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Home My WebLink About2016-02-01 Form 410 - PS Fire ManagementStatement of Organization Recipient Committee Statement Type D Initial No\ ye\ qualified O or __ _,, __ _, 0 Amendment Ust I.D, number: #113652985 I D Termination-See Pan 5 List I.D. number: /t ________ _ I I-- REf:tl1\(llo _;· C TY OF PALH SPRING 1& FEB -I AH 9: 20 JAMES THOMPSO'.i CITY CLERK • CALIFORNIA 410 · FORM For Official Use Only Date qualified as committee Date qualified as committee Date of Termination (If opplicable) .. NAME Of COMMITTEE NAME OF TREASURER Palm Springs Fire Management Assoc. PAC Cory Gorospe STRUT /\DD RESS )NO P.O. BOX) STRHT ADDRESS (NO P.O. BOX) CITY STAT£ ZIPCOOE AREA CODf/PHONE Cathedral City CA 92234 ( CITY STATE ZIP CODE FAX.IE-MAil ADDRESS CITY STATE ZIP C· IOE /\REA CODE/PHONE COUNTY OF DOMICILE JURISDICTION WHERE COMMITHE IS ACTIVE NAME OF PRINCIPAL OFflCER(S) STREET ADDRESS (NO P.O. BOX) CITY STA1E ZIP CODE AREA COD,/PHONF Attach additional information on appropriately labeled continuation sheets. , 1 .. '~\~t;{i?I I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under ' ·· ·· penalty of perjury under the laws of the State of CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE .. OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PRIJPIJNENT FPPC Form 410 {Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Management Assoc. PAC • All committees must list the financial institution where the campaign bank account Is located. NAME OF FINANCIAL INSTITUTION AR EA CODE/PHONE ADDRESS CITV Controlled Committee BANK ACCOUNT NUMS(R STATE llP CODE CALIFORNIA 410 FORM 1.0. NUMBER 113652985 • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE} YEAR OF ELECTION Pnmanly Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(SI NAME OR MEASURE(SI FULL TITLE (INCLUDE BALLOT NO. OR LETTER} CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE} PARTY D Nonpartisan D Nonpartisan CHEC~ ONE FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Management Assoc. PAC CALIFORNIA 41 0 FORM 1.0. NUMBER 113652985 General Purpo~e Comm,ttee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITY Committee O COUNTY Committee O STATE Committee PROVIDE BfflH DESCRIPTION OF ACTIVITY Sponsored Committee List additional sponsors on an attachment. NAMf or SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITV STATE ZIP CODE Small Contnbutor Committee O _ _, _ _,, Date qoalifled • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.S. FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page Date Stamp R C£jY£0 CIT y OF AlH SPRING'.:: ....---------------,.------------i Page __ _ of __ _ SEE INSTRUCTIONS ON REVERSE Statement covers period 06/30/2015 worn _________ _ 12/31/2015 through ________ _ 1. Type of Recipient Committee: All Committees-Complete Parts 1, 2, 3, and 4. D Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee D Primarily Formed Ballot Measure Committee 0 Recall (Also Complete Pad 5) 0 Controlled 0 Sponsored (Also Comp/ell> Part 6) liZ] General Purpose Committee ® Sponsored 0 Small Contributor Committee D Primarily Formed Candidate/ Officeholder Committee 0 Political Party/Central Committee 3. Committee Information COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Management Assoc. PAC STREET ADDRESS (NO P.O. BOX) 300 N El Cielo Rd /Also Comp/Ele Pait l) I.D. NUMBER 11-3652985 CITY STATE ZIP CODE AREA CODE/PHONE Palm Springs CA 92262 (760) 323-8181 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO Box 1761 CITY Palm Springs OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification STATE CA ZIP CODE 92263 AREA CODE/PHONE Date of election if awt¥f¥\1il"B f (Month, Day, ~~,. rt -AH 8: 5~ JAHES THOHPSOU ______ C~IT CLERK 2. Type of Statement: D Preelection Statement I.a Semi-annual Statement D Termination Statement (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Cory Gorospe MAILING ADDRESS 68070 Madrid Rd For Official Use Only D Quarterly Statement D Special Odd-Year Report CITY STATE ZIP CODE AREA CODE/PHONE Cathedral City CA 92234 (760) 673-1896 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle e 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 rue and corre Executed an Executed on Executed an Executed on 01/30/2015 Date Date Date Date BY------.,,s-,g-na-,-,u-,e-0""1c"'"o--nt,-ro""'11;-ng""'Offi.,.,,,..1ce-.,h"'"'o~'"'"e"""~""c,-an""'d"'id""ate-.""s,-ra,-1e""M,...ea_s_u,-0"'"P,-opo-ne,-n,-t ----- 5Y-----......,,S,-ig-na.,.tu_re_a.,..fC"'"a-n1=-ra""'11;-ng--:Offi,,,,,-,c-,eh""'a~"""e-,,..,.c,-an"""d""'id-.at-e.""'s,...ra"""te""'M:-ea"""s"'ur""e"'"Pro"'p"""o""ne"'n"'"t ----- FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov • Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Assoc. PAC Contributions Received 1. Monetary Contributions................................................... Schedule A, Line 3 $ 2. Loans Received ................................................................ ScheduleB. Line3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ 4. Non monetary Contributions............................................ Schedule c. Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ Expenditures Made 6. Payments Made .............................................................. . SchadulfJ 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 10. Non monetary Adjustment ... ,. .................................................... Schedule c. Line 3 11. TOTAL EXPENDITURES MADE. ....................................... Add Lines a ,. 9 + 10 $ Current Cash Statement 12_ Beginning Cash Balance·····-········ ............. Previous Summary Page, Line 16 $ 13. Cash Receipts .. ........ ... ................... .... . . .. ........ .......... Column A, Line 3 above 14. Miscellaneous Increases to Cash.................................. Schedule 1, une 4 15. Cash Payments . .. . . . . . . . . . . . ............................ ..... .......... Column A, Line B above 16. ENDING CASH BALANCE .................. Add Unes 12 + 13 + 14, then subtractune 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule 8, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................. .,............. See instructions on reverse $ 19. Outstanding Debts.............................. Add Line 2 + Line 9 in Column B above $ Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 567.04 5.70 572.74 SUMMARY PAGE Statement covers period CALIFORNIA 46 0 FORM 06/30/2015 from _________ _ 12/31/2015 through ________ _ Page ___ of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE 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 th is is the first report being filed for this calendar year, only carry over the amounts from Lines 2. 7, and 9 (if any). 1.0. NUMBER 11-3652985 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 711 to Oate 20. Contributions Received $ _____ _ $ ____ _ 21. Expenditures Made $ _____ _ $ ____ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subiect to Voluntary Expenditure Limit) Date of Election (rnm/dd/yy) ___j___j __ ___j___j __ Total to Date $ _____ _ $ _____ _ 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 IJan/2016) FPPC Advice: advlce@fppc.ca.gov {866/275-3772) www.fppc.ca.gov , Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Assoc. PAC Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, AlSO ENTER LO. NUMBER! CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESS) None •IND •COM DOTH •PTY •sec •IND •COM DOTH 0PTY •sec •IND •COM 00TH •PTY •sec •IND •COM 00TH 0PTY •sec •IND •COM 00TH OPTY •sec SUBTOTAL$ Schedule A Summary 1. Amount received this period -itemized monetary contributions. SCHEDULE A Statement covers period CALIFORNIA 460 FORM from ___ 0_6_/3_0_/2_0_1_5_~ through __ 1_2_13_1 !_2_0_15 __ Page ___ of __ _ AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 11-3652985 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) , <uf:\\' . ,. ::-.:<"~.:~~~~~~~~~-··-;.:· .-~f~-·~::. : : : : : : :I •contributor Codes IND -Individual -- (Include all Schedule A subtotals.) ......................................................................................................... $ ______ _ COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Polilical Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ ______ _ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ______ O sec -Small Contributor Committee FPPC Form 460 (Jan/20161 FPPC Advice: ad11ice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from __ 0_6_/3_0_/_20_1_5 __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through __ 1_2_/3_1_/2_0_1_5 __ Page ___ of __ _ NAME OF FILER Palm Springs Fire Management Assoc. PAC CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. I.D. NUMBER 11-3652985 CMP 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 office expenses SAL campaign workers' salaries eve 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 