HomeMy WebLinkAboutSMITH 460 PREELECT12(2)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Date Stamp
Statement covers period Date of election if applicable:
from U / 1 / zU' z_ (Month, Day, Year) 112 OCT 25 PM 2: 1
through
1. Type of Recipient Committee: All Committees - Complete Pans 1, 2, 3, and 4.
❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
O Recall Q Controlled
(Also Complete Part 5) Q Sponsored
(Also com
F-1 General Purpose Committee
detePart e)
Q Sponsored
Q Small Contributor Committee
Q Political Party /Central Committee
3. Committee Information
❑ Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
I.D. NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
90E) SmiTFi Cou�L, w12-
STREET ADDRESS (NO P.O. BOX)
�
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX / E -MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the
under penalty of perjury underthe laws of the State of California that the foregoing is true
[i I (, Ito 17 BpKER.�r iti_u Li i Y
2. Type of Statement:
❑ Preelection Statement
❑ Semi - annual Statement
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
COVER PAGE
Page. of u
For Official Use Only
RK
❑ Quarterly Statement
❑ Special Odd -Year Report
❑ Supplemental Preelection
Statement - Attach Form 495
NAME OF TREASURER
✓037i , CAW
W
MAILING ADDRESS
[
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX / E -MAIL ADDRESS
herein and in the attached schedules is true and complete. I certify
Executed on
By
zf
Dale
ignature ofT orASS Treasurer
Executed on
By
Date
A%;oSignatuflb
alControlling GlIllffahokl6r, C ,S Proponent or Responsible Officer ofSponsor
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Forth 460 (January/06)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612763772)
State of California
Type or print in ink.
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
505 SMO
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
WACO 4 , NA 6(sFiritz CITV Cmelc,
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: List any committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
6. Primarilv Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
COVER PAGE - PART 2
Page 3 of t I)
BALLOT NO. OR LETTER I JURISDICTION E] SUPPORT
❑ OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
7. Primarily Formed Candidate /Officeholder Committee l.istnames of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER
OR CANDIDATE
OFFICE SOUGHT OR
HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER
OR CANDIDATE
OFFICE SOUGHT OR
HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER
OR CANDIDATE
OFFICE SOUGHT OR
HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER
OR CANDIDATE
OFFICE SOUGHT OR
HELD
❑ SUPPORT
❑ OPPOSE
VII T J [Al t 4W LUUt AKtALL)Ut /YP7UNL Attach continuation sheets if necessary
FPPC Form 460 (January/06)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/276-3772)
State of Califomia
Campaign Disclosure Statement
Summary Page
SFF INSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
1. Monetary Contributions ..........................
2. Loans Received ...... ...............................
3. SUBTOTAL CASH CONTRIBUTIONS ....
4. Nonmonetary Contributions ...................
5. TOTAL CONTRIBUTIONS RECEIVED
Expenditures Made
6. Payments Made ...............................
7. Loans Made ...... ...............................
8. SUBTOTAL CASH PAYMENTS ........
9. Accrued Expenses (Unpaid Bills) ...
10. Nonmonetary Adjustment ...............
11. TOTAL EXPENDITURES MADE .......
CI
Schedule A, Line 3
....... Schedule 8, Line 3
........... Add Lines 1 + 2
....... Schedule C, Line 3
.............. Add Lines 3 + 4
....... Schedule E, Line 4
....... Schedule H, Line 3
........... Add Lines 6 + 7
........... Schedule F, Line 3
.......... Schedule C, Line 3
........ Add Lines 8 + g + 10
Type or print in ink.
Amounts may be rounded
to whole dollars.
Column A
TOTALTHIS PERIOD
(FROM ATTACHED SCHEDULES)
$ [+4 00
0
$ l 1 rioo
$ t3lgN!5.3&0
$ X31 NA
0
U
SUMMARY PAGE
Statement covers period CALIFORNIA i
from UVZo1Z ;:ORM 4,11
through li,.017U(29IZ Page 4 of t
I.D. NUMBER
Column B
CALENDARYEAR
TOTALTO DATE
$ 20150
,W/0W
$ 4q Is�o
$ 31 l islg .�5L
V
$ �1,Slq.SZ
U
$ 1.3.4,o,:3 is $ 31,511.51
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summary Page, Line 16
$
nn
—�� 1311
13. Cash Receipts .................... ............................... Column A, Line 3 above
1 j �oo
14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4
15. Cash Payments ................... ............................... Column A, Line 8 above
16. ENDING CASH BALANCE .......... Add lines 12 + 13 + 14, then subtract Line 15
$
U
13 14443
1-1,(630.44
If this is a termination statement Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2
$
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ......... ............................... See instructions on reverse
19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above
$
$
W,000
To calculate Column B, add
amounts in Column A to the
Corresponding amounts
from Column B of your last
report. Some amounts in
Column A may be negative
figures that should be
subtracted from previous
period amounts. If this is
the first report being filed
for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (if
any).
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/1 to Date
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made'
(R Subject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mm/dd /yy)
J_J $
Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)
Schedule A Type or print in ink. SCHEDULE A
Amounts may be rounded
Monetary Contributions Received to whole dollars.
Statement covers period
CALIFORNI '
from jULL�OIZ
•
through AV 120/7017,
Page � of 'C)
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D. NUMBER
BOB &A i TH C4 2G
I
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RADDRESS ZIP
EET A
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
CUMULATIVE TO DATE
CALENDAR YEAR
PER ELECTION
TO DATE
RECEIVED
(IF COMMIT-TEE, I.D. NUMBER)
CODE *
(IF SELF -EM PLOY ED, ENTER NAME
PERIOD
(JAN. 1 -DEC. 31)
(IF REQUIRED)
OF BUSINESS)
❑IND
� �Ill.�l�l�jlvl
[]OTH
V
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
[]IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL $`
Schedule A Summary
1. Amount received this period — itemized monetary contributions.
(Include all Schedule A subtotals.) ............. ...............................
