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HomeMy WebLinkAboutForm 460 Committee to Elect Roberta Fonzi 123109ecipient Committee Campaign Statement Cover Page Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from -7 / 09' SEE INSTRUCTIONS ON REVERSE I through / 2 — 3 / _ Og 1 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) Q 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 /) 3. Committee Information 1.0 NUMBER 3O rS/az- COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 1 40' CT JAN 2 6 2010 Date of election if applicable: Month, Day, Year) CITY OF ATASCADER CITY CLERK'S OFFICE 2. Type of Statement: Preelection Statement Semi-annual Statement Termination Statement Also file a Form 410 Termination) Amendment (Explain below) CITY STATE ZIP CODE MAILING ADDRESS (IF lel- 11 CITY F STATE ZIP CODE AREA CODE/PHONE V COVER PAGE Page -1— of _.L For Official Use Only Quarterly Statement Special Odd -Year Report Supplemental Preelection Statement Attach Form 495 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 and correct. ^ Executed on / ^ y By Date Signatur TTreesurer stan'Treasurer Executed on g 3 L By Al 1 Date Sidnature of Contro ma d olid.(.. St asur Hent or Resoonside Officer ofSoonsor Executed on Date Executed on Date By .- Signature of Controlling Officeholder, Candidate, State Measure Proponent By 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 Treasurer(s) NAME OF TREASURER Yr9 7 MAILING ADDRESS CITY STATE ZIP CODE NAME OF ASSSIIISSTANT TREASURER, IF ANY M CITY i'l SCJ STTAATE ZIP C O[DE2 OPTIONAL. FAX / E-MAIL ADDRESS AJA 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 and correct. ^ Executed on / ^ y By Date Signatur TTreesurer stan'Treasurer Executed on g 3 L By Al 1 Date Sidnature of Contro ma d olid.(.. St asur Hent or Resoonside Officer ofSoonsor Executed on Date Executed on Date By .- Signature of Controlling Officeholder, Candidate, State Measure Proponent By 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 ype or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE 31::)e " T OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) CITY STATE ZIP efA 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVERPAGE PART2 Page Z of BALLOT NO. OR LETTERI JURISDICTION I 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 officehofder(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 CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign disclosure Statement Type or print in ink. Amounts may be roundedSummaryPagetowholedollars. SEE INSTRUCTIONS ON REVERSE rvr mc ter, rat 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 Bilis) 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 8 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 Column A TOTALTHIS PERIOD. FROM ATTACHED SCHEDULES) Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents See instructions on reverse $ ff 19 Outstanding Debts Add Line 2 + Line 9 in Column B above $ Z C • 9( SUMMARY PAGE Statement covers period CALIFORNIA i-/ oq . from } through/ Page of I.D. NUMBER Column B CALENDARYEAR TOTALTO DATE Z is,;' 9 ZZ O O 56 525 szs 01 J 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) 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* If Subject to Voluntary Expenditure Limit) Date of Election Total to Date mm/dd/yy) Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Januaryi05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) SCHEDULER PART1 Schedule B — Part 1 Amounts may be rounded Statement covers period 1LoansReceivedtowholedollars. 7 ,_ / ._ 0from / SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER J `_ I.D. NUMBER s'^ FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE b) AMOUNT RECEIVED THIS c) AMOUNTPAID OR FORGIVEN d) OUTSTANDING gALANCEAT e) INTEREST PAID THIS r) ORIGINAL AMOUNT OF g) CUMULATIVE CONTRIBUTIONS IFCOMMITTEE,ALSOENTERI.D.NUMBER) OF SELF-EMPLOYED, ENTER NAMEOFBUSINESS) BEGINNING THIS D PERIOD THIS PERIOD" CLOSE OF TPERIODHIS PERIOD LOAN TO DATE r, " PAID CALENDAR EARw,Ju E E • RATE E E d M FORGIVEN 1® ' PER ELECTION" E E E E DATE DUEKIND COM OTH PTY SCC DATE INCURRED PAID CALENDARYEAR FORGIVEN PER ELECTION"* RATE t IND COM OTH PTY SCC E E E S E DATEDUE DATE INCURRED PAID CALENDARYEAR FORGIVEN PERELECTION— RATE t IND COM OTH PTY SCC E E E s s DATE DUE DATE INCURRED SUBTOTALS $ $ $ Z/ -S"/ `"/ $ 5 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. 1(2 NET $ May be a negative number) tnier (e) on Schedule E, Line 3) 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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)