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Home My WebLink AboutForm 460 Committee to Re-Elect Jerry Clay Sr 073108Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Statement covers period through �'o13p�20b� 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee Q State Candidate Election Committee Q Primarily Formed Q Recall Q Controlled (Also Complete Fel 5) O Sponsored ❑ General Purpose Committee (Also Complete Part 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER PENDING COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) COMMITTEE TO RE-ELECT JERRY L CLAY SIR STREET ADDRESS (NO P.Q. BOX) MONOWIP CITY STATE ZIP CODE AREA CODE/PHONE ATASCADERO CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE ATASCADERO CA 93422 OPTIONAL: FAX/ E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) R E CREWE D J U L 2 2 2008 COVER PAGE Page --A— of —1-1— For Official Use Only 11/04/2008 iTY OF ATASCADERO ]CITY CLERK'S OFFICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ® Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection ❑ Amendment (Explain below) Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER ANGELA CLAY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE ATASCADERO CA 93422 NAME OF ASSISTANT TREASURER, IF ANY 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 under the laws of the State of California that the foregoing is true qnd correct. , 1 n n Executed on 07/19/2008 Data Executed on 07/19/2008 Date Executed on Date By By By B Executed on Date y Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE JERRY L CLAY SR OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) ATASCADERO CITY COUNCIL MEMBER RESIDENTIAL/BUSINESS 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 I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ YES ❑ NO STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page 2 of !13 Z BALLOT NO. OR LETTER JURISDICTION ❑ 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 Committee List names of officeholder(s) or candidates) 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 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 1� Page 3 of 3 NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING Contributions Received 1. Monetary Contributions ........................................... schedule A, Line 3 $ 2. Loans Received...................................................... schedule s, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 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 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add cines a + s + 10 $ Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0 n $ 0 $ 0 0 $ 0 $ 0 0 $ 0 0 0 $ Column B Calendar Year Summary for Candidates OOTOTALTO DATER Running in Both the State Primary and 0 General Elections 1/1 through 6/30 7/1 to Date Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 0 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 0 report. Some amounts in 15. Cash Payments .................................................. Column A, Line 6 above Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 figures that should be subtracted from previous H this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 0 for this calendar year, only 17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ carry over the amounts any) Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0 19. Outstanding Debts ......................... Add Line 2 + Line 8 in Column B above $ 0 20. Contributions Received $ 21. Expenditures Made $ 0 $ 0 0 $ 0 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure LImlt) Date of Election Total to Date (mm/dd/yy) J�J $ *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A rounded Monetary Contributions Received Amounts may be to whole dollars. Statement covers period—], from • RM �,r,�i through C��13 Ow 1s Page + of � SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATIONANDEMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND ❑ COM ❑ OTH ❑ PTY []SCC ❑ IND [3Com []OTH ❑ PTY ❑ SCC []IND [3Com ❑ 0TH ❑ PTY ❑SCC ❑ IND [:]COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY []SCC SUBTOTAL$ Schedule A Summary 1. Amount received this period—contributions of $100 or more. 0 (Include all Schedule A subtotals.)........................................................................................................ $ 2. Amount received this period — unitemized contributions of less than $100 ............................................. $ 0 3. Total monetary contributions received this period. 0 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (Junel01) FPPC Toll -Free Helpline: 8661ASK-FPPC SCHEDULEB-PART1 Schedule B—Part 1 Amounts vmay�be'rounded Statement covers period pCALIFORNIA 4 . 1 Loans Received to whole dollars.FORM from through o(013ola-009 Page -5— of moi_ SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUALENTER , ° OUTSTANDING (b) AMOUNT 10(d) AMOUNT PAID OUTSTANDING (e) INTEREST (r ORIGINAL (g) CUMULATIVE OF LENDER OCCUPATION AND ED,EN EMPLOYER ER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSEOF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAMEOFBUSINESS) PERIOD THIS PERIOD* PERIOD LOAN TO DATE C] PAID CALENDAR YEAR $ $ % S $ ❑ FORGIVEN PER ELECTION- RATE $ $ S S S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION*" RATE S S S S $ DATE DUE DATE INCURRED to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION ** RATE S S S $ $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period.................................................................................................................... $ (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period......................................................................................................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 0 101 3. Net change this period. (Subtract Line 2 from Line 1.) ................""""' . """" . . " . . . ...................... NET $ 0 (May be a negative number) Enter the net here and on the Summary Page, Column A, Line 2. t Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee , ,e, .„ Schedule E, Line 3) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC SCHEDULEB-PART2 Schedule B —Part 2 Type or print in ink. Statement covers period, Amounts may be rounded 460 � ' Loan Guarantors to whole dollars. FORM fromr,n through` `��''� page of 3 SEE INSTRUCTIONS ON REVERSE _�Q_ NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER LOAN AMOUNT GUARANTEED CUMULATIVE BALANCE OUTSTANDING ZIP CODE OF GUARANTOR CODE (IF SELF-EMPLOYED, ENTER THIS PERIOD TO DATE TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS LENDER CALENDAR YEAR ❑IND ❑ COM $ DATE OTH PER ELECTION (IF REQUIRED) FIFTY ❑ SCC $ CALENDARYEAR F-JIND LENDER ❑ COM $ PER ELECTION DATE ❑ OTH (IF REQUIRED) O PTY ❑ SCC $ CALENDAR YEAR ❑IND LENDER s ❑ COM PER ELECTION ❑ OTH (IF REQUIRED) DATE PTY ❑ SCC $ CALENDAR YEAR ❑ IND LENDER ❑ COM $ PER ELECTION �OTH DATE (IF REQUIRED) ❑ PTY ❑ SCC $ Enter on SUBTOTAL $ Summary Page, Line 17 o0 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule C Type or print in ink. SCHEDULE C - - - - - Amounts may be rounded Nonmonetary Contributions Received to Whole dollars.CALIFORNIA Statement covers period , 60 from • - through 120/ 01nZay Page —I— of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I. D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IFANlNDlVIQUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) (IF REQUIRED) FIND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑OTH ❑ PTY []SCC ❑IND ❑COM ❑OTH ❑ PTY ❑ SCC dttaeh nrirlitinnal information on aonronriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period — nonmonetary contributions of $100 or more. (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.) ........ ..... I..... $ ......... TOTAL $ A Q C C tributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH - Other PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (June/01l FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule D Cr:FIFry a P ......... y PF %41iM, GIT 'yV= WF NUIFIL III inR. Supporting/Opposing Other Amounts may be rounded Statement covers period • - Candidates, Measures and Committees to whole dollars. from FORM • SEE INSTRUCTIONS ON REVERSE through g0130/&—'1qg'7 Page —1— of 3 NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTIONCUMULATIVE AMOUNT THIS TO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) CALENDAR YEAR TO DATE OR COMMITTEE PERIOD (JAN. I • 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 SUBTOTAL $ Schedule D Summary 1. Contributions and independent expenditures made this period of $100 or more. (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 $ 0 I N FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink.SCHEDULEE Statement covers period Amounts may be rounded CALIFORNIA J • ' to whole dollars. from FORM through Obl30/900f Page 3— of 13 ME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphemalia/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 PEr 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 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.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of $100 or more. Include all Schedule E subtotals. .............................................. $ 0 2. Unitemized payments made this period of under $100 $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................... $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 0 FPPC Form 460 (June/09) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule F Accrued Expenses (Unpaid Bills) ON NAME OF FILER COMMITTEE TO RE-ELECT JERRY L CLAY SR Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from %�],,,, through 2bZ9D[ ✓V019 SCHEDULEF Page �� of _13— I.D. NUMBER PENDING CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Clue campaign paraphemalia/misc. ACR 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 W 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 UT campaign literature and mailings PRT print ads WEB information technoloov costs (internet. e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD * Payments that are contributions or Independent expenditures must also be SUBTOTALS $ $ $ $ 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.) ..................... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments or accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)............................................................................................... ...I.......1........... INCURRED TOTALS $ .............................. PAID TOTALS $ N ................................................. NET $ 0 May be a negative number FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule G Type or print in ink. SCHEDULE G Statement covers period • . , , 1 Payments Made by an Agent or Independent Amounts may be rounded Contractor (on Behalf of This Committee) to whole dollars. from • - • page— throughy(0(3dl�d SEE INSTRUCTIONS ON REVERSE of NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR PENDING NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia/mise. 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 RL 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 M 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 CODE OR DESCRIPTION OF PAYMENT 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 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC RCHFnI11 P H Schedule H Type or print in Ink. Statement covers period CALIFORNIA Amounts may be rounded I Loans Made to Others* to whole dollars. from _� sRM 12 00l 3d/01�� SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER COMMITTEE TO RE-ELECT JERRY L CLAY SR��dd PENDING FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT REPAYMENT OR OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF RECIPIENT OCCUPATION AND EMPLOYER BALANCE LOANED THIS FORGIVENESS BALANCE AT RECEIVED AMOUNTOF LOANS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD PERIOD THIS PERIOD* CLOSE OF THIS PERIOD LOAN TO DATE PAID CALENDAR YEAR FORGIVEN PER ELECTION" RATE S S $ S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR FORGIVEN PER ELECTION*" RATE s $ $ $ $ DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ also be reported on Schedule E. Schedule H Summary 1. Loans made this period................................................................................................................................ (Total Column (b) plus unitemized loans less than $100.) ,',„e ,_, Schedule I, Line 3) $ ° 2. Payments received on loans........................................................................................................................................... $ (Total Column (c) plus unitemized payments less than $100.) NET $ 0 (May be a negative number) 0 3. Net change this period. (Subtract Line 2 from Line 1.).................................................................................... (Enter the net here and on the Summary Page, Column A, Line 7.) **If Required FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Cnher11 rin 1 T.__ _. SCHEDULE I Miscellaneous Increases to Cash Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from through " CALIFORNIA • FORM Page _0— of NAME OF FILER COMMITTEE TO RE-ELECT JERRY L CLAY SR I.D. NUMBER PENDING DATEFULL RECEIVED NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER W. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule I Summary 1. Increases to cash of $100 or more this period. 0 2. Unitemized increases to cash under $100 this period. 0 3, Total of all interest received this period on loans made to others. Schedule H, Column (e).) $ 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the 0 SummaryPage, Line 14.)........................................................................................................................... TOTAL $ FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC