HomeMy WebLinkAboutKC EMPLOYEES PAC PREELEC00(2) AMENDRecipient Committee
Campaign Statement
(Government Code Sen~ons 84200-64216,5)
SEE INSmUCTK)NS ON REVERSE
'l~pe or print In Ink.
StMement ~over, period
1. Type of Recipient Committee:
[] Officeholder, Candidate
Controlled Committee
(Al~o Complete Part 4.)
[] Ballot Measure Cor~rittee
O Pflmadly Formed
O Controlled
O Sponsored
V~o c,3m~a Pen
[] Primarily Formed Candidate/
Officeholder Committee
(,41~ Complete P~t e.)
~ General Pu~ose committee O Sponsored
~L Broad Based
e
STREET ADORESS (NO P.O. BOX)
(~-~--'~ STATE ZIP COOE
MAILING ADORESS (1~ DIFFERENT) NO. AND STREET OR P.O. BOX
Date of d~tlon If applloatfle:
(Moath, Day, Yem) ~
3. h9
2. Type of Statement:
[] Pm-election Statement
[] Semi-annual Statement
[] Termination Statement
COVE,
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Pre-election
~ Ame~mant (Explain ~elow) ~\ Statemem- Attach Form 495
Treasurer(s)
NAME OF ASSt~ANT TREASURER, IF ANY
MAILING AD(~RESS
C~Y STATE ZIP C(X)E AREA COOF. JPHONE
STATE ZIP C~E AREA ~
OPTIONN.: FAX / E4AAIL ADORESS
OPTIONAL: FAX IE-Iv~[ADORESS
FPPC Form ~0
For Technical Aa$1atance:
State of California
Type or print in Ink. COVER PAGE - PART 2
Recipient Committee ~
, Campaign Statement ~[~lJ
Cover Page -- Part 2 ~
4. Officeholder or Candidate Controlled Committee 5. Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BAllOT MEASURE
OFFICE SOUGHT OR HELD (INCLUOE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIMJBUSINESS ADOflESS (NO. AND STREET) C~'Y STATE ZIP
Related Committees Not Included In this Statement: Ucteaycommmvec
not Included In Ibis consolidated sMtement Ihs t are controlled by you or which arc primarily
formed to receive conbfbutloca or to make expenditures on behsff of your candidacy.
COMMITTEE NAME ; I.D. NUMBER
NAME OF TREASURER
COMMffTEE ADDRESS
CONTROl ~ (=n COMMITrEE?
O~s O No
STREET ADDRESS (NO P.O. BO)
BALLOT NO. OR LEI I ~R I JURISDICTION D SUPPORT
I
[] OPPOSE
IdenUfy the ¢onbolling officeholder, candidate, or state measure proponent, if any.
OFFICE SOUO~T OR HELD I DISTRICT NO. IF ANY
I
6. Primarily Formed Committee u.t...., of o~c.ho~d.~./or c..,lU.f.r./
~E ~~R ~ C~DI~TE ~ ~ HE~ D SUP~
D oPPOSE
D OPPOSE
CITY STATE ZiP COOE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT
[] OPPOSE
Attach con#nuation sheets ff necassa~y
7. Verification
I have used all reasonable diligence in preparing and reviewing this statement and ,tp the best of my knowledge the information contained herein and in the attached schedules
iS tme and complete. I certify under penalty of perjury under the la. of the Sta~orni~Jhat the foregoing is true and correct.
Executedon By
~'rE
Executedon By
DATE
FPPC Form 460 (8/99)
For T®chnlcal Assistance: 916/322-5660
State ot California
2.
3.
4.
5.
Campaign Disclosure Statement
Summary Page
SEE IN~'rRUCTIONS ON REVERSE
NAME OF FILER
~q)4 or print In Ink.
Amounts may be rounded
to whole dollam.
OFFICE
Moneta~ Contributions .................
Loans Received ................................................................... 8~ule B, Line
SUBTOTAL CASH CONTRIBUTIONS ................................... AddLInes ! +2
Nonmonetary Contributions ........................ · ........... ; ........... Schedule C, Line
TOTAL CONTRIBUTIONS RECEIVED .................................... Add LInee 3 ~
SUMMARYPAGF
I.D. NUMBER
Column C
Expenditures Made ,~
6. Payments Made ........................................................... ; ........ : Schedule E. Line
7. Loans Made .................................................... Schedule H, Line
8. SUBTOTAL CASH PAYMENTS ................................................ AddLInese*?
9. Accrued Expenses (Unpaid Bills) ............................................ Schedule F, Line
10. Nonmonetary Adjustment ....................................................... Schedule C, Line
11. TOTAL EXPENDITURES MADE ......................................... AddLInesS+9*10
Current Cash Statement ' ' ~* ':~ L ~ P ~
13. Cash Receipts .................................................. : ........... ColumnA. LIneSebove
14. Miscellaneous Increases to Cash..... .................................. $chedulel, Line4
15. Cash Payments ............................. ; .............................. ColumnA, LlneS.bov.
,6. E,..,o c^s..^L*.CE .............. A,dL,... ,,. ,,. ,,. ,h....h..,,,n. ,,
If this !s a termination statement. Line 16 must be zero. :'
' From Ixevlous 81atement Summap/Page, Column C. However, it ihls /
Is the flint report flied ~r fha cale~:tsr year, Column B .hould be b snk
except f~r Loans Received (Une 2), Loan~ Made (Une 7) and A=c~ued
Expermes (Uae 9).
17. LOAN GUARANTEES RECEIVED ................... Schedule S, Pa~t t, Column (b) $
Cash Equivalents and Outstanding Debts '~'~' ',
18. Cash Equivalents .................................................... ~ See instruceona On reverse
19. Outstanding Debts ................................... AddLIne2+LlneglnColumnCebove S
', Summary for Candidates In Both June and
November Elections
20. Contributions
Received ............ $
21. Expenditures
Made ..................
FPPC Form 460 (8/99)
For Technical Assistance: 916/322-5660
Schedule A ~n~ or print in ink. SCHEDULE
~ COM
~ OTH
~ OTH
~ IND
~ ~OM
~ OTH
~ IND
~ OOM
SUBTOTAl.
Schedule A Summary '~
1. Amount received this pedod - contributions of $100 or more. '' r ' + ~; : ' ' '
(include ell Schedule A subtotals.) .......................................................................................................
2. Amount received this pedod - unltemlzed contributions of less th~ $100 .........................................
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summery Page, Column A, Line 1.) ................... TOTAL
tOM - R~pI~I Comml#~
FPPC Form 460 (8/99)
For TechnlcM A,slstance: 9t6/322-5660