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HomeMy WebLinkAboutForm 460 Committee to Elect Roberta Fonzi 123108Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers perioid from J n— / - 0 C� through ) 2 1 W - 07K Type of Recipient Committee All Committees — 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 Part 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 N_tu1gER C_­� 6 I Z_ COMMITTEE NAME (OR CANDIDATE'S NAME IF NO C MMITTE�EE)) 1 STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE MAILINU AUURt55 (IF UIFFEREN 1) NO. AND STREET OR P O. BOX �iA CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS / y 4. Verification i{ --- 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 and Executed on _ By } DV Sign re ofT surero ssis nl Treasurer Executed on {// Z 7 `0 g `° ' " ' Data y cinna�u, nicer frro ni .. d�da�. ce .�ne����.. o. ,. ...,,. ------- _____- COVER PAGE Date Stamp RECEIVED Date of election if applicable: JAN 2 9 200 Page _J_ of -2 (Month, Day, Year) 1 For Official Use Only y — t0'-0-' CITY OF ATASCADE O CITY CLERK'S OFFI E 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) Treasurer(s) Executed on Date By Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Type or print in Ink. COVER PAGE PART Recipient Committee Campaign StatementCALIFORNIA � +� � � Cover Page — Part 2 Page of 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION _1 r- y �� C r� C i ) RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. AME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Committees Not Included in this Statement: Listanycommhittees 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. I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO RO, BOX) CITY STATE ZIP CODE AREA CODEIPHONE ❑ SUPPORT ❑ OPPOSE 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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276.3772) State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER l Contributions Received 1 Monetary Contributions Schedule A, Line 3 2. Loans Received Schedule B, 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 Lines 8 + 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 a 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 Type or print in ink. SUMMARY.PAGE Amounts may be rounded to whole dollars. Statement covers period 0. ' from through) 2—^ r — d U Page of Column A TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) $ 6- Z $ z �� <-7 $ $ zz /S- 1/3 5C.) $ zy5.5 Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts — 18. Cash Equivalents See instructions on reverse $ 19 Outstanding Debts Add Line 2 + Line 9 in Column S above $ Column B CALENDAR YEAR TOTALTO DATE 23s-C..9� $ $ Z3 6 �?z ,2-7 $ S2S' ss9'7. �7 $�a:3j 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.D. NUMBER i3��1s2. Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ . 21 Expenditures Made $ $, Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* jlf Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) I _J $ '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 (866/275-3772) %p to Schedule A Type or print in Ink. SCHEDULE A Amounts may be rounaeo Monetary Contributions Received to whole dollars. Statement covers eriod P CALIFORNIA FORM from i through 12 - 3 / , oy SEE INSTRUCTIONS ON REVERSE page --9— of NAME OF FILER _T z, Etc <:�7 I.D. NUMBER ) 3 (::) IC67 /SSZ. DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THISTO CUMULATIVE TO DATE PER ELECTION DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD �ANNDADRECEAR (IF REQUIRED) IND -ZZ-O� []COM ❑OTH 1V yy ©0 p / O O .- t� ©�12� "�-�"l TT ❑PTY ..S El SCC IND COM ❑❑°T" -C I O I p /�x"T�to A �/3 z2 ���-,Y ❑scc ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑PTY El SCC SUBTOTAL$V Q Schedule A Summary 1 Amount received this period —itemized monetary contributions. 2 0 (include all Schedule A subtotals.) $ 1 2. Amount.received this period — unitemized monetary contributions of less than $100 $ J 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1) TOTAL $ 6 6 - Z *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) I T.... .. ...I..! 1— 1— .Rr.HPr1111 5:F_PAOT1 Qwwuult: D - r -art I Amounts may be rounded Loans Received to whole dollars. Statement covers period ) from _1 � — )C/ — 0. •' SEE INSTRUCTIONS ON REVERSE through )'Z— 3/ �� Page -!�_ of v NAME OF FILER C_.)rnmitA� -rte ��-� - R��� � I I.D. NUMBER ) 3©::6 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF•EMPLOYED,ENTER NAME OF BUSINESS) a OUTSTANDING BALANCE BEGINNING THIS PERIOD (bi AMOUNT RECEIVED THIS PERIOD (c) AMOUNT PAID OR FORGIVEN THIS PERIOD" d► OUTSTANDING BALANCEAT CLOSE OF THIS PE IOD (e) INTEREST PAID THIS PERIOD (f) ORIGINAL AMOUNTOF LOAN (g) CUMULATIVE CONTRIBUTIONS TO DATE l z-, IND ❑ COM ❑ OTH ❑ PTY ❑ SCC PAID [jFORGIVEN RATE DATE INCURRED CALENDAR YEAR PER ELECTION" DATE DUE ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION *' t❑ IND ❑COM ❑ 0TH PTY ❑SCC $ $ $ a $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ % S $ [:]RATE FORGIVEN PER ELECTION" t❑ ❑COM ❑ OTH ❑ PTY ❑SCC IND $ $ $ $ $ PATE DUE DATE INCURRED SUBTOTALS $ ZZ ©© $ O $ $ Schedule B Summary 1 Loans received this period (Total Column (b) plus unitemized loans of 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.) 3 Net change this period (Subtract Line 2 from Line 1 ) Enter the net here and on the Summary Page, Column A, Line 2. 'Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. $ ZzQo $ -SOO NET $ ) � QQ (May be a negative number) lcmer lel on Schedule E, Line 3) tContributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) 0TH — Other (e.g., business entity) PTY— Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) ra Schedule C Type or print in Ink. Rr -IFnI n P r. nrnvuma 1110y Un i onmonetary Contributions Received towhotedofollarsrs. Statement covers periodq, . • � ' from 1?/ C7 • - • through �^ SEE INSTRUCTIONS ON REVERSE Page of NAME OF FILER I.D. NUMBER DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF GOODS OR SERVICES AMOUNT/ FAIR MARKET CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) VALUE (JAN 1 DEC 31) (IF REQUIRED) i 6 'c_ 4-C — ❑IND 0 ) C�- / yP ❑COM nTY�`1rV ❑SCC ❑IND ❑COM []0TH (:]PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑SCC []IND ❑COM ❑ OTH [-)PTY ❑SCC Attach additional information on appropriately labeled continuation sheets SUBTOTAL $ <-> ) Schedule C Summary 1 Amount received this period —itemized nohmonetary contributions. , O (Include all Schedule C subtotals.) $ 2. Amount received this period — unitemized nonmonetary contributions of less,than $100 $ 3 Total nonmonetary contributions received this period. Z (Add Lines 1 and 2. Enter here and on the Summary Page Column A, Lines 4 and 10) TOTAL $ "Contributor Codes IND-IndMdual 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 (666/276-3772) Schedule E Type or print in ink. Statement covers period . Payments Made Amounts may be rounded • y to whole dollars. from 1 (3—/7 d'k h' J ` �Q Pae of SEE INSTRUCTIONS ON REVERSE through g NAME OF FILER LD NUMBER CODES If one of the following codes accurately describes the payment, you may enter the code Otherwise describe the payment. CIVP 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 GSD 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 UVEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID tUNQ"A �r,"VI JAI z� -_N_Cvsca * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3+yo 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 ) $t�Z��g�l $ 33 TOTAL$ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Type or print in Ink. SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statementcoversperiod CALIFORNIA Payments Made to whole dollars. from %0 _� / — e , , ' SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER CODES If one of the following codes accurately describes the payment, CNP campaign paraphernalia/misc. MBR CNS campaign consultants MTG CTB contribution (explain nonmonetary)• OFC CVC civic donations PET FIL candidate filing/ballot fees PHO FND fundraising events POL W independent expenditure supportinglop posing others (explain)` POS LEG legal defense PRO LIT campaign literature and mailings PRT you may enter the code. Otherwise member communications RAD meetings and appearances RFD office expenses SAL petition circulating TEL phone banks TRC polling and survey research TRS postage, delivery and messenger services TSF professional services (legal, accounting) VOT print ads WEE describe the payment. radio airtime and production costs returned contributions campaign workers salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candid atelsponsor voter registration information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID �.it thS tr��. in j-asce� N& A C 11- MIMI RAW r0 * Payments that are contributions or independent expenditures mustalso be summarized on Schedule D. SUBTOTAL $ FPPC Form 460 (January/05) FPPC'roll-Free Helpline: 866/ASK-FPPC (866/275-3772)