The URL can be used to link to this page

Home My WebLink AboutForms 460 12-31-2011 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 07/01/2011 through 12/31/2011 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 O Controlled (Also Complete Pod5) O Sponsored ❑ General Purpose Committee (Also Complete Psrt6) 0 Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part l) 3. Committee Information I.D. NUMBER 1247989 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Bob Kelley STREET ADDRESS (NO P.O. BOX) 9955 Calle Refugio CITY STATE ZIP CODE AREA CODEIPHONE Atascadero Ca 93422 805/460-9143 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 Date of election if applicable: (Month, Day, Year) Date Stamp RECEIVED ITY OF ATASCADER CITY I- 2. Type of Statement: ❑ Preelection Statement Date Semi-annual Statement ❑ Termination Statement Date (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVER Page 1 of 3 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement -Attach Form 495 Treasurer(s) NAME OF TREASURER David P. Bentz MAILING ADDRESS 10275 San Marcos Rd CITY STATE ZIP CODE AREA CODE(PHONE Atascadero Ca 93422 805/462-2718 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 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 -correct' ,_, 4 Executed on 01/19/2012 Date Executed on A{p'.)'6X. Date Executed on Date Executed on By By By Slgnalure of Com,11 ng Ofnmi older Canddlde, Stele Measure ProponeM By Signature of Controlling OfficeMltleG Candidate, State Measure Proponent FPPC Form 460(January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275.3772) State of California Recipient Committee Type or print in ink. Campaign Statement Cover Page — Part 2 Page 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAMEOF BALLOTMEASURE Bob Kelley OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) City Councilman, Atascadero, Ca RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 9955 Calle Refugio 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 NAME OF TREASURER ❑ YES ❑ NO COMMITTEEADDRESS STREET CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Of 3 BALLOT NO. OR LETTER (JURISDICTION ❑SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholders) 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 Toli-Free Helpline: 8661ASK-FPPC (866/2763772) State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from 07/01/2011 SUMMARY PAGE Expenditures Made l--/ $ 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made.. ........................................................... through 12/31/2011 Page 3 of 3 SEE INSTRUCTIONS ON REVERSE 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Linea 10. Nonmonetary Adjustment ............ _............................ Schedule o, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ NAME OF FILER subtracted from previous period amounts. If this is I D NUMBER Committee to Elect Bob Kelley for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if 1247989 Contributions Received Column Column Calendar Year Summary for Candidates TOTALTHISPERIOD (rROMATTACHED SCMEDULEs) CALENDARYEAR TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 2. Loans Received ................. ._............ .................. .... Schedule a, tine 3 0 911.24 Ill through 6/30 7/1 to Date 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines I+2 $ 0 $ 911.24 20. Contributions Received $ $ 4. NOnmonetary Contributions .................................... Schedule C, Line 0 21. Expenditures — 5. TOTAL CONTRIBUTIONS RECEIVED ........................... AddLmes3+4 $ 0 $ 911.24 Made $ $ Expenditures Made l--/ $ 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made.. ........................................................... Schedule H Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines a+7 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Linea 10. Nonmonetary Adjustment ............ _............................ Schedule o, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3above 14. Miscellaneous Increases to Cash ........................... Schedule/, Line 15. Cash Payments ... ............................................ ... Column A, Linea 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 s in Column B above $ 0 $ 0 0 $ 0 0 0 $ 135.68 0 0 0 135.68 I I 0 0 0 0 0 0 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (x Subject to Voluntary apenditure Limit) Date of Election Total to Date (mm/dd/yy) l--/ $ To calculate Column B, add amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts from Column B of your last reported in Column B. 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). FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772)