2. Amount received this period — unitemized monetary contributions of less than $100 ...
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ..........
............ $ 1 i %W
............ $ 1 U
TOTAL $ ` L 4;w
'Contributor Codes
IND — Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)
E s
-ay CONF(p e u(0NATC A (
VEPOD C00 N% 10 /c /M7, — 1mj2ujZOIZ L0
Date
Received
I First
Last
Occupation
Address
City
IND
2501
250
I i otai
Tv — mint in inir
SCHEDULE B - PART 1
C e U e 13 — Part 1 Amounts may be rounded
Statement covers period
1
Loans Received to whole dollars.
Ly� 012
O _ •
NET $
from
(May be a negative number)
through l�ll2'
Page 7
SEE INSTRUCTIONS ON REVERSE
Of
NAME OF FILER
I.D. NUMBER
31)6 GM[r+i Fv- Co L,
(3
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
a
OUTSTANDING
BALANCE
(b)
AMOUNT
(c)
AMOUNTPAID
(d)
OUTSTANDING
BALANCE AT
C
(e)
INTEREST
(r)
ORIGINAL
(g)
CUMULATIVE
OF LENDER
(IF COMMITTEE, ALSO ENTER I.D.NUMBER)
(IF SELF - EMPLOYED, ENTER
NAME OF BUSINESS)
BEGINNING THIS
PERIOD
RECEIVED THIS
PERIOD
OR FORGIVEN
THIS PERIOD*
CLOSE THIS
PERIOD
PAID THIS
PERIOD
AMOUNTOF
LOAN
CONTRIBUTIONS
TO DATE
nC* 5M1TH
�va. EN60NI�WF ,e /
❑PAID
CALENDARYEAR
�
?.o, Wo
a
a V
L WIZ
a y
-7 Lt
a
IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION **
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
a
a
a
E
S
DATE DUE
DATE INCURRED
❑ PAID
CALENDARYEAR
❑ FORGIVEN
PER ELECTION'*
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
a
a
a
a
a
DATE DUE
DATE INCURRED
SUBTOTALS $ $ $ $
Schedule B Summary
1. Loans received this period .......................................... ...............................
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ............................... ...............................
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) .............................
Enter the net here and on the Summary Page, Column A, Line 2.
"Amounts forgiven or paid by another party also must be reported on Schedule A.
" If required.
(Enter (e) on
schedule E, Line 3)
tContributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275 -3772)
$
V
NET $
;� CW
(May be a negative number)
(Enter (e) on
schedule E, Line 3)
tContributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275 -3772)
Schedule C
Type or print in ink.
SCHEDULE C
Nonmoneta Contributions Received
ry
Amounts may be rounded
to whole dollars.
Statement covers riod
period
CALIFORNIA
60
from 101V2412—
FORM
through W�`20012—
Page tC)
SEE INSTRUCTIONS ON REVERSE
of
NAME OF FILER
I.D. NUMBER
B 5M 11-H - og- CrN
0,0111MVI IL, ?ZtZ—
134tSS_2-
DATE
FULL NAME, STREET ADDRESS AND
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
DESCRIPTION OF
AMOUNT/
CUMULATIVE TO
DATE
PER ELECTION
RECEIVED
ZIP CODE OF CONTRIBUTOR
CODE*
OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER
GOODS OR SERVICES
FAIR MARKET
VALUE
CALENDAR YEAR
TO DATE
(IF REQUIRED)
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
NAME OF BUSINESS)
(JAN 1 -)DEC 31)
Schedule C Summary
1. Amount received this period — itemized nonmonetary contributions.
(Include all Schedule C subtotals.) ...................................................................................... ............................... $
2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..... ............................... $
3. Total nonmonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $
'Contributor Codes
IND— Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY— Political Party
SCC — Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
&A c J M
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from L9f 11ZVr2_
through Ly(V/X?12-
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment
SCHEDULE E
Page 1 of t�
I.D. NUMBER
CW
campaign paraphemalia/misc.
MBR
member communications
RAID
radio airtime and production costs
CNS
campaign consultants
MfG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nonmonetary)*
OFC
office expenses
SAL
campaign workers' salaries
CVC
civic donations
PEr
petition circulating
TEL
t.v. or cable airtime and production costs
RL
candidate filing /ballot fees
PHO
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff /spouse travel, lodging, and meals
IND
independent expenditure supporting /opposing others (explain)*
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate /sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
voter registration
LIT
campaign literature and mailings
PRT
print ads
WEB
information technology costs (intemet, e-mail)
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 131L�f64 3t6
Schedule E Summary
1. Itemized payments made this period. (Include 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 period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)
$
$ U
............ $ C2
TOTAL $ 13 14"94 • goo
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275 -3772)
t�120Iz(A2-
Payee Address
city
Description
Reimbursement- Fee
Reimbursement - Printin , Stam s, Part Su lies
Advertisement - Radio
Fundraising Luncheon
Postage
Invitations
Reimbursement -Wine
Voter Outreach Labor
Voter Outreach Labor
Total _
Amount
2,500.00
364.19
6,780.00
1,115.93
1,258.00
201.09
288.67
472.50
504.00
13,484.38
Name of Pa ee
Ryan Shultz
Ryan Shultz
Great Valle Services
Stcokdale Count Club
USPS
Bobbie's Hallmark
Debbie Cam
tem SERV
tem SERV