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Home My WebLink AboutForm 460 Tom OMalley CC 102512 Recipient Committee COVER PAGE Type or print in ink. Date Stamp CALIFORNIA 460 Campaign Statement RECEIVED FORM Cover Page (Government Code Sections 84200-84216.5) Page of Statement c vers{period Date of election if applicable: OCT 2 5 2012 1 0 / \ / 0\`l- (Month, Day,Year) For Official Use Only from SEE INSTRUCTIONS ON REVERSE through V(-3/ 1(1„J 0 0-- CITY OF ATASCADEF O CITY CLERK'S OFFICE 1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: "t2r.,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) Q Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 (Also Complete Part 6) ❑ General Purpose Committee X Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ "V �4tp,r Q r ON-e-N CA5 C° l J y \t.), cC Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (A/so Complete Part 7) A.-,0 3. Committee Information I.D. NUMBER Treasurer(s) COMMITTEE NAME(OR CANDID„ATE'S NAME IF NO COMMITTEE) NAME OF TREASURER MAILING ADDRESS O STREET ADDRESS(NO P.O. BOX) CIT STATE ZIP CODE AREA CODE/PHONE CI STATE ZIP CODE AREA CODE/PHONE NAME F ASSISTANT TREASURER, IF ANY MAIjIN�D RE DIFF��NO.AND STREET OR P.O. BOX MAILING ADDRESS cj CITk.%scc,,5,. .ct, �SAATE (ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS \\ �t�Y;;'��` r j]`f`2 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 aws of he State of California that the foregoing is true an. . rect. l0 2 / Executed on By paste // r-t Signature• er or Assistant Treasurer Executed on ` 4 / By � � N O Date Signature of Controlling•ii older, .idateSta1 M-:.are 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/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Type or print In Ink. COVER PAGE-PART 2 - Recipient Committee CALIFORNIA A 6A Campaign Statement FORM 4 0 Cover Page-- Part 2 r� Ei Page Gr-,. of `4, 5. Officeholder or Candidate Controlled Committee 6, Primarily Formed Ballot Measure Committee NAME.OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE \0LC\ .c \c \! OFFICE SOUGHT ORtf1 LD'5INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO,OR LETTER JURISDICTION O SUPPORT ❑ OPPOSE e RESIDENTIAUBUSINESS ADDRESS (NO. D STREET) CITY STATE ZIP 1 Yr C,(,O cI\ c 3MIt_ Identify the controlling officeholder, candidate, or state measure proponent, If any, �' �� I t \ (� ) 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 IL. 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 RO.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 ❑ ❑ SUPPORT 4 YES NO ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets If necessary FPPC Form 480(Januaryl05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275.3772) State of California Campaign Disclosure Statement Type or print In Ink. SUMMARY PAGE Amounts may be rounded Summary Page Statement covers period to whole dollars, CALIFORNIA 460 from 1 0 /r /2-3 irk,.._ FORM !R` r) r� SEE INSTRUCTION`]ON ICI Vr-,I7se through \ei/l b/�L \r2—, Page 3 of NAME OF FII.I I ` I.D. NUMBER Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and '' �� —, General Elections 1, Monetary Contributions Schedule A,Line 3 $ $ � cl C..,) 2, Loans Received Schedule 8,Line 3 Q,` .' ` -1'75 1/1 through 6/30 711 to Date a 3, SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ � ) $ ( 0 5 20, Contributions. Received $ $ 4, Nonmonetary Contributions Schedule C,Line 3 RD 21, Expenditures 5, TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ RD $ 1 Made $ $ Expenditures Made ti Expenditure Limit Summary for State 6. Payments Made Schedule E,Line 4 $ % $ \ Candidates 7, Loans Made Schedule H,Line 3 V e! 8, SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ ''`' $ 11 \3 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid.Bills) schedule P Line 3 0 Date of Election Total to Date 10,Nonmonetary Adjustment Schedule C,Line 3 f , �? (mm/dd/yy) 11, TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ $ 1 J ______J / $ Current Cash Statement _ .-t:2°- /______//______/ $ 12,Beginning Cash Balance Previous summery Page,Line 18 $ I To calculate Column B,add 13,Cash Receipts Column A,Line 3 above 8(I} amounts in Column A to the 14,Miscellaneous Increases to Cash Schedule 1,Line 4 corresponding amounts 'Amounts In this section may be different from amounts 7`� from Column B of your last reported in Column B. 15.Cash Payments Column A.Line 8 above report, Some amounts In Column A may be negative 16,ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ '�I - figures that should be ■ If fhlsls a termination statement, Line 9B musf be zero. subtracted from previous period amounts. If this Is the first report being filed 17,LOAN GUARANTEES RECEIVED Schedule 8,Part 2 $ cif for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,7,and 9(If 18. Cash Equivalents See instructions on reverse $ ) any), 19, Outstanding.Debts Add Line 2+Line 9 in Column B above $ hJ 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 Monetary Contributions Received to whole dollars. Statement covers p �r;d CALIFORNIA 460 from t 0 / 1 ! ��- 2- FORM SEE INSTRUCTIONS ON REVERSE through '�}� I )� page I of NAME OF FILER I.D. NUMBER DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN, 1-DEC.31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑0TH ❑pn , ❑SCC ❑IND ❑COM ' ❑0TH El ply ❑SCC ❑IND :COM r ❑OTH [D PTY ❑SCC ❑IND ❑COM ❑0TH ❑PTY ❑SCC ❑IND �/ ❑COM El 0TH ❑Pre ❑SCC SUBTOTAL$ Schedule A Summary "contributor Codes 1. Amount received this period-Itemized monetary contributions. (Include all Schedule A subtotals,) $ COM-Recipient Committee (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than$100 �` � 0TH-Other(e.g., business entity) PTY—Political Party 3, Total monetary contributions received this period. `,�i% SCC—Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC 18661275-3772) Type or print in ink, SCHEDULE B_PART 1 Schedule B— Part 1 Amounts may be rounded Statement covers period CALIFORNIA /, Loans Received to whole dollars, from ( r-2- FORM 6a SEE INSTRUCTIONS ON REVERSE through III //`1/`'V1---- Page of -5 NAME OF FILER ID, NUMBER FULL NAME,STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER O11T5 ANDING (b) (o) • e 8 OF LENDER OCCUPATION AND EMPLOYER BALANCE AMOUNT AMOUNT PAID OUTSTANDING INTEREST. ORIGINAL CUMULATIVE (IF SELF•EMPLOYED;ENTER RECEIVED THIS BALANCE AT (IF COMMITTEE,ALSO ENTER I,D,NUMBER) BEGINNING THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF ( NAME OF BUSINESS) PERIOD PERIOD THI5 PERIOD` PERIOD PERIOD LOAN TO DATE \E�"-N**1/ \ C 1N�\C Y( ("1 PAID ry �( � Ll� g, CALENDAR YEAR �. 1--)C.N-\C C`.l. �.C•! . $"1 $ l 1 �-•�C(Cl lV� k $ $ R � � ❑FORGIVEN RATE PER ELECTION^` %&.CC• c vti C ):Lt 12` _ `t $ �(,I.ry ��.� $ $ $ Nt 4- $ th, IND ❑ COM ❑ OTH ❑ PTY ❑ SCC t 3 DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR S S Y $ $ RATE ❑FORGIVEN PER ELECTION" $ $ $ S S t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR $ $ % $ $ RATE ❑FORGIVEN PER ELECTION`* t IND ❑ COM ❑ OTH $ $ $ $ $ 0 ❑ SCC DATE DUES y.� DATE INCURRED SUBTOTALS $ $ $ $ '�'?'h �4G l (Enter(a)on Schedule B Summary Schedule E,Una3) 1. Loans received this period $ t2' (Total Column(b)plus unitemized loans of less than$100.) tCoritributor Codes $ f IND-1ridNlduaf 2. Loans paid or forgiven this period '°' INM-RividuantCommittee (Total Column(c)plus loans under$100 paid or forgiven.) (other than PTV or SCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g., business entity) 0 PTY—Political Party 3. Net change this period. (Subtract Line 2 from Line 1.) NET $ SCC-Small Contributor Committee Enter the net here and on the Summary Page, Column A, Line 2, (May b°°negative number) '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(866/275.3772)