HomeMy WebLinkAboutBTC SEMIANN01(3)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE iNSTRUCTIONS ON REVERSE
Type or print in ink.
Dale Stamp
Statement covers period
from ~ _ __
Date of election if applicable:
(Month, Day, Year)0~ ,J
COVEI~ PAGE
Page I of _~.~
For Official Use Only
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
[] Officeholder, Candidate Controlled Committee
O State Candidate Election Committee
O Recall
(Aisc Comp~ate Part 5)
[] Gene ral Purpose Committee (~ Sponsored
0 Small Contributor Committee
O Political Party/Central Committee
[] Ballot Measure Committee
0 Primarily Formed
O Controlled
O Sponsored
~Also Ccmplete Part 6)
[] PdmaHly Formed Candidate/
Officeholder Committee
2. Type of Statement:
[] Preelection Statement
[~ Semi-annual Statement
[] Termination Statement
[] Amendment (Explain below)
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Preelection
Statement - Attach Form 495
3. Committee Information
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO ~OMMITTEE) -
. l
STREET ~RESS (NO P.O. ~OX) ~
CITY , ~ STATE /.~IP CODE AREA CODE/PHONE
MAILING'ADDRESS (IF DIFFERENT) ~O, A~ ~REET OR P.O. ~OX
Treasurer(s)
NAME. OF TREASURER
NAME OF ASSISTANT TREASURER, IF ANY
AREA CODE/PHONE
./, l 7
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/ E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADD~.~
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 lrue and complete. I
certify under penalty of perju~ under the laws of the State of California that the foregoing/,~ true and correct. ~
' ' ~ S/~l~ture ol Treasure~ or Assistant Treasurer
Executed on By
Executed on By
Execuled on By
Recipient Committee
Campaign Statement
Cover Page-- Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Type or print in ink.
COVER PAGE-PART 2
6. Ballot Measure Committee
Page c~ of
NAMEOFBALLOTMEASURE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: List any committees
not included in this stafement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behaff of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
[] YES [] NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITrEE NAME I.D. NUMBER
CONTROLLED COMMITI-EE?
I [] YES [] NO
STREET ADDRESS (NO RD. BOX)
NAME OF TREASURER
COMMITTEE ADDRESS
BALLOT NO. OR LE~FER JURISDICTION
[]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 Committee List names of officeholder(s) or candidate(s) for
which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OEFICE 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 STA3E ZIP CODE AREA CODE/PHONE
Attach continuation sheets J( necessary
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 8661ASK-FPPC
State of Celifornla
Campaign Disclosure Statement
Summary Page
SEE iNsTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
,,om
through
SUMMARY PAGE
NAME OF F
Contributions Received
1. Monetary Contributions ........................................... Schedule A, Line 3
2. Loans Received ......................................................Schedule B, Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ......................... AddLines I + 2
4. Nonmonetary Contributions .................................... ScheduleC, Line3
5. TOTALCONTRIBUTIONS RECEIVED ........................... AddLines3+4
Expenditures Made
6. Payments Made ....................................................... Schedule E, Line 4
7. Loans Made ........... ~ ................................................. ScheduleH, Line7
8. SUBTOTALCASHPAYMENTS .................................... AddLine$6+ 7
9. Accrued Expenses (Unpaid Bills) ............................... ScheduleF. Line 3
10. Nonmonetary Adjustment .......................................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10
Column A Column B
TOTAL THiS PERIOD CALENDAR YEAR
(FROM ATTACHED SCHEDULES} TOTAL TO DATE
0100 D. Oo
Current Cash Statement
12. BeginnJRg Cash BalaRce ....................... Previous Summary Page, Line 16 $
13. Cash Receipts ................................................... Co/umnA, Line3ahove D.
14. Miscellaneous Increases to Cash ........................... ScheduleI, Line4
15. Cash Payments.................................................. ColumnA, Line8above
16. ENDING CASHBALANCE .......... Add Lines 12+ 13+ 14, then subtract Line 15 $ ~ . ~
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... Sch~luleB, Part2
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ See instructions on reverse
19. Outstanding Debts ......................... AddLine2+Lineg~lColurnnBabove
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
carp/over the amounts
from Lines 2, 7, and 9 (if
any).
NUMBER
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/1 to Date
20. Contributions ~(~. ~ $ ~.~
Received $ I;
21. Expenditures I ~.-- $ ~--~.(~
Made $ ~,
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
Date of Election Total to Date
(mm/dd/yy)
/II/ $
L__/ $
*Since January 1, 2001. Amounts in this section may be
different from amounts reported in Column B.
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule A Type or print in ink. SCHEDULE A
Contributions
Amoun~s may De rounaeo Statement covers period
Moneta_ry Received to whole dollars,
,,om iii
SEE INSTRUCTIONS O, REVERSE thro..h /~-J/'~/
IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE
RECEIVED (IFCOMMI~E'ALSOENTER~O NUMBER) COOE * (IFSELF'EMPLOYED.~NTERNAME PERIOD (JAN. 1 * DEC. 31) (IF REQUIRED)
OF BUSINESS)
~IND
D COM
DOTH
~ PTY
D scc
~IND
DCOM
~ OmH
~ PTY
Dscc
D~N~
Dcou
DOTH
~ PTY
D scc
~IND
~ cou
DOTH
~ PTY
D scc
~iNO
Dcou
DOTH
D PTY
Dscc
SUBTOTALS
Schedule A Summary
1. Amount received this period - contributions of $100 or more.
(include all Schedule A subtotals.) ........................................................................................................
2. Amount received this period- 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, Line 1.) ....................... TOTAL
*Contributor Codes
IND - Individual
COM- Recipient Committee
(other than PTY or SCC)
OTH - Other
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (June/Or)
FPPC Toll-Free Helpline: 8661ASKoFPPC
Schedule B - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink,
Amounts may be rounded
to whole dollars.
Statement covers period
,rom
through
SCHEDULE B - PART 1
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTER i.D. NUMBER)
?~-I IND [] COM [] OTH [] PTY
[] SCC
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(iF SE[F-EMPLOYED, ENTER
tl--~ IND [] COM [] OTH [] PTY [] SCC
NAMEOFBUSINESS)
(a)
OUTSTANDING
BALANCE
BEGINNING THIS
PERIOD
(b)
AMOUNT
RECEIVED THI
PERIOD
(c)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD *
[] PAID
$
[] FORGIVEN
[] PAiD
$
[] FORGIVEN
$
[] PAiD
$
[] FORGIVEN
$
(d)
OUTSTANDING
BALANCE AT
CLOSE DE THIS
PERIOD
$
DATE DUE
DATE DUE
(e)
INTEREST
PAID THIS
PERIOD
RATE
RATE
ORIGINAL
AMOUNT OF
LOAN
DATEINCURRED
$ $ $
~[] IND [] COM [] OTH [] PTY [] SCC DATEDUE DATE INCURRED
SUBTOTALS $ $ $ $
(Enter (e) on
Schedule B Summary Scheduk~E. Lin, 3)
1. Loans received this period .................................................................................................................... $
(Total Column (b) plus unitemized loans less than $100.)
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDARYEAR
$
PER ELEC~ION **
$
CALENDAR YEAR
$
PER E£ECTION **
$
CALENDAR YEAR
$
PER ELECTION **
$
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.) ............................................................... NET $
Enter the net here and on the Summary Page, Column A, Line 2. (May~.,~at,v.~m~,l
It Contributor Codes
IND- Individual COM- Recipient Committee (other than PTY or SCC) OTH - Other PTY- Political Party SCC- Small Contributor Committe~
'Amounts forgiven or paid byI
another party also must be
reporled on Schedule A. [
** If required.
I~PPC Form 460 (June/01}
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule B - Part 2 Type :)rint SCHEDULE B-PART?
FULL NAME, STREET ADDRESS AND IF AN iNDIVIDUAL, ENTER
AMOUNT BA~NCE
ZIP CODE OF GUARANTOR CONTRIBUTOR OCCUPATION AND EMPLOYER LOAN GUARANTEED CUMU~TIVE
(IF COMMI~EE, ALSO ENTER I.D. NUMBER) CODE (IF SE~-EMPLOYED. ENTER OUTSTANDING
NAME OF BUSINESS) THIS PERIOD TO DATE TO DATE
~IND LENDER C~ENDAR YEAR
~ COM
/~ ~~ /~ ~OTH DATE PER ELECTION
~ PTY (mF REQUIRED)
D scc
$
CALEND~ YEAR
~IND LENDER
~COM
~ OTH PER ELEC~ON
~ PTY DATE (IF REQU)RED)
~scc
$
CALENDAR YEAR
~IND LENDER
~COM
~ OTH PER ELECTION
~ PTY DATE (IF REQUIRED)
Dscc
~IND LENDER CALENDAR YEAR
~ COM ~ ~
~ PTY (~F REQUIRED)
~scc
SUBTOTAL
$
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule C
Nonmonetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from
through //~ ~,~,./-~/
SCHEDULE C
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND
ZIP CODE OF CONTRIBUTOR
(IF COMMIITEE, ALSO ENTER LD NUMBER)
CONTRIBUTOR
CODE *
I~tND
[~COM
I~OTH
[]PTY
Dscc
r-liND
OCOM
I-3OTH
F-]PTY
~scc
I-lIND
F~CO~
r~OTH
DPTY
Dscc
DIND
DCOM
r~OTH
~PTY
r~scc
Attach additional information on appropriately labeled continuation sheets.
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
DESCRIPTION OF
GOODS OR SERVICES
SUBTOTALS
AMOUNT/
FAIR MARKET
VALUE
LD. NUMBER
CUMULATIVE TO
DATE PER ELECTION
CALENDAR YEAR TO DATE
(JAN I - DEC 3~) (IF REQUIRED)
Schedule C Summary
1. Amount received this period - nonmonetary contributions 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 $
"Contributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other
PTY- Political Party
SCC - Small Contributor Committee
FPPC Form 460 (June/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC
SchedUle D
Summary of Expenditures
Supporting/Opposing Other
Candidates, Measures and Committees
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
,rom
through
Page
SCHEDULE D
I.D. NUMBER
DATE
NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR
MEASURE NUMBER OR LETTER AND JURISDICTION,
OR COMMITFEE
[] Suppo~ [] Oppose
[] Suppo~ [] Oppose
[] Suppo~ [] Oppose
[] Monetary
Contribution
[] Nonmonetary
Contribution
[] Independent
Expenditure
[] Monetary
Contribution
[] Nonmonetary
Contribution
[] Independent
Expenditure
[] Monetary
Contribution
[] Nonmonetary
Contribution
[] Independent
Expenditure
DESCRIPTION
(iF REQUIRED)
SUBTOTAL $
CUMULATIVE TO DAT
AMOUNT THIS CALENDAR YEAR
PERIOD (JAN 1 - OEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
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 per[od 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 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from
SCHEDULE F
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
~ campaign paraphernalia/misc.
CNS campaign consultants
CTB contribution (explain nonmonetary)*
CVC civic donations
FIL candidate filing/ballot fees
FND fundraising events
IND independent expenditure supporting/opposing others (explain)"
LEG legal defense
UT campaign literature and mailings
I.D. NUMBER
MBR member communications
IV[TG meetings and appearances
OFC office expenses
PET petition circulating
PHO phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
Ff~T print ads
RAD radio airtime and production costs
P, FD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
WEB information tachnoiogy costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE* ALSO ENTER I.D NUMBERI CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS
Schedule E Summary
1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $
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 (Juna/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule F
Accrued Expenses (Unpaid Bills)
SEE iNSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statem(~t covers period
from [.' 3(~' I~
Page
SCHEDULE F
LO. NUMBER
CODES: If one of the following codes accurately describes the
QV~ campaign paraphernalia/misc. MBR
CNS campaign consultants
CTB contribution (explain nonmonetary)*
CVC civic donations
RL candidate filing/ballot fees
FNO fundraising events
IXID independent expenditure suppoding/opposing others (explain)*
LEG lega~ defense
payment, you may enter the code. Otherwise, describe the payment.
