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Home My WebLink AboutForm 460 101610 Sandy Jack for Atascadero City Council 2010Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Date Stamp RECEIVED Statement covers period Date of election if applicable: 2 1 2010 10/01/2010 (Month, Day, Year) OCTUl, from through 10/16/2010 1 Type of Recipient Committee All Committees —Complete Parts 1, 2, 3, and 4. ® Officeholder Candidate Controlled Committee Q State Candidate Election Committee O Recall (Also Complete Part 5) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee Q Controlled Q Sponsored (Also complete Part 6) ❑ Primarily Formed Candidate/ Officeholder 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) CITY STATE ZIP CODE AREA CODE/PHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O BOX CITY OPTIONAL. FAX / E-MAIL ADDRESS STATE ZIP CODE AREA CODE/PHONE 11/02/2010 Cl OF ATASCADERO CLERK'S OFFICE 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 Sandyjack MAILING ADDRESS COVERPAGE Page 1 of 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 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle the i or ation containe �n2rtdiriffie aft ed schedules is true and complete. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) State of California 10/21/2010 Executed on Date,,d�eofT4Xha7orAssis0,Treasurer By 10/21/2010 Executed on Date By Sign re oftontrollingder, 'date, eas Responsible Officer of Sponsor Executed on Date By Signatur ofControlingOfficeholder Candidate, State MeasureProponent Executed on py1e BY Signature ofControlling Officetwlder.Candidate. State Measure Proponent FPPC Forth 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) State of California Campaign Disclosure Statement Summary Page Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from 10/01/2010 SUMMARYPAGE Expenditures Made 6. Payments Made 7 Loans Made 8. SUBTOTAL CASH PAYMENTS 9. Accrued Expenses (Unpaid Bills) 10 Nonmonetary Adjustment 11 TOTAL EXPENDITURES MADE Current Cash Statement 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 $ 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 S above $ 1380.00 $ 0 138u.UV $ 1400.00 0 318000 $ 3867.38 9652.00 0 9652.00 140000 0 11152.00 To calculate Column B, add 0 amounts in Column A to the through 10/16/2010 Page 2 of 8 SEE INSTRUCTIONS ON REVERSE 1380 00 report. Some amounts in Column A may be negative 2487.38 figures that should be NAME OF FILER subtracted from previous period amounts. If this is I.D. NUMBER Sandy Jack For Atascadero City Council 2010 for this calendar year only carry over the amounts 132834 0 any) Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR Running in Both the State Primary and 9 (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1 Monetary Contributions Schedule A, Line 3 $ 0 $ 14000 111 through 6/30 7/1 to Date 0 1200000 2. Loans Received Schedule 8, Line 3 0 1214000 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ $ Received $ $ 0 0 4 Nonmonetary Contributions Schedule C, Line 3 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 0 $ 1214000 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 Current Cash Statement 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 $ 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 S above $ 1380.00 $ 0 138u.UV $ 1400.00 0 318000 $ 3867.38 9652.00 0 9652.00 140000 0 11152.00 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (If Sub)ec[ to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) J --I $ Amounts in this section maybe different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) To calculate Column B, add 0 amounts in Column A to the 0 corresponding amounts from Column B of your last 1380 00 report. Some amounts in Column A may be negative 2487.38 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 0 any) 1200000 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (If Sub)ec[ to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) J --I $ Amounts in this section maybe different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule B — Part 1 Loans Received Type or print in ink, SCHEDULEB-PARTt Amounts may be rounded Statement covers period JEM to whole dollars. from 10/01/2010 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. $ $ 0 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) 10/16/2010 3 8 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER LD NUMBER Sandy Jack For Atascadero City Council 2010 132834 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT O AMOUNT PAID OUTSTANDING (e) 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 AMOUNT OF CONTRIBUTIONS (IF COMMITTEE. ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIODt PERIOD PERIOD LOAN TO DATE ❑PAID CALENDAR YEAR William S. Jack Retired $ 0 $ 2500 00 0 2500.00 $ 2500.00 % $ ❑ FORGIVEN PERELECTION— Atascadero, CA 93422 RATE $ 250000 $ 0 $ 0 Demand $ 0 7/16/10 $ DATE DUE DATE INCURRED tZ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR William S. Jack Retired $ 0 $ 250000 0 2500.00 $ 500000 $ ❑ FORGIVEN PER ELECTION*' Atascadero, CA 93422 RATE 250000 $ $ 0 $ 0 Demand $ 0 8/6/10 $ DATE DUE DATE INCURRED t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC William S Jack Retired ❑ PAID CALENDAR YEAR $ 0 $ 3000.00 0 3000 00 $ 800000 f % $ E] FORGIVEN PER ELECTION"' Atascadero CA 93422 RATE $ 300000 0 $ 0 Demand $ 0 9/2/10 $ $ DATE DUE DATE INCURRED tm IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 0$ 0 $ 1200000 $ 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. $ $ 0 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) w T... n nine I. i.d. SCHp:ntnPR-PART1 vvI1qWuurW u — V01 L I Amounts may be rounded Statement covers period Loans Received to whole dollars. ' 10/01/2010 _ • from � SEE INSTRUCTIONS ON REVERSE through 10/16/2010 page 4 of 8 NAME OF FILER LD NUMBER Sandy Jack For Atascadero City Council 2010 132834 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTEROUTSTANDING (b) AMOUNT (c) (d) OUTSTANDING (e) (f) (g) OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS AMOUNTPAID BALANCEAT INTEREST ORIGINAL CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAMEOFBUSINESS) p IOD PERIOD THIS PERIOD" PERIOD PERIOD LOAN TO DATE William S. Jack Retired E] PAID CALENDAR YEAR $ 0 E 4000.00 0 % Atascadero, CA 93422 $400000 E1200000 ❑ FORGIVEN RATE PER ELECTION- LECTION`*400000 400000 $ 0 E 0 Demand0 $ 7/16/10 $ tZ IND El COM El OTH E] PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR E E E E ❑ FORGIVEN PER ELECTION*` RATE t❑ IND ❑ COM ❑ OTH ❑ PTYS ❑ SCC E E $ $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR a s i E s ❑ FORGIVEN PER ELECTION" RATE t[]IND ❑ COM ❑ OTH ❑ PTY ❑ SCC E E E E E DATE DUE DATE INCURRED SUBTOTALS $ 0$ 0 $ 12000.00 $ 0 S§ 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 ) Enter the net here and on the Summary Page, Column A, Line 2. 0 I NET $ 0 (May be a negative number) (tnrer (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 'Amounts forgiven or paid by another party also must be reported on Schedule A. 1 If required. 1 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 10/01/2010 SEE INSTRUCTIONS ON REVERSE through 10/16/2010 Page 5 of 8 NAME OF FILER LD NUMBER Sandy Jack For Atascadero City Council 2010 132834 E CODES If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalialmisc. 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 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, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Lauren Polanski Balance due on Web design and maintenance WEB 50000 Glendale AZ 85308 KPRL Radio Sponsorship of Greyhound Football RAD 20000 Paso Robles, CA 93447 Colony Days Committee 10 x 10 booth space in Sunken Gardens CMP 100 00 Atascadero, CA 93423 * Payments that are contributions or independent expenditures must also be summarized on Schedule D SUBTOTAL $ 80000 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 $ 138000 0 0 138000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E SCHEDULE E (CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be roundedCALIFORNIA 4601 Payments Made towholedollars. 10/01/2010 _ from through 10/16/2010 Page 6 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER t.D. 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 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 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 Atascadero News 5660 EI Camino Real Atascadero CA 93422 PRT Colony Days Supplement $50000 Atascadero Main Street Atascadero CA, 93422 MTG Halloween Ball $8000 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 580.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule F Type or print in ink. Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. SEE INSTRUCTIONS ON REVI NAME OF FILER Sandy Jack For Atascadero City Council 2010 SCHEDULE F Statement covers period CALIFORNIA from 10/01/2010 FORM , through 10/16/2010 7 8 Page of 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 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 CREDITOR CODE OR ( OUTSTAA NDING I AMOUNTIN CURRED (c) AMOUNT PAID (d) 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 Bank of America 6905 Capistrano Ave. CMP 0 Est. 250 00 0 Est.250 00 Atascadero, CA 93422 KPRL Radio 32nd & Oak St. RAD 200.00 20000 20000 20000 Paso Robles, CA 93447 All Signs 2732 EI Camino Real CMP 0 Est. 1000 00 0 Est. 1000 00 Atascadero CA 93422 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 20000 $ 210000 $ 70000 $ 160000 Schedule F Summary 1 Total accrued expenses incurred this period. (Include all Schedule F Column (b) subtotals for 210000 accrued expenses of $100 or more, plus total unitemized accrued expenses under $100 ) INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F Column (c) subtotals for payments on 700.00 accrued expenses of $100 or more plus total unitemized payments on accrued expenses under $100 ) PAID TOTALS $ 3 Net change this period. (Subtract Line 2 from Line 1 Enter the difference here and on the Summary Page, Column A, Line 9 ) NET $ 1400.00 May be a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule F Type or print in ink. Amounts may be rounded (Continuation Sheet) to whole dollars. Accrued Expenses (Unpaid Bills) Statement covers period from 10/01/2010 through 10/16/2010 SCHEDULE F (CONT.) Page 8 of 8 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 paraphema►ia/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 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNTIN CURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Atascadero News 5660 EI Camino Real Atascadero CA 93422 PRT 0 65000 50000 15000 SUBTOTALS $ $ 65000 $ 50000 $ 15000 FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)