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Home My WebLink AboutForm 460 Dariz 102518Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE from Statement covers period Date of election if appiii September 23, 201$ (Month, Day, Year) through October 20, 2018 1. Type of Recipient Committee: All committees —complete Parts 1, 2, 3, and 4. 0 Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall {Also Compfete Part 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Afro Complete Parr 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Nso Compiere Part 7) 3. Committee Information I I.D. NUMBER 1407272 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Mark Dariz Committee to Elect for Atascadero City Council 2018 STREE UADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS Nov. 6, 2018 COVER PAGE OCT 2 3 201E 1 of 7 oc_l CITY OF ATASI 2. Type of Statement: i� Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Sue Dariz MAILING ADDRESS For plficial Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report 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 c9frect. r 7 , Executed on 9/25/18 Date Executed on 9/25/18 Date Executed on Date Executed on Date By Signature of Contro4ling Officeholder. Candidate, State Measure Proponent By Signature of Controlling Offrcehoider. Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppe.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Mark Dariz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of Atascadero, CA RESIDENTIALIBUSINESS ADDRESS (N0. 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 I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.R. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO PG. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 7 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 SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed CandidatelOfficeholder Committee List names of officeholder(s) or candidate(s) 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772} www.fppc,ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. from Statement covers period September 23, 2018 SUMMARY PAGE through October 20, 2018page 3 of 7 NAME OF FILER Lu. "Uro"Sue Danz 1407272 Contributions Received TOTAL A THIS PERIOD Column B CALENDAR YEAR Calendar Year Summary for Candidates Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... (FROMATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE. ....................................... Add Lines a + 9 + 10 General Elections 1,634 8,863 1. Monetary Contributions................................................... Schedule A, Linea $ $ 1/1 through 6/30 7/1 to Date 5,333.16 2. Loans Received................................................................ Schedule e. Line 3 1,634 14,196.16 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 633.52 1,133.5221. 4. Nonmonetary Contributions ............................................ schedule c, Line 3 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................................... Add Lines 3+4 $ 2,267.52 $ 15,329.68 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Lim4 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Linea 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE. ....................................... Add Lines a + 9 + 10 Current Cash 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 5 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 N this is a termination statement, Line 16 must be zero. Expenditure Limit Summary for State $ 196.56 $ 1,751.70 Candidates $ 198.56 $ 1,751.70 633.52 1,133.52 $ 198.56 $ 2,885.22 $ 11,009.02 1,634 198.56 $ 12,444.46 17. LOAN GUARANTEES RECEIVED .............. Schedule e, Pad 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. AddLinez+Lme9mCotumneabove $ 5,333.16 22. Cumulative Expenditures Made' (lr Subject to Vol~y Expendaure Oma) Date of Election Total to Date (mm/ddtyy) $ To calculate Column B, add amounts in Column A to the Corresponding *Amounts in this section may be different from amounts amounts from Column B reported in 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). FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.w.gov (666/275-3772) www.fppc.ra.gav, Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period 0. September 23, 2018 from I - • Ij October 20, 2018 4 7 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Sue Dariz 1407272 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CONTRIBUTOR IFAN INDIVIDUAL, ENTER OCCUPATIONAND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * pFSELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND 9/27/18 Lee Sn der L Ll Com Precious Metals 500 ❑ DTH Collector ❑ PTY ❑ SCC 0 IND 9126118 Sage Hider ❑ Com Eye Doctor 200 ❑ OTH Self ❑ PTY ❑ SCC B IND 9/27/18 Paul Porter ❑Com Retired Pharmacist 100 ❑ OTH ❑ PTY ❑ SCC B IND 1013118 Ned Thompson ❑coM Water Well Driller 260 L] OTH Filipponi & Thompson ❑ PTY Drilling ❑ SCC Jamie Kirk (� IND ❑ Conn Kirk Consulting 10/18/18 ❑ OTH 250 ❑ PTY ❑SCC SUBTOTAL $ 1,300 Schedule A Summary 1. Amount received this period -- itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 1,300 334 1,634 "Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Statement covers period CALIFORNIA 460 61 Loans Received September 23, 2018 FORM from th,,,gh October 20, 2018 Page 5 of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Sue Dariz 1407272 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL. ENTER OUTSTANDING AMOUNT ICt AMOUNT PAID OUTSTANDING e INTEREST ORIGINAL 9 CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IFSELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN* BALANCEAT CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS QF COMMITTEE, ALSO ENTER $.D. NUMBER) NAME OF BUSINESS} PERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Mark Dariz Architect ❑ PAID CALENDAR YEAR OMNI Design Group $ s 5.333.16 0, $5,3 3.1 $ 5,333.16 El FORGIVEN PER ELECTION RATE 5,333.16 $ % $ $ t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR 5 $ % S $ ❑ FORGIVEN PER ELECTION" RATE $ S S 3 $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAIO CALENDAR YEAR Ll FORGIVEN PER ELECTION- LECT)ON`"t❑ RATE DATE DUE DATE INCURRED toIND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ $ $ $ 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.).............................................................. NET $ n Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative comber) (tnter (e) on Schedu{e E, Line 3) tContributor Codes IND – Individual CONI -- 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. FPPC Form 460 (Jan/2016) " If required. FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received " ""'' satsmenf covers "•Fled CALIFORNIA • from September 23, 2018 FORM 20 201 , 8 through OctoberPage 6 Of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Sue Dariz 1407272 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR FAN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNTI CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF COMMrTTEE. ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) (IF REQUIRED) ❑ IND Friends of Heather Moreno for BCOMI Advertising in 10/72/18 Atascadero Mayor 2018, FPPC # ❑OTH newspaper a er 633.52 1400944 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions, (Include all Schedule C subtotals.)............................................................................................................ 2. Amount received this period — unitemized nonmonetary contributions of less than $100... ..................... -$ 633.52 .$ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ 633.52 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Sue Dariz Amounts may be rounded to whole dollars. Statement covers period from September 23, 2018 through October 20, 2018 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment SCHEDULE E CALIFORNIA .- • Page 7 of 7 I.D. NUMBER 1407272 CMP campaign paraphernalialmisc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmornetary)' 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 IND independent expenditure supportinglopposing 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 (Ir COMMITTEE. ALSO ENTER I.D NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID HART Im ressions Printin CMP Campaign Buttons 198.56 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 198.56 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 198.56 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)) ............................................................................. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A. Line 6.) ........................... TOTAL $ 198.56 FPPC Form 460 ()an/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov