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Home My WebLink AboutForm 460 Newsom 123118Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statementcovers eriod from �0_ through `PI ?WI e 1. Type of Recipient Committee: All committees — complete Parts 1, 2, 3, and 4. `Lj' O holder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure V State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information COMMITTEE NAME (OR CANDIDA 'S NAME S aaderto ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER (9-634-/ MMITTEE) CITY STATE ZIP CODE l� 6 oad _g o � �?3 CITYdJ � p xz STATE CODE�G AREA CODE/PHONE COVER PAGE Date Stamp it Treasurer(s) IVHIVIC Vt HJJIJ IHIV I I KCHJV KCK, Ir' HIV T MAILING ADDRESS CITY STATE ZIP CODE AREACODE/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 knowlec certify under penalty of perjury u der t laws of the State of California that the foregoing is true and correct. 9-1 Executed on L� �" By Executed on 4 / /'-'q /A 61 " By Dat Signature of Controllilig Offu nation coptainneedd herein and in the attached schedules is true and complete. I Treasurer or Assistant Treasurer /` _ _ or 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Page 7 ) of _ JAN Q 2�1 Date of election if applicable: (Month, Day, Year) ,i For Official Use Only lob 1$ Cil Y OF ATASCA{) t O CITY CLERK'S OFF CE 2. T�yype of Statement: L'J Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) IVHIVIC Vt HJJIJ IHIV I I KCHJV KCK, Ir' HIV T MAILING ADDRESS CITY STATE ZIP CODE AREACODE/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 knowlec certify under penalty of perjury u der t laws of the State of California that the foregoing is true and correct. 9-1 Executed on L� �" By Executed on 4 / /'-'q /A 61 " By Dat Signature of Controllilig Offu nation coptainneedd herein and in the attached schedules is true and complete. I Treasurer or Assistant Treasurer /` _ _ or 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME DF OFFICEHOLDER OR CANDIDATE L`-' — �jwff6w OFFICE. SOUGHT %O%R/�HELD �(INCLUDE LOCATION pAND DISTRICT NUMBER IFAPPLICABLE) / 11,� W t I' Rte/ COVER PAGE - PART -2 Page :P— of V 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO.AN REET) CITY STATE ZIP /� Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 3f 2-a' 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 rCONTYRbLLED COMMITTEE? ES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE 7. Primarily Formed Candidate/Officeholder Committee Listnames of officeho/der(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 Amounts may be rounded SUMMARY PAGE Summary Page to whole dollars. statement cove periodCALIFORNIA , 1 a� �d X • - from SEE INSTRUCTIONS ON REVERSE through °� Page of NAME OF FILER/ � 5�� I.D. NUMBER f + s �� iI V Contributions Received Column A TOTALTHIS PERIOD Co umn B CALENDAR YEAR Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and �r �� D General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule B, Line 3 20. Contributions �� 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ 1 3, 7 ' Received $ $ 21. Expenditures 4. Nonmonetary Contributions ........................................... Schedule C, Line 3 / I C �Lf Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ $ % 78 Expenditures Made 6. Payments Made................................................................ Schedule e, Line 4 $ 16D6 . OV 7. Loans Made....................................................................... Schedule H, Line 3 D 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ I m 0 < OD 9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 GO C>0, O a 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE ........................................ AddLiness+9+10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ /-2 7 13. Cash Receipts........................................................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 y 15. Cash Payments......................................................... Column A, Line s above C o 00 , b a 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 2 M2 q If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part2 $ y Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ b 19. Outstanding Debts .............................. Add Line 2 +Line 9 in Column B above $ �3 3 To calculate Column B, add amounts in Column Ato the corresponding amounts from 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) wvvw.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers periodKei.-I 14 IWOMULIWA L�� from • / �� through Pagof e SEE INSTRUCTIONS ON REVERSE NAME OF FILER LTJ ` (� I.D. NUMBER / I / DATE FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR S CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE SENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (Include all Schedule A subtotals.) ..............................$ b COM - Recipient Committee ..................................................................... (other than PTY or SCC) 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ OTH - Other (l Pa business entity) P Y PTY -Political Party 3. Total monetary contributions received this period. SCC - Small Contributor committee Add Lines 1 and 2. Enter here and on the Summa ColA, Li1. ......TOTAL $ ( Summary Page, Column Line ) 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 a _ Loans Receivedfrom le • c �� / / a y Page SEE INSTRUCTIONS ON REVERSE through of NAME OF FILERS I.D. NUMBER CeA Mld FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING e INTEREST ORIGINAL 9 CUMULATIVE OF LENDER (IF, SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCE AT CLOSE OF THIS. PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD' PERIOD PERIOD LOAN TO DATE ❑ PAID CALENDAR YEAR $ $ % $ $ ❑ FORGIVEN PER ELECTION" �'.. � RATE DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH [_1 PTY ❑ SCC ❑ PAID CALENDAR YEAR $ $ % $ $ FORGIVEN, E] FORGIVEN, PER ELECTION** $ $ $ $ $ DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR $ $ % $ $ ❑ FORGIVEN PER ELECTION** RATE DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ $ $ $ T .. 9 9 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 $ Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. 0 y (May be a negative number) (Enter (e) on Schedule E, Line 3) tContributor 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 C Amounts may be rounded SCHEDULE C to whole dollars. Nonmonetary Contributions Received Statement coveCALIFORNIA 460 from �5?0/g' FORM a through o 3 j 06 1 ® v Page of I SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF GOODS OR SERVICES AMOUNT/ FAIR MARKET CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) VALUE (JAN 1 -DEC 31) (IF REQUIRED) ❑IND y� oOTH PTY Nvvs (p6J.�a-37� ❑ 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.)......................................................................................................................$ _ 0 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..................................$ 0 3. Total nonmonetary contributions received this period. n f (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) .....................TOTAL $ "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 D SCHEDULE D summary of Expenditures Amounts may be rounded statement covers period Supporting/Opposing Other to whole dollars. from 16, /�- , Candidates, Measures and Committees through y 31 �1,k Page rof SEE INSTRUCTIONS ON REVERSE NAME OF FILER �j}y� 44��j/Q //)y�r pplmw-&-t I.D. NU `I v „� (1 " C/W�� / i /J DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OR COMMITTEE ❑ Monetary _ Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (include all Schedule D subtotals.)....................................................... $ 2. Unitemized contributions and independent expenditures made this period of under $100.................................................................................... $ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL.. $ n W FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Amounts may be rounded' Statement covers period _ Payments Made to whole dollars. • _ . ' from t7 � � /e SEE INSTRUCTIONS ON REVERSE through ��Page of NAME OF FILER I.D. NU7;6,3 /A90�/ A1,AV&%vl z 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 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 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 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).)............................................................................. $ TOTAL 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ...................... 0 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD SCHEDULE F Schedule F Accrued Expenses (Unpaid Bills) Amounts may be rounded to whole dollars. Statement covers period �� from Q • - ' FORM through page el-'Iof //�/ SEE INSTRUCTIONS ON REVERSE NAM OF FILER J/ I � - ' J J6 l I.D. NUMBER / V/ CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)' CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)' MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor LEG legal defense LIT campaign literature and mailings PRO professional services (legal, accounting) PRT print ads VOT voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNT IN NCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Payments that are contributions or independent expenditures must also be SUBTOTALS $ � ,93 $ o $ 1600, Ob $ summarized on Schedule D. Schedule F Summary Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ......................................... INCURRED TOTALS $ _ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................... PAID TOTALS $ Z Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and Page, Column A, Line 9..................................................................................... NET $ /DAB aa on the Summary 9 )............................................................................................... May b neg alive number FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) Amounts may be rounded to whole dollars. 6101=111J111:9e1 from lD/ /L�l (i • -%/• • through /� 3 III—L6 / ° Page ` D of /y NAME OF FILER I.D. NUMBER X-1 A%LafdYvl NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the CMP campaign paraphernalia/misc. MBR CNS campaign consultants MTG CTB contribution (explain nonmonetary)* OFC CVC civic donations PET FIL candidate filing/ballot fees PHO FND fundraising events POL IND independent expenditure supporting/opposing others (explain)* POS LEG legal defense PRO LIT campaign literature and mailings PRT payment, you may enter the code. member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Otherwise, describe the payment. RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) Attach additional information on appropriately labeled continuation sheets. TOTAL* $ * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or FPPC Form 460 (Jan/2016) independent contractor as reported on Schedule E. FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be SUBTOTALS $ $ $ $ reported on Schedule E. (Enter (e) on Schedule I, Line 3) Schedule H Summary 1. Loans made this period...................................................................................................................................................$ d (Total Column (b) plus unitemized loans of less than $100.) **If Required 2. Payments received on loans............................................................................................................................................$ (Total Column (c) plus unitemized payments of less than $100.) b f 3. Net change this period. (Subtract Line 2 from Line 1.)............................................................................................ NET $ (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE H Schedule H Amounts may be rounded statement covers eriod CALIF• _ NIA 46 Loans Made to Others* to whole dollars. from FORM /r 3 l SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER Naxudi� Cu� te�?�&,!J c:46 0 I.D. NUMBER / �O 3 FULL NAME, STREETADDRESS AND ZIP CODE [FAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING (b) AMOUNTREPAYMENT (c) OR (d) OUTSTANDING (e) INTEREST (f) ORIGINAL (g) CUMULATIVE OF RECIPIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BALANCE BEGINNING THIS LOANED THIS PERIOD FORGIVENESS * BALANCE AT CLOSE OF THIS RECEIVED AMOUNT OF LOAN LOANS TO DATE PERIOD THIS PERIOD PERIOD ❑ PAID CALENDAR YEAR $ $ % $ $ ❑ FORGIVEN PER ELECTION'* RATE $ $ $ $ $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ % $ $ ❑ FORGIVEN PER ELECTION** RATE $ $ $ $ $ DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be SUBTOTALS $ $ $ $ reported on Schedule E. (Enter (e) on Schedule I, Line 3) Schedule H Summary 1. Loans made this period...................................................................................................................................................$ d (Total Column (b) plus unitemized loans of less than $100.) **If Required 2. Payments received on loans............................................................................................................................................$ (Total Column (c) plus unitemized payments of less than $100.) b f 3. Net change this period. (Subtract Line 2 from Line 1.)............................................................................................ NET $ (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Cnhnrl� �In 1 SCHFDULFI Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 3 � a� through CALIFORNIA 460 •1 FORM / Ly of Page NAME OF FILER 26 I.D. NUMBER /Vb -3 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCEAMOUNT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. Schedule I Summary 1. Itemized increases to cash this period............................................................................................................................$ 2. Unitemized increases to cash of under $100 this period.................................................................................................$ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .......................................$ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.)............................................................................................................................. TOTAL $ SUBTOTAL$ d a D FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov