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Home My WebLink AboutForm 460 Comm to Elect Bob Kelley 123112 Recipient Committee COVER PAGE Type or print in ink. Date Stamp IFO Campaign Statement CALRNIA IV 1 FORM 460 Cover Page (Government Code Sections 84200-84216.5) 1 4 JAN Statement covers period Date of election if applicable: u 1 201 Page of 10/21/12 (Month, Day, Year) For Official Use Only from SEE INSTRUCTIONS ON REVERSE 12/31/12 11/6/12 CITY OF ATACCAD=PO through CITY CLERK'S OFF CE 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 0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report Q Recall 0 Controlled 121 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 ❑ Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee • Q Political Party/Central Committee (Also Complete Part 7) NUMBER 3. Committee Information 1 1247989 Treasurer(s) COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Bob Kelley David P. Bentz MAILING ADDRESS CT0FGT 4nnPFRR (NW) P0. BOX) CITY STATE ZIP CODE ARFA CODE/PHONE Atascadero CA 93422 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Atascadero CA 93422 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 a0d.cw ect. Executed on 1/23/13 By r A Date 4ir 92 r or Assistant Treasurer Executed on / —3e"'—/3 B . ' Date Signature of'.'tram.Officeholder, :'di.-e,State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Offipeholder,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(866/875-3772) State of California Type or print in ink. COVER PAGE-PART 2 Recipient Committee CALIFORNIA Campaign Statement FORM 4C 0 Cover Page—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 OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT Atascadero City Council El oPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. Atascadero, Ca 93422 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 STREET ADDRESS (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 11 SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD El 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 Qallfornia Campaign Disclosure Statement Amounts Type o' onnu�nim�unu SUMMARY PAGE Summary Page '~~^ Statement CALIFORNIA � d�� ~ ' �- `" �'== ""-= 10/21/12 FORM �� from SEE INSTRUCTIONS owREVERSE through 12/31/12 Page 3 of 4 NAME OF FILER /o. wmmosn Committee to Elect Bob Kelley | 1247989 ~ ~ Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS CALENDAR YEAR (�mm��CosoSCHEDULES) rm^000ATs Running in Both the State Primary and General Elections 1. Monetary Contributions Schedule A.Line a $ 0 $ 1299.00 1/1 through 6/30 7/1 to oate 2. Loans Received Schedule B,Line 3 0 0 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+o $ 0 $ 1299.00 20. Contributions Ronnivod $ $ 4. Nonmonetary Contributions Schedule U 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines o+* $ 0 $ 1209.80 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made Schedule E,Line* $ 914.68 $ 1434.68 Candidates 7. Loans Made..... ................... -- ............ Schedule H,Line 0 0 occumumuvmsxpwnuuumnwm�* Lines SUBTOTAL CASH PAYMENTS Add Lons~r $ 914.88 $ 1434.68 (if Subject m Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) Schedule F,Line 0 O Date of Election Total to Date 10. Nonmonetary Adjustment Schedule C,Line 3 O 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE Add Lines a+o+10 $ 914.68 $ 1434.68 ______/ _../ $ Current Cash Statement / / $ 12. Beginning Cash Balance Previous Summary Line $ 914.88 Tbua|muloteCo|umne.odd 13.Cash Receipts Column A'Line xabove 0 amounts in Column xmthe U corresponding amounts ~Amnun�in this ae�|onmay bedi#��ntonmumoum, 14. Miscellaneous Increases to Cash Schedule�cme* from Column aof your last reported in Column 8. 914.68 report. 8vm*omoun�ain 15.Cash Payments Column � � � A, Column A ma be rgut|ve 16. ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ 0 nnunnotxptshuu|dbu subtracted from previous If this is a termination statement, Line /0 must bnzero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED Schedule B,Part 2 * O for this calendar year, only carry over the amounts from unesu 7, and 9 (if Cash Equivalents and Outstanding Debts any). 2, ' 18. Cash Equivalents See mm�� instructions reverse $ 0 19. Outstanding Debts Add Line c~Line um Column eabove $ . O FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) ut9 :)EE Schedule E Type or print in ink. Statement covers p eriod CALIFORNIA 46 Amounts may be rounded menu Made V fA to whole dollars. 10/21/12 FORM from SEE INSTRUCTIONS ON REVERSE through 12/31/12 Page 4 of 4 NAME OF FILER LD. 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. CNP 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 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 390.00 Atascadero, Ca 93422 Atascadero Police Association 5505 El Camino Real CVC 524.68 Atascadero, Ca 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 914.68 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 914,68 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).) $ 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 $ 914,68 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)