The URL can be used to link to this page

Home My WebLink AboutForm 460 123110 David Bentz for Atascadero City Treasurer 2010Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if applicable: 10/17/2010 (Month, Day, Year) from through 12/31/2010 11/02/2010 RECEIVE JAN 13 1 2011 1 Page CITY OF ATASCAD4RO CITY CLERK'S OFFICE of 5 For Official Use Only PAGE 1 Type of Recipient Committee All Committees —Complete Parts 1, 2, 3, and 4. STATE 2. Type of Statement: Atascadero ® Officeholder Candidate Controlled Committee ❑ Primarily Formed Ballot Measure NAME OF ASSISTANT TREASURER, IF ANY ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ® Semi-annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part S) Q Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495 ❑ General Purpose Committee (Also Complete Part 6) F-1Amendment (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 I I.D NUMBER lqqnqnn COMMITTEE NAME (OR CANDIDATE'S NAME IF David Bentz for Atascadero City Treasurer 2010 STRFFT ADDRFRC mr) Pn BOX) CITY STATE ZIP CODE AREA CODE/PHONE Atascadero Ca 93422 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 MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Atascadero Ca 93422 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 corrgct. n Executed on 1/26/2011 Dale Executed on�t'o>l��1 Date Executed on Date By By By Signature of Controlling Oficeholder, Candidate, State Measure Proponent Executed on BY Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Recipient Committee Type or print in ink. COVERPAGE PART2 Campaign Statement CALIFORNIA F Cover Page --Part Z 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE David P Bentz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Treasurer for City of Atascadero, Ca RESIDENTIAL/BUSINESS 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 1.0 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 TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE UK HELD DISTRICT NO. IF ANY 7 Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidates) 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/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) State of Callfornla Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/17/2010 SUMMARY SEE INSTRUCTIONS ON REVERSE 288536 $ 8463.92 Schedule H, Line 3 through 12/31/2010 Page 3 of 5 NAME OF FILER 8463.92 Schedule F, Line 3 0 0 Schedule C, Line 3 I.D. NUMBER David Bentz for City Treasurer 2010 Add Lines 8 + 9 + 10 $ 2885.36 $ 8463.92 1330304 Contributions ReceivedColumnA Column Calendar Year Summary for Candidates TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and General Elections 1 Monetary Contributions Schedule A, Line 3 $ 0 $ 110000 2. Loans Received Schedule B, line 3 251342 7363.92 1/1 through 6130 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 $ 251342 $ 8463.92 20. Contributions 4 Nonmonetary Contributions Schedule c, Line 3 0 0 Received $ $ 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 +4 $ 251342 $ 251342 Made $ $ Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTALCASH PAYMENTS 9. Accrued Expenses (Unpaid Bills) 10. Nonmonetary Adjustment 11 TOTAL EXPENDITURES MADE Schedule E, Line 4 $ 288536 $ 8463.92 Schedule H, Line 3 0 0 Add Lines 6 + 7 $ 2885.36 $ 8463.92 Schedule F, Line 3 0 0 Schedule C, Line 3 0 0 Add Lines 8 + 9 + 10 $ 2885.36 $ 8463.92 %.+urre it t.aSn 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 $ 371.94 251342 0 2885.36 0 I 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). 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/OS) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) w w _ Tvna nr nrin4 In in4 RrHFF)I JJ F R PART 1 %0%01 aWULIRG v — 11- C11 a r Amounts may be rounded Statement covers period Loans Received to whole dollars. 10/17/2010 _ CALIF`. 1 from FOM SEE INSTRUCTIONS ON REVERSEthrough 12/31 /2010 Page 4 of 5 NAME OF FILER I.D. NUMBER David Bentz for City Treasurer 2010 1330304 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING (b) AMOUNT (c) d OUTSTANDING e (g) OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS AMOUNTPAID BALANCEAT INTEREST ORIGINAL CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IFSELF-EMPLOYED,ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS THIS PERIOD* PERIOD LOAN TO DATE David P Bentz Retired ❑PAID CALENDARYEAR $ 0 $ 4000.00 0 % 4000.00 $ 8850.50 Atascadero, Ca 93422 RATE $ ❑ FORGIVEN PER ELECTION*" $ 0 $ 400000 $ 0 Demand $ 0 10/22/10 $ tW IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED David P Bentz Retired E] PAID CALENDARYEAR $ 1486.58 $ 3363.92 0 % 4850.50 $ Atascadero, Ca 93422 ❑ FORGIVEN RATE $ PER ELECTION ** $ 4850.50 $ 0 $ 0 Demand $ 0 9/15/10 $ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED [j PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION ** t❑ IND El COM ❑ OTH [I PTY ❑ SCC $ $ $ $ $ DATE DUE PATE INCURRED SUBTOTALS $ 4000.00$ 1486.58 $ 736392 $ 0 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. $ 400000 $ 148658 NET $ 251342 (May be a negative number) (knter(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 *Amounts forgiven or paid by another party also must be reported on Schedule A. * If required FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER David Bentz for City Treasurer 2010 Type or print in Ink. Statement coverseriod Amounts may be rounded p • I 11 to whole dollars. from 10/17/2010 through 12/31/2010 Page 5 of 5 CODES. If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. NUMBER 1330304 CMP campaign paraphernalia/misc. 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 W 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 1NEB 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 Wilkins Printing 6405 EI Camino Real LIT 2450 36 Atascadero, Ca 93422 Atascadero News LIT 43500 5660 EI Camino Real Atascadero, Ca 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 288536 Schedule E Summary 1 Itemized payments made this period. (Include all Schedule E subtotals.) 2885.36 0 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).) $ 0 4 Total payments made this period. (Add Lines 1, 2, and 3 Enter here and on the Summary Page, Column A, Line 6) TOTAL $ 288536 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)