HomeMy WebLinkAboutCOUCH SEMIANN05(2)
COVER PAGE
Date Stamp
~oo
in ink.
Type or print
Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
I of '7
- -
Official Use Only
Page
~
4
PH
3
J~r'
;-1,'
Date of election if appli~~~
(Month. Day, Year)
covers period
Statement
(:>
Fo,
,~
from
Quarterly Statement
Special Odd~ Year Report
Supplemental Preelection
Statement - Attach Form 495
o
o
o
N/4-
2. Type of Statement:
D Preelection Statement
M. Semi-annual Statement
tJ - Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
2, 3, and 4.
Measure
through
1.
Primarily Formed Ballot
Committee
o Controlled
o Sponsored
(AJ.so Complete Part6)
Type of Recipient Committee: All Committees - Complete Parts
~ Officeholder, Candidate Controlled Committee D
o State Candidate Election Committee
o Recall
(Also Complete Part 5)
SEE INSTRUCTIONS ON REVERSE
1.
Primarily Formed Candidate/
Officeholder Committee
(AJsoComplelePart7)
o
o General Purpose Committee
o Sponsored
o Small Contributor Committee
o Political Party/Central Committee
Treasurer(s)
()
{!..¿;;Ut!.#
.D.
NAME IF NO COMMITTEE)
7)/?vli)
Committee Information
(OR CANDIDATE'S
COMMITTEE NAME
rl!/&YDS
3.
CITY
NAME
OF
CITY
-
AREA CODE/PHONE
ZIP CODE
STATE
CITY
AREA CODE/PHONE
ZIP CODE
STATE
CITY
ADDRESS
4. Verification
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.
under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
E-MAIL
FAX
OPTIONAL:
E-MAIL ADDRESS
FAX
OPTIONAL:
certify
!í
)(
By
Executed on
Sign
By
Executed on
Candidate. State Measure Proponent
Signatum of Controlling Officeholder, Candidate. State Measure Proponent FPPC Fa"" 460 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
State of California
Signalure of Controlling Offiœholder,
By
By
Dale
D'te
Executed on
Executed on
Type or print in ink. COVER PAGE - PART 2
Recipient Committee
Campaign Statement
Cover Page - Part 2
- -
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
-
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE
l?1 V, f) [1.-,:ðt( C-II - BALLOT NO. OR LETTER JURISDICTION
OFF CE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUf. IF APPLICABLE) SUPPORT
~K.€!l.s¡::¡eLZ> {!./TY CåtJIVt:.IL - ¿UÂIt.P c¡ o OPPOSE
R~IDENTIAUBUSINESS 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 DISTRICT NO. IF ANY
contributions or make expenditures on behalf of your candidacy.
-
COMMITTEE NAME
- 7. Primarily Formed Candidate/Officeholder Committee List names of
NAME OF TREASURER officeholder(s) or candidate(s) for which this committee is primarily formed.
.....,,:::::. o NO
COMMITTEE ADDRESS )RESS '.0. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
:----- STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE
o SUPPORT
o OPPOSE
-
COMMITTEE NAME ~"~
OFFICE SOUGHT OR HELD o SUPPORT
o OPPOSE
-
NAME OF TREASURER ROLLED COMMITTEE? , OR CANDIDATE OFFICE SOUGHT OR HELD
[YES DNO o SUPPORT
o OPPOSE
COMMITTEE ADDRESS ~ '.0. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary
FPPC Form 460 (January/OS)
FPPC Toll-Free Helpline: 866fASK·FPPC (8661275-3772)
State of California
SUMMARY PAGE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Campaign Disclosure Statement
Summary Page
.0. NUMBER
'If'~/ '1tJ
Calendar Year Summary for Candidates
Running In Both the State Primary and
General Elections
through
1_
Column B
CAlENDAR YEAR
TOTN.TODATE
from
~
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
~V/P
ColumnA
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
Contributions Received
to Date
71
through 6130
1
C>
-
()
-
C>
$
-
D
-
o
$
Schedule A. Line 3
Schedule S, Line 3
Monetary Contributions
Loans Received ..........
SUBTOTAL CASH CONTRIBUTIONS
Nonmonetary Contributions ..... ........
TOTAL CONTRIBUTIONS RECEIVED
2.
3.
4.
5.
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
D
$
C>
f?7[>~
$
20. Contributions
Received
Expenditures
Made
21
$
$
+2
Schedule C, Line 3
Add Lines
$
$
$
$
Add Lines 3 + 4
Expenditures Made
6. Payments Made
Expenditure Limit Summary
Candidates
Ll '1'1
-
$
$
Schedule E, Line 4
Schedule H, Line 3
Made
SUBTOTAL CASH PAYMENTS
Loans
7.
8.
22.
I
$
$
Add Lines 6 + 7
Date of Election
(mm/dd/yy)
-
-
9-
Schedule F. Line 3
Schedule C, Line 3
(Unpaid Bills)
Nonmonetary Adjustment """"
TOTAL EXPENDITURES MADE
Accrued Expenses
9.
10.
$
-----.J-----.J_
-----.J-----.J_
from amounts
"'Amounts in this section
reported in Column S.
To calculate Column S. 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).
$
$
AddUnes8+9+ 10
~/
$
Previous Summary Page, Line 16
Column A, Line 3 above
Current Cash Statement
12. Beginning Cash Balance
Cash Receipts
Miscellaneous
11
3.
-
-
$
$
Line 4
Cash Equivalents and Outstanding Debts
18. Cash Equivalents See instructions on reverse
Outstanding
Column A. Line 8 above
Add Lines 12 + 13 + 14, then subtract Line 15
Schedule
Schedule B, Part 2
16 must be zero.
to Cash
this is a termination statement, Line
7. LOAN GUARANTEES RECEIVED
Increases
Payments
ENrnNG CASH BALANCE
If
Cash
4.
5.
6.
$
$
Line 9 in Column 8 above
Add Lme 2 +
Debts
9.
from
through _/:l/5I /¿1~ _ I Page L of L
1.0. NUMBER
ff;l/ ~O
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Schedule E
Payments Made
8tle
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
rn
Otherwise, describe the payment
radio airtime and production
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same
voter registration
infonnation technology costs e·
costs
'RAD
RFD
SAL
"TEL
lRC
lRS
TSF
VaT
V\£B
the payment, you may enter
I\1BR member communications
MTG meetings and appearances
OFC office expenses
ÆT petition circulating
p¡..o phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal. accounting)
PRT print ads
the code.
'VI;::'
the following codes accurately describes
(explain)·
CODES: If one of
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)·
civic donations
candidate filinglballot fees
fundraising events
independent expenditure supporting/opposing others
legal defense
campaign literature and mailings
eM'
CNS
em
eve
FIL
FI\O
Ii'D
LEG
LrT
candidate/sponsor
NAME AND ADDRESS OF PAYEE
(1F COMMITTEE. ALSO ENTERI.O. Nl.A!BER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Y I/I'I~ &,f1IH(,(N(~71P1Y.$" ~ ,/>'ò
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if Payments that are contributions or independent expenditures must also be summarized on Schodule D. SUBTOTAL$ ;.1 t/b
mai
(internet
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 S, 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 $
FPPC Form 460 (JanuaryI05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Statement covers period
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Schedule E
(Continuation Sheet)
Payments Made
Page L Of---1--
.0. NUMBER
ff:J.¡ 70
through
8uC-J/-
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
PA!Y/þ
Otherwise, describe the payment.
RAD radio airtime and production costs
RFD returned contributions
SAL campaign workers' salaries
TB... t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same
VOT voter registration
the payment, you may enter
~ member communications
MTG meetings and appearances
OFC office expenses
ÆT petition circulating
PI-O phone banks
POl polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
FRf t ad
the code.
CODES: If one of the following codes accurately describes
O..F campaign paraphernalia/misc.
CNS campaign consultants
em contribution (explain nonmonetary)·
eve civic donations
FIL candidate fì1ingfballot fees
FNJ fund raising events
N) independent expenditure supporting/opposing others
LEG legal defense
UT campaign literature and mailings
candidate/sponsor
(explain)·
~.
NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
(IF COMMITTEE, ALSO ENTER I.D. NUMBER¡
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eve,
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c7llZL> CUt!? t>r '$:R a..'Z> 4~rra;'T ..,Ç?
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* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $
FPPC Fonn 460 (JanuaryI05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
SCHEDULE E (CaNT.)
Type or print In ink.
Amounts may be rounded
to whole dollars.
Schedule E
(Continuation Sheet)
Payments Made
b
¿)"7
from
ofL
Page
1.0. NUMBER
C¡Pß./'lo
through
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
candidate/sponsor
describe the payment.
radio airtime and production
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same
voter registration
information technology
costs
Otherwise,
RAD
"RFD
SAL
TEL
TRC
ms
TSF
VaT
\NEB
the payment, you may enter
M8R member communications
MTG meetings and appearanœs
OFC office expenses
F£T petition circulating
PI-() phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (Iega[, accounting)
PRT print ads
the code.
eoq,
following codes accurately describes
(explain)·
V /.1:)
CODES: If one of the
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)
civic donations
candidate filinglballot fees
fund raising events
independent expenditure supporting/opposing others
regal defense
campaign literature and maitings
Q.P
CNS
CTB
eve
FIL
FN:)
IN)
LEG
LIT
e·mai
(internet
costs
AMOUNT PAID
DESCRIPTION OF PAYMENT
OR
CODE
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE.. ALSO ENTER t.D. NUMBER)
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FPPC Fonn 460 (JanuaryIOS)
FPPC TolI·Free Helpline: 866/ASK·FPPC (866/275-3772)
SUBTOTAL $
. Payments that are contributions orin dependent expenditures mustaiso be summarized on Schedule D.
SCHEDULE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Schedule
Miscellaneous Increases to Cash
~ Of---2-
Page
.D. NUMBER
fP;21 flo
from
through
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
AMOUNT OF
INCREASE TO CASH
/19.~
I>'>' 3J
.~
13/.5""'1
DESCRIPTION OF RECEIPT
I ¡tJTE{Z£>(
.
DATE
RECEIVED
e>7/t'P/IPS-
O¿>!:Z/IP.>
C>~~$
I'
1'7~
/if>' ~
/ S';J. ~.J
/,J.{p . !i
/o//~>'
/I//I~5
/.
/;Ý.&Jfr5
c>o / ?'J
.~
II
SUBTOTAL $
~
-
$
$
$
Attach additional information on appropriately labeled continuation sheets.
Schedule
1. Itemized increases to cash this period
2. Un itemized increases to cash of under $100 this period
3. Total of all interest received this period on loans made to others. (Schedule H, Column (e)
to cash this period. (Add Lines 2. and 3. Enter here and on
Summary
4. Total miscellaneous increases
Summary Page, Line 14.)
I, O~ :;h
FPPC Form 460 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275·3772)
TOTAL $
the