HomeMy WebLinkAboutDICKERSON SEMIANN00(1) ecil~|ent Committee
Campaign Statement
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Typo or print in ink.
Statemen/t co?~re Period
1. T. yp/.~of Recipient Committee: A, Committees-Complete Parts 1, 2, 3, andT.
['l;l"Offlceholder, Candidate [] Primarily Formed Candidate/
Controlled Committee
(Also Complete part 4.)
[] Ballot Measure Committee
O Primarily Formed
O Controlled
O Sponsored
(A/so Complete Part 5.)
Officeholder Committee
(Also Complete Part 6.)
[] General Purpose Committee
Date of election if applicable:
(Month, Day. Year)
Date Stamp
AUGI5 PH[~:I5
COVER PAGE
2. Type of Statement:
aeCtion Statement
nnual Statement
[] Termination Statement
Page / of ~>
For Official Use Only
O Sponsored
O Broad Based
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Pre-election
Statement - Attach Form 495
3. COmmittee Information
STREET ADDRESS (NO P.O. BOX)
crTY STATE ZIP COOE
/
MAILING AODRESS (iF DIFFERENT) NO. AND STREET OR P.O. BOX
AREA CODE/PHONE
TreasUrer(s)
MAILING ADDRESS
CITY STATE ZIP COOE AREA CODEJPHONE
NAME OF ASSISTANT T: iEAT~ R. IF ANY
MAIUNG ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
CiTY STATE ZIP COOE AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS
OPTIONAL: FAX/E-MAIL ADDRESS
FPPC Form 480 (8/00)
For Technical Assletmme: 0'16/3~2,~660
State of California
, Typo or print in ink.. COYER PAGE- PART 2
Recipie. nt Committee : - /.'~' ~ -
Campaign Statement ~ [o~J]
Cover Page :. Part2 ~
4. Officeholder or Candidate Controlled Committee
NAME 0F FFICEHOLDER OR CANDID
OFFICE SOUGHT 0R I~LD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL/~USINES S ADDRESS (NO. AND STREET) CITY STATE ZIP
not Included In this Consolidated statement fha t are controlled by you or which are primarily
formed to receive contributions or to make expenditures on behalf of your candidacy.
COMMITTEE NAME
NAME OFTREASURER
LD. NUMBER
CONTROLLED COMMITTEE?
[] YES [] NO
CCMMITTEE ADDRESS STREET ADDRESS (NO P.O. BO~
CITY STATE ZIPCODE
7. Verification
5. Ballot Measure Committee
NAMEOFBALLOTMEASURE
BALLOT NO. OR LETTER I JURISDICTION : [] supporT
I [] OPPOSE
Identl(y the con~'olling officeholder, candidate, or state measure proponent, if any.
: NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD DISTRICT.NO. IF ANY ~
6[: Primarily Formed Committee Llstnamesofofficeholder~s)orca~dldate(s)
for which thll committee Is prlmsrlly formed.
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE
Attach continuation sheets if necessary
OFFICE SOUGHT OR HELD
[] ~UPPORT
[] dpPOSE
OFFICE SOUGHT OR HELD [] SUPPORT
[] OPPOSE
OFFICE SOUGHT OR HELD [] ~UPPORT
: [] OPPOSE
have used all reasonable diligence in preparing and reviewing this statement and to the best of my know~lec~§fflhe information contained herein and in the attached schedules
is true and complete, !:cmlify, under penalty of perjury under the laws of the State of California that ~,l~f~/~p~ng is true and correct. ~
By
SleNATURE OF CONTROUJNG OFFICEHOLDER, CN~DIDATE, STATE MEASURE P~OR RESPONSIBLE O~ICER OF SPONSOR
By
Executed On" ~I~/'7~Z4~0
Executed on
Ex~ut~ on
By
FPpc Form 450 (8/99)
For Technical A. etetance: 916/322-5660
~ State of California
Camp~aign Disclosure Statement
Summary Page
Type or print in ink.
Amounts may be rounde¢l
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
1. Monela,-y Contributions ...................................................... Schedule A, Line 3
2. Loans Received ................................................................... Schedule S, Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines I + 2
4. Nonmonetary Contributions ............................................... Schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................... AddLines 3 + 4
Expenditures Made
6. Payments Made .................................................................... Schedule E, Line 4 $
7. Loans Made .......................................................................... Schedule H, Line 7
8. SUBTOTAL CASH PAYMENTS ................................................Add Lines 6 + 7
9. Accrued Expenses (Unpaid Bills) ............................................ Schedule F, Line 3
10. Nonmonelary Adjustment ....................................................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ......................................... Add Lines a + 9 + to $.
Cur~unt Cash Statement
12. Beginning Cash Baiance ................................ Previous Summary Page. Line 16
] 3, Cash Receipls .............................................................. Column A, Line 3 above
14. Miscellaneous Increases to Cash ....................................... Schedule l, Line 4
15. Cash Payments., ......................................................... Column A, Line 8 above
16. ENDING CASH BALANCE .............. Add Lines 12 + 13 + 14, then subtract Line 15
ff this is a termination statement, Line 15 must be zero, .,.
17. LOAN GUARANTEES RECEIVED ................... Schedule e, Part I, Column (b)
Cash Equivalents and Outstanding Debts
'/8. Cash Equivalents ............................. see Instructions on te~'e~e $.
