HomeMy WebLinkAboutPATIENTS FOR COMPASSIONATE SEMIANN13(2)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 84216.5)
Type or print in ink. Date Stamp
Statement covers period Date of election if applicable:
(Month, Day, Year)
from
[�
( .. 21 J
SEE INSTRUCTIONS ON REVERSE I through ( -'��%C VAX
1. Type of Recipient Committee: All committees - 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
(A Completepert5)
Sponsored
(AlsoCompktePart6)
General Purpose Committee
Q Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
0 Political Party /Central Committee
(Also Comp/ete Part 7)
3. Committee Information
I.D. 7 ; :2�
COMMITTEE NAME (ppR CANDIDATE'S NA IF NO COMMITTEE)
U'5
Treasurer(s) -- C y
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and knowledge the inf m on ontain herein and in the attached schedules is true and com fete. I certify
under penalty of perjury under a la of a State of California that the fore g ' g is true and correct. ----Vl
/��
Executed on By �. "`
Sg ture ofTreasurerorAssaiantT asurer
r3� 141"(' 414J5
Execute
Dam
Executed on
Dam
Executed on
Dam
By �'_ p �fl�tClJr
S' ignature o4Cordroging „OfficeFwlder, Candidate, State Measure Proponent orResporeible Officer ofSponsor (.� (' n/
B Y (� i
By _--�
By
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)
State of California
Attachment to California Form 460 for Patients For Compassionate Use
Policies ID# 1332436
For period: July 1, 2013 - December 31, 2013
c-..
RE: 3. Committee Information & 4. Verification
Dege Coutee was acting treasurer during the above reporting period and
has signed the verification section of the enclosed report. Jennifer Nicoletto
became acting treasurer as of January 15, 2013, and appears as the current
treasurer as of the filing of this report.
I�
P
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
nn-,,
Amendment
List I.D. number:
❑ Termination — See Part 5
List I.D. number:
Date qualified as committee Date qualifed as committee Date of Termination
(u applicable)
Ireasurer a
NAME TREASUREI
STREET DDRESS
CITY
NAME ASSISTAN T
Date Stamp
�%f � &� --Z)
For MIA Use Only
I have used all reasonable diligence in preparing this statement and t e of my nowledge the information contained herein Is true and complete. I certify under
penalty of perjury u der he laws of the Stat is that t� g is tr and correct.
Executed on gy
TE SIGNA SURER OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OFCONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on BY
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec /2012)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
9
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFIQ'EHOLDER OR CANDIDATE
Type or print in ink.
RESIDENTIAL /BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
a;��d Ad,(w46
Pxzk--� Page
6. Primarily Formed Ballot Measure Committee
NAME
7/IMEA-SURE
BALLOT 40. O
IN❑OPPOSE
LETTER
JURISDICTION
Related Committees Not Included in this Statement: Listany committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAMEC7ZR EASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS TADDRESS (NO P.O. BOX)
CITY STATE ODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBE
NAME OF TREASURER CONTROLLED COMMITT ?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
Identify the controlling officeholder;
COVER PAGE - PART 2
Of
❑ SUPPORT
❑ OPPOSE
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 candidates) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
IN❑OPPOSE
T*U4g OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
e
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDA
OFFICE SOUGHT OR HELD
❑ SUPPORT
`
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR
❑ SUPPORT
P OSE
Attach continuation sheets if necessary
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612753772)
State of California
Campaign Disclosure Statement
Type or print in ink.
SUMMARY PAGE
Summary Page
Schedule H, Line 3
Amounts may be rounded
to whole dollars.
Add Lines 6 + 7 $
Statemen colors period
CALIFORNIA
460;
10. Nonmonetary Adjustment ........... ...............................
Schedule c, Line 3
11. TOTAL EXPENDITURES MADE . ...............................
Add Lines 8 + 9 + 10 $
from
SEE INSTRUCTIONS ON REVERSE
through
Page of
NAME OF FILER,
I.D. NUMBER
Contributions Received
Column A
Column B
Calendar Year Summary for Candidates
TOTALTHISPERICD
(FROM ATTACHED SCHEDULES)
CALENDAR YEAR
TOTALTODATE
Running in Both the State Primary and
00
aL
General Elections
1. Monetary Contributions ............ ...............................
schedule A, Line 3
$ $
2. Loans Received ....................... ...............................
schedule a, Line 3
Z
1/1 through 6/30 7/1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS .........................
Add Lines l +2
$ * $
20. Contributions �..,_
$= v�$
4. onmonetary Contributions ..... ...............................
Schedule c, Line 3
/557-
Received
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................
Add Lines 3 + 4
$ $
qz ago
_ ti
Made $ $
Expenditures Made
6. Payments Made ........................ ...............................
Schedule E, Line 4 $
7. Loans Made .............................. ...............................
Schedule H, Line 3
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 $
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ k xi
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 $
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ _
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ......... ............................... See instructions on reverse $
19. Outstanding Debts ......................... Add Line 2 + Line 9 in column 8 above $
E '24_
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).
Expenditure Limit Summary f r State
Candidates
22. Cumulative Expend Liras Made*
(If Subject to Voluntary Expenditure Limit)
at.e of Election Total to Date
(m
1— , $
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 (86612753772)
Schedule A Type or print in ink. SCHEDULE A
Amounts may be rounded S
Statement co ers eriod
• -
ff
from -
. 1
SEE INSTRUCTIONS ON REVERSE t
through P
Page Of
OF FI ER I
I.D. NUMBER
DATE F
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR C
CONTRIBUTOR I
IF AN INDIVIDUAL, ENTER A
AMOUNT C
CUMULATIVE TO DATE P
PER ELECTION
OF BUSINESS)
One Yoh �0 �1 `QIV ' ❑
❑COM
TH
❑ PTY f
f/
i3
[
[]SCC
/3 C
C'ci!C (ns , r o
o�oM
[
❑PTY �
�%260
[:]SCC
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.) ......
....................... $ E
....................... $ J
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/06)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/276 -3772)
Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.)
monetary Contributions Received Amounts may be rounded
to whole dollars.
Statement covers period
J
from
through Jl
Page of
NAM ILER '
�4 ���
�( 0'0 r� Q. t a Ct
I.D. NUMBER
�3 ` -S(P
DATE
RECEDED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
( IFCOMMITTEE ,ALSOENTERI.D.NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IFSELF- EMPLOYED, ENTER NAME
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
OF BUSINESS)
�n
La+
El SCC
V1 O1 1W ^
✓" �(
❑ COM
❑ PTY
Qw'li
E] SCC
❑COM
❑ PTY
j C�
❑ SCC
r
❑COM
PTY
Cf
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTALS
'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 (8661276.3772)
SCNFnI1LP R _ PORT I
acneauie t3 — roan i Amouuntnt may may be rounded
Statement covers period
Loans Received to whole dollars.
� '
0
from
"-4—
SEE
�,/"1
22
INSTRUCTIONS ON REVERSE
through
of
OF
OF FILER
�� X 1 04.
� �� � r>ti a� ��SQ r c �S
I.D. NUMBER
3Co
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
a
OUTSTANDING
BALANCE
AMOUNT
AMOUNT PAID
OUTSTANDING
INTEREST
ORIGINAL
CUMULATIVE
OF LENDER
(IF COMMITTEE, ALSO ENiERI.D.NUMBER)
(IF SELF- EMPLOYED, ENTER
BEGINNING THIS
RECEIVED THIS
OR FORGIVEN
BALANCEAT
CLOSE OF THIS
PAID THIS
AMOUNT OF
CONTRIBUTIONS
NAMEOFBUSINESS)
PERIOD
THIS PERIOD"
PERIOD
LOAN
TO DATE
❑ PAID
$
%
$
CALENDAR YEAR
$
f.
❑FORGIVEN "�
RATE
PER ELECTION"°"
to IND ❑ COM ❑ OTH ❑PTY ❑ SCC
DATE INCURRED
"' - -...
DATE DUE
^�
CALENDAR YEAR
$
�$'—
%
$
❑ FORGIVEN
PER EL N
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑.SCC
TE INCURRED
_
DATE DUE
r^�
❑ PAID
CALENDARYEAR
❑ FORGIV
RATE
««
PER ELEC
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
$
$
$
$
$
DATE DUE
DATE INCURRED
SUBTOTALS $ $ $ $
7
Schedule B Summary
1. Loans received this period ................................... ...............................
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ............................... ...............................
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) ................
Enter the net here and on the Summary Page, Column A, Line 2.
"Amounts forgiven or paid by another party also must be reported on Schedule A.
" If required.
............... $
.............. I...... NET $ 2
(May WiMgative number)
(tmer (e) on
Schedule E, Line 3)
tContributor 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/06)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275-3772)
Schedule C Type or print in ink. SCHEnuI F c
nnmuunas may oe rounaeo
onmonetary Contributions Received to whole dollars.
Statement covers pew
-- - -- -
, .
