIBUTIONS TO OTH E R CANDIDATES AND COMMITTEES 'l' -- INDEPENDENT EXPENDITURES 'L° - LITERATURE B-~ ~-e~s P, e/d, C4 Type or print in ink. Amounts may b~ rounded to whole dollars, ~ ~ c~.~ CODES FOR CLASSIFYING - BROADCASTADVERTISING 'N'- NEWSPAPER AND PERIODICAL ADVERTISING 'O' - OUTSIDE ADVERTISING 'S" - SURVEYS, SIG NATURE GATHE RING, DOOR-TO-DOOR SOLICITATIONS 'F' - FUNDRAISING EVENTS CODE OR L L from ~//~"/~ through SCHEDULE E (cont.) ~- ?::~: ;!!?:~5'.!:::f::. !':;::": I.D NUMBER 'T' -TRAVEL, ACCOMMODATIONSANDMEALS (MUST BE DESCRIBED) 'P" - PROFESSI~)NALMANAGEMENTANDCONSULTING SERVICES DESCRIPTION OF PAYMENT AMOUNT PAID I??. 00. 1%o. 1, ooo SUBTOTAL $ 3,3~ Schedule E (Continuation Sheet) Payments and Contributions (Other Than Loans) Made SEE ~NSTRUC~,ONS ON REVERE NAME OF OmCE"OLOE. O" C~NO,DATE AND CONTROLLED COMM'~EE 'C' - MONETARYANDIN-KIND(NON-MONETARY) CONTRIBUTIONS TO OTHER CANDIDATES AND COMMII-rEES 't' - INDEPENDENT EXPENDITURES 'L' - LITERATURE NAME AND ADDRESS OF PAYEE, CREDITOR. OR RECIPIENT OF CONTRIBUTION Type or print In ink. Amounts may be rounded to whole dollars. CODES FOR CLASSIFYING EXPENDITURES *B' - BROADCAST ADVERTISING #N*- NEWSPAPER AND PERIODICAL ADVERTISING 'O' - OUTSIDE ADVERTISING 'S' - SURVEYS, SIGNATURE GATH E RING, DOOR-TO-DOOR SOLICITATIONS · F' - FUNDRAISING EVENTS CODE OR from ~//Ol/9~ through SCHEDULE E (cont.) (MUST BE DESCRIBED) 'P' - PROFESSIONALMANAGEMENTANDCONSULTING SERVICES DESCRIPTION OF PAYMENT AMOUNT PAID SUBTOTAL $ 3t~..~5 Schedule E (Continuation Sheet) Payments and Contributions (Other Than Loans) Made SEE INSTRUCTIONS ON REVERSE NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE 'C' - MONETARYANDIN-KIND (NON-MONETARY) CONTRIBUTIONS TO OTHER CANDIDATES AND COMMITTEES ~1' - INDEPENDENT EXPENDITURES °L" - LITERATURE Type or print in ink. Amounts may be rounded to whole dollars. CODES FOR CLASSIFYING EXPENDITURES 'B' - BROADCAST ADVERTISiNG 'N' - NEWSPAPERANDPERtODICALADVERTISING 'O' - OUTSIDE ADVERTISING 'S'- SURVEYS, SIG NATURE GATH E RING, DOOR-TO-DOOR SOLICITATIONS 'E' - FUNDRAISING EVENTS CODE OR 0 SCHEDULE E (cont.) 'G' - GENERALOPERATIONSANDOVERHEAD 'T' - TRAVEL, ACCOMMODATIONSANDMEALS (MUST BE DESCRIBED) 'p' - PROFESSIONALMANAGEMENTANDCONSULTING SERVICES DESCRIPTION OF PAYMENT AMOUNT PAID SUBTOTAL