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HomeMy WebLinkAboutCOPE SEMIANN01(1)Recipient Committee Campaign Statement (Government Code Seclions 84200-84216.5) Type or print in ink. SEE INSTRUCTIONS ON REVERSE Statement covers period 1. Type of Recipient Committee: ^, committees-Complete Parts 1, 2, 3, and 7. [] Officeholder, Candidate Controlled Committee (Also Compiete Part 4.) [] Ballot Measure Committee O Primarily Formed O Controlled O Sponsored (Also Complete Part 5.) [] Primarily Formed Candidate/ Officeholder Committee (Also Complete part 6) [] General Purpose Committee ~ Sponsored O Broad Based 3. Committee Information ~TREET ADDRESS {NO P.O. BOX) MAILING ~DRESS (IF DIFFEREN~ NO. ~D STREET OR ~O. BOX Date of election If applicable: (Month, Day, Year) Date Stamp COVERPAGE 2. Type of Statement: [] Pre-election Statement [] Semi-annual Statement [] Termination Statement [] Amendment (Explain below) Treasurer(s) For Official Use Only [] Quarterly Statement [] Special Odd-Year Report [] Supplemental Pre-election Statement - At[ach Form 495 NAME OF TREASURER MAILING ADORESS CiTY STA'I~ ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX I E4~A~L ADDRESS FPPC Form 460 (8199) For Technical Aeilstance: 916/322-5660 State of California Recipient Committee Campaign Statement Cover Page -- Part 2 Type or print in ink. COVER PAGE - PART 2 4. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE 5. Ballot Measure Committee NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMSER IF APPLICADLE) RESIDENTIAL/SUSINESSADDRESS (NO AND STREET) CiTY STATE ZiP Related Committees Not Included in this Statement: List any commttteea nol Included in this consolidated statement that are controlled by you or which are primarily formed lo receive contributions or to make expenditures on behalf of your candidacy. COMMITTEE NAME I D NUMBER [] YES [] NO NAME OF TREASURER CONTROLLED COMMITrEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O, BOX) CITY STATE ZiP CODE BALLOT NO. OR LETTER JURISDICTION ~][] OPPosESUPPORT Identify the controlling officeholder, candidate, or Ithta mlature proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE OR. PROPONENT 7. Verification OFFICE SOUGHT OR HELD DISTRICT NO. iF ANY 6. Primarily Formed Committee Llstnamesofofficeholder(s)orcandldat.(,) for which this commleee is primarily formed, OFFICE SOUGHT OR HELD [] SUPPORT [] OPPOSE OFFICE SOUGHT OR HELD [] SUPPORT [] OPPOSE OFFICE SOUGHT OR HELD [] SUPPORT [] OPPOSE 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 under the laws of the State of California that the foregoing is true and correct. Executed on By SIGNATURE OF CONTROLLING OF FICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Execuled on · By SATE FPPC Form 460 (8199) For Technical Assistance: 9161322-5660 State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTtONS ON REVERSE Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. 1. Monetary Contributions ...................................................... Schedule A, Line 3 2. Loans Received ................................................................... Schedule B. Line 7 3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines ! + 2 4. Nonmonetary Contributions ............................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVEO .................................... Add Lines 3 + 4 Column A -b, oo Statement covers period ,rom /-/-0/ through ~ ~' O/ SUMMARY PAGE I.D. NUMBER Column B* Colum~ C O. O0 O. OO .00 . oPO. Expenditures Made 6. Payments Made .................................................................... Schedule E. Line 4 7. Loans Made .......................................................................... Schedule H, Line 7 8. SUBTOTAL CASH PAYMENTS ............................................... Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) ........................................... Schedule F. Line 3 10. Nonmonetary Adjustment ....................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ......................................... Add Lines 8 + 9 + 10 , ~.~0 , ~000 /) O0 , 0,00 , ~O. OU 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 ~, Line 4 15. Cash Payments ............................................................ Column A, Line 8 above 16. ENDING CASH BALANCE .............. Add Lines 12 ~' 13 * 14. then su~lract Line 15 If this is a termination statement, Line 16 must be zero, 17. LOAN GUARANTEES RECEIVED ................... Schedule B, Part 1, Column (b) Cash Equivalents and Outstanding Debts 18. Cash Equivalents ..................................................... See instructions on reverse 19. Outstanding Debts ................................... Add Line 2 + Line 9 in Column C above b. O0 730.00 · From ixevious statement Summary Page, Column C However. if this is [he first report filed for the caldndar year, Column B should be blank except for Loans Received (Line 2). Loans Made (Line 7). and Accrued Expenses (Line 9). Summary for Candidates in Both June and November Elections 111 through 6130 711 to Date 20. Contributions Received ............ $ 21. Expenditures Made .................. $ FPPC Form 460 (8199) For Technical Assistance: 9161322-5660 Schedule A Typ. or print In ink. SCHEDULE Monetary Contributions Received A m ° ~o"'~',Ydo~,r,~ ~u~ d e d from ~;--;-i~ii~, Covers period/-- / -~]/ ~~1~ ~ SEEiNSTRUCT,O"SONREVERSE I~ AN INDIV~DUAL. ENTER ~OUNT CUMU~IV~ TO DA~E CUMU~TIVE TO DATE DATE FULL ~ME. ~iLING ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPA~ON ~D EM~OYER RECEIVED THIS CALEND~ YE~ OTHER RECEIVED U~ C~Mt~EE. ~SO ENTER I 0 NUMBER) CODE * {IF SELF~M~OYED+ ENTER N~E PERIOD (JAN. 1 - DEC. 31 ) (IF APPUCABL E) [ g D COM ~ IND D cou ~ OTH ~IND ~ COM ~ OTH ~ IND ~ COM ~ OTH ~IND D COM ~OTH Schedule A Summary 1. Amount received this period - contributions of $100 or more (Include all Schedule A subtotals.) ....................................................................................................... 2. Amount received this pedod - unitemized 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, Line1.) ................... TOTAL 'Conlributor Codes IND - Individual COM - Recipienl Committee OTH - Other FPPC Form 460 (8199) For Technical Assistance: 9t61322-$660 Schedule B - Part 1 Loans Received SEE INSTRUCTIONS ON REVERSE NAME OF F~LER DATE RECEIVED FULL NAME. MAILING ADORESS AND ZIP CODE OF LENDER OR GUARANTOR Lender [] Lender [] Guaranlor COntRIBUTOR CODE [] IND [] COU [] OTH [] IND [] COM []OTH [] IND [] COM [] OTH Type or print In ink. Amounts may be rounded fo whole dollars. IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER from ,//~/~ O/ through DUE DATE DUE DATE DUE DATE LENDER INFORMATIO~I SUBTOTALS SCHEDULEB-PART1 I.D. NUMBER CALENDAR YEAR $ OTHER $ CALENOAR YEAR CALENDAR YEAR $ OTHER $ Schedule B - Part I Summary 1. Loans of $100 or more received this period. (Include all Loans Received - Part 1 (a) subtotals.) ................... 2. Amount received this period - unitemized loans of less than $100 ................................................................... 3. Total loans received this period. (Add Lines 1 and 2.) ....................................................................... TOTAL Schedule B - Part 2 Summary 4. Loans of $100 or more repaid, forgiven, or paid by a third party this period. (Include all Part 2 (c) subtotats. If forgiven or paid by a third party, also itemize the transaction on Schedule A.) ............................. 5. Loans under $100 repaid, forgiven, or paid by a third party. (Do not itemize.) If forgiven or paid by a third party, include this amount on Schedule A Summary, Line 2 ...................................................... 6. Total loans repaid, forgiven, or paid by a third party this period. (Add Lines 4 + 5.) ........................... TOTAL 7. Net change this period. (Subtract Line 6 from Line 3.) Enter the net here and on the Summary Page, Column A, Line 2 .......................................................... NET ['Conlributo~ Codes IND - Individual COM - Recipien! Commdtee OTH - Other M~y ~ a neW,ye nurnbe~ FPPC Form 460 (8199) For Tech nlcal Aislstance: 9161322-5660 Schedule B - Part 2 Repayments Made on Loans Received, Loans Forgiven, and Loans Repaid by a Third Party SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Amounta may be rounded to whole dollars. S~e,,~.