. 1
from /?,
SEE INSTRUCTIONS ON REVERSE
through
Fpage / of
DAME OF FILER/
T'� 00 '
I.D. NUMBER
8 2
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND
ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONCODE *OR
CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
DESCRIPTION OF
GOODS OR SERVICES
AMOUNT/
FAIR MARKET
VALUE
CUMULATIVE TO
DATE
CALENDAR YEAR
PER ELECTION
TO DATE
(IF REQUIRED}
NAME OF BUSINESS)
(JAN 1 -DEC 31)
-,
�;��
� 0,1 t l_
`
❑IND
❑COM
�1 �r�
" (
❑SCC
l
�
EJIND
❑COM1ti
�TM
PTY
r
(�
[:1
❑SCC
/
❑-]COM
JC20TH
/
❑SCC
/3
lY
,
❑SCC
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule C Summary
1. Amount received this period — itemized nonmonetary contributions.
(Include all Schedule C subtotals.) ...................................................................................... ............................... $
2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..... ............................... $
3. Total nonmonetary contributions received this period. 2 J
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ 2✓ /
'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 (8661276 -3772)
ichedule C Type or print in ink. SCH-EDA&ELC
Amounts may be rounded Statement covers period
14onmonetary Contributions Received to Whole dollars. CALIFORNIA ,
from
•- •
EE INSTRUCTIONS ON REVERSE through Page of 21
NAME OF FILEJR I.D. NUMBER
IF AN INDIVIDUAL, ENTER AMOUNT! CUMULATIVE TO PER ELECTION
FULL NAME, STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE
DATE OCCUPATION AND EMPLOYER FAIR MARKET TO DATE
RECEIVED ZIP CODE AL CONTRIBUTOR CODE * (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR
(IF COMMITTEE, ALSO ENTER I. D. NUMBER) NAME OF BUSINESS) (IF REQUIRED)
(JAN 1 -DEC 31)
o O � �
��
oscc
❑Scc �
❑IND
(�
❑SCC U
❑IND
❑ COOT M �c
❑SCC
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
ci 0
,14-0,Ut
"Contributor Codes 1
IND — Individual
COM — Redplent Committee
(other then PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (January/05)
Helpline: 8661ASK•FPPC (8661276 -3772)
Schedule C
Type or print in ink.
SCHEDULE C
mmounis may De rounaea
Nonmonetary Contributions Received towholedollars.
Statement covers period
CALIFORNIA ,
•- •
from
through
Page _J�__. of
3EE INSTRUCTIONS ON REVERSE
LAME OF FILER
I.D. NUMBER
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND
ZIP CODE AL CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, S)
NAME OF BUSINESS)
DESCRIPTION OF
GOODS OR SERVICES
AMOUNT!
FAIR MARKET
VALUE
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN 1 -DEC 31)
PER ELECTION
TO DATE
(IF REQUIRED)
��
Ac lWit C.,
❑IND
OCOM1
[3 PTY
(�t
(l
C^✓�
/C iIN
y
�
[3 SCC
z
00
[3oTH
OPTY
�►`
�ltQ�( -�
[]SCC
/l MO?411 Y4
V
/
l
Ci��ll/Kr
��
[3Com
[30TH
[3PTY
❑ PTY
�
❑scc
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
*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)06)
Helpline: 8661ASK -FPPC (8661275 -3772)
ichedule C
Type or print in ink.
SCHEDULE C
4onmonetary Contributions Received
Amounts may be rounded
to whole dollars.
Statement covers period ,
•
1
l .
from _
through Pager of�
EE INSTRUCTIONS ON REVERSE
i_AME OF FILEJR
��c`� /%/�., �� O i �'�
�i`°�tJ � l.t' /�Cit�VC lJ`-' .✓t
l �1..— ��
I.D. NUMBER
( �� C ��
DATE
FULL NAME, STREET ADDRESS AND
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
DESCRIPTION OF
AMOUNT!
FAIR MARKET
CUMULATIVE TO
DATE
PER ELECTION
TO DATE
RECEIVED
ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE *
(IF SELF•EMPLOYED,ENTER
NAME OF BUSINESS)
GOODS OR SERVICES
VALUE
CALENDAR YEAR
(JAN 1 - DEC 31)
(IF REQUIRED)
OM Aut ^ .
❑OTH
❑PTY ��,�� �(/ /C
,
]I ND
/ [:]Com
❑SCC
❑IND
QP/1� [3Com
.26M LV scu
[3scc OPTY
�^� ❑ IND
C d' r [3Com�� s
[:]PTY
� $cc 0
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ r
*Contributor Codes
IND— Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Poiitical Party
SCC — Small Contributor Committee
FPPC Form 460 (January/05)
Helpline: 8661ASK -FPPC (866/276 -3772)
Schedule C Type or print in ink. SCHEDULE C
Amounrs may ne rounaea
Nonmonetary Contributions Received to whole dollars.
Statement covers Period III
l
CA LIFORNIA
• -
from
through
page of .y
'EE INSTRUCTIONS ON REVERSE
LAME OF FILER
I.D. NUMBER
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND
ZIP COgE, AL CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
NAME OF BUSINESS)
DESCRIPTION OF
GOODS OR SERVICES
AMOUNT/
FAIR MARKET
VALUE
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN 1 - DEC 31)
PER ELECTION
TO DATE
IF REQUIRED)
c4"faaX0
❑ ❑CO M
❑ PTY
%
EISCC
C
EICOM
❑0TH
❑PTY
scc
z
Q�l -
oG
❑ P
`
❑$CC
U
OIND
TH
r-JPTY
3,
❑scc
Y
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ R Z�
*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 (Januaryl06)
Helpline: 8661ASK -FPPC (8661278 -3772)
Schedule C
Nonmonetary Contributions Received
Type or print in Ink.
Amounts may be rounded
to whole dollars.
Statement covers period CALIFORNIA
.
from
1
through ZE Page of
tAME OF FILER I.D. NUMBER
c� t` '41k ` C Coo r � � ��e .2-
DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF DESCRIPTION OF AN INDIVIDUAL, ENTER AMOUNT/ CUMULATIVE TO PER ELECTION
OCCUPATION AND EMPLOYER FAIR MARKET DATE TO DATE
RECEIVED ZIP CODE CONTRIBUTOR CODE * GOODS OR SERVICES CALENDAR YEAR
(IF COMMITTEE, ALSO ENTER 1. D. NUMBER) pFSELF - EMPLOYED, ENTER VALUE (IF REQUIRED)
/ NAME OF BUSINESS) (JAN 1 - DEC 31)
❑INDl�iQ
QCOM
QsCC
n % QIND
c�c ( QCOM
2errH
QPTY
QSCC �S
Q IND
QCOM
❑ OTH
[]SCC
QIND
❑COM
_ _ ❑oTH
Q PTY
Q SCC
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
"ConMbutor Codes
IND — individual
COM — Recipient Committee
(other then PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Politloal Party
SCC — Small Contributor Committee
FPPC Form 460 (January/05)
Helpline: 888 1ASK -FPPC (886/275 -3772)
Schedule D
n _ _ -- -- _ -- v — SCHEDULED
Sufi ma OT Expenditures Type or print in ink.
Supporting/Opposing Other Amounts may be rounded
to whole dollars.
Candidates, Measures and Committees
Statement covers period
from
- --
•' J • ,
•
SEE INSTRUCTIONS ON REVERSE
through 3
/�,
Page 1 .
N F FILE F_^ I
I.D. NUMBER
DATE
NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR
MEASURE NUMBER OR LETTER AND JURISDICTION,
OR COMMITTEE
TYPE OF PAYMENT
DESCRIPTION
(IF REQUIRED)
AMOUNT THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN.1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
❑ Monetary
'
Contribution
❑ Nonmonetary
Contribution
[] Independent
❑ Support ❑ Oppose
Expenditure
❑ Monetary
Contribution
❑ Nonmonetary
Contribution
❑ Independent
❑ Support ❑ Oppose
Expenditure
❑ Monetary
Contribution
❑ Nonmonetary
Contribution
❑ Independent
❑ Support ❑ Oppose
Expenditure
SUBTOTAL $
Schedule D Summary
1. Itemized contributions and independent expenditures made this period. (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 Summary Page.) ............ TOTAL $
FPPC Form 460 (January/06)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/2764772)
Schedule E Type or print in ink.
Amounts may be rounded Statement covers period • - ,
Payments Made to whole dollars. • - • '
from
SEE INSTRUCTIONS ON REVERSE through z
N F FILE ® I.D. NUMBER
C) rX 0&93b 1101;""04e
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment
CMP
campaign paraphernalia /misc.
MBR
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
PE?
petition circulating
TEL
t.v. or cable airtime and production costs
FIL
candidate filing/ballot fees
PHO
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
Lrr
campaign literature and mailings
PRT
print ads
WEB
information technology costs (intemet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ ZV `/Y
Schedule E Summary I
1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................... ........................ .I...... $
2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $
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 $
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/2753772)
SCHEDULEF
Schedule F Type or print in ink. Stateme t c vers period CALIFORNIA
Amounts may be rounded 460
Accrued Expenses (Unpaid Bills) to whole dollars. fro m •'
through Page of
SEE INSTRUCTIONS ON REVERSE
NAMt-QF,FILERj
I.D.NU�
IE4 (?0 I/kPW&�5(Vka �VYn '
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CUP
campaign paraphemalia /misc.