membercommunications RAD radio airlime and production costs
MTG meetings and appearances
(3CC office expenses
PET petition circulating
PHO phone banks
POL po[ling and survey research
POS postage, delivery and messenger services
P~O professional services (legal, accounting)
RFD returned contributions
SAL campaign workers' salaries
TEL t,v. or cable airtime and production costs
candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer belween committees of the same candidate/sponsor
VOT voter registration
LIT campaign literature and mailings PRT print ads WEB informalion technology costs (internet, a-mail)
(a) {bi (c) (d)
NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING
{IF COMMITTEE, ALSO ENTER ID. NUMt]ER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE
OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD
must also be
summarized on Schedule D. SUBTOTALS $ $ $ $
Schedule F Summary
1. Total accrued expenses incurred this period. (Include all Schedule F, Column (bi 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 $
May be 8 negalive number
FPPC Form 460 (June/01)
FPPC Toll-Free Help#ne: 866/ASK-FPPC
Schedule G
Payments Made by an Agent or Independent
Contractor (on Behalf of This Committee)
Type or print in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF AGENT OR INDEPENDENT CONTRACTOR
Statement covers period
from_.
thro.gh t;;L-8
SCHEDULE
I.D. NUMBER
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
C~P campaign paraphernalia/misc. MBR membercommunications RAD radio airtime and production costs
CNS campaign consultants
contribution (explain nonmonetary)·
CVC civic donations
FIL candidate filing/ballot fees
fundraising events
IND independent expenditure suppoding~opposing others (explain)'
LEG legal defense
UT campaign literature and mailings
MTG meetings and appearances
O~C office expenses
PET petition circulating
R-lO phone banks
POL polling and survey research
POS postage, delivery and messenger services
FRO professional services (legal, accounting)
PR]' pdnt ads
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
RFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meats
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE OR CREDITOR
(IF COMMITTEE. ALSO ENTER ID. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
'~'~'~' additional information on appropriately labeled continuation sheets. TOTAL* $
· Do 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 as repotted on Schedule E. FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule H
Loans Made to Others*
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
FULL NAME, STREET ADDRESS AND ZIP CODE
OF RECIPIENT
(~F COMMITTEE, ALSO ENTER I.D NUMBER)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF,EMPLOYED, ENTER
NAME OF BUSINESS)
*Loans that are contributions to another candidate or committee
must also be summarized on Schedule D. Loans forgiven must
also be reported on Schedule E.
Type or print in ink.
Amounts may be rounded
to whole dollars.
(a) (~)
OUTSTANDING AMOUNT
BALANCE LOANED THIS
BEGINNING THIS
PERIOD PERIOD
$
SUBTOTALS
(c)
REPAYMENT OR
FORGIVENESS
THIS PERIOD*
[] PAID
$
[] FORGIVEN
$
[] PAID
[] FORGIVEN
S[a;.=ment covers period
,rom
OUTSTanDING (e)
INTEREST
BALANCE AT
CLOSE OF THIS RECEIVED
PERIOD
$
$
DATE DOE
$
RATE
DATE DUE
$
Page
ID. NUMBER
ORIGINAL
AMOUNTOF
LOAN
DATE INCURRED
DATE INCURRED
SCHEDULEH
(s)
CUMULATIVE
LOANS
TO DATE
CALENDAR YEAR
$
PER ELECTION~
CALENDAR YEAR
$
PER ELECTION **
Schedule H Summary
1. Loans made this period .................................................................................................................................................. $
(Total Column (b) plus unitemized loans less than $100.)
2. Payments received on loans ........................................................................................................................................... $
(Total Column (c) plus unitemized payments less than $100.)
3. Net change this period. (Subtract Line 2 from Line 1.) ........................................................................................ NET $
(Enter the net here and on the SummaP/Page, Column A, Line 7.)
(Emer (e) on
Schedule I, Line 3)
'*If Required
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
S{a;.=.,ent covers period
SCHEDULEI
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE, ALSO ENTER I.D NUMBER)
DESCRIPTION OF RECEIPT
I.D. NUMBER
AMOUNTOF
INCREASETOCASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
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 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
Summary Page, Line 14.) ........................................................................................................................... TOTAL $
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 8661ASK-FPPC