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Home My WebLink AboutForm 460 Committee to Elect Bob Kelley 0630097 COVER PAGE Recipient Committee Type or print in -ink. 0.�' Campaign Statement • Cover Page J U L 3 0 (Government Code Sections 84200-84216.5) Page of Statement covers period Date of election if applicable: 01/01/09 (Month, Day, Year) For Official Use Only from CITY OF•ATASCA ERO CITY CLERK'S O FICE 06/30/09 SEE INSTRUCTIONS ON REVERSE through 1. Type of'Recipierlif Comm' ittee: All Committees - Complete Parts 1, 2, 3, and 4. 2. Type of Statement: ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State CandidateElection Committee Committee ® Semi-annual Statement ❑ Special Odd -Year Report Recall Q Controlled Termination Statement ❑ ❑ Supplemental Preelection _ (Also Q Sponsored (A)so file a Form 410 Termination) Statement - Attach Form 495 ❑ General Purpose Committee (Also comperePart s/ ❑ Amendment (Explain below) - Q Sponsored ❑ Primarily Formed Candidate/ O'Small Contributor Committee Officeholder Committee k Q Political Party/Central Committee (Also complerePart 7) 3. Committee Information I.D. NUMBER 1247989 Treasurers) -COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER David P. Bentz Committee to Elect Bob Kelley MAILING ADDRESS STREET_AD_D_RESS (NO P.O. BOX) J CITY _ STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 ' CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER. IF ANY Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA, CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the be under penalty of perjury u der the laws of the State of California that the foregoing is true corre nowledge the info ati contained herein and in the attached schedules is true and complete. I certify Executed on J;Z6loq BY S' T urer IstantTressurer Executed on / 0 Data Signature trolling didata, State Measure Proponent or Responsible officer of Sponsor Executed on By Date Signauae of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date.- Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 480 (January/06) FPPC Toll -Free Helpline: 8881ASK-FPPC (888/275-3772) z 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 Bob Kelley OFFICE'SOUGHT'OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) -Atascadero City Council RESIDENTIAUBUSINESS 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 I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES ❑ NO COVER PAGE - PART 2 CALIFORNIA• - 460 Page of 6. Primarily. Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI 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 Candidate/Officeholder Committee List names of offlcahoider(s) or candidate(s) for which this committee Is primarily formed. COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets If necessary 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 FPPC Form 480 (January/05) FPPC Toll -Free Helpline: 8881ASK-FPPC (888/275-3772) State of California , r. Campaign Disclosure Statement Type or print in Ink. SUMMARY Amounts may be rounded Statement covers period - A Summary Page to whole dollars. 01/01/09 • - • from SEE INSTRUCTIONS ON REVERSE through 06/30/09 FPg,_„ of NAME OF FILER Committee to Elect Bob Kelley 6. Payments Made .................... :.......... :....................... Schedule E, Line 4 Column A Column B Contributions Received 7. Loans Made............................................................. TOTALTHIS PERIOD. CALENDAR YEAR 0 0 "OMATTACHED SCHEDULES) TOTALTODATE. 1. Monetary Contributions ........................................... Schedule A, Line 3 ` $;, 0 $ 0 2. Loans Received...................................................... Schedule A Line 3 0 911.24 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines t + 2 $ 0 $ 91=1.24 4. Nonmonetary Contributions .................................... Schedule C, Line 3 •0 0 5. TOTALCONTRIBUTIONSRECEIVED............................ Add Lines 3+4 $ 0 $ 911.24 Expenditures Made 6. Payments Made .................... :.......... :....................... Schedule E, Line 4 $ 0 $ 0 7. Loans Made............................................................. Schedule H, Line 3 0 0 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 0 $ 0 9. Accrued Expenses (Unpaid Bilis) ............................... Schedule F Line 3 0 0 10. Nonmonetary Adjustment .......................................... Schedule C; Line 3_ 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 6 + s +,10 $ 0 $ 0 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page; Line 16 $ 235.68 To calculate Column; B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the 0 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 0 report. Some 15. Cash Payments .................................................. Column A, Line s above ColumA may be ne I ti alive - 16. ENDING CASH BALANCE...... add Lines 12 + 13 + 14, then subtract Line 15 $ 235.68 figur sns tha should be subtracted from previous I/ thic is a tarminatinn vtatampnt Cine 16 must be zero. pehi amounts If this is 17. LOAN GUARANTEES RECEIVED ........................... Schedule 8; Part 2 $ — Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See insducdons on reverse $ — 19. Outstanding Debts ......................... Add Linen + Line 9 in Column B above $ ' the first report being filed Q for this calendar year, only carry over the amounts 911 94 1 from Lines 2, 7, and 9 (if any). I.D. NUMBER 1247989 'alendar Year Summary for Candidates Running in Both the State Primary and 3eneral Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ :xpenditure Limit Summary for State :andidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) IF $ Amounts in this section may be different from amounts -.ported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) SCHEDULE B - PART 1 -gyNC V. Fl..... ... ...- Schedule B'- Part 1 Amounts may, be rounded Statement covers period , Loans Received to Whole dollars. 01/01/09 .. • from 06/30/09 SEEINSTRUCTIONS ON REVERSE through page of NAME OF FILER I.D. NUMBER Committee to Elect Bob Kelley 1247989 FULL NAME, STREET -ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER: OUTSTANDING BALANCE (b) AMOUNT (C) AMOUNT PAID OUTS ANDING BALANCEAT e INTEREST ORIGINAL e CUMULATIVE OF GENDER ALSO ENTER I.D. NUMBER) OFSELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS PERIOD OR,FORGIVEN CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE OF COMMITTEE, NAME OF BUSINESS) THIS PERIOD rRIOD Bob Kelley Realtor, Bob Kelley ❑ PAID CALENDAR YEAR Realty $ 0 $ 328.89 0 % $ 328.89 $ 0 Atascadero, Ca 93422 ❑ FORGIVEN RATE PERELECTION" 328.89 0 0 Demand0 0 10/19/08 $ $ $ $ $ DATE DUE tm. IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDAR YEAR Rah "Kelley Realtor, Bob Kelley 0 $ 328.89 0 328.89 $ 0 Realty $ % $ PER ELECTION" Atascadero, Ca 93422 ❑FORGIVEN RATE 328.89 0 0 Demand 0 10/01/08 $ $ $ $ $ DATE DUE t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED BOh Kallov Realtor, Bob Kelley ❑ PAID CALENDAR YEAR _ ... Realty $ 0 $ 253.46 0 % $ 253.46 $ 0 _ _.. _ Atascadero, Ca 93422 ❑ FORGIVEN RATE PERELECTION" $ 253.46 0 0 Demand 0 8/25/08 $ t® IND ❑'COM ❑ OTH ❑ PTY ❑ SCC _ - $ $ $ DATE INCURRED DATE DUE SUBTOTALS $ 0 $ 0 $ 911.24' $ 0 - ,�.,.n. ,n, w, Schedule B Summary Scriedde E, Line 3) $ 0 1. Loans received this period .................................................................................................................... (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period 0 (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`. ............................................... NET $ 0 9 P ( ).......••..•. .. (MayDeanegetNenumoeQ Enter the net here and on the Summary' Page, Column A, Line 2. be rtd SCh d I A tContributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee Amounts forgiven or paid by another party also must repo a ., on, e u e •• If required. FPPC Form 460 (January/05) _ - FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) r t n 8e