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HomeMy WebLinkAboutForm 460 Dariz 102518 AmendmentRecipient tent Committee COVER PAGE Campaign Statement Date Stamp • Cover Page �' `I RECEIVED ED 1 7 Statement covers period ©ate of election if applicable: Page of September 23, 2018 from (Month, Day, Year) A:Jii i 4 2020 For Official Use Only SEE INSTRUCTIONS ON REVERSE through October 20, 2018 I Nov. 6, 2018 Al" Ty OF ATASCADERO f-1 =n_V_'C 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 W Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ SpeciaJ Odd -Year Report 0 Recall 0 Controlled ❑ Termination Statement (iSlso complete Pari sl Sponsored (Also file a Form 410 Termination) ❑ General Purpose Committee (Also Complete Part 6) Z Amendment (Explain below) 0 Sponsored ❑ Primarily Formed Candidate/ Correcting errors in contribution tabulation 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (NsoComplete Part 7) 3. Committee Information I.D. NUMBER 140727, COMMITTEE NAME (OR CANDIDATE'S NAME IF NO C Mark Dariz Committee to Elect for Atascadero City Council 2018 CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODEIPHONE OPTIONAL: FAX l E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Sue Dariz MAILING ADDRESS CITY STATE ZIP CODE AREA CODEMHONE Atascadero CA 93422 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODEIPHONE OPTIONAL: FAX 1 E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the info{mation certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 7127/20 Date Executed on 7/27120 Dale Executed on Date Executed on Date By or By herein and in the attached schedules is true and complete. I By Signature of Controlling Officeholder, Candidate, Stale Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www fnnr ra ante Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Mark Dariz OFFICE SOUGHT OR HELL) (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of Atascadero, CA RESIDENTIAIJBUSINESSADDRESS (NO.ANOSTREET) 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 CODE/PHONE COMMITTEE NAME I.Q. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 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 Identity 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 Candidate/Officeholder Committee Listnames of officeholder(s) or candidates) 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 to whole dollars. Statement covers period from September 23, 2018 October 20, 2018 I Page 3 of 7 NAME OF FILER I.D. NUMBER Sue Danz 1407272 Contributions Received Column A TOTAL THIS PERIOD Column 8 Calendar Year Summary for Candidates Schedule H, Litre 3 8. SUBTOTAL CASH PAYMENTS .......................................... (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and 10. Nonmonetary Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ... ........ ........ -- ... ............. Add Lines e + 9 + 10 General Elections 1. Monetary Contributions................................................... Schedure A, Line 3 $ 1,635 $ 8,865 5,333.16 111 through 6/30 7H to Date 2. Loans Received................................................................ Schedule B, Line 3 1, 635 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines t «2 $ $ Received $ $ 4. Nonmonetary, Contributions ............................................ schedule C, Line 3 633.52 1,133.52 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED................................... Add Lines 3+4 $ 2,268.52 $ 15,330.68 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Lice 4 7. Loans Made....................................................................... Schedule H, Litre 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 e + 9 + 10 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 18 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Lim 4 15. Cash Payments......................................................... Column A, Lina a above 16. ENDING CASH BALANCE .................. Add Lines 12+ 13 « 14, then Subtract Lim 15 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Expenditure Limit Summary for State $ 198.56 $ 1,751.70 Candidates $ 198.56 $ 1,751.70 633.52 $ 832.08 $ 2,885.22 $ 11,009.02 1,634 198.56 $ 12,643.02 Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2+ Line 9 in Column B above $ 5,333.16 To calculate Column B, add amounts in Column 22. Cumulative Expenditures Made' (N s~ to voxawry Eg and tors Lima) Date of Election Total to Date (mm/dd/yy) e' 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.ca.gov (866/275-3772) www.fppc.w.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period - September 23, 2018 from 0 - October 20, 2018 4 7 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.C. NUMBER Sue Dariz 1407272 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.O. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * IIF SELF-EMPtOYEO, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS} i1 IND 9/27/18 Lee Sn der ❑ COM Precious Metals 500 ❑ OTH Collector Templeton, CA 93465 ❑ PTY ❑ SCC W1 IND 9/26/18 Sage Hider El COM Eye Doctor 200 ❑ OTH Self Atascadero, CA 93422 ❑ PTY ❑ SCC 0 IND 9/27/18 11 Com Retired Pharmacist 100 ❑ OTH Atascadero, CA 93422 ❑ PTY ❑ SCC W1 IND 10/3/18 Ned Thom son ❑ COM Water Well Driller 250 ❑ OTH Pilipponi & Thompson Atascadero, CA 93423 ❑ PTY Drilling ❑ SCG Jamie Kirk I1 IND ❑ COM Kirk Consulting 10/18/18 ❑ OTH 250 Atascadero, CA 93422 ❑ PTY ❑ sec 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 Van/2416) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov A .....y....a.. ... 4... ...l...J RIM 1:0 91114:8 191 Schedule — Part 1 to whole dollars. Statement covers period E CALIFORNIA• Loans Received September 23, 2018 • from SEE INSTRUCTIONS ON REVERSE through October 20, 2018 Page 5 of 7 NAME OF FILER W. NUMBER Sue Dariz 1407272 FULL NAME, STREETADDRESS AND ZIP CODE OCIF AN INDIVIDUAL. ENTER CUPATION AND EMPLOYER a OUTSTANDING AMOUNT t AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER {IF COMMITTEE, ALSO ENTER I NUMBER) IIF SELF-EMPLOYED. ENTER BALANCE BEGINNING THIS RECEIVED THISBALANCE OR FORGIVEN AT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS _ NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Mark Dariz Architect ❑ PAID CALENDAR YEAR OMNI Design Group a s 5.333.16 % s 5,333.1 $ 5,333.16 [] FORGIVEN taSca ero, 93422 RATE PER ELECTION - 5,333.16 s s SCC IND © COM [] OTH ❑ PTY [3s DATE DUE DATE INCURRED [] PAID CALENDAR YEAR g 3 S 5 ❑ i=pRGIVEN PER ELECTION"' RATE $ S s $ 5 DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR g S i S $ ❑ FORGIVEN PER ELECTION" RA7E T tEl IND El COM El OTH El PTY ❑SGC 3 5 5 S DATE DUE DATE INCURRED SUSTOTAt_S $ $ $ $ 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 parry 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. (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 (Ian/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received �� ��V ,,e,� Statement covers period •_ • from September 23, 2018 • - through October 20, 2018 Page 6 of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I. D. NUMBER Sue Danz 1407272 DATE FULLNAME,COD CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR OFCO CONTRIBUTOR CODE* CODE * OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN i -DEC 31) (IF REQUIRED) El IND Friends of Heather Moreno for IZ COM Advertising in 10/12/18 Atascadero Mayor 2018, FPPC # ❑ OTH newspaper 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 Summa Column A, Lines 4 and 10. ( Summary Page, 9 ) .....................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 Amounts may be rounded SCHEDULE E to whole dollarsStatement covers period . Payments Made y from September 23, 2018 SEE INSTRUCTIONS ON REVERSE through October 20, 2018 Page 7 of 7 NAME OF FILER ID.NUMBER Sue Dariz 1407272 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernaiialmisc. 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 stafflspouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor 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 ttr COMMITTEE, ALSO ENTER ID. NUMRERI CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID HART Im ressions PrintinCampaign Buttons CMP 198.56 Atascadero, CA 93422 * 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.)............................................................................................................. $ 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 $ 198.56 198.56 FPPC Form 460 Oan/2016} FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov