HomeMy WebLinkAboutCOUCH PREELEC10(1)Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Type or print in Ink.
s period
Statemen /c72,40
from / /7SEE INSTRUCTIONS ON REVERSE through d ®/0
1. Type of Recipient Committee: AN Colrnnitlees - Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee
Committee
Q Recall
Q Controlled
(Also Complete Pad 5)
O Sponsored
❑ General Purpose Committee
(A)WCO nPW@FW16)
O Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
0 Political Party/Central Committee
(Also Complete Pad 7)
3. Committee Information
I.D. NUMBER/ A.; 7 y/-
Date of election if applicable:
(Month. Day. Year)
1r1;z/?ono
Date Stamp 11 Of e
LO Q OCT _ 5 Pill ',J- p a Official Use Only
2. Type of Statement:
Preelection Statement Quarterly Statement
❑ Semi-annual Statement ❑ Special Odd-Year Report
❑ Termination Statement ❑ Supplemental Preelection
(Also file a Form 410 Termination) Statement -Attach Form 495
❑ Amendment (Explain below)
PAGE
Treasurer(s)
I,UMMII 1tt NAMt tUK UANUIUAI t"S NAMt It- NU UUMMII 1tt) NAMC Vr 1RcAOvncm
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
i 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. I certify
under penalty of perjury und75, en f the State of Califomia that the foregoing is tr a nnd correct
yo~v
e- Executed on - /D By
1,6
0~ao~fTrea:ww ~~surer
Executed on By
Dale ftmot
Executed on
Deb
Executed on pie By
ignafure of ControlFng Olficehokkr, Candbate. State Measure PropaleM FppC Form 460 (Januaryl05)
FPPC Toll-Free Helpikle: 8661ASK-FPPC (8661215-772)
State of California
By
Sill mk" of ControarV 0111ehokler. CandKWe. Sbte Measure Proponent
Recipient Committee Type or print in Ink. COVER PAGE -PART 2
Campaign Statement 460
Cover Page - Part 2
Page z of
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLI ABLE
G 7/ 0:7
e~
T /Ye L
RESIDENTIALBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
%
Related Committees Na Included in this Statement: Ust any committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions of make expenditures on behalf of your candidacy.
COMMITTEE NAME
I.D. NUMBER
NAME OF TREASURER
CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME
I.D. NUMBER
NAME OF TREASURER
CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER I JURISDICTION I ❑ SUPPORT
❑ OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
7. Primarily Formed Candidate/Officeholder Committee List names of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE
Attach continuation sheets if necessary
FPPC Form 460 (January/05)
FPPC Toll-Free Heipline: 866/ASK-FPPC (8661275-3772)
State of Califomia
Campaign Disclosure Statement
Summary Page
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from -/71
PAGE
through ! /W
Page of
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
-~7xya>
I.D. NUMBER
j3?. 7y1
Column A
Column B
Calendar Year Summary for Candidates
Contributions Received
TOTALTHISPERIOD
CALENDAR YEAR
TOTALTODATE
Both the State Primary and
Running in •n
(FROMATTACHED SCHEDULES)
General Elections
Monetary Contributions
1
Line 3
Schedule A
$
$
.
,
111 through 6/30 7l1 to Date
2. Loans Received
Schedule B, Line 3
SUBTOTAL CASH CONTRIBUTIONS
3
Add Lines 1 +2
$
$
20. Contributions ~Qi vQD $ ~i--
.
Received $
4
Nonmonetar
Contributions
Line3
schedule C
dit
E
.
y
,
ures
xpen
21.
TOTAL CONTRIBUTIONS RECEIVED
5
AddLines 3+4
$
$
Made $ $
.
Expenditures Made
o7
Expenditure Limit Summary for State
6. Payments Made
Schedule E, Line 4
$
t
$
Candidates
Loans Made
7
schedule H, Line 3
.
f<-07
22. Cumulative Expenditures Made
Limit
dit
E
8. SUBTOTAL CASH PAYMENTS
Add Lines 6+7
$
8
$
)
xpen
ure
(N Subject toVolunbry
9. Accrued Expenses (Unpaid Bills)
Schedule F Line 3
Date of Election Total to Date
10. Nonmonetary Adjustment
schedule C, Line 3
(mm/ddlyy)
11. TOTAL EXPENDITURES MADE
Add Lines 6 + 9 + 10
$
~
$
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 1, Line 4
15. Cash Payments Column A, Line 6 above
16. ENDING CASH BALANCE Add lines 12 + 13 + 14, then subtract Line 15
If this is a termination statement, Lire 16 must be zero.
