HomeMy WebLinkAboutDICKERSON 460 SEMIANN22Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
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1. Type of Recipient Committee: All Committees —Complete Parts 1, 2; 3, and 4.
[x"'Officehotder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
0 State Candidate Election Committee Committee
O Recall O Controlled
(Also Complete Port5) O Sponsored
(Also Complete Par! 5)
❑ General Purpose Committee
O Sponsored ❑ Primarily Formed Candidate/
O Small Contributor Committee Officeholder Committee
O Pofitical.Party/Central Committee (Also Compiete Part 7)
3. Committee Information
I.D. NUM
NO MMITTE )
C:Zjk
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREACODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and
certify under penalty of perjlfyu der the laws of the State of California that the fon
Executed on
to
Executed on ate !� ^� By
COVER PAGE
Date Stamp
Date of election if applicable: Page tl of
—
(Month, Day, Year) For Official Use Only
A
2. Type of StoSgMpt� i C L iJ 1L' i I 'r, C[ (_
❑ Preelection Statement ❑ Quarterly Statement
ES' Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file 6:Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
t��NAME OF TREAStI
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREACODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS
of my knowled i�lformation contained herein and in the attached schedules is true and complete. I
to and cores /
or
�omwnin9 ........ rruponent or rw5pu-1— uincer or sponsor
Executed on By
Dale Signature of Controlling Officeholder. Candidate, Stale Measure Praponent
Executed on By
Date signature. of Controlling Officeholder, Candidate, State Measure Proponent 'P>`
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/775-3772)
www.fppc.ca.gov
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICE OLDER OR CAN rIDATIE
OFFICE SOUGHT OR HEL[)(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP
Related Committees Not Included in this Statement: List any 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
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.U. BUX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME
I.D. NUMBER
NAME OF TREASURER I CONTROLLED COMMI I I EE?
❑ YES ❑ NO
COVER PAGE - PART 2
Page of
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER 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 Candidate/Officeholder Committee Listnamesof
officeholder(s) or candidate(s) for which this committee is primarily formed.
i
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary
NAME OF OFFICEHOLDER O CANDIDATE
SOUGHT OR HELD
IFFICE
O�
SUPPORT
1
❑ 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
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
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t
Amounts may be rounded
to whole dollars.
Stateme f co,prs period
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SCHEDULE E
w
Page_ ,,.._•._ of
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
PET
office expenses
circulating
SAL
TEL
campaign workers' salaries
t.v. or cable airtime and production costs
CVC
FIL
civic donations
candidate filing/ballot fees
PHO
petition
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 supportinglopposing 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
WEB
information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
sa." 1-N2:1
l - �
* CIIRTO Al $
Payments that are contributions or independent expenditures muss also be summarized on Schedule D. a
b
Schedule E Summary p
1. Itemized payments made this period. Include all Schedule E subtotals..........••...•.......•..••...................•••••.......••.......••• $
2. Unitemized payments made this period of under$100...........................................................................................................................I....I......... $ �7
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 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE B - PART 1
Schedule B — Part 1 Vtowho{edollars.
1 �'OV, S_ erioc
460
Loans Received
from —,`r "`�' If ,
• -
SEE INSTRUCTIONS ON REVERSE
through 2�
Page of
NAMEOF FILER
I.D. NrUUMBE}Rf
0 1.
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
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
(IF COMMITTEE. ALSO E TER I.D. NUMBER)
(IF SELF-EMPLOYED, ENTER
NAME OF BUSINESS)
BEGINNING THIS
PERIOD
PERIOD
THIS PERIOD •
CLOSE OF THIS
"'RIOD
PERIOD
LOAN
TO DATE
�*�f
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION
' `
RATE
2
t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
DATE INCURRED
DATE DUE
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION-
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY [:I SCC
$
$
$
$
$
DATE DUE
-
DATE INCURRED
t
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION;
RATE
DUE
DATE INCURRED
tEl IND ❑ COM ❑ OTH El PTY El SCC
}DATE
SUBTOTALS $ $ $
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 $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) .............................
Enter the net here and on the Summary Page, Column A, Line 2.
'Amounts forgiven or paid by another party also must be reported on Schedule A.
"` If required.
.......................................$ —�
.......................................$ �lJ'
NET $ �``
(May be a negative number)
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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 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov