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HomeMy WebLinkAboutForm 460 Dariz 123118 AmendmentRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE from Statement covers period October 21, 2018 through December 31, 2018 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also LompkNe Part 51 ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also com*te Part 6) ❑ Primarily Formed Candidate! Officeholder Committee (Also Caplan Pad 7) I.D. NUMBER 1407272 Mark Dariz Committee to Elect for Atascadero City Council 2018 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Atascdero CA 934022 MAIJNG ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA COOEIPHONE FAX / E-MAIL ADDRESS COVER PAGE Date Stamp Date of election if applicable: RECEIVED Page 1 of 6 (Month, Day, Year) )'} For Official Use Only November 6, 2018 ITY OF ATASCADERO 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Wl Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) Amendment (Explain below) Correcting Errors in contribution tabulation Treasurer(s) NAME OF TREASURER Sue Dariz 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 CODEIPHONE OPTIONAL FAX 1 E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the infor ioncoptained 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. Executed an 7/27120 Date Executed on 7/27/20 Date Executed on Date Executed on Date By or By Signature of Controlling Officeholder, Candidate. State Measure Proponent By SfgnaEure of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www fnnr ra anv Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Mark Dariz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of Atascadero, CA RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE XIP Atascadero, CA 93422 Related Committees Not Included in this Statement: Listanycommmees 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 E.D. NUMBER NAME OF TREASURER CONTROLLED COMIMIITTFE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O_ BOX) CITY STATE ZIP CODE AREA CODEIPHONE 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 COVER PAGE - PART 2 Page 2 of 6 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE 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 Listnamesof 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. from Statement covers period October 21, 2018 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through December 31, 2018 Page 3 of 6 NAME OF FILER I.D. NUMBER Sue Dariz 1407272 Contributions Received 1. Monetary Contributions.. ................................................. Schedule A, Line 3 2. Loans Received................................................................ Schedule e, Linea 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .... ...... ............. ............ Add Lines 3+4 Expenditures Made 6. Payments Made................................................................ schedule E, Line 4 7. Loans Made....................................................................... Schedule rt Line 3 8. SUBTOTAL CASH PAYMENTS... ....................................... Add Lines 6+7 9. Accrued Expenses (Unpaid Bills)... ...... Schedule F, Lift 3 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 6 + 9 + 10 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Pape, 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, teen subtract Line 15 If this is a termination statement, Line 16 must be zero. Column A TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) $ 1635 4,000.00 Column B CALENDAR YEAR TOTAL TO DATE $ 10,500 1,333.16 $ -2,365.00 $ -2,365 $ -4,000.00 $ 9,468.16 $ 9.333.16 $ 11,084.86 $ 9,333.16 $ 11,084.86 $ 9,333.16 $ 12,218.02 $ 12,643.02 -2,365.00 17. LOAN GUARANTEES RECEIVED ................................ Schedule 6, Pane $ 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 -Line 9m Column s above $ 9,333.16 944.86 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). Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (e Subject to Voluntary Expendaure Limit) Date of Election Total to Date (mm/dd/yy) 3 "Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 SChedule b — Fart 1 to whole dollars. Statement covers period Loans Received October21, 2018 CALIFORNIA , ' FORM from through December 31, 201 E Page 4 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Sue Dariz 1407272 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING AMOUNT I AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN BALANCE AT CLOSE OF THIS pglD THIS AMOUNT OF CONTRIBUTIONS NAME OF BUSINESS) PERIOD THIS PERIOD' PERIOD PERIOD LOAN TO DATE M k D r1Z Architect VI PAID CALENDAR YEAR OMNI Design Group $ 4,000.00 g 1,333.16 g 5.333.1 g 5,333.16 PER ELECTION** Atascadero, CA 93422 ❑ FORGIVEN HATE g 5, 333.16 g g g t IND ❑COM F1 OTH ❑PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR S g $ $ ❑ FORGIVEN PER ELECTION" RATE S S g S S DATE DUE DATE INCURRED ❑ IND ❑ COM ❑ OTH © PTY ❑ SCG ❑ PAID CALENDAR YEAR g S S S El FORGIVEN PER ELECTION** RATE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC S g g $ S DATE DDE DATE INCURRED SUBTOTALS $ $ 4,000.00 $ 1,333.16 $ Schedule B Summary 1. Loans received this period ............................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period........................................................................................................$ nnn nn (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.).............................................................. NET $ -4 'Ono nn Enter the net here and on the Summary Page, Column A, Line 2. (May be a negai a ­mbe„ *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. (Enter (e} on Scheduie E, Lune 31 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 Oan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Sue Dariz Amounts may be rounded to whole dollars. Statement covers period from October 21, 2018 through December 31, 201: CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment SCHEDULE E Page 5 of 6 I.D. NUMBER 1407272 CMP 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'saiaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filingiballot 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 (IF COMMITrFF,ALso ENTER ro. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Pay back loan made to campaign for campaign signs and mailers 4,000.00 Atascadero, CA 93422 Color Craft Campaign signs, mailers and postage CMP 5,333.16 Atascadero, CA Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 9,333.16 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 $ 9,333.16 1,333.16 9,333.16 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses {Unpaid Bills} SEE INSTRUCTI NAME OF FILER Sue Dariz ON REVERSE Amounts may be rounded to whole dollars. SCHEDULE F Statement covers period from October 21, 2018 through December 31, 201L 6 6 Page of I.D. NUMBER 1407272 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/mist. 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 cifculating TEL t.v. or cable airtime and production costs FIL candidate filinglballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodgingand 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 casts (internet, e-mail) NAMEAND ADDRESS OF CREDITOR {Ir COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (OUTSTANDING OUTSTAA NDING BALANCE; BEGINNING ( AMOUNT INNCURRED THIS PERIOD (c) AMOUNT PAID7E) THIS PERIODBALANCE ( OUTSTAA NDING AT CLOSE OF THIS PERIOD tALsoREPORT OtyOF THIS PERIOD Mark Dariz Loan to campaign 5,333.16 4,000.00 1,333.16 Atascadero, CA 93422 Payments that are contributions or independent expenditures must also be SUBTOTALS $ 5, 333.16 $ $ 4 $ summarized on Schedule D. ,000.00 1,333.16 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 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 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 onthe Summary Page, Column A, Line 9.) ................. .................................................................................................................................................................. NET $ 4,000.00 ,4,000.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca_gov (866/275-3772) www.fppc.ca.gov