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Home My WebLink AboutForm 460 101610 Committee to Elect David Bentz 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 10/01/10 through 10/16/10 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) Q 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 I.D. NUMBER 1330304 NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) David Bentz for Atascadero City Treasurer 2010 STREET ADDRESS (NO P.O. BOX) 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 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 under penalty of perjury under the laws of the State of California that the foregoing is true Executed on 10/18/2010 Date Executed on 10/18/2010 Date Executed on Date Executed on Date By By By Date of election if applicable: (Month, Day Year) COVER PAGE MEW OCT 2 0 201Pag® 1 of 6 For Official Use Only CITY OF ATASCA ERO 11/02/2010 CITYCLFRK'S OFr ICE 2. Type of Statement: ® Preelection Statement ❑ Quartedy 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 David P Bentz MAILING ADDRESS 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 my knowledge the information contained herein and in the attached schedules is true and complete. I certify •r ct. � �P A,,,.,. By Signature ofControlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/271(-3772) State of California Type or print in ink. COVER PAGE PART Recipient Committee RNIA Campaign Statement FORM 460 0 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 RESIDENTIAUBUSINESS 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 TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (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 STREETADDRESS (NO P.0 BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 6 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION I ❑ 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 ❑ 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 (866/276-3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/01/10 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 10/16/10 page 3 of 6 NAME OF FILER LD, NUMBER David Bentz for City Treasurer 2010 1330304 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR Running in Both the State Primary and (FROMATTACHED SCHEDULES) TOTALTO DATE General Elections 1 Monetary Contributions Schedule A, Line 3 00 $ 600. $ 110000 0 4850.50 1/1 through 6/30 7/1 to Date 2. Loans Received Schedule e, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 600.00$ 5950.50 20. Contributions Received $ $ 4 Nonmonetary Contributions Schedule C, Line 3 0 0 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 60000 $ 5950.50 Made $ $ Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTAL CASH 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 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 8, 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 $ 337418 0 337418 0 0 337418 314612 60000 0 337418 371.94 4850.50 $ 5578.56 0 $ 5578.56 0 0 $ 5578.56 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 (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded �'�/ to dollars. Statement covers period CALIFORNIA whole ' from 10/01/10 4 6 10/16/10 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 OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 DEC. 31) (IF REQUIRED) OF BUSINESS) ❑IND 10/03/10 Committee to Elect Jim Bowman for Ontario ®COM 500.00 50000 City Council 2010, ID#1285919, 3016 South DOTH Edenglen Ave, Ontario, Ca 91761 D PTY D SCC MIND 10/08/10 Nolan J Nelson, D D S ❑COM Dentist, Atascadero 10000 10000 DOTH State Hospital Atascadero, Ca 93422 D PTY [:]SCC [-]IND ❑ COM DOTH D PTY []SCC ❑ IND ❑ COM ❑ OTH D PTY D SCC ❑ IND ❑ COM ❑ OTH D PTY D SCC SUBTOTAL$ 600.00 Schedule A Summary I *Contributor Codes 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 ) $ 60000 $ 0 TOTAL $ IND — Individual COM — Recipient Committee (other than PTY or SCC) 0TH — Other (e.g. business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/2763772) SCHEDULE B - PART 1 Schedule B — Part 1 'yp.unt '' ay b "' u Amounts may be rounded statement covers period pCALIFORNIA Loans Received to whole dollars. 10/01/10 FORM • from 10/16/10 5 6 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER David Bentz for City Treasurer 2010 1330304 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING (b) AMOUNT (c) AMOUNT PAID ( OUTSTANDING a INTEREST (t ORIGINAL (g) CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D.NUMBER) NAMEOFBUSINESS) PERIOD THIS PERIOD" PERIOD LOAN TO DATE David P Bentz Retired, CEO Revenue E] PAID CALENDARYEAR Allocation Mgmt. $ 0 $ 4850.50 0 % $ 4850 50 $ 485050 E3 FORGIVEN Atascadero, Ca 93422 RATE PERELECTION" $ 0 0 0 Demand 0 9/15/10 $ $ $ $ DATE DUE DATEINCURRED tZ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR PER ELECTION"" ❑ FORGIVEN RATE s s $ s s DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ 07H ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION" s s s a s DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 0$ 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. I If required. u $ I 1 V NET $ 0 (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 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/01/10 through 10/16/10 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. CNP campaign paraphernalia/misc. WBR member communications RAD radio airtime and production costs CNS campaign consultants VrG 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) NAME AND ADDRESS OF PAYEE (IFCOMMITTEE,ALSOENTERI.O.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Wilkins Printing 6405 EI Camino Real LIT 337418 Atascadero, Ca 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 337418 Schedule E Summary 1 Itemized payments made this period. (Include all Schedule E subtotals.) $ 337418 2. Unitemized payments made this period of under $100 $ 0 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 $ 337418 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)