HomeMy WebLinkAboutBFLAG SEMIANN04(2)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-842165)
SEE INSTRUCTIONS ON RE~¥Ld~iSE ' '
through
1. Type of Recipient Committee: AIICommitte.s - Complete Parts 'l, 2, 3, and4.
[] Officeholder, Candidate Controlled Committee O State Candidate Election Committee
(~ Recall
SGeneral Purpose Commiltee
O Sponsored
'~pS on~itai Ica~ ;n2 ~ t~;rn tCr: imcrr/trot emei t t ee
Type or print in ink.
3. Committee Information
E] Ballot Measure Committee C) Primarily Formed
O Controlled
C) Sponsored
[] Primarily Formed Candidate/
Officeholder Committee
liD NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
STREET
ADDRESS (IF DIFFERENT) NO AND STREET OR PO SOX '
C~TY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4, Verification
Date Stamp
COVER PAGE
Date of election if applicable:
(Month, Day, Year)
Page // of ~
For Official Use Only
2. Type of Statement:
[] Preelection Statement
~ TSe~ rl~i-n~iinou; IS tS~ ta;7~ ~t
~] Amendment (Explain below)
[] Quaderly Statement
[] Special Odd-Year Report
[] Supplemental Preelection
Statement ~ Attach Form 495
Treasurer(s)
NAME TREASURER
CITY
I have used alt reasonable diligence in preparing and reviewing this statemen and to the best of my~'/ l~owledr~eth i~fofFn~Atk ow edge the i tion contained herein and in the
pena,ty of perjury under the laws of the State of California ,hal/he foregoing is tr,,eCa~-kd'*'Ce,r~.~t'~-e~ .~/ ~'
attached
schedules
E ec~ted on ~ By ~ ~ ) '
Campaign Disclosure Statement
Summary Page
SEEINSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
Type or print in ink.
Amounts may be rounded
to whole dollars.
1. Monetary Contributions ...........................................ScheduleA, Line
2. Loans Received ...................................................Schedule B Line
3. SUBTOTAL CASH CONTRIBUTIONS ...................... AddLines 1 +
4. Nonmonetary Contributions ............................... Schedule C One
5, TOTAL CONTRIBUTIONS RECEIVED .......................... AddLines 3 +
EXpenditures Made
6. Payments Made Schedule E, Line
7. Loans Made ...................................................... Schedule H, Line
8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 +
9. Accrued Expenses (Unpaid Bills) ............................ $chedulel~ Line3
10. Nonmonetary Adjustment ......................................... Schedule C, Line
11. TOTAL EXPENDITURES MADE .............................. Add Lines S + g + fO
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summery Page, Line ~6
13. Cash Receipts ................................................. ColumnA, Line3above
14. Miscellaneous Increases to Cash ........................ Schedule 1, Line 4
15. Cash Payments .............................................. ColurnnA Lineaabove
16. ENDING CASH BALANCE .......... Add Lines ~2 + 13 + 14, then subtract Line 15
ff this is a termmahon statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... ScheduleB, Part2
Cash Equivalents and Outstanding Debts
18, Cash Equivalents .................................... Seeinstrucfion$ on rever~e
19. Outstanding Debts ....................... AddLine2+LineginColumnBahove
ColumnA
TOTAL THIS PERIOD
Statement covers period
from /~)" '/' ~'~(
Column B
CALENDAR y~AR
TOTAL TO CATE
To calculate Column 8. add
amounts in Column A to the
corresponding amounts
from Column B of your last
repod. Some amounts in
Column A may be negative
figures that should be
subtracted from previous
period amounts. If this is
the first repod being filed
for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (if
any).
SUMMARY PAGF
Page ~. of '~'-'
NUMBER
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/~ to Dale
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
Date of Election Total to Date
(mm/dd/yy)
--J---J--- $
--J L $
--1---1___ $
--£__/ $
*Since January t, 2001. Amounts in this section may be
different from amounts repoded in Column B.
FPPC Form 460 (Junel01)
FPPC Toll-Free Helpline: 8661ASK-FPPC
Schedule E
Payments Made
SEE ~NSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink,
Amounts may be rounded
to whole dollars.
Statement covers period
from _/cO
through /
SCHEDULF F
Page
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CM° campaign paraphernalia/misc.
CTB contribution (explain nonmonetary)'
CVC civic donations
independent expenditure supporting/opposing others (explain)*
LEG legal defense
UT campaign literature and mailings
I D NUMBER
MTG meetings and appearances
DFC office expenses
PET petition circulating
phone banks
PRO professional services (legal, accounting)
pdnt ads
RAD radio airtime and production costs
I%cO returned contributions
SAL campaign workers' salaries
TEL tv or cable aidlme and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer belween committees of the same candidale/sponsor
VDT voter registration
WEB informalion technology costs (internet, e maiD)
NAME AND ADDRESS OF PAYEE
(~F COMMr~r EE ALSO ENTER I O NUMBER} CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Payments that are contributions or independent expenditures must also be summarized on Schedule O. SUBTOTALS ,, //~,.~,..._...,
Schedule E Summary
1, Payments made this pedod of $100 or more. Cnclude all Schedule E subtotals.) .....................................................................................
2. Unitemized payments made this period of under $100 ..........................................................................................................................................
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ...............................................................................
4. Total payments made this pedod. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars,
Statement covers period
through / ~-- '~/' ~
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, descdbe the payment.
CMP campaign paraphernalia/misc MBR membercommunications
CNS campaign consultants
CTB contribution (explain nonmonetary)*
CVC civic donations
FIL candidate filing/ballot fees
FND fundraising events
independent expenditure supporting/opposing ethers (explain)*
LEG legal defense
MTG meetings and appearances
OFC office expenses
PET petition circulating
PHC) phone banks
POL polling and survey research
lOS peslage, delivery and messenger services
PRO professional services (legal, accounting)
SCHEDULE E (CONT.)
Page
ID. NUMBER
PAD radio airtime and production costs
RFD returned contdbutions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
LIT campaign literature and mailings PAT print ads WEB information technology costs (intemet e-mail)
Payments that are contributions or independent expend tures must also be summarized on Schedule D.
FPPC Form 460 (Junel01)
FPPC Toll-Free Helpline: 8661ASK-FPPC
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print in ink.
Amounts may be rounded
to whole dollars.
through
CODES: If one of the following codes accurately describes the
c~, campaign paraphernalia/misc MBR
CNS campaign consultants MTG
CTB con~ribufion (explain nonmonetary)* QFC
CVC civic donations
F!L
FND
~D
LEG
LrT
PET
candidate flling/ballo~ fees
fundraisin9 events POL
independent expenditure suppoding/opposing others (explain)* POS
lega~ defense PRO
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
SCHEDULE E (CONT)
Page ~ of~__
ID NUMBER
payment, you may enter the code. Otherwise, descdbe the payment.
n~mberoommunicalions RAD radio aidime and production costs
meetings and appearances
office expenses
petition circulaEng
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legat, accounting)
print ads
CODE OR
RFD returned contributions
SAL campaign workers' salaries
t.v or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voler registration
information technology costs (intemet. e-mail)
OESC RIPTION OF PAYMENT
AMOUNT PAiD
~00 ~7 ~
SU.TOT^, s Z ' 00
Payments that are contributions or independent expenditures must also be summarized on Schedule D.
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC