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Home My WebLink AboutForm 460 Keen 063021Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Stalleipent covers period from 1/1/2021 through 6/30/2021 1. Type of Recipient Committe6: All Committees - Complete Parts 1.2, 3, and 4. m Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballat Measure O State Candidate Election Committee Committee Q Recall Q Controlled (Also compwd Part 5) (�� Sponsored 'Mo complete Pao 6) ❑ neral Purpose Committee Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Centra( Committee rAlsoCampleiePart 7} 3. Committee Information COMMITTEE NAME (OR Keen for Counci12020 ID.NUMBER 1428685 NAME IF NO COMMITTEE) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE Q. Verification COVER PAGE REVE "ZI VE Date of election if applicable: AUG 03 21121 Page._ ___ of _'5_ (Month, Day, Year) For Official Use Only CITY OF ATASCADEF 0 CITY CLERK'S OFFIC E 2. Type of Statement: ❑ Preelection Statement ❑ quarterly Statement Z Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Rachel McElhinney MAILING ADDRESS CITY STATE ZIP CODE A.EACODE HONE Atascadero CA 93423 NAME OF ASSISTANT TREASURER. IFANY MAILING ADDRESS CITY STATE ZIP Cmr AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement anc 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 under the laws of the State o` California that the for ' is and ct.� Executed on By e gn asurer or ssislani reasurer Executed on Zl Date ignalure Officeholder, Camidate, Siaie Measure Proponent or Responsible officer o Sponsor Executed on Date Executed on Date B/ ignulure of Controlling OffeeWder, Carklidate, Sratnt Measure Proponent By igneture of CDnImIling Officeholder. Candidate. State Measure Proponeni FPPC Form 496 (Feb/2019) FPPC Advice: advi�e@fppc.ca.gav (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 Victoria Keen OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Atascadero City Council RESI DEN TIALIBUS INESS ADDRESS (NO. AND STREET) CITY STATE ZIP Atascadero CA 93422 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. COMMITTEE NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME T COMMITTEE ADDRESS I.D. NUMBER ❑ YES ❑ NO CITY STATE ZIP CODE AREACODE/PHONE bZilVl: I77ELI :5; 7,1 0 Page of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION E] 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 Attach continuation sheets if necessary FPPC Form 460 (Jan/2016] FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Statement covers period e . Summary Page to whole dollars. from 1/1/2021 6/30/2021 1 Page 3 of NAME OF FILERI.D. NUMBER Victoria Keen 1428685 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHISPERIOD CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ 126.48 2. Loans Received................................................................ Schedule B, Line 3 $ 0 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines t +2 $ 126.48 4. Nonnlonetary Contributions ............................................ Schedule C, Linea $ 0 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+ 4 $ 126.48 10. Nonmonetary Adjustment...__.................................................. Expenditures Made Expenditure Limit Summary for State $ 170.96 Candidates 6. Payments Made................................................................ schedule E, Line 4 $ 170.% 7. Loans Made....................................................................... schedule n, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 170.96 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 10. Nonmonetary Adjustment...__.................................................. Schedule C. Line 3 0 11. TOTAL EXPENDITURES MADE .......................... _....... Add Lines 8+9+10 $ 170.96 Current Cash Statement 12. Beginning Cash Balance ............................ F%vbus Summary Page, Line 16 $ 145.33 13. Cash Receipts........................................................... Column A, Line 3 above 126.48 14. Miscellaneous Increases to Cash .................................. Schedule L Line 4 0 15. Cash Payments......................................................... Column A, Line a above 170.96 16. ENDING CASH BALANCE ..................AddLbree 12+ 13+ 14, then subhect tine 15 $ 100.85 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED.............. .................. Schedules, Pad2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse 19. Outstanding Debts .............................. Add line 2+ Line 9 in Column B above $ 0 $ 0 $ 126.48 0 $ 126.48 $ 126.48 1/1 through 6130 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State $ 170.96 Candidates 0 22. Cumulative Expenditures Made' 170.% $ (a Subject to Voluntary Expenditure Limit) 0 Date of Election Total to Date 0 (mm/dd/yy) $ $ 170.96-/ To calculate Column B. add amounts in Column A to the corresponding *Amounts in this section may be different from amounts amounts from Column B reported in 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 Darty over the amounts from Lines 2, 7, and 9 (if any). FPPC Form 496(Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A to "nine 1 oluds' Monetary Contributions ReceivedCALIFORNIA Statement Covers period , i from 1/1/2021 FORM through 6/30/2021 SEE INSTRUCTIONS ON REVERSE i Page of NAME OF FILER I.D. NUMBER Victoria Keen 1428685 DATE FULL NAME, STREETADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED CONTRIBUTOR CONTRIBUTOR CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE, ALSO EWER I.D. NUMBER) QF SELF-EMPLOYED, ENTER NAME PERIOD (JAN.1-DEC. 31) ff REQUIRED) ®IND 6/8/2021 Deborah Keen EJ COM retired $126.48 $126.48 ❑ 07H Atascadero�CA 422 ❑ PTY ❑ SCC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCO ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 126.48 Schedule A Summary Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — uniternized monetary contributions of less than $100 ...........................$ 126.48 3. Total monetary contributions received this period. Acid Lines 1 and 2. I=nter here and on the Summa Page, Column A, Line 1. ....TOTAL $ 126.48 "Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Palitical Party SCC - Small Contributor Committee FPPC Form 496 (Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made Victoria Keen Amounts may be rounded to whole dollars. statement covers period e . •A Fom 1/1/21 through 6/30/21 Page !1! 1 of 7 1428685 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalialmisc. 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.O. NUMSERI CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Mechanic's Bank, 6950 El Camino Real, Atascadero, CA 93422 Bank Fees 165.50 A Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 165.50 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).)... ................................... . . .................................... $ 165.50 5.46 ............ $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 170.96 FPPC Form 496(Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov