Cover Attach Recipient Committee Campaign Statement (Government Code Sections 842-8421 6.5) Date Stamp RECEIVED Date election if applicable OtT 2 9 215 1/18/215 (Month, Day, Year) termination 11/3/215 CITY OF NOVATO COVER PAGE age For Official Use Only 1. Type Recipient Committee: All Committees - Complete Parts 1,2,3, and 4. 2. Type Statement: LI Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure LI Preelection Statement LI Quarterly Statement State Candidate Election Committee Committee LI Semi-annual Statement LI Special Odd-Year Report o Recall Q Controlled Termination Statement LI Supplemental Preelection (Also Complete Part 5) Q Sponsored (Also file a Form 41 Termination) Statement - (Also Complete Part 6) LI General Purpose Committee LI Amendment (Explain below) Sponsored LI Primarily Formed Candidate! Small Contributor Committee Officeholder Committee (Also Complete Part 7) o Political Party!Central Committee Form 495 3. Committee Information Treasurer(s) COMMITTEE NAME (OR CANDIDATE S NAME IF NO COMMITTEE) Yes on Measure C 215 I NAME OF TREASURER Diet Stroeh MAILING ADDRESS 45 Leveroni Court STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 45 Leveroni Court Novato CA 94949 415-883-985 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Novato CA 94949 415-883-985 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty perjury under the laws the State California that the foregoing is true and correct. /tj a c/c c ate 5gnature o6er orjent Treasurer Date By Signature Ct Controlling Otficeholder, Candidate, State Measure Proponent or Responsible Officer ot Sponsor Date By Signature Controlling Officeholder, Candidate, State Measure Proponent Date By Signature Controlling Officeholder, Candidate, Slate Measure Proponent FPPC Form 46 (Januarylo5) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772) State California
Recipient Committee Campaign Statement Cover Part 2 COVER PAGE - PART 2 2 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP NAME OF BALLOT MEASURE City Novato Measure C 215 BALLOTNO. OR LETTER I JURISDICTION I j SUPPORT C Novato OPPOSE Identify the controlling ficeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 your candidacy. DISTRICT NO. IF ANY COMMITTEENAME NAME OF TREASURER COMMITTEEADDRESS CONTROLLED COMMITTEE? YES LI NO STREETADDRESS (NO P. BOX) 7. Primarily Formed CandidatelOfficeholder Committee List names ficeholder(s) or candidate(s) for which this committee is primarily formed. SUPPORT CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER SUPPORT LI SUPPORT NAME OF TREASURER COMMITEEADDRESS STREETADDRESS (NO P. BOX) CONTROLLED COMMITTEE? LI YES LI NO LI SUPPORT CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 46 (Januarylo5) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275.3772) State California
Campaign Disclosure Statement Summary 1/18/215 Yes on Measure C 215 138275 1. 2. 3. 4. 5. SUMMARY PAGE termination 3 7 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR (FROMATACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and Monetary Contributions Schedule A, Line 3 3 Loans Received Schedule B, Line 3 SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 Nonmonetary Contributions Schedule C, Line 3 TOTAL CONTRIBUTIONS RECEIVED AddLines3+4 General Elections i/l 6/3 3 2. Contributions Received 6486.9 21. Expenditures 9486.9 Made 7/1 to Date Expenditures Made 6. Payments Made Schedule E, Line 4 7. Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 9. Accrued Expenses (Unpaid Bills) Schedule F Line 3 1. Nonmonetary Adjustment Schedule C,Line3 11. TOTALEXPENDITURES MADE Add Lines8+9+ 7 3 3-3 6486.9 6486.9 3 3 6486.9 9486.9 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date Election (mm/dd/yy) Total to Date Current Cash Statement 12. Beginning Cash Balance PreviousSummanj,Linel6 13. Cash Receipts ColumnA, Line 3above 14. Miscellaneous Increases to Cash Schedule I, Line 4 15. Cash Payments Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 72 + 13 + 74, 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 Seeinstructionsonreverse 19. Outstanding Debts Add Line 2 + Line 9 in Column B above 3 3 To calculate Column B, add amounts in Column A to the corresponding amounts Column B your last report. Some amounts in Column A may be negative figures that should be subtracted previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts Lines 2, 7, and 9 (if any). *Amounts in this section may be different amounts reported in Column B. FPPC Form 46 (JanuarylO5) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
