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Home My WebLink AboutForm 460 Committee to Elect Bob Kelley 123109Recipient Committee Campaign Statement Cover Page Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers periodI Date of election if applicable: from 7/01/2009 (Month, Day Year) through 12/31/2009 Date Stam RECEIVED F F B - 1 2010 COVER PAGE Page 1 of 4 For Official Use Only CITY OF ATASCADEI O CITY CLERK'S OFFIC 1 Type of Recipient Committee 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 Candidate Election Committee Committee Semi-annual Statement Special Odd -Year Report 0 Recall Q Controlled Termination Statement E] Supplemental Preelection Also Complete Part 5) Q Sponsored Also file a Form 410 Termination) Statement Attach Form 495 General Purpose CommitteeF-1General Complete Part 5) Amendment (Explain below) Q Sponsored Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee Also Complete Part 7) 3. Committee Information LD NUMBER 1247989 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Bob Kelley CITY STATE ZIP CODE MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER David P Bentz CITY STATE ZIP CODE 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 and rect. Executed on 01/18/2010 By Date A,,,, natureof re urerorAssistantTreasurer Executed on 01/18/2010 By Date Signature of Controlling Officeholder Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder Candidate, Slate Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (666/275-3772) State of California Type or print in ink. COVERPAGE PART2 Recipient Committee CALIFORNIA Campaign Statement FORM 4601CoverPage — Part 2 Page 2 of 4 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Bob Kelley NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO OR LETTER JURISDICTION SUPPORT OPPOSE11AtascaderoCityCouncil NAME OF OFFICEHOLDER OR CANDIDATE ESS (NO AND STREET) CITY STATE ZIP SUPPORT Identify the controlling officeholder, candidate, or state measure proponent, if any Atascadero Ca 93422 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 OFFICE SOUGHT OR HELD DISTRICT NO IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER 7 Primarily Formed Candidate/Officeholder Committee List names of NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s) or candidate(s) for which this committee is primarily formed. YES NO COMMITTEE ADDRESS STREETADDRESS (NO PO BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES NO COMMITTEE ADDRESS STREETADDRESS (NO PO BOX) 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/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) State of California Campaign Disclosure Statement To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last Type or print in ink. SUMMARY PAGE Summary Page report. Some amounts in Column A may be negative figures that should be subtracted from previous Amounts may be rounded to whole dollars. Statement covers period- CALIFO' period amounts. If this is the first report being filed 7/01/2009 • - for this calendar year only carry over the amounts from Lines 2, 7 and 9 (if from any). through 12/31/2009 Page 3 of 4 SEE INSTRUCTIONS ON REVERSE NAME OF FILER LD NUMBER Committee to Elect Bob Kelley 1247989 Column Column B Calendar Year Summary for CandidatesContributionsReceivedTOTALTHISPERIODCALENDARYEAR PrimaryRunninginBoththeStatePrima andFROMATTACHEDSCHEDULES) TOTALTO DATE g General Elections 1 Monetary Contributions Schedule A, Line 3 00 $ 00 00 911.24 1/1 through 6/30 7/1 to Date 2. Loans Received Schedule B, Line 3 3. SUBTOTALCASH CONTRIBUTIONS Add Lines 1 + 2 00 $ 911.24 20 Contributions Received $ $ 4 Nonmonetary Contributions Schedule C, Line 3 00 00 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 00 $ 00 Made $ $ Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTAL CASH PAYMENTS 9 Accrued Expenses (Unpaid Bills) 10. Nonmonetary Adjustment 11 TOTAL EXPENDITURES MADE Schedule E, Line 4 $ Schedule H, Line 3 Add Lines 6 + 7 $ Schedule F, Line 3 Schedule C, Line 3 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 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 B above $ 00 $ 00 00 $ 00 00 00 $ 23568 00 00 00 00 00 00 00 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last 00 00 report. Some amounts in Column A may be negative figures that should be subtracted from previous 23568 period amounts. If this is the first report being filed 00 for this calendar year only carry over the amounts from Lines 2, 7 and 9 (if any). 911.24 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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) SCHEDULEB PART1 Schedule B — Part 1 AmountsVmay be rounded Statement covers periodpCALIFORNIA Loans Received to whole dollars. 7/01 /2009FORM' from 12/31/2009 4 4 SEE INSTRUCTIONS 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 OUTSTANDING BALANCEAT e) INTEREST M ORIGINAL 9) CUMULATIVE OF LENDER COMMITTEE, ALSO ENTERLD. NUMBER) IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATEIFNAMEOFBUSINESS) PERIOD THIS PERIOD* PER Bob Realtor, Bob Kelley PAID CALENDAR YEAR Realty 00 32889 0 ,, 32889 00 FORGIVEN PER ELECTION** Atascadero, Ca 93422 RATE 328.89 00 00 Demand 00 10/19/08 DATE DUE DATE INCURREDtvIND COM OTH PTY SCC PAID CALENDAR YEAR Bob Kelley Realtor, Bob Kelley 00 32889 0 32889 00 Realty Atascadero Ca 93422 FORGIVEN RATE PER ELECTION** 32889 00 00 Demand 00 10/01/08 DATE DUE DATE INCURREDt® IND COM OTH PTY SCC Bob Kelley Realtor, Bob Kelley PAID CALENDAR YEAR Realty 00 25346 0 , 25346 00 FORGIVEN PER ELECTION** Atascadero Ca 93422 RATE 25346 00 00 Demand 00 8/25/08 tZ IND COM OTH PTY SCC I I DATE DUE I DATE INCURRED SUBTOTALS $ 00$ 00 $ 911.24 $ 00 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 ) NET $ 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. 00 00 00 May be a negative number) 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)