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Home My WebLink AboutForm 460 093010 David Bentz for Atascadero Treasurer 2010Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 07/01/2010 through 09/30/2010 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 Pert 5) 0 Sponsored ❑ General Purpose Committee (Also Complete Part 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1330304 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) David Bentz for Atascadero City Treasurer 2010 STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODE/PHONE Atascadero Ca 93422 CITY STATE ZIP CODE AREA CODE/PHONE Atascadero Ca 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.0 BOX CITY STATE ZIP CODE AREA CODE/PHONE STATE ZIP CODE AREA CODE/PHONE OPT1r)K1Al FAX / E-MAIL ADDRESS Date of election if applicable: (Month, Day Year) 11/02/2010 Date Stamp RECEIV OCT - 5 201 Page CITY OF ATASCA$ERO CITY CLERK'S OF ICE 2. Type of Statement: ® Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER David P Bentz MAILING ADDRESS COVERPAGE of 6 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement Attach Form 495 CITY STATE ZIP CODE AREA CODE/PHONE Atascadero Ca 93422 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS 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 compctk A Executed on 10/02/2010 Data Executed on 10/02/2010 Date Executed on Date By By By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of ControllingOtrceholder Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612763772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE David P Bentz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Treasurer for City of Atascadero, Ca RESIDENTIAL/BUSINESS ADDRESS (NO 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 TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS ADDRESS (NO RO BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.0 BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION COVER PAGE PART 2 Page 2 of 6 ❑ 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 Candidate/Officeholder 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 p 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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (6661275.3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period frnm 07/01/2010 SUMMARYPAGE SEE INSTRUCTIONS ON REVERSE 6. Payments Made Schedule E, Line 4 $ through 09/30/2010 Page 3 of 6 NAME OF FILER 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment Schedule C, Line 3 11 TOTAL EXPENDITURES MADE I.D. NUMBER David Bentz for City Treasurer 2010 1330304 Column Column Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR Primary Runningin Both the State Prima and (FROMATTACHEDSCHEDULES) TOTALTO DATE General Elections 1 Monetary Contributions Schedule A, Line 3 $ 50000 $ 50000 4850.50 4850.50 1/1 through 6/30 7/1 to Date 2. Loans Received Schedule B, Line 3 3. SUBTOTALCASH CONTRIBUTIONS Add Lines 1 +2 $ 5350.50 $ 5350.50 20 Contributions Received $ $ 4 Nonmonetary Contributions Schedule C, Line 3 0 0 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 +4 $ 5350.50 $ 5350.50 Made $ $ Expenditures Made 6. Payments Made Schedule E, Line 4 $ 7 Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment Schedule C, Line 3 11 TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Pape, Line 16 $ 13. Cash Receipts Column A, Line 3above 14. Miscellaneous Increases to Cash Schedule 1, Line 4 15. Cash Payments Column A, Line 8above 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 $ 2204.38 $ 0 2204.38 $ 0 0 2204.38 $ M 5350.50 0 2204.38 314612 4850.50 2204.38 0 2204.38 0 0 2204.38 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 (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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A Monetary Contributions Received Type or print In ink. SCHEDULE A Amounts may be rounded Statement covers period to whole dollars. 07/01/2010CALIFORNIA ' from I FORM SUBTOTAL$ 50000 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 $ X11 11 0 50000 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 (6661275-3772) 09/30/2010 4 6 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER David Bentz for City Treasurer 2010 1330304 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER CUPATIO MPLOYER DC AMOUNT RECPE THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * SELF-EMPLOYED, RED (JAN. 1 DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND G Michael Milhiser []COM CAO, Morongo Band of 500.00 500.00 09/17/10 ❑ OTH Mission Indians ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑COM ❑ OTH ❑ PTY ❑ SCC []IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC [:]IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC SUBTOTAL$ 50000 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 $ X11 11 0 50000 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 (6661275-3772) SCHEDULE B PART 1 ' Schedule B — Part 1 Amounts ` "' may be may b "' "'�' rounded Statement covers period CALIFORNIA Loans Received to whole dollars. 07/01/2010 .. • from 09/30/2010 5 6 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER David Bentz for City Treasurer 2010 1330304 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE (b) AMOUNT (c) AMOUNT PAID (d) OUTSTANDING gALANCEAT (e INTEREST ORIGINAL UL CUMULATIVE OF LENDER ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN CLOSE OF THIS PAID THIS PERIOD AMOUNTOF LOAN CONTRIBUTIONS TO DATE (IFCOMMITTEE, NAME OF BUSINESS) p THIS PERIOD* E3 PAID CALENDARYEAR David P Bentz Retired, CEO Revenue $ 0 $ 4850.50 0% S 4850.50 Allocation Mgmt. $4850.50 ❑ FORGIVEN PER ELECTION** RATE 0 485050 0 Demand s 0 9/15/10 s $ s s DATE DUE DATE INCURRED tv IND E] COM [:]OTH E3 PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION S S S S S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION** s s s s s DATE DUE DATE INCURRED tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 4850.50$ 0 $ 4850.50 $ 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. SCQ" a E, Line 3) $ 485050 $ 1 NET $ 4850.50 (May be a negative number) 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) Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/0112010 SEE INSTRUCTIONS ON REVERSE through 09/30/2010 Page 6 of 6 NAME OF FILER I.D. NUMBER David Bentz for City Treasurer 2010 1330304 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 PEr 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 WEB 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 City of Atascadero 6907 EI Camino Real FIL 30000 Atascadero, Ca 93422 All Signs & Graphics 2732 EI Camino Real LIT 92013 Atascadero, Ca 93422 Wilkins Printing 6405 El Camino Real LIT 90000 Atascadero, Ca 93422 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. 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 ) SUBTOTAL $ 213013 $ 213013 $ 84.25 $ 0 TOTAL $ 2204.38 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)