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Home My WebLink AboutForm 460 Tom OMalley for Mayor 102512 Recipient Committee COVER PAGE Campaign Statement Type or print in ink. Date Stamp CALIFORNIA 460 RE Cover Page CEIVED FORM (Government Code Sections 84200-84216.5) Page �7 of ``� Statement covers period Date of election if applicable: OCT 5 2012 \O/ \ /It (Month, Day,Year) For Official Use Only from 11..11 It,., 1�] SEE INSTRUCTIONS ON REVERSE through 1°/Jb(1 L_ \ \ /6-)(1(2.___ CITY OF ATASCADERO CITY CLERK'S OFFICE 1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: XOfficeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement El Quarterly Statement Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report Q Recall 0 Controlled Part 5) ❑ Termination Statement ill Supplemental Preelection (Also Complete Pa 0 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/ `` LIN -2,S AC IC ACS Q c-- CX.S i S v\t Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) N'" <i" `"\- ,(:':)04.fe. 6 oecaz N 3. Committee Information I.D. NUMBER i 3L 4a 60 Treasurer(s) COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 1 NAME OF TREASURER 10 v\'\CY IACI A k — o,s--V`ICsyC -``LO\`1_ t,10 K\ CAA 'r \f v VvCCvr! MAILING ADDRESS ( CL� l ..e CX {)NC) STR ET bb0 ADDRESS(NO V BOX) [t o CIT,' s (� \ �jt STATE ��L._ (y or)),AREA�CODE/PHONE 1150 C� CITE �� STATE C AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILIf ADDRE S (IF DIFFERENT)NO.AND STREET OR P.O. BOX MAILING ADDRESS CIT ST TE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE CC)*'' CA. `k [ `9LL OPTIO AL: 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 co - . Executed on ldi By Da e-,urerorAssistantTreasurer t __ � i \ Executed on � � ��'-'- By Date Signgture-ofEbntro holder,rr' date asure 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-PART2 Recipient Committee Campaign Statement CAF RRNIA 460 Cover Page-- Part 2 ,- ,i �,.\tAj ,,--- VC)1.1L1 Page of '~'. naassmemosmeaamosanmeetsaramasmm 5. Officeholder or Candidate Controlled Committee 6, Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE VA Ci\C i OFFICE SOUGHT OR HELD(INCLUDE LQC,1(ATIO AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO,OR LETTER JURISDICTION ❑ SUPPORT oel' C_:\ Cr S ' ,... CU`.0 ❑ OPPOSE RESIDENTIAL/BUSINESS ADDR SS (N f,)AND ST E T) CITY STATE ZIP A °` Identify the controlling officeholder, candidate, or state measure proponent, If any, I 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? T, Primarily Formed Candidate/Officeholder Committee List names or officeholder(s) or candidate(s) for which this committee Is primarily formed, ❑ YES ❑ NO COMMITTEE ADDRESS STREETAODRESS (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 p YES [] NO ❑ SUPPORT COMMITTEE ADDRESS STREET ADDRESS (NO RO,BOX) ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets If necessary FPPC Form 460(January/05) FPPC Toll.Free HelplIne:8661ASK•FPPC(8661276.3772) State of California Campaign Disclosure Statement Type or print In Ink, SUMMARY,PAGE Amounts may be dollars,rounded CALIFORNIA 460 Summary Page period 1V V g to whole dollars, Statement covers from r� (\ FORM SEE INSTRUCTIONS ON REVERSE through gar /t 6 I Page of 3 NAME Of F11.1417 1 I,D, NUMBER ....(..c, 1,,,N , ____ (1 „^\ k n AVOW Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHIS 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 $ $ � 5 2, Loans Received Schedule 8,Line 3 0 1/1 through 6/30 7/1 to Data 20, Contributions 3, SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 $ $ 2:--c--)��` Received $ $ 4. Nonmonetary Contributions Schedule C,Line 3 -� �") 21, Expenditures 5, TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 3" $ 7 1 9 Made $ $ Expenditures Made -0._ Expenditure Limit Summary for State 6, Payments Made Schedule 5,cane 4 $ (6 $ 2--J.0, Candidates 7, Loans Made Schedule H,Line 3 8, SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ > $ 2 536 y� 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) 9, Accrued Expenses (Unpaid Bills) Schedule F Line 3 0 Date of Erection Total to Date 10,Nonmonetary Adjustment Schedule C,Line 3 • (,1 (mmlddlyy) 11. TOTAL EXPENDITURES MADE Add Lines 6+s+10 $ 0 $ 2— 3b'-" j / $ Current Cash Statement y l _�___J $ 12,Beginning Cash Balance Previous Summary Page,Line 18 $ ��(� To calculate Column B,add 13,Cash Receipts Column A,Line 3 above 0 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. 15,Cash Payments Column A,Linea above report, Some amounts in /} c L: ' Column A may bel negative 16.ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ L-3 figures that should be subtracted from previous if this is a termination statement, Line 16 must be zero, period amounts. If this is 0 the first report being flied 17,LOAN GUARANTEES RECEIVED Schedule B,Part 2 $ for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts nm Lines 2, 7, and (if �• anY) 18, Cash Equivalents See instructions on reverse $ 19, Outstanding Debts Add Line 2+Line 9 in Column B above $ FPPC Form 460(January/05) FPPC Toil-Free Helpline: 866/ASK-FPPC(8661275-3772)