$ /D, 000 .
~BQS; ~7
$ _-T -
-7 1,
17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $
-199--
Cash Equivalents and Outstanding Debts
18. Cash Equivalents see instructions on reverse $
19. Outstanding Debts Add Line 2 + Line 9 in Column B above $
401-
101'
To calculate Column B, 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).
I if $
Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
Schedule A Type or print in ink. SCHEDULE A
Amounts may be rounded Statement covers period
Monetary Contributions Received to whole dollars. ,
from
through Page of
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER I.D. NUMBER
//ev, n 13~ ~y1s
DATE
ADDRESS AND ZIP CODE OF CONTRIBUTOR
FULL NAME, STREET
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
CUMULATIVE TO DATE
CALENDAR YEAR
PER ELECTION
TO DATE
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE
(IFSELF-EMpLOYED,ENTER NAME
PERIOD
(JAN. 1 -DEC. 31)
(IF REQUIRED)
OF BUSINESS)
❑ IND
❑ COM
❑ OTH
❑ PTY
❑SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
p PTY
❑ SCC
SUBTOTAL$
Schedule A Summary
1. Amount received this period - itemized monetary contributions.
(include all Schedule A subtotals.) $
2. Amount received this period - unitemized monetary 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
IND- Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
Schedule E Type or print In ink. Statement covers period
Payments Made Amounts may be rounded / '
to whole dollars. from ®1 •
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER
I.D. NUMBER
_T;V V,/,Z> Cd l{G~
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CiVP
campaign pamphemalia/misc.
NW
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nonmonetary)'
OFC
office expenses
SAL
campaign workers' salaries
CVC
civic donations
PET
petition circulating
TEL
t.v. or cable airtime and production costs
FL
candidate filing/ballot fees
PFID
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff/spouse travel, lodging, and meals
IND
independent expenditure supporting/opposing others (explain)'
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate/sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
voter registration
LIT
campaign literature and mailings
PRT
print ads
VVEB
information technology costs (intemet, e-mail)
NAME AND ADDRESS OF PAYEE
(IFCOMMRTEE,ALSO ENTER I.D.NUMBER)
CODE OR
DESCRIPTION OF PAYMENT
AMOUNTPAID
,eel-14(ly /~~/all - /.5-;rf ~i I eve I 7s -5 Z_1f ~Y1
,
00 71301
7-1 4A /Vi de 1F4FPzeg;,e1,-,050V
also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.) $
~b
2. Unitemized payments made this period of under $100 $ 7.~. _
3. Total interest paid this period on loans. (Enter amount from Schedule B, 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 $ 407
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
Schedule E
(Continuation Sheet)
Payments Made
NAME OF FILER
type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
SCHEDULE E (CONT.)
from _V_/ - ~/0
through
Page of
I.D. NUMBER
CODES: If one of the following codes accurately describes the payment, you may enter the code.
Otherwise, describe the payment.
CIuP
campaign paraphernalia/misc.
"
member communications
RAD
radio airtime and production costs
CNtS
campaign consultants
MfG
meetings and appearances
RFD
returned contributions
'
CTB
contribution (explain nonmonetary)*
OFC
office expenses
SAL
salaries
campaign workers
CVC
civic donations
PET
petition circulating
TEL
t.v. or cable airtime and production costs
FIL
candidate SWxyballot fees
PHD
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff/spouse travel, lodging, and meals
IND
independent expenditure supporting/opposing others (explain)*
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate/sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
WEB
voter registration
e-mail)
costs (internet
n technolo
ti
i
f
I rr
namnaian literature and maiinas
PRT
print ads
,
gy
orma
o
n
NAME AND ADDRESS OF PAYEE
(IF COMMI TEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNTPAID
X r 0 e7, W-
X_ 61KC
jg,,f6
-07-2.
~
ADD
SUBTOTALS A ig qi
'Payments that are contributions or independent expenditures must also be summarized on Schedule D. , ' ,
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)