HomeMy WebLinkAboutCOUCH PREELEC98(2)Officeholder, Candidate,
and Controlled Committee
Campaign Statement - Long Form
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Check one of the following boxes to indicate the type d statement being filed:
Type or print In ink.
Pre-election Statement
~I Supplemental Pre-election Statement (Attach a completed Fofm 495 to this statement.)
' Special Odd-YearCampaign RepOrt :.
m Semi-annual Statement
= Termination Statement (Attach a completed Form 415 to this statement.)
I ~fficehoider Candidate, and Controlled Committee
Included in this Statement
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMIER IF APPtlCARLE)
g,~e~s~eM d;rl ~o,,,~;/
RES4DENTIAL
~
FILE COPY
Date Stamp
Statement covers period
,-,
through la/l?/9~ 98COT 22 AMII: h6'
Date of election if a ppiical~ ~ E g e ,:, ~ i D C i f Y C L E R K
(Month, Day, Year) ~ ~'-~i ic ~
COVER PAGE - LONG FORM
II
For Official Use Only
uther Committees I~ot Included in this l ~,tement:
committees r~t i~cl~d tn ~ cobolIda t~ ~eteme~ .t~t e~ c~trdled by y~ t~ lny
c~m~ees of ~ch you ha~ k~le~e that a~ primaH~ f~m~ to receive c~trl~t~
~ m make ex~ures ~ ~ffofyour ca~lda~.
C~M~[ ~M[ I l.O. NUMIER
~M[ ~ T~R C~ROLLED C~M~E[7
COMMITTEE AD~SS (,NO. AND STREET)
CITY STATE ZI CO0[ AREA COOE./DAYTIIdE
C13MMITTEE NAME
ltD. NUMIER
NAME OF TRE, A$4J!tER CONTROttED COMMITTEE?
COddMfTTEE ADORESS (NO. AND STI~ET)
OTY STATE ZIP COO[ AREA CODE/DAYTIME PHONE
iII
Verifigtion
I have reviNN the ~tement a~ to the ~ of my kn~l · information con~in~ herein a~ in the m~ached Kh~ules is
I h$~ u~d all rea~ab~ dil~e~e in pre~ring this ~atement.
,.o,_...:,,,.,.._.-.,Z=;=..,,,._.,......,,o=""=:' ,.,,..........,....,.,,
re~n~bl diligl~e in pre~ri~ this ~atement. I h~ve review~ the ~atlmlnt and to the ~ of my kn~ge the info ~ontain~ he in ed schedules i$ true and
O DATE ~ AND S;A~ SIG~TURE ~ ~NDIOA~~R
ExK~ On At By
DATE CffY A~ STATE S~NATURE ~ ~N~OATE~FF~EH~DER
Executed on At By
DATE ~ AND STATE S~NA T URE ~ CANDtDA T [ ~ F ~ ~ ~t DE R
FOR INF~MATI~ RE,NO TO BE PROVIDED TO YOU ~RSUA~ TO THE ~FORMATt N~E$ A~ ~ 1~77. SEE INEORMATION MANUAL ~ CAMPAIGN DSCLOSUR[ PROVISItS OF THE POLIT~AL REFORM A~
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Contributions Received
2. Loans Received ......................................... Schedule a, une
3. SUBTOTAL CASH CONTRIBUTIONS ...................... AcedUnes
4. Non-monetary Contributions ......................... Schedu/e C, Une
5. SUBTOTAL CONTRIBUTIONSi(Exdude Enforceable Prorakes) Add Unes 3
6. Enforceable Promises
(Exclude Loan Guarantees, Line 18 below) ................... $cheduk D, Une
7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddU. esS
Monetary Contributions ............................... Schedu/e A, Une 3 · $
Expenditures Made
8. Cash Payments (Other than Loans Made) ............ Schedu/e E, Une S $
9. Loam Made ............................................. SchedukH, Line7
10. SUBTOTALCASH PAYMEN.TS ............................ AddUnesa, 9 $
11. Accrued Expenses(Unpaid Bills) ........................ ScteduteF, UneS
12. TOTAL EXPENDITURES MADE ......................... AddUnes 10 ·, S
Current Cash Statement
13. Beginning Cash Balance .................. Prev~us Summary Page, une t7 S
14. Cash Receipts ...................................... ColumnA, Line3mbove
1S. Miscellaneous Increases to Cash ........................ Sdmtde t, Une 4
16. Cash Payments .................................... ColumnA, Une lOabove
17. ENDING CASH BALANCE ..... AddLines 13
ff thb b a tetminetlOn ltatement, Line l T mulf be zero.
IB. LOAN GUARANTEES RECEIVED .............. Sc~du/e ~, P=rt t, Column(b]S
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................Seeinstrucuomonreveae S
20 OUtstanding Debts ................. AddLine 2 ,, Line If tnColumnCmbove $
Type or print in ink.
Amounts may be rounded
to whole dollars.
COIUmfi A
TOTAL ~ P![RJO0
(FROM ATIACHED SCHEDULES)
io, z: io.
Ip,
i0,
ID, z iD
12.111
1.?..
12,11'1
SUMMARY PAGE
Statement COverS period ! , .~ .: ,.~. ! ~:
through/O//7/~ OO [ Page '~ of;
t.D. NUMBER
Column B* Column C
TOTAl. PREVIOUS PERIO0 TOTAL TO DAI'~
(~EE NOTE IELOW) (ADD COCUMN$ A · I) .
1~,~7c) _ s .~?,78~
/ 7, 5'7'~ s ,2, 7, 7~?
11, ~D.,~ _ $ 25,S20
1 I, q~3 s 23, 5Z o
$
s
S
· From previous Statement Summary Page, Column C. However, if
this is the first reDOrt filed for the calendar year, Column B should be
blink except for Loam Received (Line 2), Enforceable Promises (Line
6), LOam Made (Line 9), and Accrued Expenses (Line 11 ).
Summary for Candidates in Both June and
November Elections
111 through 6/30 711 to Date
21. ontrib tions 27,
22.
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
D-,,,,'J (;,,~-, /2,;,,..,Js ,,,~ D".";=/ ~,-"'~
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE (w COMMITTEE, IN ADDITION TO COMMrFrE['S NAME AND ADDRESS, ENTER I.O. NUMBER
RECEIVED o~ IF NO I.D. NUMBER HAS IEEN ASSIGNED, ENTER TREASURER'S NAME AND ADDRESS)
Type Or print in ink.
Amounts may be rounded
to whole dollars.
OCCUPATION AND EMPLOYER
(IF $ELF,EMPtOYED, ENTER
NAME Olc BUSINESS)
Statement covers period
,.,~. '~ , /~
AMOUNT
RECEIVED THIS
PERIOD
SCHEDULE A
/'2~,a it.1
Page 3 of g l
I.D. NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
/%/~a z>,, ,-, .., s ~'~ ,, ,A r. A., ;,'-/s
s 9. ,5'o,~.'"
$
S 1~, z~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 -- contri butions of less than $100.
(Do not itemize.)
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) ....................................... TOTAL
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE 0~ COMMITTEE, IN ADDITION TO COMMrrtrEE'S NAME AND ADDRESS. ENTER I.D. NUMBER
RECEIVED O~, IF NO LD. NUMIER HAS IEEN ASII6NED, ENTER TREASURER'$ NAME AND AI)I)RE$S)
Z:>~,,e/',/,,,..-,e
Kc P/~ - p,~r_.
,,~,,
Type or print in ink,
Amounts may be rounded
to whole dollars,
OCCUPATION AND EMPLOYER
(If SELF-~MPtOYED, ENTER
NAME Of
Statement covers period
,,_ ,-/,/,s
SCHEDULE A (cont.)
I.D. N6MBER
AMOUNT CUMULATIVE TO DATE
RECEIVED THIS CALENDAR YEAR
PERIOD (JAN. 1 - DEC. 31)
E'~q"~ee~' 2,5'0. Z5~.
2 ~ ~9. Zoo.
E.45 ,..¢ ~'eA. 5'O0.
foe,. Co~.
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
SUBTOTAL $ 7.SO .,5-'_
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type or print in Ink.
Amounts may be rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE 0~ COMMITTEE, IN ADDITION TO COMMITTEE'$ NAME AND ADDRESS, ENTER I.D. NUMIER
RECEIVED O~, IF NO I.D, NUMIER HAS IEEN A$$1~I~D, !ffTER TREASURER'S NAME AND ADDRESS)
OCCUPATION AND EMPLOYER
(ff $[LF*EMIq. OYED, ENT[R
NAME Of IU$1NE$S)
Statement covers period
,,o.,
SCHEDULE A (cont.)
