HomeMy WebLinkAboutTATUM PREELECTION20(1)Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 7~ / _ .2 OZ 0
through
/o? — 3 % --2 a 2 a
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
[►Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
0 State Candidate Election Committee Committee
0 Recall 0 Controlled
(Also Complete Part 5) Q Sponsored
(Also Complete Part 6)'
❑ General Purpose Committee
0 Sponsored ❑ Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part 7)
3. Committee Information
I.D. NUMBER / y 3 0 9 /f
67re 9 o rL, . 7a
STREETRES�(
STATE ZIP CODE ARE CODE/PHONE
.
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREACODE/PHONE
OPTIONAL: FAX/E-MAILADDRESS
•d
COVER PAGE
Date Stamp
Date of election if applicable: Page of —
(Month, Day, Year)For Official Use Only
20 CT 2 I °i� 2� 3 d
2. Type of Statement:
M Preelection Statement
Quarterly Statement
Semi-annual' Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Kr% ster» Dih ki`ks
MAILING
��<
CITY/ SyT�ATE
%
NAME OF ASSISTANT TREASURER, IF ANY
10 / 09 -
MAILING ADDRESS
'V
CITY STATE
ZIP CODE AREACODE/PHONE
OPTIONAL: FAX/E-MAILADDRESS
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.
certify under penalty of perjury under the laws of the State of California that the foregoing is true
Executed on /O -02 / — 2 O By
s Date _ Sig ature of Treasurer or Assistant Treasurer
Executed on By
Date Signature of Co (ling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fooc.ca.gov
G
AF
Schedule A Amounts may be rounded SCHEDULE A
LU wnoie uooars.
Monetary Contributions Received
Statement covers period
CALIFORNIA , 1
from
O- .
through 42- .- 3 / oy
Page of
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER// �� �� C
I D NUMBER
a
DATE
FULL NAME, STREETADDRESS AND ZIP CODE OF
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
RECEIVED
CONTRIBUTOR
CODE *
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDARYEAR
TO DATE
(IF COMMITTEE,ALSO ENTER I.D. NUMBER)
(IF SELF-EMPLOYED, ENTER NAME
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
Sv ��� ���Gq
JKIND
OM
�/�y
60 . D -Z>
266.6-0
7-,20
El SCC
l�tis; h esr
Kelr n S LQ vlcl Cr 1
❑ IND
L�,.v►�
�QO. �6
goo-
(�•�033a�'
El PTY
El SCC
/yrs BOG9
�- f �29`,aYt��
s au^ W'9El
El IND
O
pR C.
0Ou ✓1 C l 1 IP19C�
El OTH
D (�yGh .Lc111�S
❑PTY4--✓
El SCC
9
0 06, as
y, d 0 G.
WIND
❑COM
4`!__1F Etnp
��
❑ OTH
❑ PTY
El SCCZ
F6
dG.
❑ IND
❑ COM
❑ OTH
❑ 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 $
30
""300
.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 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fooc.ca.eov
SCHEDULE B - PART 1
ren wunw u y r+
Schedule B — Part 1 to whole dollars.
Statement covers period
- 1
NIA
Loans Received
-7— .104 OCALIFO
•
ORM
from
SEE INSTRUCTIONS ON REVERSE
through
Page of
NAME OF FILER
I.D. NUMBER
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
OUTSTANDING
BALANCE
AMOUNT
RECEIVED THIS
AMOUNT PAID
OR FORGIVEN
OUTSTANDING
BALANCE AT
INTEREST
PAID THIS
ORIGINAL
AMOUNT OF
CUMULATIVE
CONTRIBUTIONS
OF LENDER
(IF COMMITTEOFL E ENTER I.D. NUMBER)
(IF SELF-EMPLOYED, ENTER
BEGINNING THIS
PERIOD
THISPERIOD-
CLOSE OF THIS
PERIOD
LOAN
TO DATE
NAME OF BUSINESS)
PERIOD.
PERIOD
❑ PAID9
/P 6Ny 7u
P S7r a
$ go. �
�/ qo, o-6$ALENDAR
$
YEAR
RATE
�� �
❑FORGIVEN
PER ELECTION
DATE DUE
DATE INCURRED
to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
PAID
CALENDAR YEAR
$
$
Y
$
$
❑ FORGIVEN
PER ELECTION-
RATE
t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
$
$
°/
$
$
❑ FORGIVEN
PER ELECTION"
RATE
DATE DUE
DATE INCURRED
t ❑ IND ❑ COM [_1 OTH [_1 PTY El SCC
SUBTOTALS $ gC%O,. 0,A_ $ $ $
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.
................................... $
................................... $
.......... NET $
tcn[er ted on ocneuure c, une aj
qqa-05
9yL9. 4:7�
(May be a negative number)
1'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 (Jan/2016))
FPPC Advice: advice@fppc.ca-gov (866/275-3772)
www.fppc.ca.gov