IND independent expenditure supporting/opposing others (explain r 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 COMMITTEE. ALSO ENTER I.D NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID None * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 0 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ 0 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ _____ _ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Assoc. PAC DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (If COMMITTEE. ALSO ENTER I.D. NUMBER) Sun Community Federal Credit Union 425 N Civic Dr Palm Springs, CA 92262 Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded · to whole dollars. Statement covers period 06/30/2015 rrom _______ _ through __ 1_2_/3_1_/2_0_1_5 __ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ _______ O 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ _____ 5_._7_0 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ....................................... $ ______ O 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ 5_.7_0 SCHEDULE I CALIFORNIA 460 FORM Page ___ of __ _ 1.0.NUMBER 11-3652985 AMOUNT OF INCREASE TO CASH 5.70 5.70 FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov • --. Recipient Committee Campaign Statement Cover Page Type or print in ink. Date Stamp t." CALIFORNIA 460 (Government Code Sections 84200-84216.5) Statement covers period /-!--I? nom_~-------- SEE INSTRUCTIONS ON REVERSE {, ->-.D-1.? through __ ____,c.,/ _____ _ 1. Type of Recipient Committee: AH committees -Complete Parts 1, 2, 3, and 4. • Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee O Recall (Also Complete Part SJ ~ General Purpose Committee ® Sponsored O Sman Contributor Committee O Political Party/Central Committee 3. Committee Information D Ballot Measure Committee O Primarily Formed 0 Controlled 0 Sponsored (Also Complete Part 6) D Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 1.0. NUMBER COMMITTEE !"'AME (OR CANDIDATE'S NAME JF NO COMMITTEE) L ~-L """-:S,rY/f--~ A~ t?f/4-n~~ /f,5;0L 'f J4 <:_ MAILING ADDRESS (IF FFEREND . AND STREET OR P.O. BOX ~o tSox l, 6 t CT!? I STATE ZIP CODE AREA CODE/PHONE OP~: m/E~~:,;µ a, 22.z 1.i 4. Verification Data of election if applicable: (Month, Day, Year) RECEIYEO C·r: Pt,LM SP~; • 2001/02 FORM .. ~ ! . of __ _ J Al1tS T HOMP ·J, "'' CtTY ClERrf ~·• •-ll· For Official Use Only • 2. Type of Statement: • Preelection Statement • Quarterly Statement • Semi-annual Statement • Special Odd-Year Report • Termination Statement • Supplemental Preelection • Amendment (Explain below) Statement -Attach Form 495 Treasurefis) S:~,· MAILING ADDRESS 79-92F CITY-•--/ ..1-~ ... b STATE ZWCDE AREA CODE/PHONE fr:_ <._ t4 7 ZZ 6 J: 7/4 -YCJT -ol "T MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I 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. certify under penalty of pe~ury under the laws of the State of California that the foregoing is nd correct. s>-u-= 1r Executed on _ __, ___ __, ____ .,,.Dale-,---~----- Executed on -----,,.Dale-,---------- Executed on -------... 0819-.------- Executed on _____ .,,.0ate ______ _ By _ __,,.,......,.....--,,.....,....,,,.......,....,....,.,....,,......,..,..,......,.......,-.....,.---.,......,,,.....-,,.,...:=---.,.----sigriatura of C<in1rOling Offi""'1older, Candidate, Stale Measure Proponent or Resp:lflSible Offics,-of Sponsor By--------,,,..----,,........,.......,.,,....,.-.--,.--...,.. ...... -....,----------Sgnat""' atConlrn/ling Officeno/,w, Garuia'ate, S181!! Measure Propaoent BY-------------------....--------.----------Signatura afConlmlling Officeholder, Can,;lldall>, Slate Measure Proponent FPPC fom, 460 (June/01) FPPC Toti-Free Helpline, 866/ASK-FPPC State of California Type or print in ink. SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from /-/-/F CALIFORNIA 46 0 FORM SEE INSTRUCTIONS ON REVERSE Contributions Received 1. Monetary Contributions ... . .. .. .. .. .. . .. .. .. ... .... . . .. . .. . .. .. . .. Sehedule 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 ........................ Ma Lines 3 + 4 $ Expenditures Made 6. Payments Made....................................................... schedule E, Line 4 $ 7. Loans Made . . . .. . .. . . . . ... . .. . . . . .. . .. .. ... . .. .. . . . .. . .. . . . . . . . . . . . . . .. . Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Addlines6+ 7 $ 9. Accrued Expenses (Unpaid Bills) .............................. SChedu/eF, Line 3 10. Nonmonetary Adjustment .......................................... Schedule c, une 3 11. TOTALEXPENDITURESMADE ................................ AddLiness+9+10 $ Current Cash Statement 12. Beginning Cash Balance....................... Previous Summary Page, Une 15 13. Cash Receipts ................................................... Column A. Line 3 above 14. Miscellaneous Increases to Cash.......... ................ Schedule 1. Line 4 15. Cash Payments ............................................... ,., ColumnA.Line8above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14. then subtract Line 15 $ If this is a lennination statement, Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED .. ., .. . .. ........ .. ... ... . Scheclule B. Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................... ,.... See instructions on reverae $ 19. Outs ta ndlng Debts . . . . .. . . . . . . . . . . . .. . . . . . Add Line 2 .. Line 9 in Column B above $ TOTAL ll-llSPERIOO (FROMATTACHEOSCHEOUlES) 5b7·DY through t: -~_3,Q -/ .>-Page ___ of __ _ $ $ $ $ $ $ ColumnB CALENDAR VEAR TOTAL TO DATE 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). I.•. NUMBER 1/-.)65-~·~ Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 711 to Dale 20. Contributions Received $ ____ _ $ ____ _ 21. Elependitures M~e $ ____ _ $ ____ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made~ llfSubJe<:t:to Vcluntary Eltpendltura UmltJ Date of Election Total to Date (mm/dd/yy) __J__J __ $ __J__j __ $ __J__J __ $ ___J___J __ $ __J $ ___J___J __ $ *Since January 1, 2001. Amounts in this section may be different from amounls reported in Column B. FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866JASK-FPPC Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAMEOF~ t,-.._ Type or print in ink. Amounts may be rounded to whole dollars. .~I- DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SElF•EMPlOYED, ENTER NAME OF BUSINESS) (IFCOMMITTEE,AlSOENTERI.0.NUMBER) CODE * Schedule A Summary 1. Amount received this period-contributions of $100 or more. •IND •COM 00TH •PTY •sec •IND •COM 00TH 0PTY •sec •tND •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec QIND •COM DOTH 0PTY •sec SUBTOTAL$ Statement covers period from /-/ -/£: •· . . 7 b /·- through ,3?0 SCHEDULE A CALIFORNIA 4 6 0 FORM Page ___ of __ _ I.D. NUMBER //-6.> 2-95". AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) "Contributor Codes IND-Individual (Include all Schedule A subtotals.) ............................................................................................... , ........ $ _____ _ COM -Recipient Committee (other than PTY or SCC) 0TH-Other 2. Amount received this period-unitemized contributions of less than $100 ............................................. $ ______ _ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ l10 n,..,._. PTY -Political Party SCC -Small Contributor Committee FPPC Form 4-60 (June/01) FPPC Toll-Free Helpline: B66/ASK-FPPC Schedule B -Part 1 Loans Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from / -/ -/ )- SEE INSTRUCTIONS ON REVERSE through 6 ~,;:k;? ~ /.> FULL NAME, STREET ADDRESS AND ZIP C E OF LENDER PF COMMITTEE, ALSO ENTER I.D. NUMBER) to IND • COM O 0TH O PTY O sec to IND o coM o om o PTY o sec t • IND O COM O 0TH O PTY O sec Schedule B Summary ~f SELF-EMPLOYED, ENTER NAME OF BUSINESS) OUTSTANDING BALANCE BEGINNING THIS PE I $ ___ _ SUBTOTALS $ ~I- (bl (CJ AMOUNT AMOUNT PAID RECEIVED THIS OR FORGNEN PERIOD THIS PERIOD * QPAID s 0 FORGIVEN $ •PAID QFORGI\IEN $ ___ _ $ ___ _ QPAID S· ___ _ • FORGIVEN $ 1. Loans received this period .................................................................................................................... $ (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period ......................................................................................................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) \PA-c OUTSTANDING BALANCEAT CLOSE OF THIS p I DATEOUE $ DATE DUE $ ___ _ DATE DUE $ 3. Net change this period. (Subtract Line 2 from Line 1.) ............................................................... NET $ J/l(;5vs.