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Home My WebLink AboutCOUCH PREELEC10(1)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in Ink. s period Statemen /c72,40 from / /7SEE INSTRUCTIONS ON REVERSE through d ®/0 1. Type of Recipient Committee: AN Colrnnitlees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Pad 5) O Sponsored ❑ General Purpose Committee (A)WCO nPW@FW16) O Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Pad 7) 3. Committee Information I.D. NUMBER/ A.; 7 y/- Date of election if applicable: (Month. Day. Year) 1r1;z/?ono Date Stamp 11 Of e LO Q OCT _ 5 Pill ',J- p a Official Use Only 2. Type of Statement: Preelection Statement Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd-Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement -Attach Form 495 ❑ Amendment (Explain below) PAGE Treasurer(s) I,UMMII 1tt NAMt tUK UANUIUAI t"S NAMt It- NU UUMMII 1tt) NAMC Vr 1RcAOvncm MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification i have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury und75, en f the State of Califomia that the foregoing is tr a nnd correct yo~v e- Executed on - /D By 1,6 0~ao~fTrea:ww ~~surer Executed on By Dale ftmot Executed on Deb Executed on pie By ignafure of ControlFng Olficehokkr, Candbate. State Measure PropaleM FppC Form 460 (Januaryl05) FPPC Toll-Free Helpikle: 8661ASK-FPPC (8661215-772) State of California By Sill mk" of ControarV 0111ehokler. CandKWe. Sbte Measure Proponent Recipient Committee Type or print in Ink. COVER PAGE -PART 2 Campaign Statement 460 Cover Page - Part 2 Page z of 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLI ABLE G 7/ 0:7 e~ T /Ye L RESIDENTIALBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP % Related Committees Na Included in this Statement: Ust any committees not included in this statement that are controlled by you or are primarily formed to receive contributions of make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) 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 CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll-Free Heipline: 866/ASK-FPPC (8661275-3772) State of Califomia Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from -/71 PAGE through ! /W Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER -~7xya> I.D. NUMBER j3?. 7y1 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR TOTALTODATE Both the State Primary and Running in •n (FROMATTACHED SCHEDULES) General Elections Monetary Contributions 1 Line 3 Schedule A $ $ . , 111 through 6/30 7l1 to Date 2. Loans Received Schedule B, Line 3 SUBTOTAL CASH CONTRIBUTIONS 3 Add Lines 1 +2 $ $ 20. Contributions ~Qi vQD $ ~i-- . Received $ 4 Nonmonetar Contributions Line3 schedule C dit E . y , ures xpen 21. TOTAL CONTRIBUTIONS RECEIVED 5 AddLines 3+4 $ $ Made $ $ . Expenditures Made o7 Expenditure Limit Summary for State 6. Payments Made Schedule E, Line 4 $ t $ Candidates Loans Made 7 schedule H, Line 3 . f<-07 22. Cumulative Expenditures Made Limit dit E 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ 8 $ ) xpen ure (N Subject toVolunbry 9. Accrued Expenses (Unpaid Bills) Schedule F Line 3 Date of Election Total to Date 10. Nonmonetary Adjustment schedule C, Line 3 (mm/ddlyy) 11. TOTAL EXPENDITURES MADE Add Lines 6 + 9 + 10 $ ~ $ 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 1, Line 4 15. Cash Payments Column A, Line 6 above 16. ENDING CASH BALANCE Add lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Lire 16 must be zero. $ /D, 000 . ~BQS; ~7 $ _-T - -7 1, 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $ -199-- Cash Equivalents and Outstanding Debts 18. Cash Equivalents see instructions on reverse $ 19. Outstanding Debts Add Line 2 + Line 9 in Column B above $ 401- 101' To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). I if $ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. , from through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER //ev, n 13~ ~y1s DATE ADDRESS AND ZIP CODE OF CONTRIBUTOR FULL NAME, STREET CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IFSELF-EMpLOYED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH p PTY ❑ SCC SUBTOTAL$ Schedule A Summary 1. Amount received this period - itemized monetary contributions. (include all Schedule A subtotals.) $ 2. Amount received this period - unitemized monetary contributions of less than $100 $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ *Contributor Codes IND- Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Type or print In ink. Statement covers period Payments Made Amounts may be rounded / ' to whole dollars. from ®1 • SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER _T;V V,/,Z> Cd l{G~ CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CiVP campaign pamphemalia/misc. NW member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FL candidate filing/ballot fees PFID phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads VVEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IFCOMMRTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID ,eel-14(ly /~~/all - /.5-;rf ~i I eve I 7s -5 Z_1f ~Y1 , 00 71301 7-1 4A /Vi de 1F4FPzeg;,e1,-,050V also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ ~b 2. Unitemized payments made this period of under $100 $ 7.~. _ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 407 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E (Continuation Sheet) Payments Made NAME OF FILER type or print in ink. Amounts may be rounded to whole dollars. Statement covers period SCHEDULE E (CONT.) from _V_/ - ~/0 through Page of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIuP campaign paraphernalia/misc. " member communications RAD radio airtime and production costs CNtS campaign consultants MfG meetings and appearances RFD returned contributions ' CTB contribution (explain nonmonetary)* OFC office expenses SAL salaries campaign workers CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate SWxyballot fees PHD phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT WEB voter registration e-mail) costs (internet n technolo ti i f I rr namnaian literature and maiinas PRT print ads , gy orma o n NAME AND ADDRESS OF PAYEE (IF COMMI TEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID X r 0 e7, W- X_ 61KC jg,,f6 -07-2. ~ ADD SUBTOTALS A ig qi 'Payments that are contributions or independent expenditures must also be summarized on Schedule D. , ' , FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)