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HomeMy WebLinkAboutForm 460 Dariz 063019 AmendmentRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from January 1, 2019 through June 30, 2019 COVER PAGE Date Stamp RECEIVED Page 1 of 4 Date of election if applicable: (Month, Day, Year) For Official Use Only Nov. 6, 2018 ITY OF ATASCADERO 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 O Controlled ❑ Termination Statement (Mo complelePao 5) O Sponsored p (Also file a Form 410 Termination) (Mc Complete Part 6) F-1General Purpose Committee Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ Correcting errors in contribution tabulations and payments O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee Information COMMITTEE NAME (OR CAN 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 CODEIPHONE Atascadero CA 93422 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL. FAX I E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Sue Danz MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE Atascadero CA 93422 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge thein ation tamed herein and in the attached schedules is true and complete. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. ; Executed on 7/27/20 Date Executed on 7/27/20 Date Executed on Date Executed on Date By IN By Signature of Controlling Officeholder. Candidate. State Measure Proponent By Signature of ConlroRing Officeholder. Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www fnnr rn onv 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 IFAPPLICABLE) City Council, City of Atascadero, CA RESIDLNTIALlBUSINESSADDRESS (NO.ANDSTREET) 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.Q. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS {NO P.O. BOX) 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 COVER PAGE - PART 2 Page 2 of 4 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.r-a.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Sue Dariz Contributions Received 1. Monetary Contributions................................................... schedule A, Line 3 $ 2. Loans Received................................................................ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1.2 $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3.4 $ Amounts may be rounded to whole dollars. Statement covers period from Jan 1, 2019 through June 30, 2019 Column A Column B TOTAL THIS PERIOD CALENDAR YEAR (FRON ATTACHED SCHEDULES) TOTALTO DATE 0 $ 8,865 -1,333.16 5,333.16 -1,333.16 $ -1,333.16 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 944.86 7. Loans Made....................................................................... Schedule rl, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 944.86 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 + 9 + 10 $ 944.86 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Pape, tine 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A urge 8 above 16. ENDING CASH BALANCE ..................add Lines 12.13. 14, then subtract Line 15 $ tt this is a termination statement, Line 16 must be zero. 0 17. LOAN GUARANTEES RECEIVED ................................ schedules. Pane $ I Cash Equivalents and Outstanding Debts 18. Cash Equivalents.. .............................................. See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2. Line 9 in Column B above $ I $ 12.029.72 $ 12,029.72 $ 13,162.88 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). SUMMARY PAGE Page 3 of 4 11407272 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 5 5 21. Expenditures Made S 5 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' 6r Subject to Voluntary EApendltura Lholl) 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 IJan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule t3 — Part 1 to whole dollars. Statement covers period Loans Received Jan 1, 2019 CALIFORNIA I 60 from FORM 4 4 June 30, 2019 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER LD. NUMBER Sue Dariz 1407272 FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER [IF COMMITTEE, ALSO ENTER $, D. NUMBER} (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN* BALANCE AT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Mark Dariz Architect m PAIL) CALENDAR YEAR OMNI Design Group s 944.86 FORGIVEN PER ELECTION- LECTION"1,333.16 Atascadero, CA 93422 RATE 1,333.16 $ g 388.30 $ g 1 LZ IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ 5 $ ❑ FORGIVEN PER ELECTION" RATF 5 5 $ $ $ DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ 0TH ❑ PTY ❑ SCG ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION RATE ❑ IND ❑COM ❑ OTH ❑PTY ©SCC g $ $� $ DATE DUE DATE INCURRED SUBTOTALS $ $ 1,333.16 $ $ Schedule B Summary 1. Loans received this period....................................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period.........................................................................................................$ 1-A:� Is (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 $ -1,: 1:1 16 (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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov