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Home My WebLink AboutForm 460 123110 Committee To Elect Bob KelleyRecipient 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 12/31/2010 Date of election if applicable' (Month, Day Year) RECtERED JAN 3 1 2011 ITY OF ATASCADER CITY CLERK'S OFFICE COVER PAGE Page 1 of 6 For Official Use Only 1 Type of Recipient Committee All Committees—Complete Parts 1 2, 3, and 4. STATE 2. Type of Statement: Atascadero ® Officeholder Candidate Controlled Committee ❑ Primarily Formed Ballot Measure NAME OF ASSISTANT TREASURER, IF ANY ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee MAILING ADDRESS QJ Semi-annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled CITY ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) Statement Attach Form 495 ❑ General Purpose Committee (A/so Complete Part 6) E]Amendment (Explain below) 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 1247989 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Bob Kelley 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.0 BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX / E-MAIL ADDRESS 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 I E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of riVy knowledgethe informati 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 corr t. 101/26/2011 l Executed on BY Date gillpillsoor ApMal Treasurer Executed on BY ✓� v Wrn. `Kiev Date Signature ofCcrodingOfficeholderCandi te,StateMeasureProponentorResponsibleOffcerofSponsor Executed on BY Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on BY Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) 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 Bob Kelley OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Atascadero City Council 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 TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO PO BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO RO BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE PART 2 Page 2 of 6 BALLOT NO. OR LETTER JURISDICTION [-]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 (866/2753772) State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. SUMMARYPAGE Statement covers period from _ 07/01/2010 through 12/31/2010 Page 3 of 6 NAME OF FILER Committee to Elect Bob Kelley I.D NUMBER 1247989 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and General Elections 1 Monetary Contributions Schedule A, Line 3 $ 0 $ 0 2. Loans Received Schedule 8, Line 3 0 911.24 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 $ 0 $ 911.24 20 Contributions Received $ $21 4 Nonmonetary Contributions Schedule C, Line 3 0 0 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ 0 $ 0 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 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. 10000 $ 0 10000 $ 0 0 10000 $ 23568 0 0 10000 13568 17 LOAN GUARANTEES RECEIVED Schedule A 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 $ 911.24 10000 0 10000 0 0 10000 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 Helpi(ne: 866/ASK-FPPC (866/275-3772) SCHEDULEB PART1 Iy pa V. Fl..... ... ... n. Schedule B — Part 1 Amounts may be rounded Statement covers period i CALIFORNIA 460 Loans Received to whole dollars. 07/01/2010 • ' from 12/31/2010 4 6 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Committee to Elect Bob Kelley 1247989 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCEBALANCEAT AMOUNT RECEIVED THIS (o) AMOUNT PAID OUTSTANDING INTEREST PAID THIS ORIGINAL AMOUNT OF CUMULATIVE CONTRIBUTIONS OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD OR FORGIVEN THIS PERIOD" CLOSE OF THIS R PERIOD LOAN TO DATE ❑ PAID CALENDAR YEAR Bob Kelley Realtor, Bob Kelley $ 0 $ 32889 0 328.89 $ 0 Realty % $ Atascadero Ca 93422 ❑ FORGIVEN RATE PER ELECTION - 328.89 328.89 0 $ 0 Demand $ 0 10/19/08 $ tz IND ❑ COM E] OTH [I PTY [I SCC $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR Bob Kelley Realtor Bob Kelley$ 0 $ 32889 0 32889 $ 0 Realty % $ Atascadero, Ca 93422 ❑ FORGIVEN RATE PER ELECTION** 32889 $ 0 $ 0 Demand $ 0 10/01/08 $ t® IND ❑ COM ❑ OTH El PTY ❑ SCC $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR Bob Kelley Realtor, Bob Kelley $ 0 $ 25346 0 25346 $ 0 Realty % $ Atascadero Ca 93422 ❑ FORGIVEN RATE PER ELECTION" 25346 0 $ 0 Demand $ 0 8/25/08 $ t® IND [:]COM E) OTH El PTY El SCC $ $ DATE DUE DATE INCURRED SUBTOTALS $ 0 $ 0 $ 911.24 $ 70— 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 $ $ 0 Q 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 Amounts forgiven or paid by another party also must be reported on Schedule A. *" FPPC Form 460 (January/05) If required. FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule D C1 Ir"r .-Mms Af CVMAMA1-&pp■_. SCHEDULED V401r15-11Gpl' V11 iypr up prim in n1K. Supporting/Opposing Other Amounts may be roundedCALIFORNIA Statement covers period ' Candidates, Measures and Committees to whole dollars, from 07/01/2010 • - • SEE INSTRUCTIONS ON REVERSE through 12/31/2010 5 Page of 6 NAME OF FILER I.D NUMBER Committee to Elect Bob Kelley 1247989 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE OR COMMITTEE (IF REQUIRED) PERIOD (JAN. 1 DEC. 31) (IF REQUIRED) Committee to Elect Chuck Ward 2010 Monetary 10/25/2010 ID# 1331768 - Contribution 10000 10000 Atascadero, Ca 93422 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 10000 Schedule D Summary 1 Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) 10000 2 Unitemized contributions and independent expenditures made this period of under $100 3 Total contributions and independent expenditures made this period. (Add Lines land 2 Do not enteron the Summary Page) TOTAL $ 10000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Bob Kelley Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/2010 through 12/31/2010 CODES If one of the following codes accurately describes the payment, you may enter the code Otherwise describe the payment. Page 6 of 6 LD NUMBER 1247989 E CMa 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Committee to Elect Chuck Ward 2010 ID# 1331768 Atascadero Ca y3422 CTB 10000 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 10000 Schedule E Summary 1 Itemized payments made this period (Include all Schedule E subtotals.) $ 100 00 0 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)) $ 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 $ 10000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)