HomeMy WebLinkAboutSMITH 460 PREELECT12(2) AMEND 10/26/12"'IRecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200 - 84216.5)
Type or print in Ink. Date Stamp
Statement covers period Date of election If applicable:
from `
�q/ I / � (7— (Month, Day, Year)
12 01 T 26 PM 3: 08
SEE INSTRUCTIONS ON REVERSE I through 101W/ 2012—
1. Type of Recipient Committee: Ail committees - Complete Parts 1, 2.3, and 4.
Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
Q Recall Q Controlled
(Also Complete Part 5) O Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
Q Sponsored
Q Small Contributor Committee
Q Political Party /Central Committee
3. Committee Information
NAME (OR CANDIDATE'S NAME IF NO
❑ Primarily Formed Candidate/
Officeholder Committee
(Also complete Part 7)
I.D. NUMBER
S3 :__m f TH F0F —CirY (2,G)(A VU - 29 ► z
STREET ADDRESS (NO P.O. BOX)
S (IF DIFFERENT) NO. AND STREET OR
CITY STATE ZIP CODE AREA CODE /PHONE
COVER PAGE
Page of
For Official Use Only
t1ko/2atZ_
" i ELG i; "'Y CLERK
2. Type of Statement:
ki6preeiection Statement ❑ Quarterly Statement
❑ Semi - annual Statement ❑ Special Odd -Year Report
❑ Termination Statement ❑ Supplemental Preelection
(Also file a Form 410 Termination) Statement - Attach Form 495
Amendment (Explain below)
r,o RL Tw IN -kapip Co NfA611I( N
Treasurer(s)
NAME OF TREASURER
DE68E]i c
MAILING ADDRESS
[
CITY STATE ZIP CODE AREA CODEIPHONE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX / E -MAIL ADDRESS OPTIONAL: FAX / E -MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the t of k w dge the in ation 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 tru and corre
Executed on BY
' 1 e re or lTreasurer
Date
Executed on L��12 By
Date —Signature 61 Controlling State Measure Proponent or Responsible Officer of Sponsor
Executed on BY
Date By of Controlling ORceftolder, Carxfidate, Slate Measure Proponent
Executed on BY
Date Signature of Controlling Officetrolder, Carxlida te, State Measure Proponent FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
State of California
Type or print in ink. COVER PAGE - PART 2
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
& Sm a-H
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Wh PsFiEU) Q-1TV CoukCAL�
RESIDENTIAL/BUSINESS AIJDRESS (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 I.D. NUMBER
NAME OF TREASURER I CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
Page Z of `k
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER JURISDICTION I 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 list names of
ofhceholder(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
Attach continuation sheets if necessary
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (866/275 -3772)
State of California
Campaign Disclosure Statement
Summary Page
OFF INSTRI Ir:TIr1NS nN RFVERSE
NAME OF FILER
;06 SMIT14 R)
Contributions Received
1. Monetary Contributions ............ ............................... Schedule A, Line 3
2. Loans Received ....................... ............................... schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2
4. Nonmonetary Contributions ..... ............................... schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .•••••• ••••.• .............. Add Lines 3 +4
Expenditures Made
6. Payments Made ........................ ............................... schedule E, Line 4
7. Loans Made .............................. ............................... schedule H, Line 3
8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7
9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3
10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE . ............................... Add Lines 8 + g + 10
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summary Page, Line 16
13. Cash Receipts .................... ............................... column A, Line 3 above
14. Miscellaneous Increases to Cash ........................... schedule I, Line 4
15. Cash Payments ................... ............................... Column A, Line 8 above
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15
If this is a termination statement, Line 16 must be zero.
Type or print in ink.
Amounts may be rounded
to whole dollars.
2-0 12-
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
$
U
$ C2
�vy
$
$ t3,4�4.3�
O
$ l3/44'q .316
O
v
$
j a �JU
v
t3,4�1.3�d
$
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 s in Column B above
$ 2D'000
SUMMARY PAGE
Statement covers period CALIFORNIA
from lUl l /?.otZ FORM 4
through LVL / w/Zo Page of
I.D. NUMBER
Column B
CALENDAR YEAR
TOTALTO DATE
$ 2-9.11,50
?,Of 000
$ 49.,1 —
$ 31519.52
O
$ 31 X51°►. S2
y
O
$ 31 t5►q -5Z
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 6130 7/1 to Date
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
(N Subject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mm/dd /yy)
I If $
I —I— If $
Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275 -3772)
Schedule A Type or print in ink.