MBR
member communications
RAID
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
FIL
candidate filing/ballot fees
PHO
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 CREDITOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR
DESCRIPTION OF PAYMENT
(
OUTSTANDING
BALANCE BEGINNING
OF THIS PERIOD
(
AMOUNT INCURRED
THIS PERIOD
(
AMOUNT PAID
THIS PERIOD
(ALSO REPORT ON E)
(
OUTSTANDING
BALANCE AT CLOSE
OF THIS PERIOD
. Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $
summarized on Schedule D.
Schedule F Summary
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.).......
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.)
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and
on the Summary Page, Column A, Line 9.) ................................................................. ...............................
............ INCURRED TOTALS $
i
i
....................... PAID TOTALS $
.... NET $
May be a negative number
FPPC Form 460 (January /05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)
Schedule G Type or print in ink. SCHEDULE G
Payments Made by an Agent or Independent Amounts may be rounded State t c vers period • -
Contractor (on Behalf of This Committee) to whole dollars. from • - '
v
through L11V Page o
SEE INSTRUCTIONS ON REVERSE
NA LER / ( I.D. UMBER
C)�* 0
NAME OF AGENT OR INDEPENDENT CONTRACTOR
/nom, , r / h
�_--
CODES: If one of the following codes accurately describes the payment, you may enter the code.
Otherwise, describe the payment.
CMP
campaign paraphemalia /misc.
MBR
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
FIL
candidate filing/ballot fees
PHO
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
Lrr
campaign literature and mailings
PRT
print ads
WEB
information technology costs (intemet, e-mail)
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
NAME AND ADDRESS OF PAYEE OR CREDITOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
Attach additional information on appropriately labeled continuation sheets. TOTAL* $
* Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or
independent contractor as reported on Schedule E.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
SCHEDULE H
Schedule H Type or print in ink.
Statem t c vers period
, • ,
Amounts may be rounded
• ,
Loans Made to Others* to whole dollars.
from
•
SEE INSTRUCTIONS ON REVERSE
through
Page of
N F FILE _ J
g 0
I.D. NUMBER
c1a
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(a)
OUTSTANDING
BALANCE
(b)
AMOUNT
(c)
REPAYMENT OR
(d)
OUTSTA DING
BALANCE AT
(e)
INTEREST
M
ORIGINAL
(9)
CUMULATIVE
OF RECIPIENT
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
(IF SELF- EMPLOYED, ENTER
BEGINNING THIS
LOANED THIS
PERIOD
FORGIVENESS
CLOSE OF THIS
RECEIVED
AMOUNT OF
LOAN
LOANS
TO DATE
NAME OF BUSINESS)
PERIOD
THIS PERIOD"
PERIOD
El PAID
CALENDAR YEAR
FORGIVEN
RATE
PER ELECTION "
DATE DUE
DATE INCURRED
PAID
CALENDAR YEAR
$
%
$
$
FORGIVEN
RArE
PER ELECTION "
$
$
$
$
$
DATE DUE
DATE D
"Loans that are contributions to another candidate or committee
must also be summarized on Schedule D. Loans forgiven must SUBTOTALS
$
$
$
$
also be reported on Schedule E.
Schedule H Summary _
1. Loans made this period ................................... ...............................
(Total Column (b) plus unitemized loans of less than $100.)
2. Payments received on loans ............................ ...............................
(Total Column (c) plus unitemized payments of less than $100.)
3. Net change this period. (Subtract Line 2 from Line 1.) ...................
(Enter the net here and on the Summary Page, Column A, Line 7.)
(Enter (e) on
Schedule I, Line 3)
..... ............................... $
........................... NE ( m
ber
" "If Required
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (886/2764772)
SCHEDULFI
Miscellaneous Increases to Cash Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from
through
CALIFORNIA
• FORM
Page,� of
cam. Ilse
I.D. NUMBER
133-04Y4
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
DESCRIPTION OF RECEIPT
AMOUNT OF
INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets.
Schedule I Summary
Itemized increases to cash this period ..... ...............................
2. Unitemized increases to cash of under $100 this period ....................................... ...............................
3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ..........
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
SummaryPage, Line 14.) ..................................................................................... ...............................
TOTAL
SUBTOTAL $
FPPC Form 460 (January /05)
FPPC Toll -Free Helpline: 666 /ASK -FPPC (866/275 -3772)