The URL can be used to link to this page

Home My WebLink AboutForm 460 093010 Sandy Jack for Atascadero CC 2010Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers periodI Date of election if applicable: from 07/01/10 (Month, Day, Year) 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 under penalty of perjury under the laws of the State of California that the foregoing is true and correc Executed on 10/Date By Date Executed on 10/4/2010 By Date Signature c Executed on By Date 11/2/10 OCT -42010 OF ATASCADERO ITY CLERK'S OFFICE COVER PAGE • O- • .- Page 1 of 9 For Official Use Only 2. Type of Statement: Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Sandy Jack, MAILING ADDRESS Atascadero CA 93422 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS contained ched schedules is true and complete. I certify Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/2763772) State of California 09/30/10 SEE INSTRUCTIONS ON REVERSE through 1 Type of Recipient Committee All Committees —Complete Parts 1, 2, 3, and 4. ® Officeholder Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information LD NUMBER 132834 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Sandy Jack For Atascadero City Council 2010 STREET ADDRESS (NO PO BOX) Atascadero CA 93422 CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.0 BOX 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 under penalty of perjury under the laws of the State of California that the foregoing is true and correc Executed on 10/Date By Date Executed on 10/4/2010 By Date Signature c Executed on By Date 11/2/10 OCT -42010 OF ATASCADERO ITY CLERK'S OFFICE COVER PAGE • O- • .- Page 1 of 9 For Official Use Only 2. Type of Statement: Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Sandy Jack, MAILING ADDRESS Atascadero CA 93422 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS contained ched schedules is true and complete. I certify Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/2763772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/10 SUMMARYPAGE Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTALCASH PAYMENTS 9 Accrued Expenses (Unpaid Bills) 10 Nonmonetary Adjustment 11 TOTAL EXPENDITURES MADE Schedule E, Line 4 $ Schedule H, Line 3 Add Lines 6 + 7 $ Schedule F Line 3 Schedule C, Line 3 Add Lines 8 + 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 8 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. 17 LOAN GUARANTEES RECEIVED 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 $ 8272.62 $ 0 8272.62 $ 70000 0 8922.62 $ 8272.62 0 8272.62 70000 0 8922.62 0 To calculate Column B add through 09/30/10 Page 2 of 9 SEE INSTRUCTIONS ON REVERSE from Column B of your last 8272.62 report. Some amounts in Column A may be negative NAME OF FILER figures that should be subtracted from previous LD NUMBER Sandy Jack For Atascadero City Council 2010 the first report being filed 0 for this calendar year only 132834 Contributions Received from Lines 2, 7 and 9 (if Column A Column B Calendar Year Summary for Candidates TOTALTHISPERIOD (FROM ATTACHED SCHEDULES) CALENDARYEAR TOTALTO DATE Running In Both the State Primary and g r General Elections 1 Monetary Contributions Schedule A, Line 3 $ 14000 $ 14000 2. Loans Received Schedule B, Line 3 1200000 1200000 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 1214000 $ 1214000 20. Contributions Received $ $ 4 Nonmonetary Contributions Schedule C, Line 3 0 0 21 Expenditures 5 TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 1214000 $ 1214000 Made $ $ Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTALCASH PAYMENTS 9 Accrued Expenses (Unpaid Bills) 10 Nonmonetary Adjustment 11 TOTAL EXPENDITURES MADE Schedule E, Line 4 $ Schedule H, Line 3 Add Lines 6 + 7 $ Schedule F Line 3 Schedule C, Line 3 Add Lines 8 + 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 8 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. 17 LOAN GUARANTEES RECEIVED 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 $ 8272.62 $ 0 8272.62 $ 70000 0 8922.62 $ 8272.62 0 8272.62 70000 0 8922.62 0 To calculate Column B add 1214000 amounts in Column A to the 0 corresponding amounts from Column B of your last 8272.62 report. Some amounts in Column A may be negative 386738 figures that should be subtracted from previous period amounts. If this is the first report being filed 0 for this calendar year only carry over the amounts from Lines 2, 7 and 9 (if any). 1270000 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) f J Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received ~riIVto whole - period Statement covers dollars.naea CALIFORNI, from 07/01/10 . SEE INSTRUCTIONS ON REVERSE through 09/30/10 Page 3 of 9 NAME OF FILER I.D. NUMBER Sandy Jack For Atascadero City Council 2010 132834 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED OF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 DEC 31) (IF REQUIRED) OF BUSINESS) IND ❑❑COM Mission Cities Insurance Agency 8/2/10 8305 San Diego Road W] OTH 100 00 100 00 Atascadero CA 93422 ❑ PTY ❑ SCC []IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 10000 Schedule A Summary 1 Amount received this period— itemized monetary contributions. (Include all Schedule 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 $ 10000 14000 *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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) T...... .. ..6 i.. ...L SCHEDULEB PART1 scneauie ti — Fart i Amounts may be rounded Statement covers period Loans Received to whole dollars. 07/01/10 CALIFOR• 1 from FORM 4 9 09/30/10 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Sandy Jack For Atascadero City Council 2010 132834 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING (b) AMOUNT (c) AR UNTPAID (d) OUTSTANDING (e) INTEREST ( ORIGINAL (g) CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IFSELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAME OF BUSINESS) PERIOD THIS PERIOD" PERIOD PERIOD LOAN TO DATE William S. Jack Retired ❑ PAID CALENDAR YEAR $ o $ 250000 0 2500 00 250000 ,, $ $ ❑ FORGIVEN Atascadero CA 93422 RATE PER ELECTION" $ 0 $ 2500 00 $ 0 Demand $ 0 7/16/10 $ tw IND [I COM [I OTH [_1 PTY ❑ SCC DATE DUE DATE INCURRED William S Jack Retired E] PAID CALENDAR YEAR $ o $ 250000 0 2500 00 $ 500000 % $ ❑ FORGIVEN PER ELECTION** Atascadero CA 93422 RATE $ 0 $ 250000 $ 0 Demand $ 0 8/6/10 $ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED William S Jack Retired0 E] PAID CALENDAR YEAR $ o $ 300000 0 ,, 300000 $ 800000 Atascadero CA 93422 RATE $ ❑ FORGIVEN PER ELECTION" $ 0 $ 300000 $ 0 Demand $ 0 9/2/10 $ tgz IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 12000 00 $ 0 $ 1200000 $ 0 ; 0 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. 1200000 0 1200000 (May be a negative number) tri -iter te) 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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) T e or rint in ink SCHEDULE B PART 1 Schedule B — Part 1 Amounts may be rounded Statement covers period I dollars. CALIFORNIA ' • Loans Received to whole 07/01/10 FORM from 09/30/10 5 9 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Sandy Jack For Atascadero City Council 2010 132834 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING (b) AMOUNT (c) AMOUNT PAID OUTSTANDING (e) INTEREST (r ORIGINAL CUMULATIVE UL OF LENDER OCCUPATION AND EMPLOYER AND SELF-EMPLOYED, ENTER (U OCCUPATION BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D.NUMBER) NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE William S Jack Retired ❑ PAID CALENDAR YEAR $ o $ 400000 0 4000 00 % $ $1200000 ❑ FORGIVEN Atascadero, CA 93422 RATE LECTION**$ PER ELECTION— $_0 $ 400000 $ 0 Demand $ 0 7/16/10 $ DATE DUE DATE INCURRED tsz IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION*" RATE $ $ $ $ $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Retired0 ❑ PAID CALENDARYEAR ❑ FORGIVEN PERELECTION— RATE $ $ $ $ $ DATE DUE DATE INCURRED t❑ IND ❑COM❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 4000 00 $ 0 $ 400000 $ 0 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 ) 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. NET $ (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 be a negative number) FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Sandy Jack For Atascadero City Council 2010 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/10 through 09/30/10 CODES If one of the following codes accurately describes the payment, you may enter the code. Otherwise describe the payment Page 6 of 9 I.D. NUMBER 132834 CW campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants WG 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 RND 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Lauren PolanskiPartial on Web Design WEB 30000 Glendale AZ 85308 City Of Atascadero Candidate Statement $275 00 6905 EI Camino Real FIL Filing Fee 2500 30000 Atascadero CA 93422 All Signs --Invoice #2049 Partial on campaign signs 2732 EI Camino Real CMP 1409.52 Atascadero, CA 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2009.52 Schedule E Summary 1 Itemized payments made this period. (Include all Schedule E subtotals.) $ 824962 2. Unitemized payments made this period of under $100 $ 23.00 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 $ 8272.62 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E (Continuation Sheet) Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/10 SCHEDULE E (CONT.) through 09/30/10 Pae 7 of 9 SEE INSTRUCTIONS ON REVERSE 9 NAME OF FILER LD NUMBER Sandy Jack For Atascadero City Council 2010 132834 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 M 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 VVEB 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 Johnny Howard LIT 143.46 Glen Allen, VA 23060 All Signs --Invoice #2049 and Invoice 2081 Balance due on both invoices 2732 EI Camino Real CMP 149743 Atascadero CA 93422 Wilkin's Printing ---Invoice # 4893-480 Partial payment 6405 EI Camino Real LIT 70000 Atascadero CA 93422 Bank of America Heritage Foundation 6905 Capistrano Ave CMP 214 Massachusetts Ave. NE 20000 Atascadero CA 93422 Washington, DC 20002-4999 All Signs --Invoice #2082 2732 EI Camino Real CMP 29877 Atascadero CA 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 283966 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule EType CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Wilkin's Printing ---Invoice # 4893-480 SCHEDULE E (CONT.) (Continuation Sheet) or print in ink. Amounts may be rounded Statement covers period CALIFORNIA Payments Made 1142.36 to whole dollars. from 07/01/10 .1 • ' SEE INSTRUCTIONS ON REVERSE through 09/30/10 Page 8 Of 9 NAME OF FILER 411 84 Atascadero CA 93422 I.D. NUMBER Sandy Jack For Atascadero City Council 2010 Balance due 6405 EI Camino Real 132834 CODES If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/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 FIND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals M 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 UVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.O. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Wilkin's Printing ---Invoice # 4893-480 Partial payment 6405 EI Camino Real LIT 1142.36 Atascadero CA 93422 All Signs --Invoice #2142 2732 EI Camino Real CMP 411 84 Atascadero CA 93422 Wilkin's Printing ---Invoice # 4893-480 Balance due 6405 EI Camino Real POS 1846.24 Atascadero CA 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 340044 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTI NAME OF FILER REVERSE Sandy Jack For Atascadero City Council 2010 Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE F Statement covers period from 07/01/10 through 09/30/10 Page 9 of 9 LD NUMBER 132834 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 W 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 SUBTOTALS $ 0 $ 100000 $ 30000 $ 70000 summarized on Schedule D. Schedule F Summary 1 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.) 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 ) 3 Net change this period. (Subtract Line 2 from Line 1 Enter the difference here and on the Summary Page, Column A, Line 9 ) INCURRED TOTALS $ PAID TOTALS $ 1000.00 30000 NET $ 70000 May be a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Lauren Polanski WEB 0 80000 30000 50000 Glendale AZ 85308 KPRL Radio RAS 32nd & Oak Street 0 20000 0 20000 Paso Robles, CA 93447 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 0 $ 100000 $ 30000 $ 70000 summarized on Schedule D. Schedule F Summary 1 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.) 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 ) 3 Net change this period. (Subtract Line 2 from Line 1 Enter the difference here and on the Summary Page, Column A, Line 9 ) INCURRED TOTALS $ PAID TOTALS $ 1000.00 30000 NET $ 70000 May be a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)