HomeMy WebLinkAboutBFLAG SEMIANN99(1) ecipient Committee
Campaign Statement -- Long Form
(Government Code Sections 84200-84216.5)
Type or print in IdL
SEE INSTRUCTIONS ON REVERSE
~J Pre-election Statement ~Semi~annual Statement
[:~ Special Odd-year Camplign Report
[] Supplemental Pre-election Statement (Attach a completed Form 495 to this Statement.)
i'1 Termination Statement (Attach a completed Form 41S to this statement.)
Statement covers period
Date ~ e~ ~ a~
(~, ~V, Year)
~COVER PAGE - LONG FORM
For Official Use Only
Committee Information
NAME OF COMMITTEE
AIX)~SS O~ COMMITTEE tINO. AND STREEt) J I.O. NUMIIR
} 8 ; ss
~ ~
~A~SS ~ T~R ~. AND St~i~
~Y STATE Z~ CODE ~A C~~ ~
(Check Boxes) See definitions and important information on reverse.
Is this a sponsored committee? .................. I~ Yes r-1.0
is this a broad based political committee? ......... G]ve. [] me
II Verification
II
Primarily Formed Committee (See 'det;initi'on on~everse:i"
NAME Ot CAND~ATE(~) OR O~FK'THOLI~R6)
CHECK CleW
CESOUGI4TOIIH~LD
AtMch additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained
herein and in the attached schedules is true and complete, I certify under penalty of perjury under the laws of the State of California that the foregoing is true
and correct. ,
CITY AND SLATE
Executed on At
R. If REQUIRED
fOR INFORMATION REQUIRED TO BE PROVII~D TO YOU PUI~UANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAl. ON CAMPAIGN DiSCLOS_~RI~rR~,_VIJION~S~Qr ~THE POLITICAL REFORM ACT
Schedule A
Monetary Contributions Received
TypecxWinti~ink.
Amounts ruby be rounded
to whole dollars.
5BE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE e, COMMITTEE, IN AIX)FTION TO COMMITTrEE'e, NAME AND ADOREIS, E~IER I.D. NUMI~R
RECEIVED op, · eo ~,O- NUMNe HAS NEe ASS4GN~D, emTe feE~sueee's NAMe ANO AOOeESS)
Monetary Contributions Summary
OCCUPATION AND EMPLOYER
(fir S~LF-EMPt0YED, ENTER
NAME Of IIUgNES$)
StBtemfvt covers period
through ~' 3~'*~ ..
AMOUNT
RECEIVED THIS
PERIOD
SUBTOTAL
SCHEDULE A
I.D. NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
1. Amount received this period -- contributions of $100 or more.
(Include all Schedule A subtotals.) ........................................................................... -: $ _//~2~O, ~
-2. Amount received this period --contri butions of less than $100.
(Do not itemize.) ........................................................................................... S ~
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) .............................. TOTAL $ //,'~/--~O. o~
Recipient Committee
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
Contributions Received
1. Monetary Contributions ............................... Schedde~, Une3 $
2. Loans Received ......................................... Schedde e, Une 7
3. SUBTOTAL CASH CONTRIBUTIONS ...................... AddUnes I, 2 $
4. Non-monetary Contri butions ......................... Schedule CUne
S. SUBTOTAL CONTRIBUTIONS (Exclude Enforceable Promises) AddLines3 + 4 $
6. Enforceable Promises
(Exclude Loan Gueraneees, Line I I below) ................... Schedule D, LIne 7
7. TOTAL CONTRIBUTIONS RECEIVED
Expenditures Made
8. Cash Payments (Other than Loans Made) ............ SchecAde E, Une S
9. Loans Made ............................................. Schedde H, Um 7
10. SUBTOTAL CASH PAYMENTS ............................ AddUntie · 9
11. Accrued Expenses (Unpaid Bills) ........................ Schedule F, Une
12. TOTAL EXPENDITURES MADE
Current Cash Statement
13. Beginning Cash Balance .................. Previous Summary Page, Line 17
14. CaSh Receipts ...................................... ColurnnA, LlneJabove
15. Miscellaneous lncreases to Cash ........................
16. Cash Payments .................................... ca~unm A, Une f0 above
17. ENDING CASH BALANCE ..... Add Ltnes l]t ~ 14 + lS, then subtract Une16
ff this iS a termination statement, Line f 7 must be zero.*
18 LOAN GUARANTEES RECEIVED .............. Schedule B, Part I, Column (13) $
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................ see instructions on reverse $
20. Outstanding Debts ................. AddLine 2 + Line 11inColumnCabove $
TypeeWiminML
Amounts may be rounded
to whek doffmrs.
Column A
TOTAL THI~
(FROM ATTACHED SCHEDUtE5)
/t~ec. -
//~:D, oo
/7~,
O
ENDING CASH IALARCE giOUtD
NOT BE A NEGATNE AMOUNT
Statemere covers period
from /--/- F~
throufh ~; ~ r ~ f
Column B*
TOTAL IPR~VI01.~
($EE NOTE NL0'W)
SUMMARY PAGE
iPaee ~
ID, NUMBER
Column C
TOTAL TO DATE
(kDD COLUM~ A · I)
$
S
S
* From previous Statement Summer/Page, Column C. However, if
this is the first report filed for the calendar year, Column B should be
blank except for Loans Received (Line 2), Enforceable Promises (Line
6), Loans Made (Line 9), and Accrued Expenses (Line 11 ).
