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Home My WebLink AboutForm 460 Bob Kelley 102512 CI Y1E11 PAGE Recipient Committee — p Type or print in ink. Date Stamp CALIFORNIA Campaign Statement 4 6 I 'Cover Page C E IV (Government Code Sections 84200-84216.5) 1 5 Statement covers period Date of election if applicable: Page of 10/1/12 (Month, Day, Year) OCT 2 4 2012 For Official Use Only from SEE INSTRUCTIONS ON REVERSE through 10/20/12 11/6/12 CITY aa t)t A° AC D_F�O � 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 Q Recall 0 Controlled ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 (Also Complete Part 6) ❑ General Purpose Committee ❑ 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 I. NuMBER Treasurer(s) 1247989 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Bob Kelley David P. Bentz MAILING ADDRESS 10275 San Marcos Rd STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 9955 Calle Refugio Atascadero Ca 93422 805/462-2718 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Atascadero Ca 93422 805/460-9143 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 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. 10/24/12 1 �_ ` Executed on By Date ig sv, :n to ofTre 14 Assistant Treasurer • Executed on B. 0., 'L' Date Signature of rolling Officeholder,Ca didate,State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/06) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Type or print in ink. COVER PAGE-PART2 Recipient Committee Campaign Statement CA FORMNIA 460 Cover Page—Part 2 Page 2 of 5 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Bob Kelley OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Atascadero City Council RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 9955 Calle Refugio Atascadero, Ca 93422 Identify the controlling officeholder, candidate, or state measure proponent, If any. 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 NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO _ COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Summary Page to whole dollars. Statement covers period CALIFORNIA 460 10/1/12 FORM J from -, SEE INSTRUCTIONS ON REVERSE through 10/20/12 Page. 3 of NAME OF FILER I.D. NUMBER Committee to Elect Bob Kelley 1247989 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE g r r J t� General Elections 1. Monetary Contributions Schedule A,Line 3 $ 900.00 $ 1299.00 0 0 111 through 6/30 7/1 to Date 2. Loans Received Schedule B,Line 3 Contributions 20 00 20. 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ _ 900.00 $ 1299.00 Received $ _ $ 4. Nonmonetary Contributions Schedule C,Line 3 O 0 21. Expenditures 5. TOTALCONTRIBUTIONS RECEIVED AddLines3+4 $ _ 900.00 $ 1299.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made Schedule E,Line 4 $ _ 520.00 $ 520.00 Candidates 7. Loans Made Schedule H,Line 3 0 0 520.00 520.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ _ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) Schedule F,Line 3 _ 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment Schedule C,Line 3 _ 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ 520.00 $ 520.00 / / $ Current Cash Statement / _I $ 12. Beginning Cash Balance Previous Summary Page,Line 16 $ _ 534.68 To calculate Column B,add 13. Cash Receipts Column A,Line 3 above _ 900.00 amounts in Column A to the 0 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash Schedule I,Line 4 from Column B of your last reported in Column B. 00 report. Some amounts in 15.Cash Payments Column A,Line 8 above 520.- Column A may be negative 16. ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ _ 914.68 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED Schedule B,Pan 2 $ 0 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines Line$2,7, ands(if 18. Cash Equivalents See instructions on reverse $ _ - 19. Outstanding Debts Add Line 2+Line 9 in Column B above $ _ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded period Statement covers p 460 Monetary Contributions Received to whole dollars. CALIFORNIA from _ 10/1/12 FORM SEE INSTRUCTIONS ON REVERSE through 10/20/12 Page 4 of 5 NAME OF FILER I.D. NUMBER Committee to Elect Bob Kelley 1247989 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) Hidden Oaks Village [lCOM 10/11/12 941 Buena Fortuna Circle (1OTH 500.00 500.00 Atascadero, Ca 93422 ❑PTY ❑SCC Home Builders Assn of the Central Coast PAC ❑10/4/12 co(10TH 200.00 200.00 PO Box 748 (10TH San Luis Obispo, Ca 93406 El PTY ❑SCC ❑IND PG&E Corporation ❑COM 10/11/12 77 Beale Street\ (1oTH 200.00 200.00 San Francisco, Ca ❑PTY ❑SCC ❑IND ❑COM ❑0TH ❑PTY ❑SCC ❑IND ❑CUM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 900.00 Schedule A Summary • *Contributor Codes 1. Amount received this period-itemized monetary contributions. IND-individual (Include all Schedule A subtotals.) $ 900.00 COM-RecipientCommittee (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 $ 0 0TH-Other(e.g., business entity) PTY-Political Party 3. Total monetary contributions received this period. scC-Small ContributorCommittee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 900.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(886/275i-3772) SCHEDULE E Schedule E Type or print in ink. Statement covers period Pa menu Made Amounts may be rounded CALIFORNIA /�6O y to whole dollars. 10/1/12 FORM "1' from SEE INSTRUCTIONS ON REVERSE through 10/20/12 Page 5 of 5 NAME OF FILER I.D. NUMBER Committee to Elect Bob Kelley 1247989 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 FL 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 ND 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 WEB 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 Atascadero News 5660 El Camino Real PRT 195.00 Atascadero, Ca 93422 Bob Kelley 9955 Calle Refugio FIL 325.00 Atascadero, Ca 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS 520.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 520.00 2. Unitemized payments made this period of under$100 $. 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1,Column (e).) 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $. 520.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275.3772)