HomeMy WebLinkAboutForm 460 Dariz 123121 AmendmentRecipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from July 1, 2021
through December 31, 2021
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
® ffceholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
State Candidate Election Committee Committee
Q Recall Controlled
(Also compwe Part sl Sponsored
(Also Canpbfe Pert 6)
❑ General Purpose Committee
Sponsored ❑ Primarily Formed Candidate/
Small Contributor Committee Officeholder Committee
Political PartylCentral Committee (AAsoCompfetePart t)
3. Committee Information I.D. NUMBER
1407272
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Mark Dariz Committee to Elect for Atascadero City Council 2020
STREET ADDRESS (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 AREACODEIPHONE
OPTIONAL. FAX I E-MAILADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my
certify under penalty of perjury under the laws of the State of California that the foregoing is true anS
Executed on 1/29/22
Date
Executed on 1/29/22
Executed on
Date
Executed on
Date
By
Date of election if applicable:
(Month, Day, Year)
Nov. 3, 2020
2. Type of Statement:
COVER PAGE
Date Stamp CALIFORNIA
460
RECEIVED FORM
Page 1 of 2
uQIY ���� For Official Use Only
CITY OF ATA SCAD E
CITY CLERK'S OFFICE
❑ Preelection Statement ❑ Quarterly Statement
Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
Amendment (Explain below) ff
�G a') Vl,' v✓ckac f�
Treasurer(s)
NAME OF TREASURER
Sue Dariz
MAILINGADDRESS
CITY STATE ZIP CODE AREA CODElPHONE
Atascadero CA 93422
NAME OF ASSISTANT TREASURER, IF ANY
MAILINGADDRESS
CITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX/E-MAIL ADDRESS
i
contained herein and in the attached schedules is true and complete. I
or
or
By Signature of Controlling Officeholder, Candidate, Stale Measure Proponent
By
Signature of Controlling Qificcrwlder, Cendidale, Slate Measure Proponent
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
schedule E. Line 4 $ 0 $
SUMMARY PAGE
Summary Page
8. SUBTOTAL CASH PAYMENTS .......................................
to whole dollars.
9. Accrued Expenses (Unpaid Bills) ....... ........................
Statement covers period
CALIFORNIA
,•0
Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ....................................
Add Lines 8+9+10 $ 0 $
from
FORM
Page 2 of 2
SEE INSTRUCTIONS ON REVERSE
through
NAME OF FILER
I.D. NUMBER
Mark Dariz Committee to Elect for Atascadero City Council 2020
1407272
Column A
Column B
Calendar Year Summary for Candidates
Contributions Received
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
CALENDAR YEAR
TOTAL TO DATE
Running in Both the State Primary and
General Elections
1. Monetary Contributions ............ ..............
Schedule ALine 3
$ $
v1 through 6130 711 to Date
2. Loans Received ............. --...............................................
schedule e, Line 3
20. Contributions
3. SUBTOTAL CASH CONTRIBUTIONS ..............................
Add Lines 1+2
$ $
Received $ $
4. Nonmonetary Contributions ............................................
Schedule C, Line 3
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...... --........
- ........... .Add Lines 3+4
$ $
Made $ $
Expenditures Made
6. Payments Made................................................................
schedule E. Line 4 $ 0 $
7. Loans Made.......................................................................
Schedule H, Line 3
8. SUBTOTAL CASH PAYMENTS .......................................
Add Lines 6+7 $ 0 $
9. Accrued Expenses (Unpaid Bills) ....... ........................
........... Schedule FLine 3
10. Nonmonetary Adjustment.........................................................
Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ....................................
Add Lines 8+9+10 $ 0 $
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......................................................... Columna, Line a above
16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15
If this is a termination statement, Line 16 must be zero.
$ 1,383
$ 1,383
17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $
18. Cash Equivalents ................................................ See instructions on reverse $
19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $
To Calculate Column B,
add amounts in Column
A to 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 (it
any).
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made'
(e subject b Vdumary Expendture Lima)
Date of Election Total to Date
(mmiddiyy)
3
*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)
www.fppc.ca.gov