19. Outstanding Debts ................................... Add Line 2 + Line 9 In Column C above $.
lq,
/
SUMMARY PA~F
COlumn B*
TOTAL PREVIOUS PERIOD
1.0. NUMBER
Column C
TOTAL TO DATE
(COLUMNS A + E)
$
except tot Loans Received (Line 2), Loans Made (Line ?), and Accrued
· From previous stateruenl Summary Page, Colurun C. However, If this
Is Ihe first report ~iled for the calendar year, Colurun B should be blank
Expenses tUne 9).
Summary for Candidates in Both June and
November Elections
111 through 6/30 71! (o Date
20. Conlributions
Received ............ $ · (:~ ~
21. Expenditures ~ ,_~.
Made .................. $
' FPPC F~m 4~0
For Technical Assistance: 91~22-5660
Schedule B - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE:
Type or print In ink.
Amounts may be rounded
to whole dollars,
Stetemen~/o~_rs period
from
NAME OF FILER
DATE
RECEIVED
FULL NAME~ MAILING ADDRESS AND ZIP CODE
OF LENDER OR GUARANTOR
(IF COMMITTEE~ ALSO ENTER I.O. NUMBER)
[] Lender ;Fi Guarantor
[] Lender [] Guarantor
[] Lender [] Guarantor
CONTRIBUTOR
CODE *
[] iND
[] COM
[] OTH
I-J IND
[] COM
[] OTH
IF AN INDIVIDUAL, ENTER
OCcUpATION A~[~ EMI~LO~ER
(IF SELF-EMPLOYEO. ENTER
NAME OF BUSINESS)
LENDER INFORMATION
INTEREST RATE OF LOAN
DUE DATE
INTEREST RATE
DUE DATE
INTEREST RATE
SCHEDULE B - PART 1
I.D, NL~MBER
GUARANTOR NFORMAT ON
CUMU~TIVE
TOD~E
CALENDAR YEAR
$
OTHER
CALENDAR YEAR
$
OTHER
(b)
AMOUNT
GUARANTEED
[] IND
~1COM
[] OTH
DUE DATE
CALENDAR YEAR
OTHER
OTHER
CALENDAR YEAR
$
· SUBTOTAL
Enter (b} ~1
Schedule B ~ part1 SUmmary
1. Loans of $100 or more received this period. (Include all Loans Received - part 1 (a) subtotals.) ................... $
2. Amount received this period - unitemized loans of less than $100 ........ ,.....;....;i~ ........................................... $
3. Total loans received this period. (Add Lines I and 2.) ................................. ;;~ ................................... TOTAL $
Schedule B - Part 2 ~Summary -:-
4. Loans of $100 or mote repaid, forgiven, or paid by a third party this peried. (InclUde all Part 2 (c)
subtotals. If fO~'giveh Or paid by a third party, also itemize the transaction on SchedUle A.) ............................. $ ,/~-'T--
5. Loans under $100 repaid, forgiven, or paid by a third party. (Do not itemize.) If forgiven or
paid by a third party¢ include:this amount on Schedule A Summary, Line 2, .,,,~,,~,..,~.,,~,,~,,,.,,....., ........ ,; ........ ; $ ~ t IND-In~iividual
J c(~M ~ I~Pie~nt C°mmittee
6. Total loans repaid, forgiven, or paid by a third party this period. (Add Lines 4 + 5.) ........................... TOTAL $ ~/Z''~O43 ~''-''- L OTH- Other
7. Net change this pedod. (Subtract Line6 fromLine 3.)
Enter the net here and on the Summary Page, Column A, Line 2 .......................................................... NET $
ForTechn ce Assistance: 916~22-5660
Schedule B - Part 2
Repayments Made on Loans Received, Loans
Forgiven, and Loans Repaid by a Third Party
Type or print in ink.
Amounts may be rounded
to whole doltsrs,
EB~PART2
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
DATE OF ' '
REPAYMENT D.~TE OF
OR ORIGINAL LOAN
FORGIVENESS , ·
FULL NAME OF LENDER
: INTEREST
RATE
(i~ CHANGED)
(C)
AMOUNT REPAID OR
FORGIVEN ON PRINCIPAL*
[EXCLUDE PAYMENT OF INTEREST)
OUTSTANDING
PRINCIPAL
(d)
INTEREST
PAID
Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL $
* IMPORTANT: If any part of a loan is forgiven or repaid by a third party, also itemize the transaction on Schedule A,
including the name and address of the person forgiving the loan or the third party making the payment, and the amount
forgiven or paid.
TOTAL INTEREST'
PAID THIS PERIOD $
Enter the arnount ln ~olumn (d) in b~e Schedule E
Summa~ Une 3.'DO ~cany ihls total to the
Schedule B Summary.
For TechnlcM A~ g~nCe: 916/322-5650
Schedule B - Part 3 Typo or print in Ink. · ~' ~sCHEDUI .E B- PART 3
Attach additional information on appropriately labeled continuation sheet& TOTAL $ ~'~_~>'~
the same amount as entered '
on ~fle Summaq/ Page,
ColurnnC, Une2. FPpC Form 460 (8/99)
For Techn Cai AS,,ISt~ih~e: 916~322,5660
MARK DICKERSON
ATFORNEY AT LAW
BAKERSHZLD, CA 93301