Amounts may be rounded
Monetary Contributions Received to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
9&,& Sm iTH FOP- CC(Y owzt'
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER
DATE CONTRIBUTOR OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF - EMPLOYED, ENTER NAME
OF BUSINESS)
❑IND
\ r/� ❑COM
V� 1�F& 1 ❑OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SCHEDULE A
Statement covers period CALIFORNIA ,
p/ I/ l2.- FORM •
from
through IC�1Zo1 w(Z Page of —`
I.D. NUMBER
s z
AMOUNT CUMULATIVE TO DATE PER ELECTION
RECEIVED THIS CALENDAR YEAR TO DATE
PERIOD I (JAN. 1 - DEC. 31) (IF REQUIRED)
t/ 4.00
SUBTOTAL $ I / �0 O
Schedule A Summary •Contributor Codes
1. Amount received this period — itemized monetary contributions. IND - Individual
COM — Recipient Committee
(Include all Schedule A subtotals.) ......................................................................... ............................... $ (other than PTY or SCC)
OTH —Other (e.g., business entity)
2. Amount received this period — unitemlzed monetary Contributions of less than $100 ............................. $ PTY — Political Party
3. Total monetary contributions received this period. SCC - Small Contributor committee
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275 -3772)
XV E.r* Cjt,.r(-P1 eMT 10 N 5 AITA- A- Ilvl," i
t etoD CvvPfi wb 10/1 I Mz - 1017,01 2011
la- W* to
Amount
Received
Total
Contribut
this
Receive
Date
Address
City
Stati
zip
Code
period
to date
Received
First
Last
Occu ation
Guinn Construction
IND
IND
IND
IND
IND
IND
100
100
100
250
100
100
100
250
10/9/201
Geor a
Martin
10/9/201
Lawrence & Esth
Brandon
10/9/201
anice
Becker
Becker
10/9/201
ohn & olene
ld
Smith
rcial
Total
800
SCHEDULE B - PART 1
Type or Prue m mom.
Schedule B — Part 1 Amounts may be rounded Statement covers period
'
CALIFORNIA ,
Loans Received to whole dollars. `C / (/ZO(Z
from
•
• -
,01w1 WI Z
(0 Cl
through
Page of
SEE INSTRUCTIONS ON REVERSE
I.D. NUMBER
NAME OF FILER
SAT 'PO - CITY C� v L 2s� iz
13 sSZ
(d) let
IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT (�) OUTSTANDING INTEREST
FULL NAME, STREET ADDRESS AND ZIP CODE AMOUNT PAID BALANCEAT
OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS PAID THIS
lg)
ORIGINAL CUMULATIVE
AMOUNT OF CONTRIBUTIONS
OF LENDER (IF SELF - EMPLOYED, ENTER BEGINNING THIS OR FORGIVEN CLOSE OF THIS
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAMEOFBUSINESS) PERIOD THIS PERIOD PERIOD
LOAN TO DATE
❑ PAID
CALENDAR YEAR
SYYII I
CIVIL V'41MEEcl
U
u,1OUc�
D %
�,ano
s
$
:
C] FORGIVEN
:
PER ELECTION-
�N�SS (�/� >NE�.
ATE
CCX)O
V
0
zo I'Z-
$ 0
ZO 12_
s Z-OL�
t IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
$20
$
$
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION'
RATE
S
S
$
$
$
DATE DUE
DATE INCURRED
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
❑ PAID
CALENDARYEAR
❑ FORGIVEN
RATE
PER ELECTION"
t❑ IND [] COM El OTH El PTY [] SCC
S
f
S
S
DATE DUE
DATE INCURRED
SUBTOTALS $ $ $ $
(Enter (e) on
Schedule B Summary Schedule E, Line 3)
1. Loans received this period ..................................................................................... ............................... $
(Total Column (b) plus unitemized loans of less than $100.)
U
2. Loans paid or forgiven this period .......................................................................... ............................... $ U
(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.) ................................ ............................... NET $ U
Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number)
`Amounts forgiven or paid by another party also must be reported on Schedule A.
If required.
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 (8661275 -3772)
i
Schedule C
Nonmonetary Contributions Received
SEE
Type or print in ink. SCHEDULE
Amounts may be rounded Statement covers period �
to whole dollars. _ •
from � , t 1 -0q_
through L01 ?fO jZpl2 Page of
MME OF FILER
IF AN INDIVIDUAL, ENTER AMOUNT/
FULL NAME, STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF FAIR MARKET
DATE * OCCUPATION AND EMPLOYER GOODS OR SERVICES
ZIP CODE OF CONTRIBUTOR CODE (IFSELF- EMPLOYED, ENTER VALUE
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS)
❑IND O,G
NtkNff, c sas s ❑coM
wlt8129
EIPTY c
❑ IND
❑COM
❑OTH
❑ PTY
❑SCC
❑ IND
❑COM
❑OTH
❑ PTY
❑ SCC
❑ IND
❑COM
❑OTH
❑ PTY
❑ SCC
Attarh additional information on appropriately labeled continuation sheets. SUBTOTAL $ 5'()p
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.) .........
....................... $ s()U
....................... $ rJ
OU
I.D. NUMBER
�3A <6sS-2
CUMULATIVE TO I PER ELECTION
DATE TO DATE
CALENDAR YEAR (IF REQUIRED)
(JAN 1 - DEC 31)
'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
............ TOTAL S
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Schedule E
Payments Made
RFF wsTRl ICTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
NAME OF FILER
�
o� Sm1T�i r (Z CITY COUNGL- 2oI7-
Statement covers period
from L t_l_Z0'Z
through
SCHEDULE E
Page J of -`
I.D. NUMBER
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CW
campaign paraphernalia/misc.
MBR
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nonmonetary)*
OFC
office expenses
SAL
TEL
campaign workers' salaries
t.v. or cable airtime and production costs
CVC
civic donations
PET
PHO
petition circulating
phone banks
TRC
candidate travel, lodging, and meals
FIL
candidate filing /ballot fees
POL
polling and survey research
TRS
staff /spouse travel, lodging, and meals
FND
W
fundraising events
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
WEB
voter registration
information technology costs (internet, e-mail)
LIT
campaign literature and mailings
PRT
print ads
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 13.40,_5Y
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.) ....
... ............................... $ t 3,4g9.3�
... ............................... $ t:J
............................... $
Z
................ TOTAL $ 3Is
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
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