HomeMy WebLinkAboutSMITH SEMIANN97(1) fficeholder, Candidate,
and Controlled Committee
Campaign Statement -- Long Form
(Government Code Sections 84200-84216 5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink,
Check one of the following boxes to indicate the type of statement being filed: [] Pre-election Statement
[] Supplemental Pre-elect~on Statement (Attach a completed Form 495 to this statement )
[] Special Odd-Year Campaign Re~ort
[] Semi-annual Statement
Date of election ff applicable ~?
(Month. Day. Year)
". ~ 5S
COVER PAGE - LONG FORM
For Official~
Termination Statement (Attach · completed Form 41 S to th~s statement.)
fficeholder. Candidate, and Controlled Committee
Included in this Statement
NAME OF OFFICEHOLDER OR CANDIDATE
COMMI~EE NAME - iD ~UM~ER
NAME OF TREASURER
II
Other Committees I lot Included in this Statement: Li~ any other
committees not included in this consolidated ~tatement that are controlled by you and any
commit/eel of which you have knowledge that are primarily formed zo receive contributions
or to make expenditures on behalf of your candidacy.
CONTROLLED COMMITTEE 7
I D NUMBER
CONTROLLED COMMITTEE 7
Attach additional information on appropriately labeled continuation sheets.
III Verification
I have used all reason·Die diligence in prep· ring this statement. I have reviewed the statement and to the be~t of my k nowtedg~heh n for m atio n conta, med herein a/~ in th~'~ttached schedules is
trueandcomplete. ~ertify~nderpena~t~f~e~n~erthe~aw~ftheS~ate~J~a~)f~rniathatthef~reg~ingistruea~r~e~t~/I ~ , [ ~ ~/~
E,e,.t,don A, ,y
An officeholder or candidate who controls a cum mittee must also verify the campaign ~tatement Ihaveusedallreasonablediligenceandtothe~a~stofmyknowledgethetreasurerhasusedaU
complete. I certify under ~enalty of perjury under the laws of the State of Cahfom~a that the foregoing ~$ true and correct ~ · (~ ~
Executed on At By
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
through /~7/3 ~'~ J ~
SUMMARY PAGE
I.D. NUbqBER
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Contributions Received
I. Monetary Contributions ............................. S~hedule A, Line
2. Loans Re<eived ......................................... ~ a, L/ne
3. SUBTOTALCASHCONTRIBUTIONS .................... Ao~dl../nes! +2
4. Non-monetary Contributions ...................... Schedule c, L/ne
5. SUBTOTAL CONTRIBUTIONS (Exclude Enforceable Promises) Add Unes 3 +
6. Enforceable Promises
(Exclude Loen Guarantees, Une1~ below) ................. Schedule D, L/ne 7
7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddLinesS +
Expenditures Made
8. Cash Payments (Other than Loans Made) ........... Schedule E, Line 5
9. LOans Made ............................................ Schedu/e H, L/ne 7
10. SUBTOTAL CASH PAYMENTS ............................ AddLinesa + g
11. Accrued Expenses (Unpaid Bills) Schedu~ F, Une S
12. TOTAL EXPENDITURES MADE ............. Add£ines PO + 11
Current Cash Statement
13. Beginning Cash Balance .................. PreviousSummaryPage, £tne 17
14. Cash Receipts ..................................... Column A, Une 3 above
1S. Miscellaneous Increases to Cash ........................ Schedule I, Line 4
16. Cash Payments ................................... ColumnA, Line lOabove
17. ENDING CASH BALANCE Add Ltnes 13 + 14 + 15, then subtractLine 16
If this b · termination ~tatement, Une 17 mu~t be zero.
18. LOAN GUARANTEES RECEIVE D .............. ~cheduleB, Parfl, Column(b)
Cash Equivalents and Outstanding Debts
19. Cash Equivalents .............................. Seein~truc~ionsonreverse $
20. Outstanding Debts .............. A~dLine 2 + Line lf inColumnCabove $
Column A
TOTAL T~II$ ~RIOD
53.66
66
Column B*
TOTAL ~REVIOUS PERIOD
(~EE NOTE
Column C
$ $
53, ¥5
· From previous Statement Summary Page, Column C. However, if
this is the first reDort filed for the calendar ).ear. Cotumn B should be
blank except for Loans Received (Line 2). Enforceable Promises (Line
6, Loans Made (Line 9), end Accrued Expenses Line 1 I).
Summary for Candidates in Both June and
November Ejections
1/1 through 6/30 7/1 to Date
21. Contribqtions .~
Rece~veo s
22. Expenditures ~
Made ....... $
Schedule E
Payments and Contributions
(Other Than Loans) Made
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
· - - //CODES ~R CLASSIFYING EXPENDITURES
Statement covers period
/--/'
SCHEDULE E
I.D. NUMBER
I
If one of the following codes accurately describes the expenditure,you may enter the code and leave the "Description of Payment' cotumn blank. Refer to the
back of Schedule E-Conti nuation Sheet for detailed explanations of each category.
*C°- MONETARYANDIN-KIND(NON-MONETARY) °B'- BROADCASTADVERTISING "G'-- GENERALOPERATIONSANDOVERHEAD
CONTRIBUTIONSTOOTHERCANDIDATE5 °N'- NEWSPAPERANDPERIODICALADVERTISING 'T:'- TRAVEL, ACCOMMODATIONSANDMEALS
AND COMMITTEES "O"- OUTSIDE ADVERTISING (MUST BE DESCRIBED)
*P'- PROFESSIONAL MANAGE MENT AND CONSULTING
'[' - INDEPENDENTEXPENDITURES °S~- SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOORSOLICITATIONS SERVICES
'L' -- LITERATURE 'F' - FUNDRAtSINGEVENTS
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
UF COMM fIT~E. IN ADDrTION TO COMMrrTEE*$ NAME AND ADDRE S5. EmER I O NUMBER OR. IF NO I D REPORT ONLY TH E LUMP SUM OF SUCH PAYMENTS ON LINE 4 OF THE SUMMARY SECTION BELOW.
CODE OR DESCRIPTION OF PAtMENT AMOUNT PAID
Important: Contributions and expenditures made out of campaign funds to or on behalf of other
~iceh~de~ candidates~ c~mmittees~ ~r ba~t measures must a~s~ be entered ~n the A~cati~n Pa~/e~ Part ~. SUBTOTAL
Payments and Contributions Made Summary
1. Payments made this period of $100 or more. (include all Schedule E subtotals.) ......................................................
2. Paymentsmadethis period of under$100. (Donot itemize.) ......................................................................
3. Total interest paid this period on outstanding ~oans. (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, and4. Enter here and on the Summary Page, ColumnA, LineS) ........... TOTAL