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HomeMy WebLinkAboutForm 460 123110 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. Statemen covers period Date of election if applicable: �© D (Month, Day Year) from Zz through � / P _ L,l �he> RE MED FEB - 2 2011 iTY OF ATASCADER CITY CLERK'S OFFICE COVER PAGE Page—J— of 7— For Official Use Only 1 Type of Recipient Committee- All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement: Officeholder Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Preelection Statement ❑ Quarterly Statement O State Candidate Election Committee Committee Semi-annual Statement ❑ Special Odd -Year Report O Recall Q Controlled [] Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) O Sponsored (Also file a Form 410 Termination) Statement Attach Form 495 ❑ General Purpose Committee (Also complete Part 6) ❑ Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I D Nl)MIER COMMITTEE NAME (OR CANUWAIE S NAMw�,{6 NO COMMITTEE) ' 2Oto �`4 N bq GIC MDQ STREET ADDRESS (NO P 0 BOX) A % env CA - CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEWHONE OPTIONAL. FAX / E-MAIL ADDRESS d- Verification _ I have used all reasonable diligence in preparing and reviewing this statement and to the best of under penalty of perjury fuunder t e laws the State of California that the foregoing is true and col Executed on V � By� Pe Executed on / ` BY ' Date C7"..-. Executed on Date Treasurer(s) NAME OF TREASURE_ h / MAILING ADD SS 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 herein and in the attached schedules is true and complete. I certify By Signature of controlling Officeholder, Candidate. Stale Measure Proponent Executed on BY Dale Signature of Controlling Officeholder, Candidate. State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from f� D SUMMARYPAGE SEE INSTRUCTIONS ON REVERSE $ 4ql Z. { 73 Schedule H, Line 3 through ` Z Page r of NAME OF FILER/. �./ �� � C y � �\ / �'' � /T ✓ /Y ���NGQ l✓' Al Schedule C, Line 3 I r� NUMBER $ '1 q 12, 7 /32 6,3 3 Contributions Received Column Column Calendar Year Summary for Candidates TOTAL THIS PERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and 1 Monetary Contributions /aj Schedule A, Line 3 $ 113,,S-7 $ zrn,, r/ General Elections 2. Loans Received Schedule B, Line 3 &C '00�'[' r� 7e c' PC1/1 through 6/30 7/1 to Date 3 SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ ZBi °�� $ %�{ „ % 20 Contributions 4 Nonmonetary Contributions Schedule C Line 3 Received $ $ 5 TOTAL CONTRIBUTIONS RECEIVED rGig/ '7 Add Lines 3+4 $ 2 0 i 3 •s $ ' I _ J'Z q 3r f % 21 Expenditures 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 $ 4ql Z. { 73 Schedule H, Line 3 Add Lines 6 + 7 G $ ""h { ( F It 7-3 Schedule F Line 3 Schedule C, Line 3 Add Lines 8+ 9+ 10 $ '1 q 12, 7 Current Cash Statement Q ^7 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 2,q? (�r "Jg 13 Cash Receipts Column A, line 3 above r4 `3 °, 14 Miscellaneous Increases to Cash Schedule 1, Line 4 uu 15 Cash Payments Column A, Line 8 above `'7 -7 3 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ __30 0 °,,Z, Z 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 $ $ / yS7o� i 3 $ K° 7 $�sZg73 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) IExpenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) $ I Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/06) FPPC Toll -Free Helpline- 866/ASK-FPPC (866/276-3772) Schedule A Type or print in Ink. SCHEDULE A Moneta Contributions Received Amounis may be rounded ry to whole dollars. Statement c verriod e - Zp fromOD , ' e . through Z�l D Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER �A.✓,� c,/ G<< -fog ✓ �s �'% ��� L / d I.D. NUMBER 132- 83 4 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (E COMMITTEE, ALSOAENTERND ZIP I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 DEC 31) (IF REQUIRED) OF BUSINESS) '4 ND ❑COM I�N�ne 1 13,Y7 ❑ OTH AjC„g�p�L 0sc ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC []IND ❑ COM ❑ OTH ❑ PTY ❑ SCC []IND [-]COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 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 ) $ Il3,,S7 TOTAL $ %�3 t7 "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) Twna nr nrinr in role SCHEDULE B PART 1 Scneouie ti — Fart i Amounts may be rounded dollars. Statement covers erlod • I ' Loans Received to whole from '1b • SEE INSTRUCTIONS ON REVERSE through Page ` of NAME OF FILER 1.0 NUMBER FULL NAME, STR ET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTST NDING BALANCE AMOUNT RECEIVED THIS lo) AMOUNT PAID OUTSTANDING BALANCEAT INTEREST ORIGINAL CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IFSELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD OR FORGIVEN THIS PERIOD' CLOSE OF THIS I PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE 2' �IC ^ �`�� ❑ PAID CALENDARYEAR ) E] FORGIVEN �7rf2 2 / RATE PER ELECTION" $ $ -� $ 0 3) 0ww+-/) $ % v $ t IND ❑ COM ❑ OTH PTY ❑ SCC DATE DUE DA INC RRED v❑I /Z e7 e t ❑ PAID CALEEN'DAARR YEAR ❑ FORGIVEN 9Y 2- 2- RATE PER ELECTION"" /64 $ C $ $ $ IND El COM ❑ OTH [I PTY [I SCC DATE DUE DA E INCURRED 4Cj< /� / r, �j ❑PAID CALENDARYEAR 10$ Zee 1) 0% 3Dm O $ O �/� A As� RATE $ E] FORGIVEN PER ELECTION"* $ 3 00 0 $ $ $ l� Md $ t� IND E] COM E] OTH E] PTY ❑ SCC DA IN URRED DA DATE DUE SUBTOTALS $ $ $ d 'qC C) $ 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. $ oZ 760 NET $ .2- '71P D (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) Tvnn nr nrint In Ink SCHEDULE B PART 1 scneouie ti — vart i Amounts may be rounded Statement covers erlod CALIFORNIA Loans Received to whole dollars. �� , ' from Page of SEE INSTRUCTIONS ON REVERSE through �� �! �D NAME OF FILER LD NUMBER "Slglvb 61 ;Lep /'0 FULL NAME, STR ET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTST NDING BALANCE (b) AMOUNT RECEIVED THIS (c) AMOUNT PAID OUTSTANDING BALANCEAT a INTEREST ORIGINAL y) CUMULATIVE (IF COMMITTEE, ALSO ENTER/I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAMEOFBUSINESS) BEGINNING THIS PERIOD PERIOD OR FORGIVEN THIS PERIOD' CLOSE OF THIS PERIOD PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE /�� �Kf J . /v �s� n 1�'il ❑ PAID CALENDAR YEAR : 0 s wo 0% s s 12-400 ❑FORGIVEN �j7 �St % 7 � 2 2 RATE PER ELECTION" t IND ❑ COM [I OTH E] PTY ❑ SCC DATE DUE / ��� ❑ PAID CALENDAR YEAR $ ® 4a % ❑ FORGIVEN n /�:�fisc+a�A e� o �C� 9.42 �- /68� RATE . PER ELECTION*" s� s s DATE DUE DAT INC RED IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑❑ PAID CALENDD/ AR7DYE©AR $ s/`°v % FORGIVEN � �f� bGLLc444 %yl z2 ATE PER ELECTION*A (% $ s `1 0o r z� L' s t� IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DAT INC RED SUBTOTALS $ 2700 $ $ 1., 79 D $ O 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 $ (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 Type or print in ink. Statement covers eriod Payments Made Amounts may be rounded , y to whole dollars. b d from FORM SEE INSTRUCTIONS ON REVERSE through Z �` �D Page of NAME OF FILER LD NUMBER �h 11 c ` Fv� j4 / � %� 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 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 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 Lrr 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 �p C;4- r13 -12- 2 A7,—otJ Gr¢ b ov"-1 s. /d cw Deo di CA T3Lj22- ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ -7,Iy k'l 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 $ gy7S'8q FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID n' J pq SCHEDULE E (CONT.) (Continuation Sheet) Type or print in ink. Amounts may be rounded Statement covers period , ISEE Payments Made to whole dollars. from 31> oFPage 9 3 7 4 7 A6e4.7--5 tJ s INSTRUCTIONS ON REVERSE ,r,4� C�►tti�o Lam} P through 1Z �• of _ 7 NAME OF FILER � LD NUMBER C,,k ,,z, �-scwf�L ;2� i0 /32 Y-7,4 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 FIL PET petition circulating TEL t.v. or cable airtime and production costs 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 Lrr 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 n' J pq A 7-/4 /{PR L7aro 9 3 7 4 7 A6e4.7--5 tJ s ,r,4� C�►tti�o Lam} P 13-7-3 ,�'✓�'SG8}1C�p lam* `��� � � " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 430, d g FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)