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Home My WebLink AboutForm 450 Atascadero Professional Firefighters 123108Recipient Committee Campaign Statement — Short Form SEE INSTRUCTIONS ON REVERSE For use by recipient committees that have not received a contribution or other receipt that must be itemized, have not received or made loans, and have no outstanding accrued expenses. 1 Type of Recipient Committee ❑ Ballot Measure Committee Q Primarily Formed Q Controlled Q Sponsored ❑ Primarily Formed Candidate/ Officeholder Committee 3 Committee Information Type or print in ink. Statement covers period from 9/30/2008 through 2/2/09 ® General Purpose Committee Q Sponsored Q Small Contributor Committee COMMITTEE NAME Atascadero Professional Firefighters L3600 STREETADDRESS(NO PO BOX) 6005 Lewis Avenue LD NUMBER 1312619 CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR PO BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX/ E-MAIL ADDRESS SHORTFORM L•J Date of election if applicable: (Month, Day Year) F F Q % 20r J page I of 3 For Official Use Only 11/5/08 MY OF ATASCADER CITY Cl FRK'S OFFICE 2. Type of Statement: ❑ Pre-election Statement ❑ Quarterly Statement ® Semi-annual Statement ❑ Special Odd -year Report ❑ Termination Statement ❑ Supplemental Pre-election Statement Attach Form 495 ❑ Amendment (Explain) (Also check type of statement you are amending) Treasurer(s) NAME OF TREASURER Matt Vierra MAILING ADDRESS 6005 Lewis Avenue CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 NAME OF ASSISTANT TREASURER, IF ANY Bill White, President MAILING ADDRESS 6005 Lewis Avenue CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 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 knowled a informati n co ain d herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and Corr 'Et Executed on 2/2/09 By DATE SIr3 NAT[ IRF nF TRFASI IRFR nR ASSISTANT TRFACI IRFR Executed on DATE Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 450 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Recipient Committee Campaign Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. from statement covers period 9/30/2008 SHORT FORM Contributions Received 7 Monetary contributions received this period 8 Non -monetary contributions received this period 9 Total contributions received from previous statement Previous Summary Page, Line 10 $ (If this is the first statement for the calendar year, enter zero.) 10 TOTAL CONTRIBUTIONS RECEIVED TO DATE Add Lines 7 + 8 + 9 $ Current Cash Statement 11 Beginning cash balance Previous Summary Page, Line 15 $ 50600 12. Cash receipts this period Line 7 above 13 Miscellaneous increases to cash $ 14 Cash expenditures this period Line 3 above 15 ENDING CASH BALANCE THIS PERIOD Add Lines 11 + 12 + 13, then subtract Line 14 $ 50600 FPPC Form 450 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) through 2/2/09 Page Z- of `3 NAME OF COMMITTEE LD NUMBER Atascadero Professional Firefighters L3600 1312619 Expenditures Made 1 Expenditures of $100 or more made this period $ 250000 2. Expenditures under $100 made this period (Not itemized ) 3 SUBTOTAL EXPENDITURES MADE THIS PERIOD Add Lines 1 + 2 $ 4 Nonmonetary Adjustment From Line 8 Below 5 Total expenditures made from previous statement Previous Summary Page, Line 6 $ Zero (If this is the first statement for the calendar year, enter zero.) 6. TOTAL EXPENDITURES MADE TO DATE Add Lines 3 + 4 + 5 $ 250000 Contributions Received 7 Monetary contributions received this period 8 Non -monetary contributions received this period 9 Total contributions received from previous statement Previous Summary Page, Line 10 $ (If this is the first statement for the calendar year, enter zero.) 10 TOTAL CONTRIBUTIONS RECEIVED TO DATE Add Lines 7 + 8 + 9 $ Current Cash Statement 11 Beginning cash balance Previous Summary Page, Line 15 $ 50600 12. Cash receipts this period Line 7 above 13 Miscellaneous increases to cash $ 14 Cash expenditures this period Line 3 above 15 ENDING CASH BALANCE THIS PERIOD Add Lines 11 + 12 + 13, then subtract Line 14 $ 50600 FPPC Form 450 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Recipient Committee Type or print in ink. Campaign Statement — Short Form Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF COMMITTEE Atascadero Professional Firefighters L3600 5 Payments Made (if more space is needed, use additional copies of this page for continuation sheets.) Statement covers period from 9/30/2008 through 2/2/09 Page 3 of 3 LD NUMBER 1312619 DATE* NAME AND ADDRESS OF PAYEE DESCRIPTION OF PAYMENT NAME OF CANDIDATE AND OFFICE OR NAME OF BALLOT MEASURE AND AMOUNT CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) BALLOT NUMBER OR LETTER THIS PERIOD AMOUNTS TO DATE* AND JURISDICTION Atascadero Professional Firefighters L3600 Payment was for design "No on Measure D-08" Calendar Year 9/30/08 and mailing of a "Re -Elect Jerry Clay" $ brochure that was "Elect Roberta Fonzi" 200000 mailed to registered Other voters in Atascadero ® Support ❑ oppose The funding was divided by the three topics.$ ❑ Contribution ❑ Ind. Exp Atascadero Professional Firefighters L3600 Payment made toward "No on Measure D-08" Calendar Year 10/31/08 newspaper ad run in the "Re -Elect Jerry Clay" Atascadero News. The 'Elect Roberta Fonzi" 50000 $ funding was divided by Other the three topics ® Support ❑ Oppose __ _-__......._... ...... ...._.. — . _....._......_- - Contribution Ind. Exp ❑❑ $ Calendar Year $ Other 250000 ❑ Support ❑ Oppose ❑ Contribution ❑ Ind. Exp $ SUBTOTAL $ 250000 * Required only for payments which are contributions or independent expenditures FPPC Form 450 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)