Cover Page Government Code Sections

Transcription

1 y w e ptit Recipient om ee Campa Statement Cover Page Government Code Sections l or print Statement corers period in ink o election ifs Month DaY p Icable far Stamp W Page o For Officia Use Only COVE PA GE Job SEE INSTRt ICTIONS ON REVERSE through 1 Typ of R Com mittee All Committees Complete Parts and 4 Officeholder Candi Committee E Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall C Controlled Also Complete Part 5 C Sponsored Also Complete Part 6 General Purpose Committee 0 Sponsored Ej Primarily Formed Candidate Officeholder Committee 0 Small Contributor Committee Also Complete Part 7 Political PartyCentral Committee 2 Type of Statement E Preelecti Statement Ej Quarterly Statement Semi annual Staterent El Special OddYear Report Termination Statement Supplemental Preelection Also file a Form 410 Termination Statement Attach Form 495 E Amendment Explain below 3 Committ Information COMMITTEE NAME OR CANDIDATE S NAME 1F NO COMMITTEE ID NUMB 00 7 Treasurers NAME OF TREASURER MAILING ADDRESS STREET ADDRESS NO PO BOAC CITY STATE ZIP CODE AREA CODEPHONE CITY STATE ZIP CODE AREA CODEWHONE t UPI 4Yj 50 JY7 MAILING ADDRESS IF DIF FERENTJ No AND STREET OR PO BOX NAME OF ASSISTANT TREASURER IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE PHONE CITY STATE ZIP CODE AREA CODE PHONE OPTIONAL FAX ADDRESS OPTIONAL FAX 1 ADDRESS 4 Verification I ha ve used all reasonable diligence in preparing and re vi ewing this statement and to the best of k under penalty of perjury under the la s of the State of California that the foregoing is true and c e Wedge the ajion contained herein and in the attached schedules is true and complete l certify Executed 0 on D Signature of Treasurer or Assistant Treasurer Signature ofcontrolling Officeholder Candidate State Measure Proponent or Responsible Officer of Sponsor Signature of Controlling Officeholder Candidate State Measure Proponent Signature of Contra ling Officeholder Candidate State Measure Proponent FPPC Form 460 January105 FPPC TollFree l elpline 866 ASK FPPC State of California

2 e f I Campa D c o ure Statement Summar Pa Amou ma be rounded SUMMARY PAGE s Received 1 s Schedule A Line 3 Column A TOTALTHfSPERIOD FROM ATTACHED SCHEDULES 04 2 Loans Received Schedule B Line 3 3 CASH CONTRIBUTIONS Add Lines I 2 4 C Schedule C Line 3 5 TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 4 s Made 6 Pa Made Schedule E Line Loans Made Schedule H Line 3 8 CASH PAYMENTS Add Lines 6 7 z14 ClYT07 9 Accrued Expenses Unpaid Bills Schedule F Line 3 10 Adjustment Schedule C Line 3 1 TOTAL EXPENDITURES MADE Add Lines al 7 s Limit Summar for State Candidates 22 Cumulative s Made tf Subject to Voluntar Limft of Election mm dd J Total to Current Cash Statement 12Be Cash Balance Previous SummarPa Line 16 To calculate Column 13 add 13 Cash Receipts Column A Line 3 above amounts in Column A to the correspondin amounts 14 Miscellaneous Increases to Cash Schedule Line 4 Column B ofyour last 15 CashPa Column A Line 8 above D7 report some amounts in V Column A ma bene Ile 16 ENDING CASH BALANCE Add Lines then subtract Line 15 fi that should be subtracted previous If this is a termination statement Line 16 must be zero period amounts If this is the first report bein filed 17 LOAN GUARANTEES RECEIVED for this calendar year onl Schedule 8 Part 2 carr over the amounts CashE and Outstandin Debts Lines 2 7 and 9 if any 18 CashE see instructions on reverse Amounts in this section ma be different amounts reported in Column B 19 Outstandin Debts Add Line 2 Line 9 in Column S above FPPC Form 460 Januar y05 FPPC Toll Free Helpline 866 ASK FPPC

3 Schedule A s Received to Statement whole dollars m covers cers period SCHEDULE A throu Pa of 5 IDNUMBER Cc 1 IF AN INDIVIDUAL ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AN EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE IF COMMITTEE ALSO ENTER W NUMBER RECEIVED CODE IFSELF EMPLOYED ENTER NAME PERIOD JAN I DEC 31 IF REQUIRED F BUSINESS El COM fj OTH DIND F1 COM CTH E IND Com Ej OTH IND Com OTH El F1 IND COM E OTH Ej Schedule A Summar Contributor Codes 1 Amount received this period itemized monetar contributions IND Individual Include all Schedule A COM Recipient Committee subtotals other than or OTH 2 Amount received this period unitemized monetar contributions of less than Other e business entit Political Part 3 Total monetar contributions received this period Add Lines 1 and 2 Enter here and on the Summar Pa Column A Line 1 TOTAL Small Contributor Committee FPPC Form 460 Januar FPPC Toll Free Helpline 8661ASK FPPC N

4 ochedule D Su mmar of Expende tures inpposi 90ther n Candidates A erd sures and Committee Statement coversp 40 SCHEDULE D NAME 0F FILER throu 0 Ra of d ID NUMBER DATE ON t ILM NAME OF CANDIDATE OFFICE AND DISTRICT OR MEASURE NUMBER OR LETTER AND JURISDICTION OR COMMITTEE 11 J 1ot ye TYPE OF PAYMENT y ro ff DESCRIPTION IF REQUIRED 0 t AM PERIOD qif 76 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE JW I DEC 31 IF REQUIRED SLIpport L r tv lotl V oppose Sao frsc s a1fyt r 4S o f Schedule D Summar I Itemized contributions onsand independent expenditures made this s period 2 Unitemized contributions and independent expenditures made this period of under 100 Include all Schedule D subtotals Total contributions and independent expenditures made this period Add Lines 1 I and 2 Do 17 1 not enter 7 on the 4 Summar Pa TOTAL C2 1 FPPC Form 460 Januar Free Helpfine866 ASK FPPC FPPC Toll

5 Statement covers period SCHEDULED throu Pa of ID NUMBER DATE NAME OF CANDIDATE OFFICE AND DISTRICT OR MEASURE NUMBER OR LETTER AND JURISDICTION OR COMMITTEE TYPE OF PAYMENT DESCRIPTION IF RLE QUIRED CUMULATIVE TO DATE PER ELECTION AMOUNT THIS CALENDAR YEAR TO DATE PERIOD JAN I DEC 31 IF REQUIRED IF I I r Li Nonrnonetar j D j C r Lkpr colrt ut 0 El ry El K 14 xpenditure E 0 d 3 4W 7 FPPC Form 460 Januar FPPC Toll Free Helpline 866 ASK FPPC