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Home My WebLink AboutBFLAG SEMIANN99(1) ecipient Committee Campaign Statement -- Long Form (Government Code Sections 84200-84216.5) Type or print in IdL SEE INSTRUCTIONS ON REVERSE ~J Pre-election Statement ~Semi~annual Statement [:~ Special Odd-year Camplign Report [] Supplemental Pre-election Statement (Attach a completed Form 495 to this Statement.) i'1 Termination Statement (Attach a completed Form 41S to this statement.) Statement covers period Date ~ e~ ~ a~ (~, ~V, Year) ~COVER PAGE - LONG FORM For Official Use Only Committee Information NAME OF COMMITTEE AIX)~SS O~ COMMITTEE tINO. AND STREEt) J I.O. NUMIIR } 8 ; ss ~ ~ ~A~SS ~ T~R ~. AND St~i~ ~Y STATE Z~ CODE ~A C~~ ~ (Check Boxes) See definitions and important information on reverse. Is this a sponsored committee? .................. I~ Yes r-1.0 is this a broad based political committee? ......... G]ve. [] me II Verification II Primarily Formed Committee (See 'det;initi'on on~everse:i" NAME Ot CAND~ATE(~) OR O~FK'THOLI~R6) CHECK CleW CESOUGI4TOIIH~LD AtMch additional information on appropriately labeled continuation sheets. I have 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. , CITY AND SLATE Executed on At R. If REQUIRED fOR INFORMATION REQUIRED TO BE PROVII~D TO YOU PUI~UANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAl. ON CAMPAIGN DiSCLOS_~RI~rR~,_VIJION~S~Qr ~THE POLITICAL REFORM ACT Schedule A Monetary Contributions Received TypecxWinti~ink. Amounts ruby be rounded to whole dollars. 5BE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE FULL NAME AND ADDRESS OF CONTRIBUTOR DATE e, COMMITTEE, IN AIX)FTION TO COMMITTrEE'e, NAME AND ADOREIS, E~IER I.D. NUMI~R RECEIVED op, · eo ~,O- NUMNe HAS NEe ASS4GN~D, emTe feE~sueee's NAMe ANO AOOeESS) Monetary Contributions Summary OCCUPATION AND EMPLOYER (fir S~LF-EMPt0YED, ENTER NAME Of IIUgNES$) StBtemfvt covers period through ~' 3~'*~ .. AMOUNT RECEIVED THIS PERIOD SUBTOTAL SCHEDULE A I.D. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) CUMULATIVE TO DATE OTHER (IF APPLICABLE) 1. Amount received this period -- contributions of $100 or more. (Include all Schedule A subtotals.) ........................................................................... -: $ _//~2~O, ~ -2. Amount received this period --contri butions of less than $100. (Do not itemize.) ........................................................................................... S ~ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) .............................. TOTAL $ //,'~/--~O. o~ Recipient Committee Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE Contributions Received 1. Monetary Contributions ............................... Schedde~, Une3 $ 2. Loans Received ......................................... Schedde e, Une 7 3. SUBTOTAL CASH CONTRIBUTIONS ...................... AddUnes I, 2 $ 4. Non-monetary Contri butions ......................... Schedule CUne S. SUBTOTAL CONTRIBUTIONS (Exclude Enforceable Promises) AddLines3 + 4 $ 6. Enforceable Promises (Exclude Loan Gueraneees, Line I I below) ................... Schedule D, LIne 7 7. TOTAL CONTRIBUTIONS RECEIVED Expenditures Made 8. Cash Payments (Other than Loans Made) ............ SchecAde E, Une S 9. Loans Made ............................................. Schedde H, Um 7 10. SUBTOTAL CASH PAYMENTS ............................ AddUntie · 9 11. Accrued Expenses (Unpaid Bills) ........................ Schedule F, Une 12. TOTAL EXPENDITURES MADE Current Cash Statement 13. Beginning Cash Balance .................. Previous Summary Page, Line 17 14. CaSh Receipts ...................................... ColurnnA, LlneJabove 15. Miscellaneous lncreases to Cash ........................ 16. Cash Payments .................................... ca~unm A, Une f0 above 17. ENDING CASH BALANCE ..... Add Ltnes l]t ~ 14 + lS, then subtract Une16 ff this iS a termination statement, Line f 7 must be zero.* 18 LOAN GUARANTEES RECEIVED .............. Schedule B, Part I, Column (13) $ Cash Equivalents and Outstanding Debts 19. Cash Equivalents ................................ see instructions on reverse $ 20. Outstanding Debts ................. AddLine 2 + Line 11inColumnCabove $ TypeeWiminML Amounts may be rounded to whek doffmrs. Column A TOTAL THI~ (FROM ATTACHED SCHEDUtE5) /t~ec. - //~:D, oo /7~, O ENDING CASH IALARCE giOUtD NOT BE A NEGATNE AMOUNT Statemere covers period from /--/- F~ throufh ~; ~ r ~ f Column B* TOTAL IPR~VI01.~ ($EE NOTE NL0'W) SUMMARY PAGE iPaee ~ ID, NUMBER Column C TOTAL TO DATE (kDD COLUM~ A · I) $ S S * From previous Statement Summer/Page, Column C. However, if this is the first report filed for the calendar year, Column B should be blank except for Loans Received (Line 2), Enforceable Promises (Line 6), Loans Made (Line 9), and Accrued Expenses (Line 11 ). Summary for Non-Controlled Committees Primarily Formed to Support or Oppose Candidates in Both June and November Elections 1/1 through 6/30 711 to Date 21 Contrib tions · Rece~v~4~ .... s 22. $ Recipient Committee Tyeo,.,k.k,N. ALLOCATION PAGE Allocation Page to whole dollaR. ~; from /'/' ¢~ re,D, NUMBER List contributions and independent expenditures that total $100 or more made to support or oppose off/ceho/ders, candidates, ballot measures, or committee~ SEE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE DATE NAME OF OFFICEHOLDER OR CANDIDATE AND OFFICE, OR NAME OF CUMULATIVE TO DATE MEASURE AND BALLOT NUMBER OR LETTER. OR NAME OF COMMITTEE CHECK ONE IND. AMOUNT THIS EXP,* PERIOD IF OTHER THAN OFFICEHOLDER, CANDIDATE, OR MEASURE COMMITTEE SU~OnT OPPOS~ *See reverse regarding independent expenditures. SUBTOTAL Allocation Summary 1. Contributions and independent expenditures of $100 or more made this period. (Include all Allocation Page subtotals.) ...................................................................... 2. ~ontributions and independent expenditures under $100 made this period. (Do not itemize.) ......................................................................................... CUMULATIVE TO DATE OTHER (IF APPLICABLE) Attach additional information on appropriately labeled continuation sheets. 3. Total contributions and independent expenditures made this period. (Do not carry this to the Summary Page.) ............................................................ TOTAL Schedule E (Continuation Sheet) Payments and Contributions (Other Than Loans)Made SEE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE 'C'- MONETARY AND IN. KIND (NON-MONETARY) ' 8' - CONTRIBUTIONS TO OTHER CANDIDATES *N* - AND COMMITTEES *0o _ INDLePENDENT EXPENDITURES °S° _ LITERATURE "F* - Type of pdnt in ink. Amounts may be rounded to whole doeart Statement covers period from /'/' q~ 'G"- -p- _ ~hroll~ CODES FOR CLASSIFYING EXPENDITURES BROADCAST ADVERTISING NEWSPAPER AND PERIODICAL ADVERTISING OUTSIDE ADVERTISING SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS FUNDRAISING EVENTS SCHEDULE E (cont.) p,~, ~ of . I.D. NUMBER H GENERAL OPERATIONS AND OVERHEAD TRAVEL, ACCOMMODATIONS AND MEALS (MUST BE DESCRIED) PROFESSIONAL MANAGEMENT AND CONSULTING SERVICES NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIIUTION (IF COMMrrTEE, IN AN)rrlON TO COMMrrTEE~ N~M! AND ADDREe,$. l~l"lll I.D. NUMIER O~ (~ NO I.D. NUMN~R HAS I~EN AS~GNED, ENT~R TRIASUg~R'S NAME AND ADDIIES*,) CODE G C OR DESCRIPTION OF PAYMENT AMOUNT PAID ~/~/,// / 6t~ o, o ~3 SUBTOTAL Schedule E Payments and Contributions (Other Than Loans) Made SEE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE TypecH'prlntifiink. Amountsmeyberounded towhekdoearso CODES FOR CLASSIFYING EXPENDITURES Statement covers I~riod ,,0, / -/- ¢~ SCHEDULE E Page. et __ I.D, NUMBER If one of the following codes accurately describes the expenditure, may enter the code and leave the "Description of Payment' column blank. Refer to the back of Schedule E-Continuation Sheet for detailed explanations oefYce~h category. "C" - MONETARY AND IN-KIND (NON-MONETARY) "B" - CONTRIBUTIONS TO OTHER (ANDIDATES · N" '- AND COMMITTEES "O' - '1" - INDEPENDENT EXPENDITURES "S" - 'L'- LITERATURE "F"- BROADCAST ADVERTISING 'G" - NEWSPAPER AND PERIODICAL ADVERTISING "T" - OUTSIDE ADVERTISING SURVEYS, SIGNATURE GATHERING, DOOR-TO-OOOR SOLICITATIONS 'P* ' FUNDRAISING EVENTS GENERAL OPERATIONS AND OVERHEAD TRAVEL, ACCOMMODATIONS AND MEALS (MUST BE DESCRIED) PROFESSIONAL MANAGEMENT AND CONSULTING SERVICES NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION 8f COMMITTEE, IN ADOITKI/t TO COMMITII:E~ NAME AND ADOtlS$o !IfiIR I.O. NUMIIR OR, IF NO tO, NUMIER HAS IIIN ASSIGNED, INTER TRIASURIR'S NAME AND ADnRE$S) IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E. REPORT ONt, Y THE LUMP SUM OF SUCH PAYMENTS ON UNE 4 OF THE SUMMARY SECTION BELOW. CODE OR DESCRIPTION OF PAYMENT Impor{ant: Contributions and expenditures made out of campei n funo~ to or on behalf of off/ceho/ders, candidate, committees, or betlot measures rnu~ also be ~nter~ the Allocation Pap. SUBTOTAL $ Payments and Contributions Made SummaW 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 period. (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 $ AMOUNT PAID 27,~.6/ '75'2 .,-/,? I / ~;. e~ O ¢/7,t,c,' 7