Summary for Non-Controlled Committees
Primarily Formed to Support or Oppose
Candidates in Both June and November
Elections
1/1 through 6/30 711 to Date
21 Contrib tions
· Rece~v~4~ .... s
22. $
Recipient Committee Tyeo,.,k.k,N. ALLOCATION PAGE
Allocation Page
to whole dollaR. ~;
from /'/' ¢~
re,D, NUMBER
List contributions and independent expenditures that total $100 or more made to support or oppose off/ceho/ders, candidates, ballot measures, or committee~
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
DATE NAME OF OFFICEHOLDER OR CANDIDATE AND OFFICE, OR NAME OF CUMULATIVE TO DATE
MEASURE AND BALLOT NUMBER OR LETTER. OR NAME OF COMMITTEE CHECK ONE IND. AMOUNT THIS
EXP,* PERIOD
IF OTHER THAN OFFICEHOLDER, CANDIDATE, OR MEASURE COMMITTEE SU~OnT OPPOS~
*See reverse regarding independent expenditures. SUBTOTAL
Allocation Summary
1. Contributions and independent expenditures of $100 or more made this period.
(Include all Allocation Page subtotals.) ......................................................................
2. ~ontributions and independent expenditures under $100 made this period.
(Do not itemize.) .........................................................................................
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Attach additional information on appropriately labeled continuation sheets.
3. Total contributions and independent expenditures made this period.
(Do not carry this to the Summary Page.) ............................................................ TOTAL
Schedule E
(Continuation Sheet)
Payments and Contributions
(Other Than Loans)Made
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
'C'-
MONETARY AND IN. KIND (NON-MONETARY) ' 8' -
CONTRIBUTIONS TO OTHER CANDIDATES *N* -
AND COMMITTEES *0o _
INDLePENDENT EXPENDITURES °S° _
LITERATURE "F* -
Type of pdnt in ink.
Amounts may be rounded
to whole doeart
Statement covers period
from /'/' q~
'G"-
-p- _
~hroll~
CODES FOR CLASSIFYING EXPENDITURES
BROADCAST ADVERTISING
NEWSPAPER AND PERIODICAL ADVERTISING
OUTSIDE ADVERTISING
SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS
FUNDRAISING EVENTS
SCHEDULE E (cont.)
p,~, ~ of .
I.D. NUMBER
H
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIIUTION
(IF COMMrrTEE, IN AN)rrlON TO COMMrrTEE~ N~M! AND ADDREe,$. l~l"lll I.D. NUMIER O~ (~ NO I.D.
NUMN~R HAS I~EN AS~GNED, ENT~R TRIASUg~R'S NAME AND ADDIIES*,)
CODE
G
C
OR
DESCRIPTION OF PAYMENT
AMOUNT PAID
~/~/,//
/ 6t~ o, o ~3
SUBTOTAL
Schedule E
Payments and Contributions
(Other Than Loans) Made
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
TypecH'prlntifiink.
Amountsmeyberounded
towhekdoearso
CODES FOR CLASSIFYING EXPENDITURES
Statement covers I~riod
,,0, / -/- ¢~
SCHEDULE E
Page. et __
I.D, NUMBER
If one of the following codes accurately describes the expenditure, may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations oefYce~h category.
"C" - MONETARY AND IN-KIND (NON-MONETARY) "B" -
CONTRIBUTIONS TO OTHER (ANDIDATES · N" '-
AND COMMITTEES "O' -
'1" - INDEPENDENT EXPENDITURES "S" -
'L'- LITERATURE "F"-
BROADCAST ADVERTISING 'G" -
NEWSPAPER AND PERIODICAL ADVERTISING "T" -
OUTSIDE ADVERTISING
SURVEYS, SIGNATURE GATHERING, DOOR-TO-OOOR SOLICITATIONS 'P* '
FUNDRAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
8f COMMITTEE, IN ADOITKI/t TO COMMITII:E~ NAME AND ADOtlS$o !IfiIR I.O. NUMIIR OR, IF NO tO,
NUMIER HAS IIIN ASSIGNED, INTER TRIASURIR'S NAME AND ADnRE$S)
IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
REPORT ONt, Y THE LUMP SUM OF SUCH PAYMENTS ON UNE 4 OF THE SUMMARY SECTION BELOW.
CODE OR
DESCRIPTION OF PAYMENT
Impor{ant: Contributions and expenditures made out of campei n funo~ to or on behalf of off/ceho/ders,
candidate, committees, or betlot measures rnu~ also be ~nter~ the Allocation Pap. SUBTOTAL $
Payments and Contributions Made SummaW
1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ...................................................... $
2. Payments made this period of under $100. (Do not itemize.) ....................................................................... $
3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part II, Column (d).) ..............................$
4. Total accrued expenses paid this period. (Do not itemize. Enter amount from Schedule F, Line 4.) ..................................... $
5. Total payments made this period. (Add Lines 1,2, 3, and 4. Enter here and on the Summary Page, Column A, Line 8.) ........... TOTAL $
AMOUNT PAID
27,~.6/
'75'2 .,-/,?
I / ~;. e~
O
¢/7,t,c,' 7