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HomeMy WebLinkAboutDICKERSON SEMIANN01(1) e~ipien't Committee -Campaign Statement (Government Code Sections 84200-84216.5) Type or print in Ink. SEE INSTRUCTIONS ON REVERSE 1. Typp~5~Recipient Committee: All Committees- Complete Parts 1, 2, 3, and 7. ~ Officeholder, Candidate [] Primarily Formed Candidate/ Controlled Committee (Also Complete patf 4 J [] Ballot Measure Committee O Primarily Formed O Controlled O Sponsored (Also Complefe part 5.) Officeholder Con~ittee (Also Contplate par~ 6.) [] General Purpose Committee Date of election if applicable: (Month, Day. Year) _© Date Stamp 01AU613 PH3: SA~EH~F[r [ u C!TY C[ 2. Type of Statement: 0 Sponsored 0 Broad Based ection Statement annual Statement [] Termination Statement [] Amendment (Explain below) COVERPAGE For O~lclal Use O~y ERK [] Quarlerly Statement [] Special Odd-Year Report [] Supplemental Pre-election Statement - Attach Form 495 3. Committee Information IID'NUMBER COMMITTEE NAME STREET ADDRESS (NO RO. BOX) CITY STATE ZIPCCOE AREA CODE/PHONE MA~AD~ R~[ S~iF~DiFFERF~, ,O. ~D S7 REET 0R p.o. i}?/ ~''~/ Treasurer(s) NAME OF TREASURER / MAILING ADDRESS Oily STATE ZIP COOE AREA CODFJPHONE NAME OF ASSISTANT TREASURER~'. If ANY MAIUNG ADDRESS CITY STATE ZiP COOE AREA COOE~PHONE OPTK)NAL: FAX/E-MAIL ADDRESS CITY STATE ZIPCOOE AREA COOF-~HONE OPTIONAl.: FAX / E-MAIL ADDRESS · Recipient Committee Campaign Statement Cover Page -- Part 2 Type or print In ink. COVER PAGE · PART 2 Page '"'~ of ~ 4. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDEP. OR CANDIDATE ~ OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/~USINESS ADORESS (NO. AND STREET) CITY STA'[ E ZIP Related Committees Not Included in this Statement: LI,t any committees not Included In this consolidated statement that ere controlled by you or which are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE'/ [] YES [] NO COMMITTEE ADDRESS STREET AODRESS (NO P.O. 6OX' CITY STATE ZIP COOE AREA CODE/PHONE 7. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the b/es~ ,st, eandcom, ,ete. ,ce? par,u,¥,,nde the,awso,,heS,a,eo, /,.7 Ex.ut~ on ~ ~ / By ~ 5. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION [] SUPPORT I [] OPPOSE Identify the conbolling officaholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD I DISTRICT NO. IF ANY I 6. Primarily Formed Committee Ll,t n,m, ofomc,holdo~,) or candidate(s) for which this committee Is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT [] OPPOSE NAME OF OFFICEHOLDER OR CANOIDATE OFFICE SOUGHT OR HELD [] SUPPORT [] OPPOSE NAME OF OFFICEHOU)ER OR CANDIDATE OFFICE SOUGHT OR HELD Attach continua~on sheets #necessary  ow[edge the information contained herein ue and correct. [] SUPPORT [] OPPOSE and in the attached schedules Executed on By Executed on By DATE FPPC Form 460 (8/99) For Technical Asalllenca: 9t6/322-5660 Slate of California oarnpaign Disclosure Statement 'Summary Page SEE INSTRUCTIONS ON REyERSE Type or print In ink. Amounte may be rounded to whole dollars. s~,.;.,,~.~ove/, period from /////C~/ SUMMARY PAGE Page ~ of ~ . NAME OF FILER ContributionB ~eceived 1. Monetary Contributions ...................................................... Schedule A, Line 3 2. Loans Received ................................................................... Schedule 8. Line 7 3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines t + 2 4. Nonmonetary Contributions ............................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 Column A $ ~ $ Expenditures Made 6. Payments Made .................................................................... Schedule E, Line 7. Loans Made .......................................................................... Schedule H. Line 8. SUBTOTAL CASH PAYMENTS ................................................ Add Lines 6 + 9. Accrued Expenses (Unpaid Bills) ............................................ Schedule F, Line 10. Nonmonetary Adjustment ....................................................... ScheduleC. Line3 11. TOTAL EXPENDITURES MADE ......................................... Add Lines S + 9 + tO Column B* I.D. NUMBER Column C Current Cash Statement 12. Beginning Cash Balance ................................ Previous Summary Page, Line 16 13. Cash Receipts .............................................................. Column A, Line 3 above 14. Miscellaneous Increases to Cash ....................................... Schedule I, Line 4 15. Cash Payments ............................................................ Column A. Line 8 above 16. ENDING CASH BALANCE .............. Add Lines 12 + 13 + 14, then subtract Line 15 II this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................... Schedule B, Pert 1, Column (b) $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ..................................................... See Inslructlons on reverse 19. Outstanding Debts ................................... Add Line 2 + Line 9 in Column C above · 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 Loans Received (Line 2). Loans Made (Line 7), and Accrded Expenses (Une 9). Summary for Candidates in Both June and November Elections 111 through 6/30 7/1 Io Date Contributions Received ............$ ~-~ ~ 21. Expenditures Made .................. FPPC Form 460 (8/9g) For Technical Aeefstence: 9t6~22-566n · ~rlnt In Ink. SCHEDULE B - PART 3 $checlule U - Part ;~ . . Am;)'U~l~-m'll~'l~'r'~;~l~led StatementFove.~ ~rl~ =~,11 =ielF,~. I ~ . Annual Repo~ of Outstand;ng Loans Recmved to whole dollar,. ~om ////~/ ~ ~1~1 e I FULL NAME OF LENDER O~IGINAL DATE OF LOAN AMOUNT OF O~IGI~L rOAN ~P~D PRINCIPA ~ UNPAID INTER~ST Attach additional information on appropriately labeled continuation sheets. TOTAL $ NOTE: This total sh~:~ld be the same amount as entered on the Summary Page, Column C. L/ne 2. FPPC Form 460 (8/99) For Technical Asslstence: 916/322-5660