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Home My WebLink AboutForm 460 Citizens in Support of Measure D20 123120Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 10/ 18/20 through 12/31/20 1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure V State Candidate Election Committeecommittee O Recall Controlled tarso Cwptefe Part 5) (9 Sponsored (Also CaMoVe Part Bl ❑ 9neral Purpose Committee Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee fMcComplefePart 7j 3. Committee information I.D NUMBER 1430938 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee in Support of Measure D-20 STREETADDRESS (NO P.O. BOXI CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX (Also file a Form 410 Termination) ❑ Amendment (Explain below) CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL- FAX 1 E-MAIL ADDRESS 4, Verification Date of election if applicable. (Month, Day, Year) 11/03/2020 2. Type of Statement: Date Stamp RECEIVED JAN 0 4 2020 OF ATASCADERO CLERKS OFFICE ❑ Preelection Statement ❑ Semi-annual Statement Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE Page of — For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report NAME OF TREASURER Joseph Modica Jr. MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Atascadero NAME OF ASSISTANT TREASURER, IF ANY Ron Overacker MAILING ADDRESS CA 93422 CITY STATE ZIP CODE AREA CODEIPHONE Atascadero CA 93422 OPTIONAL: FAX 7 E-MAIL ADDRESS 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 12/31/20 Date Executed on Dale Executed on Executed on By Signature of Controlling Officeholder, Candidate. Stale Measure Proponent or Responsible Officer of Sponsor By Signature of Controlling ORceholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder. Candidate. State Measure Proponent FPPC Form 460 (1an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO.ANDSTREET) 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 contributions or make expenditures on behalf of your candidacy. CITY STATE ZIP CODE AREACODE/PHONE COMMITTEE NAME I.D. NUMBER ❑ YES ❑ NO COVER PAGE - PART 2 Page of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE D-20 BALLOT NO. OR LETTER JURISDICTION ® SUPPORT D-20 City ofAtascadero ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER. CANDIDATE, OR PROPONENT NONE DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s) or cendidate(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 AREACODE/PHONE Attach continuation sheets if necessary FPPC Form 4601Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 10/18/20 through 12/31/20 SUMMARYPAGE Page of NAME OF FILER I.U. NUIMBEK Committee In Support of Measure D-20 1430938 Contributions Received Column A TOTALTHIS PERIOD 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 Column B Calendar Year Summary for Candidates 6. Payments Made................................................................ Schedule E, Line 4 (FROM ATTACHED SCHEDULES) 4436.13 CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and 7. Loans Made....................................................................... Schedule H. Line 3 amounts from Column B 15. Cash Payments......................................................... Column A, Line 8 above 4436.13 General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ 3000 $ 15,058.00 15058.00 9. Accrued Expenses (Unpaid Bills) ...................... schedule F Line 3 should be subtracted from -94.31 1/1 Mrough 6/30 7/1 to Dale 2. Loans Received................................................................ Schedule B. Line 3 this is the first report being 206.02 17. LOAN GUARANTEES RECEIVED Schedule 8. Part 2 521.27 11. TOTAL EXPENDITURES MADE .................................... AddLmes 8 + 9 + 10 3000 4547.84 15,00 058.. 20 Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines t +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C. Line 3 206.02 521.27 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED...- ... ............. .......... .Add Lines 3+4 $ 3206.02 $ 15,579.27 Made $ $ Expenditures Made 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1436.13 To calculate Column B, 6. Payments Made................................................................ Schedule E, Line 4 $ 4436.13 $ 15058.00 7. Loans Made....................................................................... Schedule H. Line 3 amounts from Column B 15. Cash Payments......................................................... Column A, Line 8 above 4436.13 of your last report. Some 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6 * 7 $ 4436.13 $ 15058.00 9. Accrued Expenses (Unpaid Bills) ...................... schedule F Line 3 should be subtracted from -94.31 0 10. Nonmonetary Adjustment......................................................... Schedule C. Line 3 this is the first report being 206.02 17. LOAN GUARANTEES RECEIVED Schedule 8. Part 2 521.27 11. TOTAL EXPENDITURES MADE .................................... AddLmes 8 + 9 + 10 $ 4547.84 $ 15,579.27 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1436.13 To calculate Column B, 13. Cash Receipts........................................................... Column A. Line 3 above 3000.00 add amounts in Column 0 A to the corresponding 14. Miscellaneous Increases to Cash .................................. schedule L Line 4 amounts from Column B 15. Cash Payments......................................................... Column A, Line 8 above 4436.13 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED Schedule 8. Part 2 $ filed for this calendar year, ...................... .......... only carry over the amounts from Lines 2, 7, and 9 (H Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (if subject to Voluntary Expenditure Limit) Dale of Election Total to Date (mmldd/yy) $ `Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A LU wnulr U031ais. Monetary Contributions Received Statement rovers riod ne CALIFORNIA , 60 from 10/18/20 - Page of SEE INSTRUCTIONS ON REVERSE through 12/31/20 NAME OF FILER I.D, NUMBER Committee In Support of Measure D-20 1430938 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) ❑ IND 10/26/2020 SEIU Local 620 ❑ COM 1000 1000 Candidate Fund Account m OTH ❑ PTY ❑ SCC ❑ INDEl I0/28/2020 Waste Management & Affiliated Entities COM 2000 2000 Z OTH Sun Valley, CA 91352 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 3000 Schedule A Summary Amount received this period — itemized monetary contributions. 3,000 (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.). $ 0 TOTAL $ 31000 `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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded a441 114119MIN Nonmonetary Contributions Received �....�.��" �' Statement covers period CALIFORNIA 10/18/20 from FORM • SEE INSTRUCTIONS ON REVERSE through 12/31/20 Page of NAME OF FILER I.D. NUMBER Committee In Support of Measure D-20 1430938 DATE FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR • IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT! FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED (IFCOMMITTEE,ALSOENTERI.O.NUMBERy CODE (IFSELF-EMPLOYED.ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED) NAME of BusrNEssl (JAN 1 - DEC 31) m IND 10-31-20 Ron Overacker ❑ COM Police Officer, City of Social Media $34.21 $34.21 ❑ OTH Atascadero Advertising Atascadero, CA 93422 ❑ PTY ❑ SCC 9 IND 11-1-20 Ron Overacker ❑ COM Police Officer, City of Social Media $71.81 $106.02 ❑ OTH Atascadero Advertising Atascadero, CA 93422 ❑ PTY ❑ SCC ®IND 11-2-20 Ron Overacker ❑ COM Police Officer, City of Social Media $100.00 $206.02 ❑ OTH Atascadero Advertising Atascadero, CA 93422 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 206.02 Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. 206.02 0 (Include all Schedule C subtotals.).................................................................................................. .$ 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ....... 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.)....... 0 TOTAL $ 206.02 0 _ . 'Contributor Codes IND — Individual COM -- Recipient Committee (other than PTY or SGC) OTH —Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Committee In Support of Measure D-20 Amounts may be rounded to whole dollars. SCHEDULE E Statement covers period from 10/18/20 through 12/31/20 I 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 1430938 CMP campaign paraphernalialmisc. MBR 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 FIL candidate filing/ballot fees PHO 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 candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME ANDADDRESS OF PAYEE {IF COMMITTEE,ALSO ENDER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID A -Town Daily News (Access Publishing) - Paso Robles, CA 93446 D K)UG & KVEC (American General Media) San Luis Obispo, CA 93401 Facebook Menlo Park, CA 94025 WEB I Online Advertising RAD I Radio Advertising WEB I Social Media Advertising 313.50 1733.00 755.97 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2802.47 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 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 $ 4317.47 118.66 4436.13 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule ESCHEDULE E (CONT.) Amounts may be rounded Statement covers period (Continuation Sheet) to whole dollars. CALIFORNIA 460 Payments Made from 10/18/20. - SEE INSTRUCTIONS ON REVERSE through 12/31/20 page of NAME OF FILER I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR 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 FIL candidate filing/ballot fees PHO 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 supportinglopposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS of PAYEE (IF COMMITTEE. ALSO ENTER I.O. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Cam ai n Partner WEB Website Hosting 104.00 Massachusetts, 01467 SLO New Times Inc. Print Ad AND Digital Ads 419.00 an Luis Obispo, CA 93401 KPRL RAD Radio Advertising 192,00 Paso Robles, CA 93446 Scripps Media Inc (KSBY) 11' lad Digital Advertising 500.00 Cincinnati, OH 45202 * Payments that are contributions cr independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1515.00 FPPC Form 460 Jan 2016 FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Amounts may be rounded to whole dollars. Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE Statement covers period from 10/18/20 through 12/31/20 SCHEDULEF Page of NAME OF FILER I.D. NUMBER Citizens In Support of Measure D-20 1430938 CODES: If one of the following codes accurately describes the payment, you may enter the code CMP campaign paraphernalia/mist. MBR member communications CNS campaign consultants MTG meetings and appearances CTB contribution (explain nonmonetary)` OFC office expenses CVC civic donations PET petition circulating FIL candidate filing/ballot fees PHO phone banks FIND fundraising events POL polling and survey research IND independent expenditure supporting/opposing others (explain)` POS postage. delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads Otherwise, describe the payment. RAD radio airtime and production costs RFD returned contributions SAL campaign workers'sataries TEL t.v. or cable airtime and production costs TRC candtdate travel. lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidatefsponsor VOT voter registration WEB information technology costs (internet, e-mail) Payments that are contributions or independent expenditures must also be SUBTOTALS $ 94.31 $ 0 $ 94.31 $ 0 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) .................................. PAID TOTALS $ 94.31 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and -94.31 on the Summary Paae. Column A. Line 9.)............................................................................................................... .......... NET $ May be a negative number FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov (a) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING (b) AMOUNT INCURRED AMOUNT PAID OUTSTANDING (Ir COMMITTEE, ALSO ENTER i.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCEAT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Facebook Social Media 94.31 $0 94.31 0 enlo Park, CA 94025 p Advertising p $0 0 Payments that are contributions or independent expenditures must also be SUBTOTALS $ 94.31 $ 0 $ 94.31 $ 0 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) .................................. PAID TOTALS $ 94.31 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and -94.31 on the Summary Paae. Column A. Line 9.)............................................................................................................... .......... NET $ May be a negative number FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D SCHEDULE D summary OT txpenaitures Amounts may oe rounoeci Statement covers period to whole dollars. Supporting/Opposing Other • ' • Candidates, Measures and Committees from FORM SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Committee In Support of Measure D-20 1430938 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNTTHIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTERAND JURISDICTION, TYPE OF PAYMENT REQUIRED) PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (IF (JAN.1-DEC. 31 ) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent Su ort Oose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent Support Opposel Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 2. Unitemized contributions and independent expenditures made this period of under $100.................................................................................... $ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.).......... TOTAL.. $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D (Continuation Sheet) Amounts may be rounded SCHEDULE D (CONT) to wnole oonars. Summary of Expenditures Statement covers rind - Pe7DN . , Supporting/Opposing Other "Candidates, from Measures and Committees through ofNAME F FILERBER NAME OF CANDIDATE, OFFICE. AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTERAND JURISDICTION, TYPE OF PAYMENT CALENDARYEAR TO DATE OR COMMITTEE (IF REQUIRED) PERIOD (JAN.1-DEC. 31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ FPPC Form 460(Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) Amounts may be rounded to whole dollars. Statement covers period from SCHEDULE F (CONT.) NAMEANDADDRESS OF CREDITOR (IF COMMITTEE. ALSO ENTER I.O. NUMBER) CODE OR DESCRIPTION OF PAYMENT fel OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNTPAID THIS PERIOD (ALSO REPORT ON E) through Page of NAME OF FILER I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR 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 Lv. or cable airtime and production costs FIL candidate filing/ballot fees PHO 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 WEB information technology costs (internet, e-mail) A Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAMEANDADDRESS OF CREDITOR (IF COMMITTEE. ALSO ENTER I.O. NUMBER) CODE OR DESCRIPTION OF PAYMENT fel OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNTPAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCEATCLOSE OF THIS PERIOD SUBTOTALS$ $ $ $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule G Payments Made by an Agent or Independent Amounts may be rounded Contractor (on Behalf of This Committee) to whole dollars. NAME OF FILER NAME OF AGENT OR INDEPENDENT CONTRACTOR from covers SCHEDULE G Page of CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR 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 FIL candidate filingtballot fees PHO 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 WEB information technology costs (Internet, e-mail) Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR I CODE OR DESCRIPTION OF PAYMENT I AMOUNT PAID (IF COMMITTEE, ALSO ENTER I. D. NUMBER) Attach additional information on appropriately labeled continuation sheets. TOTAL` $ Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.".gov SCHEDULE H Schedule H Amounts may be rounded Statement covers period [o whole dollars. ' Loans Made to Others' from SEE INSTRUCTIONS ON REVERSE through Of 7NUMBER NAME OF FILER FULL NAME, STREETA AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT REPAYMENTOR OUTSTANDING ORIGINAL v CUMULATIVE OF RECIPIENT PIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS LOANEDTHIS FORGIVENESS BALANCE AT CLOSE OF THIS INTEREST RECEIVED AMOUNTOF LOANS NAME OF BUSINESS) FRinnpFginn PERIOD THIS PERIOD' LOAN TO DATE ❑ PAID CALENDAR YEAR S f % f S RATE ❑ FORGIVEN PER ELECTION"* S f S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR S RATE ❑ FORGIVEN PER ELECTION" S f S f S DATE DUE DATE INCURRED 'Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. SUBTOTALS $ $ $ $ (Enter (e) on Schedule I. Line 3) Schedule H Summary 1. Loans made this period............................................................................. (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans..................................................................... (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.) .............................. (Enter the net here and on the Summary Page, Column A, Line 7.) ............... I ................ I ........ $ ..............$ ..... NET $ "If Required (May M a negahve numeer) FPPC Form 460 (Jan/2036)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov 4rhpr alp I SCHEDULEI Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period CALIFORNIA from FORM through Pegs of NAME OF FILER I.D. NUMBER DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER I.O. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 1. Itemized increases to cash this period............................................................................................................................$ 2. Unitemized 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).) .......................................$ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.)............................................................................................................................. TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov