HomeMy WebLinkAboutDICKERSON SEMIANN00(2) ecipient Committee
Campaign Statement
(Government Code Sections 84200-84216.5)
Type or print in ink.
SEE INSTRUCTIONS ON REVERSE
through
1, Type of Recipient Committee: Att Committees- Complete Pads 1, 2, 3, end 7.
[~fficeholder, Candidate [] Primarily Formed Candidate/
Controlled Committee
(Also Complete Part 4.)
[] BalJot Measure Committee
O Primarily Formed
0 Controlled
0 Sponsored
Officeholder Committee
(AI~ complete Part 6J
[] General Purpose Committee
O Sponsored
O Broad Based
I LD. NUMBER
3. Committee Information ~ ~.~ ii ~.-(
COMMITTEE NAME ~ (
STREET ADORESS {NO RO. BOX)
CITY STATE ZIP COOE ,~ AREA CODFJ~HONE
MAILING ADORESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP COOE AREA CODFJPHONE
OPTIONAL: FAX / E-MAIL AI3ORE SS
Date of election if applicable:
(Month, Day, Year)
Date St;m~
FEB --2 Pt'! t2: 5,~
(ERSFiE! D CITY CLER
2. Type of Statement:
[]/~e-election Statement
[~' Semi-annual Statement
COVER PAGE
[] Termination Statement
[] Amendment (Explain below)
Treasurer(s)
[] Quarterly Statement
MAILING ADDRESS
[] Special Odd-Year Report
[] Supplemental Pre-election
Statement - Attach Form 495
STATE ZIP CODE AR A CODFJPHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADORESS
Ci~Y STATE ZIP COOE AREA COOFJPHONE
OPTIONAl.: FAX IE-MAiL AOO~ESS
FPPC Form 460 (8/99)
For Technical Assistance: g!6/3~2.$$60
State of California
Recipient Committee
Campaign Statement
Cover Page -- Part 2
Type or print in ink.
COVER
Page '~' of '~
4. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE / ,
RESlDENTIAL~USINESS ADDRESS (NO. AND STREET) CITY STATE ZI~,
/
Related Committees Not Included in this Statement: Llstanycommlrteea
not included In this consolidated statement that are controlled by you or which are primarily
formed to receive contributions or re make expenditures on behalf of your candidacy.
COMMI~IE E NAME /I.D. NUMBER
CONTROCLED COMMITTEE?
NAME OF TREASURER I~ YES [--1 NO
COMMITI~E ADDRESS
STREET ADDRESS (NO P.O. BOX)
STATE ZIP CODE
AREACODE/PHONE
5. Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LET[ER
IJURISDICTION I [] SUPPORT
I[] OPPOSE
Identify the controlling officeholder, candidate, or slate measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE sOUGHT OR HELD I DISTRICT NO. IF ANY
6. Primarily Formed Committee Llstnamesofofficeholder(s) orcandldare(s)
for which this commlffee Is pr#rmrlly formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT
[] OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
NAME OF OFFICEHOLDER OR CANDIDATE
r-]SUPPORT
[]OPPOSE
[] SUPPOR¢¢
[]OPPOSE
Attach continuation sheets if necessary
Verification
7. enable dili ence in preparing and reviewing th s statement and to the best.e~ rrN I ~/~vledge the information contained herein and in the attached schedules
I have used all teas g ............ , ok^ ~'~te of California/theft) (fpregoing is true and correct.
~s true and complete I certify under penalty el perjury under me ~uwa u, t.,~ ,-,.,~ "]"-/7-//
Executed Da By
DATE
Executed on. By
DATE
SIGNATURE O¢ CONTROLUI~ OFFICEHO~.O~R, CANOIDATE, STATE MEASURE PROPONENT
SIGNATURE OF CONTROU.IH~ OFFICEHOLDER. CANOIDATE, STATE MEASURE P~OPCNENT
FPPC Feint 460 (8/99)
For Technical Assletance: 916/322-5660
State of California
CamPaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts may be rounded
to whole dollars.
through
SUMMARY PAGE
I.D. NU,',~CC~
NAME~RLER
Contributions Received
1. Monetary Contributions ......................................................
2. Loans Received ...................................................................
3. SUBTOTAL CASH CONTRIBUTIONS ................................... AddS.rhea t +
4. Nonmonetary Contributions ............................................... Schedule C, Line
5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 +
Column A
,/
$
Column B' Column C
Expenditures Made
6. Payments Made .................................................................... Schedule E, Line 4
Schedule H, Line 7
7. Loans Made ..........................................................................
8. SUBTOTAL CASH PAYMENTS ................................................ Add Lines S + ?
9. Accrued Expenses (Unpaid Bills) ............................................ Schedule F, Line 3
10. Nonmonetary Adjustment ....................................................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ......................................... Add Lines a + 9 + 10
$
$
Current Cash Statement
12. Beginning Cash Balance ................................ Previous Summary Page, Line t6 $
1 3. Cash Receipts .............................................................. Column A, Line 3 above
14. Miscellaneous Increases to Cash ....................................... Schedule I, Line 4
Column A, Line 8 ebove
15. Cash Payments ............................................................
16. ENDING CASH BALANCE .............. Add Lines 12 + 13 + 14, then subtract Line 15 $
If this Is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................... Schedule B, Part I, Column
$
Cash Equivalents and Outstanding Debts
See instructions on reverse $
18. Cash Equivalents .....................................................
19. Outstanding Debts ................................... AddLine2+LlneginColumnCebove $
· From previous statement Summary Page, Column C. However, if this
is tim first repod filed for the calendar year, Column B should be blank
except for Loans Received (Line 2), Loans Made (Line 7), and Accrued
Expenses (Une 9).
Summary for Candidates in Both June and
November Elections
111 through 6J30 711 to Date
20.
21.
/
Contributions
Received ............
Expenditures
Made ..................
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660
:hc~dule B - Part 3
~nual Report of Outstanding Loans Received
~ ,,., / '/__=~ .. -: ,: ·
~ J ii ii
II
I
4 ttach additional inforroation on appropriately labeled continuation sheets. TOTAL $ /~_~ ~~~
NOTE: T'nl; total ~ukl be
the ~me amount as entered
For Te~hnlrml A~el~tm~e: 9t~2-56G0
THE LAW OFFICES OF
MARK DICKERSON
· ]~LFNGIA. GA
FEB "2 pY P: 55
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