HomeMy WebLinkAboutVEREEN PREELECT13(2) 04/15/13recipient Committee
Compaign Statement
Cover Page
(Government Sections 84200 - 84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period Date of election if applicable:
from
A i2r► I 21 (Month, Day, Year)
—i
through Ma V 19 2013 June
1. Type of Recipient Committee: All 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 Comp/ete Pad 5) Q Sponsored
(Also compete Part 6)
❑ General Purpose Committee
0 Sponsored
0 Small Contributor Committee
O Political Party/Central Committee
3. Committee Information
4.
❑ Primarily Formed Candidate/
Officeholder Committee
(Also compete Part 7)
i.D. NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
�eXee n -For � �t,u�C:
_DoocAcl c
Wo4rd 1 Zo 3
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Date Stamp
PAY 21 AM 11: 44
2. Type of Statement:
Ja Preelection Statement
❑ Semi - annual Statement
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
COVER PAGE
Page of
For Official Use Only
❑ Quarterly Statement
❑ Special Odd -Year Report
❑ Supplemental Preelection
Statement - Attach Form 495
Treasurers)
NAME OF TREASURER REt'1-
wpQ Y-o 1/ e O�Y1 ►'� yo -n S
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
I have used all reasonable diligence in preparing and reviewing this 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 atm 3nect. . 4_ �,
Executed on &7 /_5 By
�( Dale f n
Executed on ` —/ 5- 2 J3 By
Date
Executed on
Date
By
signaWreo tContraNin90fficeholder. Candidate, stale Meawie Proponent
Executed on By Signature of Coro" Olfimhoider. Candidate. Stab Measure PmPmerA
Dab FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)
State of California
Type or print in ink.
Recipient Committee
CampaiW Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Dona -[ d V%r2e -4
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
C,c i'u o u rl 6( Oa-rd Zo 3
RESIDENTI 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.
COMMtTTEENAME I.O. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
COVER PAGE - PART 2
Page of
BALLOT NO. OR LETTER I JURISDICTION I O SUPPORT
❑ OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
DISTRICT NO. IF ANY
7. Primarily Formed Candidate /Officeholder Committee List names 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
Attach continuation sheets if necessary
FPPC Form 460 (JanuaryMS)
FPPC Toll -Free Helpiine: 866 /ASK -FPPC A86e/ TSW72)
State of California
Schedule A
Monetary Contributions Received
Type or print in ink. SCHEDULE A
Amounts may be rounded Statement covers period
to whole dollars.
from 21
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. —
. e, Column A, Line 1. TOTAL $ _ ` J a -5 - O O
( Add Lines 1 and 2 Enter here and on the Summary Page, ) ....................... FPPC Form 460.tJanuary105)
FPPC Toll -Free Helpline: 8661ASK -FPPC (866/2753772)
Page
SEE INSTRUCTIONS ON REVERSE
through of
NAME OF FILER I.D. NUMBER
-D6 vial of Ve- re iv r C,6 "ACA Wad I Zo 3
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
O
F SELFAEMP DYED, ENTER NAME EMPLOYER
AMOUNT
RECEIVED IODTHIS
CUMULATIVETO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
OF BUSINESS)
,J ck- vne -s "I Tay lcor
doom
/3
[]0TH
/ .0C)
❑PTY
❑scc
� `B ckcKkI er
'�
ND
[3COM
�-
,
❑scC
p r —
;WIND
[3Com
�}
�
[]0TH
❑ PTY
❑scc
�e—
E❑ICOM
❑ °;�
%00.00
.�<?,0O
[]
❑SCC
❑IND
[3Com
[] OTH
❑ PTY
❑ SCC
SUBTOTAL $ 3P, 5 , 0 0
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. —
. e, Column A, Line 1. TOTAL $ _ ` J a -5 - O O
( Add Lines 1 and 2 Enter here and on the Summary Page, ) ....................... FPPC Form 460.tJanuary105)
FPPC Toll -Free Helpline: 8661ASK -FPPC (866/2753772)
SCHEDULEB -PART1
Type or pnm In rnK.
Schedule B - Part 1 Amounts may be rounded
Statement covers period
I '
Loans Received to whole dollars.
from
•
`
Z 3
throughMOV
Page of
SEE INSTRUCTIONS ON REVERSE
I.D. NUMBER
NAME OF FILER
T) 0 n al.d Vere en r Q+1 C Ward
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL , ENTER
OCCUPATION AND EMPLOYER
a
OUTSTANDING
BALANCE
tbl
AMOUNT
RECEIVED THIS
(c)
AMOUNT PAID
>
OUTSTANDING
BALANCE AT
°
INTEREST
PAID THIS
ORIGINAL
AMOUNT OF
9
CUMULATIVE
CONTRIBUTIONS
OF LENDER
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
(IF SELF -EMPLOYED. ENTER
NAME OF BUSINESS)
BEGINNING THIS
PERI D PER
PERIOD
OR FORGIVEN
THIS PERIOD"
CLOSE OF THIS
PERIOD
PERIOD
LOAN
TODATE
�a ��re�
nai.d
❑ PAID
CALENDARYEAR
7?e �
RATE
❑ FORGIVEN
PER ELECTION"'
�.
s1-50o °`'
$ 300
$
$
$,Lam
DATE DUE
DATE INCURRED
t❑ IND ❑ COM ❑ OTH /❑ PTY [I SCC
❑ PAID
CALENDARYEAR
❑ FORGIVEN
PER ELECTION **
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
$
S
s
$
$
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
PER ELECTION°'
❑ FORGIVEN
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
s
s
s
DATE DUE
$
DATE INCURRED
$
SUBTOTALS $ 30 Opo $ $ $
Schedule B Summary
1. Loans received this period ..................................................................................... ............................... $
s3O 0, ba
(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.) .••.••........•••..•• NET $ �y �`
..............................
(May be a negative number)
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. tine 3)
tContributor Codes 1
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 4604January105)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772)
Schedule E Type or print in ink. Statement covers period
Amounts may be rounded
ft"writs Made to whole dollars. from ko rj ( 2-1
SEE INSTRUCTIONS ON REVERSE I through v v� Page 15> of
I.D. NUMBER
NAME OF FILER `
ID O n O� W Y -�' (-e � �` � Ceti` VtU ( a-�rz� Z0 t 3
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CW
campaign paraphemalialmisc.
NW
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nonmonetaryr
OFC
office expenses
SAL
campaign workers' salaries
CVC
civic donations
PET
petition circulating
TEL
t.v. or cable airtime and production costs
FIL
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)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
e-t-)Y'e o /Y�i ` u� -� Sc)'� je) 3S; as
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
1. Itemized payments made this period. Include all Schedule E subtotals. ..... ........................................................... $ /0 35.
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. ) ............................. TOTAL $ -3 5. 0 y
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK -FPPC (86612753772)
Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE
pang Amounts may be rounded Statement covers period
Summary` Page to whole dollars. �� 460
from
through J8 J 2
Page of
SEE INSTRUCTIONS ON REVERSE
I.D. NUMBER
NAME OF FILER
Contributions Received
1. Monetary Contributions ............ ............................... Schedule A, Line 3
2. Loans Received ....................... ............................... schedule s, 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
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
$ .3'�2 S, a d
fob 1(10
$ J. O0
-0-
Column B
CALENDAR YEAR
TOTALTODATE
$ 1760,00
1Pov,00
$ 506•Od
l
$ (oQg5.00 $
Expenditures Made
6. Payments Made ........................ ............................... schedule E, Line 4 $ 1035,06
7. Loans Made .............................. ............................... schedule H, Line 3
8. SUBTOTAL CASH PAYMENTS ..... ............................... Add tines 6 + 7 $ !� 3 Si L
9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3
10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE . ............................... Add Lines 8 + 9 + 10 $ 3 S' 60
Current Cash Statement 6
12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ _
13. Cash Receipts .................... ............................... Column A, Line 3 above J ,
14. Miscellaneous Increases to Cash ........................... schedule i, Line 4 ,
15. Cash Payments ................... ............................... Column A, Line 8 above 0 3 'On
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 6 �• 3 f
ff 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 $ /800,00
19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $
3500,00
$
$
3261,31
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 $36-00 $
21. made
$ 3/16 �� 3 1 $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made'
(if subject to voluntary Expenditure limit)
Date of Election Total to Date
(mm /dd /yy)
_1 - . $
_
If $
`Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)