~ Enter the net here and on the Summary Page, Column A, Line 2. iMoyb<I o,-..galivenum~~ t Contributor Codes $ $ e INTEREST PAID THIS PERIOD __ % RATE __ % RATE $ ___ _ __ % RATE jEntef (e) on Schedule E, Une 3) SCHEDULE B -PART 1 CALIFORNIA 46 0 FORM Page___ of __ _ 1.D. NUMBER ORIGINAL AMOUNT OF LOAN DATE INCURRED $ ___ _ DATE INCURRED $ ___ _ DATE INCURRED g CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR $ ___ _ PER ELECTION ... $ ___ _ CALENDAR YEAR $ ___ _ PER ELECTION"" $ ___ _ CALENDAR YEAR PER ELECTION .. *Amounts forgiven or paid by another party also mus! be reported on Schedule A. •• If required. IND-Individual COM -Recipient Committee (other than PTY or SCC) 0TH -Other PTY -Political Party sec -Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC ScheduleE Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be roundod to whole dollars. Statement covers period from / -/ -/5- through b --J,b -I}.~ CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULEE CALIFORNIA 460 FORM Page ___ of __ _ l.D. NUMBER I I -3 {>--z_? 2 OvP 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 office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime aod production costs FIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and meals FtO fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals W 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 lJI.EB information technology costs (internet, e-ma~) NAME AND ADDRESS OF PAYEE (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID V/DLLL * Payments that are contributions or Independent expenditures must also ba summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of $100 or more. (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).) ............................................................................... $ _____ _ U6/.4....'-. 4. Total payments made this period. (Add lines 1, 2, and 3. Enter here and on the Summary Page, Column A, line 6.) ............................. TOTAL $ ~-L..-=4-...-.=--~~- FPPC Form 460 {June/01} FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from /-/-/£ through 6 -..R> -✓,>- SCHEDULE E (CONT.) CALIFORNIA 460 FORM Page ___ of __ _ I.D.NUMSER CODES: If one of the following code o.,p campaign paraphernalia/misc. ccurately describes the payment, you may enter the code. Otherwise, describe the payment. CNS campaign consultants CTB contribution (explain nonmonetary)" CVC civic donations FIL candidate filing/ballot fees Fl\O fundraising events NJ independent expenditure supporting/opposing others (explaint LEG legal defense UT campaign literature and mailings NAME AND ADDRESS OF PAYEE (If COMMITTEE, ALSO ENTER I.D. NUMBER) }I!_~ MBR member communications RAD radio airtime and production costs MTG meetings and appearances RFD returned contributions OFC office expenses SAL campaign workers' salaries F£T petition circulating 1EL l.v. or cable airtime and production costs Pl-0 phone banks TRC candidate travel, lodging, and meals POL polling and survey research TRS staff/spouse travel, lodging, and meals POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor PRO professional services (legal, accounting) VOT voter registration PRT print ads VVE8 information technology costs (internet, e-mail) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ l/[~ FPPC Form 460 (June/01) FPPC Toll.f'ree Helpline: 866/ASK-FPPC Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILE';:? I &-,lp-,-c_ DATE RECEIVED FULL NAME ANO ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER J.C. NUMBER) Type or print in ink. Amounts may be rounded to whole dollars. fc._L "-~/~_, 4 ~ ~~/o/'e--<;;;$ r~a""'~/ ~,"'J!-L~ r b---• z.,.-._ ~ ZS.., f'( (Iv,·'<. ,-( h.... 2 K ~ '22£.·· Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Statement covers period from / -/ -/.>- through b ~-/~ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Increases to cash of $100 or more this period ........................................................................................................... $ _____ _ 2. Unitemized increases to cash under $100 this period ............................................................................................... $ _____ _ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ................................. $ _____ _ 4. Total miscellaneous increases to cash this period. (Add lines 1, 2, and 3. Enter here and on the , c£' Summary Page, Line 14.) ........................................................................................................................... TOTAL $ _____ _ SCHEDULE I CALIFORNIA 460 FORM Paga ___ of __ _ LO.NUMBER AMOUNT OF INCREASE TO CASH FPPC Form 460 (June/01) FPPC Toll-Fraa Helpline: 866/ASK-FPPC