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HomeMy WebLinkAboutKC EMPLOYEES PAC PREELEC01(1) ecipient Committee Campaign Statement (Govemmenl Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print In ink. Statement covers period through ~-- ~. ~-' 0 Dale o f elect ~'~ ~.~i~l~l~ e:! (Month, Day,~ear) '~' ~ Date Stamp COVER PAGE Page I of ' For Official Use (~ly 1. Type of Recipient Committee: All Comrnlttees -Complete Parts 1, 2, 3, and 7. [] Officeholder, Candidate Controlled Committee (Also Complete Part 4.) [] Ballot Measure Committee 0 Primarily Formed 0 Controlled © Sponsored (Also Complete Part 5.) [] Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 6.) ~General Purpose Committee 0 Sponsored ~., Broad Based 3. Committee Information COMMITTEE NAME STREET ADDRESS (NO P.O. BOX) 2. Type of Statement: ~.?re-election Statement [] Semi-annual Statement [] Termination Statement [] Amendment (Explain below) [] Quarterly Statement [] Special Odd-Year Report [] Supplemental Pre-election Statement - Attach Form 495 Treasurer(s) MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE & STATE ZIP CODE MAILING A~DRESS (IF DIFFERENT) NO. AND STREET OR RO. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODF-JPHONE OPTIONAL: FAX I E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS FPPC Form 460 (6199) For Technical Assistance: 9161322-5660 State of California Recipient Committee Campaign Statement Cover Page -- Part 2 Type or print in ink. COVER PAGE - PART 2 4. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE 5. Ballot Measure Committee NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NDMBER IF APPLICABLE) RESIDENnAL/BUSINESSADDRESS (NO ANDSTREET) CITY STATE ZiP Related Committees Not Included in this Statement: List any committees not included In this consolidated statement that are controlled by you or which are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. COMMITTEE NAME ID. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [] YES [] NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O, BOX) CITY STATE ZIP CODE AREA CODE/PHONE BALLOT NO. OR LETTER JURISDICTION [] SUPPORT [] OPPOSE Identify the controlling officeholder, candldale, or itata measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE OR, PROPONENT OFFICE SOUGHT OR HELD J DISTRICT NO. iF ANY I 6. Primarily Formed Committee Llstname, of officeholder(s) orcandidat,(,) for which fills committee Is primarfly 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 OFFICEHOLDERORCANDrDATE OFFICE SOUGHT OR HELD 7. Verification Attach continuation sheets if necessaq/ [:]SUPPORT [::]OPPOSE I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained hereiD and in the attached schedules is true and complete. I certify under penalty of perjury under the lawl of the State~,~mia %t~,~foregoing is tree and correct, Executed on (~-- ~--'~-O I By By SIGNATURE O~ CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. STATE MEASURE PROPONENT Execuled on Executed on. FPPC Form 460 (8~99) For Technical Assistance: 916/322-5660 State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Amounts may be rounded to whole dollars, Statement coverl period SUMMARY PAGE Page ~ of__ NAME OF FILER Contributions Received 1. Monetary Contributions ...................................................... ScheduleA. Line 3 2. Loans Received ................................................................... Schedule B, Line 7 3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines I ~. 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 Bills) ............................................ Schedule F, Line g 10. Nonmonetary Adjustment ....................................................... Schedule C. Line 3 11. TOTAL EXPENDITURES MADE ......................................... Add Lines 8 * 9 + tO Current Cash Statement 12. Beginning Cash Balance ................................ Previous Summary Page, Line 16 13, Cash Receipts .............................................................. Colum. 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 B. Part 1, Column (b) Cash Equivalents and Outstanding Debts 18. Cash Equivalents ..................................................... See instructions on reverse 19. Outstanding Debts ................................... Add Line £ * Line 9 in Column C above Column A s ~ Column B* TOT~/. pREViOUS P~ RiO0 (SEE NOTE BELOW) '1 g- 7--c:::1 I I.D. NUMBER Column C * From previous statement Summary Page, Column C However. if this is the 9rst report filed for the calendar year. Column B should be blank except for Loans Received (Line 2). Loans Made (Line 7). and Accrued Expenses (Line 9). Summa~ for Candidates in Both June and November Elections 111 through 6/30 7/1 to Dale 20. Contributions Received ............ $ 21. Expenditures Made .................. $ FPPC Form 460 (8~99) For Technical Assistance: 9161322-5660 Schedule A Type er print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollar~, from SEE INSTRUCTIONS ON REVERSE RECEIVED (IF COMMI~EE. ALSO ENTER m D NUMAR) CODE e (IF SELF-EMpLOYED. ENlER N~E PERIOD (JAN. I - DEC. 31 ) (iF 93301 ~TH ~[JN COUNIY ~PLoYEE'S ~S't~ i~ ~ ~ 93301 ~ 93301 93301 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 4ss4 *Contributor Codes ~ IND - Individual COM - Recipient Commiltee 4~S4 OTH- Olher FPPC Form 460 (8199) For Technical Assistance: 9161322-5660