__ I~lle ~
I.D. NUMBER
AMOUNT CUMULATIVE TO DATE
RECEIVED THIS CALENDAR YEAR
PERIOD (JAN. 1 - DEC. 31)
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
SUBTOTAL $ ~'o0- '; ': "-
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE ~F COMMII"rEE, IN ADDITION TO COMMITTEE'$ NAME AND ADDRESS, ENTER I.O. NUMBER
RE CEIVE D o~, IF NO I.D. NUMIER HAS IEEN AS~NED, ENTER TREA$4.IRER'$ NAME AND ADDRESS)
Type or print in Ink.
Amount~ may be rounded
to whole dollan.
Statement covers period
,,. ,q, he
OCCUPATION AND EMPLOYER
(IF $ELF*[MPtOYEID, ENTER
NAME O~ It, l~lN/S~.)
AMOUNT
RECEIVED THIS
PERIOD
'~i;~i:rOT.~["i' "2.
SCHEDULE A (cont.)
I.D, NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule E
Payments and Contributions
(Other Than Loans) Made
Type or print in ink.
Amounts may be rounded
to whole dollart
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
CODES FOR CLASSIFYING EXPENDITURES
Statement covers period
,,o.
SCHEDULE E
· ~ 7~ :.~,,- -a!-':
Page 7 of f
I.D. NUMBER
If One of the following codes accurately describes the expenditure, ou may enter the code and leave the "Description of Payment' column blank· Refer to the
back of Schedule E-Continuation Sheet for detailed explanations of Y;ach category.
'c"-
(o~;'~4u,-~9 7~
MONETARY AND IN-KIND (NON-MONETARY)
CONTRIBUTIONS TO OTHER CANDIDATES
AND COMMITTEES
INDEPENDENT EXPENDITURES
LITERATURE
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
(If COMMIITEE, IN ADI)fTION TO COMMrrrEE'$ NAME AND ADDFE$$. ENIER I.D. NUMIER OR, IF NO LD.
NUMIER HAS IEEN ASSIGNED, ENTER TRIASURIR~ NAME ANO ADORE$$)
CODE
l~et o~he;.d lae.,olur,dd
'B' - BROADCAST ADVERTISING 'G' -
*N* - NEWSPAPER AND PERIODICAL ADVERTISING °T' -
'0' - OUTSIDE ADVERTISING
'S' - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS 'P" '
'F' - FUNDRAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DE SCRIBED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
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.
AMOUNT PAID
OR
DESCRIPTION OF PAfMENT
.......... committees, or ballot measure must also be entered on the Allocation Page, Part I.
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 $100. (Do not itemize.) .......................................................................
3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part I!, Column (d).) ..............................
4. Total accrued expenses paid this period. (Do not itemize. Enter amount from S ....................................
5. Total payments made this period. (Add Lines 1, 2, 3, and 4. Enter here and on the Summary Page, Column A, Line
SUBTOTAL
251.
/2, tt?
Schedule E
(Contin uation Sheet)
Payments and Contributions
(Other Than Loans) Made
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
'C' - MONETARY AND IN-KIND (NON-MONETARY) 'B' -
CONTRIBUTIONS TO OTHER CANDIDATES · N' -
AND COMMITTEES 'O' -
'1' - INDEPENDENT EXPENDITURES 'S' -
"L"- LITERATURE i "F"-
NAME AND ADDRESS OF PAYEE. CREDITOR, OR RECIPIENT OF CONTRIBUTION
(IF COMMITTEE, IN ADOffl0N TO COMMrrrELr'$ NAME ANO ADDRESS,, ENTER I.D. NUMBER OR, IF NO I.D.
NUMIER HAS IEEN ASSIGNED, ENfER TREAR/RER'S NAME AND ADDRESS)
P,~,:;~,Z ,~e// /:>,,/,7:,<:4 / A;e. - .,/,:,s
Type or print in ink.
Amounts may be rounded
to whole dollars.
CODES FOR CLASSIFYING EXPENDITURES
BROADCAST ADVERTISING
NEWSPAPER AND PERIODICAL ADVERTISING
OUTSIDE ADVERTISING
SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS
FUNDRAISING EVENTS
CODE OR
I l
Z-
Statement covers period
,,ore
t,,ro,..,,
SCHEDULE E (cont.)
I.D. NUMBER
-p- _
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIBED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
DESCRIPTION OF PAYMENT
AMOUNT PAID
q, "/~'Z
SUBTOTAL