HomeMy WebLinkAboutDICKERSON SEMIANN02(1) c- ipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216,5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
St. t em ent c.)~ve?s period
from . I1 /
1. Typ~ Recipient Committee: AII Committees - Complete Pa~ls l, 2, 3. and4.
{~'Officeholder, Candidate Controlled Committee [] Ballot Measure Committee
O State Candidate Election Committee O Primadly Formed
(D Controlled
O Sponsored
[] Primarily Formed Candidate/
Officeholder Committee
(~) Recall
[] General Purpose Committee O Sponsored
O Small Contributor Committee
O Political Party/Central Committee
3. Committee Information ILb' NUMB~-~ii/ ~_..(
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO,COMMITTEE) j
Date of election if
(Month, Day, Year)
Date Stamp
02
COVER PAGE
Page / of~:~__._
For Olficlal Use Only
2. Type of Statement:
~] Pre~lection Statement
L~emi-annual Statement
[] Termination Statement
[] Amendment (Explain below)
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Preelection
Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
MAILING ADDRESS
NAME OF ASSISTANT TREAS~IER. IF ANY
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF I~IFFERENT) NO. AND STREET OR P.O. SOX MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZiP CODE AREA C'ODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
4.
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my know edg~ythe/t~rmi~on contained herein and in the is true and complete. I
Verification
certify under penalty of perjury u~.der/the laws of the State of California that the foregoing is true and correct. ,,//ii ~/ attached schedules
Executed on / o -z -
By
Executed on
Date
Executed on
ny
By
Sig~atureof C~l~O~ficehoider, Candldate, Stat® Measu~ePropomml FPPC Form 460 (June/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
Recipient Committee
Campaign Statement
Cover Page-- Part 2
Type or print in ink.
COVERPAGE-PART2
Page ~ of ~
5. Officeholder or Candidate Controlled Committee
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STAT ZIP
Related Committees Not included in this Statement: List any committees
not included in this statement that are controlled by you or ere primarily formed to receive
contributions or make expenditures on behaff of your candidecy.
COMMITTEE NAME I.D. NUMBER
NAM E OF TREASURER CONTROLLED COMMITTEE?
[] YES [] NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX
CITY STA3E ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITrEE?
[] YES [] NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX
CITY STALE ZIP CODE AREA CODE/PHONE
6. Ballot Measure Committee
NAMEOFBALLOTMEASURE
BALLOT NO. OR LE3q'ER 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. IE 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 OFFICE SOUGHT OR HELD [] SUPPORT
OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ;r-"l
SUPPORT
[] OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD I-~
SUPPORT
[] OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT
[]
OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (June/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
State of California
Campaign Disclosure Statement
Summary Page
SEEINSTRUCTiONS ON REVERSE
Typo or print in ink.
Amounts may be rounded
to whole dollars.
NAME OF FILER
Contributions Received
1. Monetary Contributions ........................................... Schedule A. Line 3
2. Loans Received ...................................................... Schedule B. Line 7
3. SUBTOTALCASH CONTRIBUTIONS ............ : ............ AddLines I +2
4. Nonmonetary Contributions ................ . ................... ScheduleC. Line 3
5. TOTAL CONTRIBUTIONS RECEIVE[3 ......... : ................. AddLines 3 + 4
Statement/co/v/ers period
from /,////(~ ~--
Column A Column B
TOTN. THIS PERIOD CALENOAR YEAR
(FRO~I ATTACHED SCHEDULES) TOTALTO DATE
$ $ ~.~
Expenditures Made
6. Payments Made ......... ~...._.: ..................................... ScheduleE, Line4 $
7. Loans Made ............................................................. Schedule H. Line 7
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7
9, Accrued Expenses (Unpaid Bills) ............................... Schedu/eF, Line3
10. Nonmonetary Adjustment .......................................... Schedule C. Line 3
11. TOTAL EXPENDITURES MADE ................................ AddLInes8+9+10
Current Cash Statement
12. Beginning Cash Balance ....................... PreviousSummaryPage. Line 16
13. Cash Receipts ........................................... :.;::..' 'CotumnALin¢A~ve
14. Miscellaneous Ir~c_r,e, ases to Cash ............sc~ule L Line
15 Cash Payment~';~' :,~A~?A ~n ~,~ , ~ ColumnA Llne8above
16. ENDING CASH BALANCE .......... Add Lines 12 + 13+ 14. then subtract Line 15
If this is a termination statement, Line 16 must be zero.
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 fimt report being tiled
for this calendar year. only
carry over the amounts
fmm Unes 2, 7, and 9 (if
any).
17. LOAN GUARANTEES RECEIVED ........................... s~edu/ee. Pe~t2
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ See instructkms on reverse
19. Outstanding Debts ......................... AddLine2+Llne9inColumnBabove
SUMMARY PAGE
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
20. Contributions
Received
Expenditures
Made
1/1 through 6/30 7/1 to Date
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made'
Date of Election Total to Date
(mm/dd/yy)
__J / $
__l / $
__J / $
__! /.__ $
__L__J $
*Since January 1. 2001. Amounts in this section may be
different from amounts reported in Column B.
FPPC Form 460 (June/01)
FPPC Tofi-Free Helpline: 8661ASK-FPPC
· Schedule B- Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement c~ve7 period
from
through ~//'~/~) ~----
NAME OF FILER
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMM[TFEE. ALSO ENTER I.D. NUMBER)
IF AN INDIVIDUAL, ENTER
t[] IND [] COM [--I OTH r-I PTY [] SCC
t[] IND [] COM [] OTH [] PTY [] SCC
OCCUPATION AND EMPLOYER
(IF SELF~MPLOYED, ENTER
NAM~ OF BUSINESS)
Amounts may be rounded
to whole dollars.
(b)
AMOUNT
RECEIVED THIS
PERIOD
(c)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD *
[]PAID
$
[] FORGIVEN
$
[] PAID
$
[] FORGIVEN
$
[]PAID
$
[] FORGIVEN
$
OUTST(,~N) DING
BALANCE AT
CLOSE OF THIS
PERIOD
$
DATE DUE
DATE DUE
(e)
INTEREST
PAID THIS
PERIOD
RATE
RATE
Page
SCHEDULE B - PART 1
I.D. NUMBER
ORIGINAL CUMULATIVE
AMOUNTOF CONTRIBUTIONS
LOAN TO DATE
(a)
OUTSTANDING
BALANCE
BEGINNING THIS
PERIOD
DATE INCURRED
DATE INCURRED
CALENDAR YEAR
$
PER ELEC'RON **
$
$ $ $
t[] IND [] COM [] OTH [] PTY [] SCC DATEDUE DATE INCURRED
SUBTOTALS $ $ $ $ ,~,
Schedule B Summary (E.,~(.)o~
1. Loans received th s per od ....... $ ~
(Total Column (b) plus unitemized leans leas 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.) ................................................ NET $
Enter the net here and on the Summary Page, Column A, Line 2.
It Contributor Codes
IND-Individual COM - Recipient Committee (other than PTY or SCC)
OTH - Other PTY - Political Party SCC - Small Contributor Committee/
*Amounts forgiven or paid by~
another party also must be
reported on Schedule A.
"" If required, j
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Information on appropriately labeled continuafion sheets. TOTAL $ /~
NOTE: ~Ns
CO~nn C, LIM R ~ F~ ~ ~
MARK DICKERSON
USA USA