HomeMy WebLinkAboutROBINSON PREELEC98(2) il ice h o I d e r, C a n d i d ate, ~ype o, p,l.t t. t.k.
and Controlled Committee statem~r~,~o.,sp. riod Date Stamp
(Government C~e Se~ons 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE through / ~/~'~'/~/
Check one of the following boxes to indicate the type of statement being filed:
Pre-election Statement
[] Supplemental Pre-eledion Statement (Attach a completed FOrm 495 tO this statement,)
"1 Special Odd-Year Campaign Report
)Semi-annual Statement
Termination Statement (Attach a completed Form 415 to this statement.)
I fficeholder Candidate, and Controlled Committee
Included in t~is Statement
OFFICE SOUGjOR I"ELD (II~UD~ LOCATION AND DISTRICT NUMBER kt APPLICABLE)
..DENT~ OR .u~--" A~;.SS ~ND. A.O
,2-37:i G,I!
CITY STATE ZIP CODE
L ' - ? .,2,
COMMITTEE NAME
COVER PAGE - LONG FORM
Page of __
Date of electionif ~i:~l~i:22 P?'T 2: h 3 Fo, Offici.~ Use
(Month, Day, Year)
BAKEf'~S:i~t_D t:iTY CLERK ~
i i/7/2,[
II Other Committees qot Included in this Statement: ust~,y othe,
commiffees nOt included in this consolidated statement that are controlled by you and any
coma/trees of which you have knowledge that are primarily formed to receive contributions
or to mike exDenditures on behalf of your candidacy.
COMMITTEE NAME ~ I D NUMBER
NAME O~ 1REASURER CONTROLLED COMMITTE
ZiP COOl ARI~A CODE/DAYTIME PHONE
AREA CODE/DAYTIME PHONE COMMITfEE ADDRESS (NO. AND STREET)
I.D. NUMBER CITY STATE
COMMrrrEE NAME I I.D. NUMRER
COMMfrrEE ADDRESS (NO. AND STREET)
CITY STATE ZIP COD[ AREA CON/DAYTIME PHONE NAME OF TREAe, URER CONTROLLED COMMITTEE
] YEs [] ND
NAME OF TREASURER COMMITrEE ADDRESS (NO AND STREET)
PERMANENT ADDRESS OF TREASURER
(NO. AND STREET) CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE
iII
CrPY STALE ZiP CODE AREA CODE/DAYTIME PHONE
Attach additional information on appropriately labeled continua lion sheets.
Verification
0,%4 T/ ,[,C .GNA,.RE,,REA,u .'
An offkehoider or candidate who controls · committee must also verify the campaign statement. I have used all reasonable diligence and tothe best of my knowledge the treasurer has 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.
Executed on At By
DATE CITY AND STATE
Executed on At By
DATE CITY AND STATE
Executed on At By
DAlE CITY AND STATE
SIGNATURE OF CANDIDATEIOFFICEN¢NOER
SIGNATURE OF CANDIDATE/OFFICEH~I. DER
SIGNATURE OF CANDIDATEIOFFICEHOLD[R
FOR tNFORMAT~ON R[Q4JIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICIS AC~ Of 1977. SEE INFORMATION MANUAL ON CAM_~P~iGN DISCLOSURE PROVISIONS OF THe[POLITICAL REFORM ACT
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NANI~OF OFFICEHOL/~DER OR CANDIDATE AND CONTROLLED COMMITTEE
ContribUtions Received
1. Monetary Contributions ............................... Schedu~ A una 3 $
2 Loans Received ......................................... Schedu/e a, Ume 7
3. SUBTOTAL CASH CONTRIBUTIONS ...................... AddUnas I + 2 S
4. Non-monetary Contributions ......................... ScNdule C, Ure 3
5. SUBTOTAL CONTRIBUTlONSi(ExdudeEnforeeblePrombes) AddLines3 ,,4 S
6. Enforceable Promises
(Exclude Loan Guarantees, Une 18 be/ow) ................... Sd'eedule D, Une 7
7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnesS + 6 S
Expenditures Made
8. Cash Payments (Other than Loans Made) ............ Sch,du/e E, Una SS
9. Loans Made ............................................. Sch, d~ H. Line 7
10. SUBTOTAL CASH PAYMENT5 ............................ AddUnes8 + 9 $
11. Accrued Expenses (Unpaid Bills) ........................ ~hed~F, UreS
12. TOTAL EXPENDITURES MADE ......................... AddUn,sl0,, S
Current Cash Statement
13. Beginning Cash Balance .................. Prevtous Summary Page, rjne 17 S
14. Cash Receipts ............................... : ......ColumnA. Une3above
15. Miscellaneous Increases to Cash ........................khedu/, f, Un, 4
16. Cash Payments .................................... Column A, Line 10 above
17. ENDING CASH BALANCE ..... AddUnes l3 ,14 · 15, thensubtretlUne 16 $
If this ts a termination Statement, Line 17 must be xero.
18. LOAN GUARANTEES RECEIVED .............. khedu/e e, Patti, ColumniN S
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................See lnstruc~ons on reverse S
20. Outstanding Debts ................. AddUre2 + Line ff tnColumnCmbove $
Type m, prim in ink.
Amounts may be rounded
to whole doibws.
COlUmn A
TOTAL THIS le~RIOO
fROM ATIACH~D KHEDULES)
7
7
7sv
/~ ~2
'6
f_- ~O
~NBINI CAIH ~ IHOUU)
NOT N A NEGATIVE AMOUNT
Statemeet covers period
from
through
SUMMARY PAGE
m
__]pmg~__ of__ k
I.D. NUMBER
Column C
TOTAL TO DATE
s 75'0
s
* From previous Statement Summary Page, Column C. HOWever, if l
this is the fillt reDoft flied for the calendar yelr. Column B should be
blank except for Loins Received (Line 2), Enforceable Promises (L,ne
6), Loins Mede (Line g), end Accrued Expenses (Llne11). ' '
Summary for Candidates in Both June and
November Elections
111 through 6/30 711 to Date
21. ontrib tions
ece,, ....' 7sv
22. ~a/~e~d!!.u.r.e,! S
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
N~ OF OFFICEHOL~DER OR CANDIDATE AND CONTROLLED COMMITTEE
. i¢r6/ t~u~,,~ s~,,!
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE (w COMMfTrEE, IN ADOfflON TO CCIMMITTEE'S NAME AND ADDRESS, ENTER I.O. NUMIER
RECEIVED o~ It NO I.D. NUMIER HAl IEEN ASSIGNED, ENTER TRIEASURER'S NAME AND ADDRESS)
/~//~/2~
Type or print in Ink.
Amounts may be rounded
to whole doffmrs.
OCCUPATION AND EMPLOYER
(W $ELF-EMR. OYIED, ENTER
NAME Ot BUSINESS)
froIll
Statement covers period
through
AMOUNT
RECEIVED THIS
PERIOD
c/c"c.,~ /_,/9'? ,,... /,--,, :: ',
~ ,
ftfr -/ IL c,~,fi r d'
$UITOTAL $
MOnetary Contribution'~ $urnn~ary
1. Amount received this period -- contributions of $100 or more.
(Include all Schedule A subtotals.) ....................................................................................................
2. Amount received this period -- contri butions of less than $100.
(Do not itemize.) .......................................................................................................................
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................................... TOTAL
SCHEDULE A
Page
I,D. NUMBER
CUMULATIVE TO DATE
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
s 7~"~-c,,o
$ ~
S 7~'*r~-c''o
Schedule E
Payments and Contributions
(Other Than Loans) Made
Type or print in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
E OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
/
CODES FOR C~SSIFYING EXENDITURES
Statement covers period
from
SCHEDULE E
m
through _ ] Page of_
I.D. NUMBER
if one of the following code accurately describes the expenditure, ou may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations o?ecach category.
'C' - MONETARY AND IN-KIND (NON-MONETARY)
CONTRIBUTIONS TO OTHER CANDIDATES
AND COMMITTEES
'1° - INDEPENDENT EXPENDITURES
*L'- LITERATURE
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
(IF COMMITTEE, IN ADDITION TO COMMITTEE'I NAME AND ADDM$$, ENTER I.D. NUMIER 0P,, IF NO I.D.
NUM~R HAS MEN A$SlGN~D. ENTER TMAS4.HIER'S NAME AND
'S" - BROADCAST ADVERTISING
'N'- NEWSPAPERANDPERIODICALADVERTISING
'O° - OUTSIDE ADVERTISING
aS" - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS
'F" - FUNDRAISING EVENTS
"G" - GENERAL OPERATIONS AND OVERHEAD
°T' - TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DE$(RIBED)
'P°- PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
CODE OR
IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON LINE 4 OF THE SUMMARY SECTION BELOW.
DESCRIPTION OF PAtMENT AMOUNT PAID
Im rtant: Contributions and expenditures made out of campaign funds to or on behelf of other SUBTOTAL $
on ~f~'c~holde~, candidates, cornre;trees, or ballot measures must also be entered on the Allocation Page, Part L ; ....
Payments and Contributions Made Summary
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 perlod. (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