HomeMy WebLinkAboutCOUCH SEMIANN99(2) ecipient Committee
Campaign Statement
(Govemmeat Code SeclJeas 84200-84216.5)
COVER PAGE
Type or print in ink.
SEE INSIRUCTIONS ON REVERSE
1. Type of Recipient Committee: A. Commi.eN- ComCete Parts 1, 2, 3, and 7.
Date of election if applicable:
(Month, Day, Year)
Date Stamp
2. Type of Statement:
For Officlst Use Only
j~ Officeholder, Candidate
Controlled Committee
(Aisc Comptete Part 4.)
[] Ballot Measure Committee
O Primarily Formed
O Controlled
O Sponsored
(Also Complete Part 5.)
[] Primarily Formed Candidate/
Officeholder Committee
(Al~o Complete Part 6J
[] General Purpose Committee
O Sponsored
O Broad Based
[] Pre-election Statement
~ Semi-annual Statement
[] Termination Statement
[] Amendment (Explain below)
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Pre-election
Statement - Attach Form 495
3. Committee Information
COMMITTEE NAME
STREET ADDRESS (NO RO. BOX)
CITY STATE ZIP COOE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR I~O. BOX
CITY STATE ZIP CCOE
AREACODE/PHONE
AREA CODE/PHONE
Treasurer(s)
NAME OF I~EASURER
AREACODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP COOE AREA CODE/PRONE
OPTIONAL: FAX / E-MAIL ADDRESS
OPTIONAL: FAX / E-MAIL ADDRESS
FPPC Form 460 (8/99)
For TechnlcM Assistance: 916/3~2-5660
S~ate of California
ReCipient Committee
Campaign Statement
Cover Page -- Part 2
Type or print in ink.
COVER PAGE o PART 2
Page ~k~ of
4. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DIS~:~ICT NUMBER IF APPLICABLE)
Related Committees Not Included in this Statement: LIst any commlttees
not Included In this consolidated stetement the t are con.oiled by you or which ere primarily
formed to receive contributions or to make expenditures on beheff of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF OFFICEHOLDER OR CANDIDATE
NAM E OF OFFICEHOLDER OR CANDIDATE
NAM E OF OFFICEHOLDER OR CANDIDATE
Attach continuation sheets if necessary
OFFICE SOUGHT OR HELD [] SUPPORT
[] OPPOSE
OFFICE SOUGHT OR HELD [] SUPPORT
[] OPPOSE
OFFICE SOUGHT OR HELD
[] SUPPORT
State of California
campaign Disclosure Statement
Summary Page
Type or print In Ink.
Amounts may be rounded
to whole dollars.
SEE iNSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
1. Monetary Contributions ...................................................... Schedule A. Line 3 $
2. Loans Received ................................................................... Schedule B, Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines t + 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 7
8. SUBTOTAL CASH PAYMENTS ................................................ Add Lines 6 + 7 $
9. Accrued Expenses {Unpaid Bi~ls} ............................................ Schedule F, Line 3
10. Nonmonelary Adjustment ....................................................... ScheduleC, Line3
11. TOTAL EXPENDITURES MADE ......................................... AddLInes8+9+ 10 $
Column A
TOTAL THrS PERIOO
.~?,/
from
throug
Page
SUMMARY PAGE
I.D. NUMBER
Column B* Column C
TOTAL PREVIOUS PERIOO TOTAL TO {)ATE
-o - $ 39¥
· .0 ° -0 °
-oo o0o
$ 'TSt 9 $ (. 3 7&
-O°
-O' - O' *0'
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.
17. LOAN GUARANTEES RECEIVED ................... Schedule e, Part 1, Column (b) $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ..................................................... See instructions on reverse
19. Outstanding Debts ................................... Add LIne 2 + Line g in Column C above
39,/
* From previous statement Summan/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), Loans Made (Line 7), and Accrued
Expenses (Une 9),
Summary for Candidates in Both June and
November Elections
1/1 through 6/30 7/1 lo Date
20. Contributions
Received ............ $
21. Expenditures
Made ..................
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660
Schedule A Typ. or print in ink. SCHEDULE A
Amounts may De rounder] S:-;.,~,=i~ covers ~r;~,d I
Monetary Contributions Receivedto whole dollars, from 7///g~ i~~I~
~AME OF RLER I.D. NUMBER
IF AN INDIVIDU~, ENTER AMOUNT CUMU~TIVE TO DA~ CUMU~TIVE TO DATE
OATE FULL NAME, MAIMNG ADDRESS AND ZIP CODE OF CON~IB~OR CONTRIB~OR ~CUPATION AND EMPLOYER RECEIVED ~IS CALENDAR ~AR O~ER
RECEI~D (~F C~EE. A~O ENTER I.D. NU~ER) CO~E * (IF SE~-~OYEO, EN~R ~ PER~D (JAN. 1 - DEC. 31 ) (IF APPLIC~LE)
~ BUSINESS)
~IND
~ COM
~ OTH
~IND
DcoM
~ OTH
~IND
~ COM
~ OTH
~IND
~ COM
~ OTH
DIND
D COM
~ OTH
SUBTOTALS
Schedule A Summary
1. Amount received this period - contributions of $100 or more.
(Include all Schedule A subtotals.) ....................................................................................................... $
2. Amount received this period - unitemized 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.) ................... TOTAL $
*Contributor Codes
,NO-Individual
COM - Recipient Commiltee
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660
Schedule E Type or print in ink.
Payments Made Amounts may Pe rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Statement covers period
through /~/~'/¢~? Page ~' of {~
CODES: If one of the following codes accurately describes the payment, you may enter the code. OthenNise, describe the payment.
DFC office expenses
PET petition circulating
PHO phonebanks
PaL polling and suwey research
POS postage, deliver7 and messenger services
PRO professional san/ices (legal, acccunting)
PRT pdnt ads
I.D. NUMBER
RFD returned cont~buti(:~3s
SAL campaign workers salades
TEL {.v. orcab~e a/d/me and production costs
TRC candidate travel, lodging and meals (explair0
TRS staff/spouse travel, lodging and meals (explain)
TSF bansfer between committees of Ihe same c~andidate/spon$or
VDT voter registra~on
MTG meetingsandappearances RAD radioairtJmeandproductioncosls WEB ~nforrnat~ontechrmlogycosts(~nternet, e_n~)
NAME AND ADDRESS OF PAYEE OR CREDITOR
(IF COMM3TT~E E, AL~O ENTER ID. NUMBER) COOE OR DESCRIPT3ON OF PAYMENT AMOUNT PAID
re co ts or independent expenditures must also be summarized an Schedule D. SUBTOTAL
Schedule E Summary
1. Payments made this pedod of $100 or more. (Include all Schedule E subtotals.) ............................................................................................... $ 3/'7°
2. Unitemized payments made this pedod of under $100 ..................................................
......................... $ ;t o.
3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part 2, Column (d).) ....................................... $ -? -
4. Tolal payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6 ) ............. TOTAL $ ~'~'~
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660
Schedule I Typa or print in ink. SCHEDULE
Miscellaneous Increases to Cash Am~'u~t~s-m'-a~'b~'~-ded
to whole dolla,a, from
SEE INSTRUCTIONS ON REVERSE through
NAME OF FILER I.D. NUMBER
DATE FULL NAME AND ADDRESS OF SOURCE DESCRIPTION OF RECEIPT AMOUNT OF
RECEIVED pF COMMITTEE, ALSO EN?ER I+D, NUMBER) INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Increases to cash of $100 or more this period ...........................................................................................................
2. Unitemized increases to cash under $100 this period ...............................................................................................
3. Total of all interest received this period on loans made to others. (Schedule H, Part 2 (b).) .................................
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) ........................................................................................................................... TOTAL
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660