unitemized DEC. Political Small Schedule A Monetary Contributions Received Schedule A Summary 1. Amount received this period itemized monetary contributions. (Include all Schedule A subtotals.) 3. Total monetary contributions received this period (Add Lines 1 and 2. Enter here and on the Summary, Column A, Line 1.) TOTAL 1/18/215 termination YesonMeasureC2l5 138275 SCHEDULE A 4 7 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION CONTRIBUTOR (IFCOMMIUEE,ALSOENTERI.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE * fifself-employed,entername PERIOD (JAN. 1-31) (IF REQUIRED) OF BUSINESS) NONE 2. Amount received this period EIND LjCOM ElOTH EIND El TH El IND El TH EIND El TH El 5CC El IND El TH El PlY SUBTOTAL monetary contributions less than 1 *Contributor Codes ND Individual COM Recipient Committee (other than PTY or SCC) TH Other (e.g., business entity) PTY Party SCC Contributor Committee FPPC Form 46 (Januarylo5) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
itemized DEC Political Other Small Schedule C - Nonmonetary Contributions Received 1/18/215 SCHEDULE C termination I.D. NUMBER Yes on Measure C 215 138275 FULL NAME, STREET ADDRESS AND IFAN INDIVIDUAL, ENTER AMOUNT/ CUMULATIVE TO CONTRIBUTOR DESCRIPTION OF PER ELECTION DATE FAIR MARKET DATE ZIP CODE OF CONTRIBUTOR OCCUPATION AND EMPLOYER CODE * GOODS OR SERVICES TO DATE RECEIVED (IF SELF-EMPLOYED, ENTER VALUE CALENDAR YEAR (IF COMMITTEE, ALSO ENTER ) (IF REQUIRED) NAME OF BUSINESS) (JAN 1-31) Kiosk Creative LLC 9/29/215 ECOM Design and 75 Grant Ave. #2 TH Printing costs Novato, CA 94945 EpTy ECOM DOTH 1PTY ECOM DOTH D PTY ECOM EOTH D PTY Attach additional in formation on appropriately labeled continuation sheets. SUBTOTAL 6486.9 6486.9 6486.9 Schedule C Summary 1. Amount received this period nonmonetary contributions. (Include all Schedule C subtotals.) 2. Amount received this period unitemized nonmonetary contributions less than 1 3. Total nonmonetary contributions received this period. (Add Lines I and 2. Enter here and on the Summary, Column A, Lines 4 and 1.) TOTAL 6486.9 6486.9 *Contributor Codes IND Individual COM Recipient Committee (other than PTY or SCC) TH (eg., business entity) PTY Party SCC Contributor Committee FPPC Form 46 (January/5) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
Schedule E Payments Made 1/18/215 termination 6 Yes on Measure C 215 138275 CODES: If one the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. fdtvf 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 fice expenses SAL campaign workers salaries cvc civic donations PEt 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 NO independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees the same candidate/sponsor LEG legal defense PRO pressional services (legal, accounting) VOl voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IFCOMMITrEE,ALSO ENTER ) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Kiosk Creative LLC Design and printing costs 75 GrantAve. #2 LIT 3 Novato, CA 94945 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) 2. Unitemized payments made this period under 1 3. Total interest paid this period on loans. (Enter amount Schedule B, Part 1, Column (e).) 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary, Column A, Line 6.) TOTAL 3 3 FPPC Form 46 (January/5) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Schedule F Accrued Expenses (Unpaid Bills) 1/18/215 SCHEDULE F termination 7 7 Yes on Measure C 215 138275 CODES: If one the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. avp 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 fice expenses SAL campaign workers salaries CVC civic donations PET 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 ND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees the same candidate/sponsor LEG legal defense PRO pressional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMIHEE, ALSO ENTER ) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ONE) OF THIS PERIOD Kiosk Creative LLC LIT 75 GrantAve. #2 3 3 Novato, CA 94945 Payments that are contributions or independent expenditures must also be ft summarized on Schedule D. SUBTJ 1A 3 3 p Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses 1 or more, plus total unitemized accrued expenses under 1.) INCURRED TOTALS 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses 1 or more, plus total unitemized payments on accrued expenses under 1.) PAID TOTALS 3. Net change this period. (Subtract Line 2 Line 1. Enter the difference here and on the Summary, Column A, Line 9.) NET 3-3 May be a negative number FPPC Form 46 (Januaryl5) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)