*,,;. covers period from /--/--O/ through ~~0/ SCHEDULEB-PART2 Page ~___ of/~ IDNUMBER DATE OF REPAYMENT OR FORGIVENESS (d) INTEREST AMOUNT REPAID OR OUTSTANDING INTEREST DATE OF FULL NAME OF LENDER RATE ORIGINAL LOAN FORGIVEN ON PRINCIPAL * PRINCIPAL PAiD (IF CHANGED) TOTAL INTEREST Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ PAID THIS PERIOD $ * IMPORTANT: If any part of a loan is forgiven or repaid by a third party, also itemize the transaction on Schedule A, Enter the amount in column (d) in the Schedule E: including the name and address of the person forgiving the loan or the third party making the payment, and the amount Summary Lkle 3. Do not car~/ this total to the forgiven or paid. Schedule B Summary FPPC Form 460 (B/99) For Technical AasIstance: 9161322-5660 ,rlnt in ink. SCHEDULE B * PART 3 Schedule B - Part :3 Am'o~n~'~'~'~'b~'~Jed Statamentcoversperlod ~nnual Repo~ of Outstanding Loans Received to whole dollars, from ~EE INSTRUCTIONS ON REVERSE dAME OF FILER Attach additional information on appropriately labeled continuation sheets, TOTAL NOTE: This total should be the same amount as entered on the Summaq/ Page, Column C, Line 2. FPPC Form 460 {8199) For T®chnlcal Assistance: 9161322-5660 Schedule C Nonmonetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER DATE FULL NAME, MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE * [] IND [] cou [] OTH [] IND [] COM [] OTH [] IND [] COM [] OTH [] IND [] COM [] OTH Type or print in ink. Amounts may be rounded to whole dollars. S;~;G,,,G,~{ covers period ,,o., /-/-0/ thro.gh IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF ~LF-EMPI-OYEO. EN?ER DESCRIPTION OF GOODS OR SERVICES AMOUNT/ FAIR MARKET VALUE SCHEDULE C Page (~ of /~ LD NUMBER (JAN 1 - DEC 31) JIF APPLICABLE) Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this pedod - nonmonetary contdbutioos of $100 or more. (Include all Schedule C subtotals.) ................................................................................................................... $ 2, Amount received this period - unitemized nonmonetary contributions of less than $100 ................................ $ 3. Total nonmonetary contributions received this period, (Add Lines 1 and 2, Enter here and on the Summary Page, Column A, Lines 4 and 10.) ................... TOTAL $ *Coolributor Codes IND - Individual COM - Recipient Commiltee OTH - O{her FPPC Form 460 (8199) For Technical Assistance: 916/322.5660 Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEEINSTRUCTIONS ON REVERSE Type or print in Ink. Amounts may be rounded to whole dollars. SCHEDULE D ,,om /--/"0/ ,hrouo,, ..0. q o, I NAME OF E LER · CANDIDATE AND OFFICE. DATE MEASURE AND JURISDICTION, OR COMMITTEE [] Suplx~l [] Oppose E~ Support [] Oppose 'P(PB OF PAYMENT ContdbuUo~ Independent Expendik]re Expenditure O uo~ay Co~bufion Contdbu~:m [] Indepe~xlen{ Expenditure DESCRIPTION OF NONMONETARY CONTRIBUTION (IF REQUIRED) [] Support [] Oppose SUBTOTAL S ?0~, ~.~ ID. NUMBER 0o. oO $ $ Other $ CUMULATIVE AMOUNT Calendar Year Other Calendar Year $ Schedule D Summary 1. Contributions and independent expenditures made this period of $100 or more. (include all Schedule D subtotals.) ........................................ $ ~ 2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................. $ ~ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summar~ Page.) ........ TOTAL $ ?.-~f~), ~)0 FPPC Form 460 (8199) For Technical Alslstance: 9161322-5660 Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print In ink. Amounts may be rounded to whole dollars. from through NAME OF FILER CODES: If one of the following codes accurately describes the payment, you may enter the code. OthenNise, describe the payment. CMP campaign par aphemaliaJmisc. CNS campaign consultan{s CTB conlribution (explain nonmonetary )' CVC civic donations FND Irundraising events IND independent expenditure supposing/opposing others (explain)* LIT campaign literature end mailings MTG meetings and appearances DFC office expenses PET petition circulalJng PHO phone banks POL polling and sun~ey research POS postage, deJivepj and messenger services PRO professional services (iogal, accounting) PRT prinl ads RAD radio airtime and production costs SCHEDULE E Page 1("~ of-~- LD. NUMBER RFD relumed contributions SAL campaign workem salaries TEL t.v. o~ cab~ airfime and production costs TRC candidate travel, lodging and moab (explain) TRS stafflspouse travel, lodging and meals (explain) TSF transfer beiween committees ol the same candidate/sponsor VDT voter registraliort WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMIT~IE~:. ~J.$O ENTER ID NUM6ER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Schedule E Summary 1. Payments made this pedod of $100 or more. (Include all Schedule E subtotals.) ............................................................................................... 2. Unitemized payments made this period of under $100 ........................................................................................................................................ 3. Total i,ntarest paid this period on outstanding loans. (Enter amount from Schedule B, Pad 2, Column (d).) ....................................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6,) ......................... TOTAL FPPC Form 460 (itl99) For Technical Assistance: 9161322-5660 Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period NAME OF FILER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign pa raphernalia/misc. CNS campaign consultants CTB contdbulJon (explain nonmonetary)* CVC civic donations FND fundraising events IND independent expenditure suppoding/opposing olhers (explain)' LIT campaign literature and mailings MTG rneelings and appearancas DFC olflce expenses PET petition circulMing PHO phone banks POL polling and survey research POS postage, delive~ and messenger services PRO professional services (legal. accounting) PRT print ads RAD radio aidime and produclien costs SCHEDULE F * Payments that are contributions or independent expenditures must also be summarized on Schedule D. i.D. NUMSER I RFD returned contribu{ions SAL campaign workers salaries TEL t.v. ~ cable aidime and production costs TRC candidate travel, lodging and meals (expiein) TRS slalflspouse travel, lodging and meals (explain) TSF transfer behveen committees of the same candidalelsponsor VDT voler regislration WEB inlon'nation technology cost s (internet, e-mail) I.) {b) (;) Id) NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING SUBTOTALS $ $ $ $ Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ FPPC Form 460 {8199) For Technical Assistance: 9161322-5660 Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) SEE INSTRUCTIONS ON REVERSE NAME F FILER , Type or print in Ink, Amounts may be rounded to whole dollars. SCHEDULE G NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign pa r aphem alia/misc CNS campaign consultants CTB contribution (explain nonmoneta~J)* CVC civic donations FND tundraising events IND independent expenditure suppoding/opposin9 others (explain)* campaign lilerature and mailings MTG meetings and appearances PET peUtion cimulating PHO phone banks POL polling and sun~ey research POS pos~ge, detivery and messenger services PRO professional services (legal. accountiog) PRT print ads RAD radio airfime and produclion cosls * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RFO relur ned contribulion s SAL campaign ~xkers salaries TEL I.v. or cable ai~lime and production costs TRC candidate Iravel. lodging and meals (explain) TRS staff/spouse traveUodging and meals (explain) TSF transfer belween committees of Ihe same candidate/sponsor VDT voler registralion WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAiD Attach additional information on appropriately labeled continuation sheets. TOTAL* * I~o not transfer to any other schedule or to the Summaq, Page. This total may not equal the amount paid to the agent or independent contractor FP PC Form 460 (8199) asreportedonScheduleE. For Technical Assistance: 9161322-5660 Schedule H - Part 1 Loans Made to Others* SEE INSTRUCT~ONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. ,,om F 'OI through ~ SCHEDULE H - PART NAME OF FILER OATE OF LOAN NAME AND ADDRESS OF RECIPIENT (IF COMMITTEE. ALSO ENTER I O NUM6ER) INTEREST RATE DUE DATE AMOUNT *Loans that are contributions to another canclldate or committee must also be summarized on Schedule D. SUBTOTAL $ Schedule H - Part I Summary 1. Loans of $100 or more made this period. (Include all Loans Made - Part 1 subtotals.) ............................................... $ 2. Unitemized loans under $100 made this period ............................................................................................................. $ 3. Total loans made this period. (Add Lines 1 and 2.) .......................................................................................... TOTAL $ Schedule H - Part 2 Summary 4. Payments received on loans of $100 or more. (Include all loan payments received and all loans of $100 or more forgiven by this committee - Part 2 (a) subtotals. If forgiven, also itemize on Schedule E.) ................................................................................................................... $ 5. Unitemized payments received on loans under $100. (Including a forgiveness.) ............................................................................................................................................ $ 6. Total loan payments received this period. (Add Lines 4 and 5.) ........................................................................................................................................ TOTALS 7. Net change this period. (Subtract Line 6 from Line 3. Enler the net here and on the Summary Page, Column A, Line 7.) ................................................................ NET $ FPPC Form 460 (8199) For Technical Assistance: 916/322-5660 Schedule H - Part 2 Repayments on Loans Made to Others and Loans Forgiven BEE INSTRUCTIONS ON REVERSE Type or print in Ink. Amounta may be rounded to whole dollam. Statement covers period through ~/~ ~<::~(~) 1 SCHEDULEH-PART2 NAME OF FILER I.D. NUMBER REPA~ENT OR ~IGINAL FULL NAME OF RECIPIENT OF LOAN OUTST~DING INTEREST RATE {IF CHANGED) AMou.d;~PA,O o. FORGIVEN ON PRINCIPAL* (EXCLUDE RECEIPT OF INTERE$' Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ RECEIVED THIS $ * IMPORTANT~' If any part of a loan is forgiven, also itemize the forgiveness on Schedule E. If a repayment is received Enter the amount in column (b)in the Schedule I Summary. Line 3. Do not carry from a third party, enter the name and address of third party in the ~FULL NAME OF RECIPtENT OF LOAN ' column above, along with the this total to the Schedule H Summary. name of the recipient of the loan, FPPC Form 460 (8199) For Technical Asiistance: 9161322-5660 SCHEDULE H - PART 3 ~,nnual Report of Outstanding Loans Made towholedollars, from ~EE,NSTRUCT,O.S O" REVERSE ,hrou0. ~IAME OF FILER ID NUMBER Attach additional information on appropriately labeled continuation sheets. TOTAL NOTE: This Iotalshouldbe the same amount as entered on Ihe Summary Page, Column C, Line 7. FPPC Form 460 (8199) For Technical Assistance: 9t61322-5660 Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Amounts may be rounded to whole dollar~, FULL NAME AND ADDRESS OF SOURCE NAME OF FILER DATE RECEIVED DESCRIPTION OF RECEIPT Affach additional information on appropriately labeled continuation sheets. SUBTOTAL $ SCHEDULEI I.D. NUMSER AMOUNT OF INCREASE TO CASH Schedule I Summary 1. Increases to cash of $100 or more this period ........................................................................................................... 2. Unitemized increases to cash under $100 this period ............................................................................................... 3. Total of all interest received this period on loans mede to others. (Schedule H, Part 2 (b).) ................................. 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL FPPC Form 460 (8199) For T®chnlcal Assistance: g161322-5660