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Home My WebLink About2017-02-01 Form 460 - PS Fire ManagementRecipient Committee Campaign Statement Cover Page -Amended Date Stamp !' R!ICEI V .------------,----------'Ty OF P. AL SPR I SEE INSTRUCTIONS ON REVERSE Statement covers period 07/01/2016 from _________ _ 12/31/2016 through ________ _ 1. Type of Recipient Committee: All Committees-Complete P•rts 1, 2, 3, •nd4. 0 Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee D Primarily Formed Ballot Measure Committee 0 Recall (AlaoC.,,.,,.,..Pat!S) fill General Purpose Committee fil Sponsored 0 SmaH Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (Also~Pat6) D Primarily Formed Candidate/ Officeholder Committee (Also Ccmplole Pad 7) I.D.NUMBER 11-3652985 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Management Association STREET ADDRESS (NO P.O. BOX) CITY Palm Springs STATE ZIP CODE CA 92262 MAILING ADDRESS (IF DIFFERENT) NO. ANO STREET OR P.O. BOX CITY STATE ZIP CODE Palm Springs CA 92263 OPTIONAL: FW:. I E-MAIL ADDRESS 4. Verification AREA CODE/PHONE ( AREA CODE/PHONE Date of election if applicable: (Month, Day, Year) 2. Type of Statement: D Preelection Statement QI Semi-annual Statement D Termination Statement 111 JAN (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Cory Gorospe MAILING ADDRESS CllY Cathedral City NAME OFASSISTANTTI!EASURER, IF ANY n/a MAILING ADDRESS CITY OPTIONAL: FAX I E-MAIL ADDRESS STATE ZIP CODE CA 92234 STATE ZIP CODE s For Official Use Only AREA CODE/PHONE ( AREA CODE/PHONE I have used all reasonable diligence in preparing and reviewing this statement and to the best Executed on 01/24/2017 Oate Executed on Date Execu1ed on Dal& Executed on Date 8Y------,,s1g=na1ure="""'or""c,.,.ontroa="";ng,,..Dffi"'"'"'"""'h"">01oe.,,.,..,.~"""cru"'ddilll=.,.,.1e...,,,s,,..,1ate.,,...,.,Me:--:-a"'su,,.,,re,....,P"'"roix,ne="'n,..,.t----- By _____ -=:-.....,..---,.,.,..,..,.,.,..,..,..,,..-=.,..,...,.,,,,....,...==-,--,=...,....=-=-=--.------ Signature of Controlling O!fice!lolder. Candida!e, Stale Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advlce@lfppc.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 Association Contributions Received 1. Monetary Contributions................................................... Schedule A, Une 3 $ 2. Loans Received................................................................ Schedule B. Ur,e 3 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Unes 1 + 2 $ 4. Nonmonetary Contributions............................................ Schedule c. une 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................. Add Lines 3 + 4 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedule H, Une 3 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... SchecluleF.Line3 10. Non monetary Adjustment... ...................................................... Sch«Jule c. Line 3 11. TOTAL EXPENDITURES MADE. ....................................... AddUnes8+9+10 $ Current Cash Statement 12. Beginning Cash Balance............................ Previous Summary Page, line 16 $ 13. Cash Receipts ........................................................... CalumnA,Unr,3above 14. Miscellaneous Increases to Cash .................................. Schedule 1. Line 4 15. Cash Payments ......................................................... Column A, Line Babove 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, thensubtractUne 15 $ If this is a termination statement. Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedules. Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See instn.K:lions on re1111rse $ 19. Outstanding Debts.............................. Add Line 2 + Line 9 in Column B above $ Amounts may be rounded to whole dollars. Column A TOTAL nilS PERIOD (FOOM ATTACHED SCHEDULES) 573.04 .12 573.16 SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM from ___ 0_7_10_1_12_0_1_6 __ 12/31/2016 through _______ _ Page ___ of __ _ $ $ $ $ $ $ ColumnB 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 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.D. NUMBER 11-3652985 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 7/1 to Dale 20. Contributions Received $ ____ _ $ ____ _ 21. Expenditures Made $ ____ _ $ ____ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Sullject to VOiuntary E%pendlhNe UmlC) Date of Election (mm/dd/yy) __ ..,____J __ _ __J__J __ Total to Date $ _____ _ $ _____ _ •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 A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Association Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF cor.MITTEE, Al.80 ENTER LD. NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (If 68.F-EMPLOYED, ENTER NAME OF BUSINESS) Schedule A Summary 1. Amount received this period -itemized monetary contributions. •IND •COM 00TH •PTY •sec •IND •COM 00TH •PTY •sec •IND •COM DOTH •PTY •sec •IND •COM 00TH •PTY •sec •IND •COM 00TH OPTY •sec SUBTOTAL$ SCHEDULE A Statament covers period 07/01/2016 from ________ _ CALIFORNIA 460 FORM ~rough __ 1_~_3_1_n_0_1_6 __ Page ___ of __ _ AMOUNT RECEIVED THIS PERIOD LO.NUMBER 11-3652985 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE *Contributor Codes IND -Individual (IF REQUIRED) (Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political 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_ SCC -Smal Contributor Committee FPPC Form 460 tJan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B -PART 1 Schedule B -Part 1 Loans Received Amounts may be rounded to whole dollars. Statement covers period 07/01/2016 from __ ..;.....;..;_.;.;....;;..;..;; __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through __ 1_2/_3_1_/2_0_16 __ Page ___ of __ _ NAME OF FILER Palm Springs Fire Management Association FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE,ALSO ENTER LD. NUWIER) to IND O COM O 0TH O PTY O sec to IND O COM O 0TH O PTY O sec to IND • COM • 0TH O PTY O sec Schedule B Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER l4'ME OF BUSINESS) 1~1 OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT BEG~:.:~D THIS PERIOD THIS PERIOD• CLO~:R?6JHIS •PAID $ $ 0 FORGIVEN $ ___ _ , ___ _ s DATE DUE QPAID $ s 0 FORGIVEN , ___ _ , ___ _ $ DATE DUE. •PAID $ * 0 FORGIVEN , ___ _ $ DATE DUE SUBTOTALS $ $ $ $ $ $ $ INTEREST PAIDTHIS PERIOD --~ AATE __ % RATE __ % RATE (Enter (e) on 5-E, Line 3) I.D.NUMBER 11-3652985 ORIGINAL AMOUNTOF LOAN $ O,,.TE INCURRED s DAlE INCURRED DAlE INCURRED CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR s PER ELECTION"' $ CALENDAR YEAR s PER ELECTION• s CALENDAR YEAR $ PER ELECTION .. s 1. loans received this period .................................................................................................................... $ -------1.JL- (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ......................................................................................................... $ --------1.11- tContributor Codes IND -Individual COM -Recipient Committee (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 $ Enter the net here and on the Summary Page, Column A, Line 2. (May1>aaneu-en...-i *Amounts forgiven or paid by another party also must be reported on Sched~ A. -If required. (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: advlce@lfppc.ca.gov (866/275•3772) www.fppc.ca-aov SCHEDULEE Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period 07/01/2016 from _______ _ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through __ 1_2/:_3_1/_2_01_6 __ Page ___ of __ _ NAME OF FILER Palm Springs Fire Management Association CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1.0.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/baHot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and swvey research TRS stafffspouse travel, lodging, and meals IND Independent expendHure 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 UT campaign literature and mailings PRT print ads WEB Information ted'lnology coats (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID * 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. (Acid Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, line 6.) ........................... TOTAL $ _____ _ FPPC Form 460 (Jan/2016) FPPC Advice: advlcet,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 Association DATE RECEIVED FULL NAME ANO ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. Statement covers period 07/01/2016 fiom _______ _ through __ 1_2/_3_1/_20_1_6 __ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ _____ .1_2_ 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ _____ _ 3. Total of an 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 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._12_ SCHEDULE I CALIFORNIA 460 FORM Page ___ of __ _ I.D.NUMBER 11-3652985 AMOUNT OF INCREASE TO CASH FPPC Form 460 {Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov .. R;"lcipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE nt covers period 06/30/2016 from----~::::::::::::::::::::::~~::::---_ 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 (Al.lo Q)mplele Pait 5) ~ General Purpose Committee ® Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (Also Complete Psrt6) D Primarily Formed Candidate/ Officeholder Committee (Also Comp/916 Part 7) I.D. NUMBER 11-3652985 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Management PAC STREET ADDRESS (NO P.O. BOX) 300 N El Cielo Rd CITY Palm Springs STATE ZIP CODE CA 92262 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 1761 CITY STATE ZIP CODE Palm Springs CA 92263 OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification AREACODEJPHONE 760-323-8181 AREA CODE/PHONE ... Date Stamp S RECEWE.Ppo\1Ll r ( CALIFORNIA 460 FORM F p I\ l M -> " n '"' .. Date of election H appllcab~ (Month, Day, Year) tQ\l 2. Type of Statement: D Preelection Statement ~ 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 Cl1Y Cathedral City NAME OF ASSISTANT TREASURER, IF ANY n/a MAILING ADDRESS Cl1Y OPTIONAL: FAX I E-MAIL ADDRESS ~Mn: 09 Page ___ of __ _ For Official Use Only D Quarterly Statement D Special Odd-Year Report STATE ZIP CODE CA 92234 (760) 673-1896 STATE ZIP CODE AREA CODE/PHONE 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. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on \ J 14 t I""\-BY---1--+--~......--i--.......+-,i--........--......------ Date Executed on _____ _,,.08...,.te _____ _ Executed on-----_,,.0...,.,te _____ _ Executed on _____ ,..01 ... te _____ _ BY-----....,,,.--,-..,.,,....,....,,,......,,.,,,........,.,......,,......,,.,..,.....,,,..,...,,,_-.,,.....---,------Signature of Controlling Officeholder, Candidate, State Measure Proponent By _______ s ... lg-na""tu_re_of.....,.Con ...... tro""ll, .... ng-.Offl ..... ce.,.h-,old..,...e-~""ca-n""dkl""a.,...te-,,s"'"m...,.te""'Me-,--asu-,-e""'Pro_p_011_e_m,------- FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gav ... Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Association PAC 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 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Scheoule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 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 $ 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, Line 4 15. Cash Payments ...... .......... ..... .............. ............ .......... Column A, line B above 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ ScheduleB, Part2 $ Cash Equivalents and Outstanding Debts Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHE0L/LES) 573.04 .12 573.16 18. Cash Equivalents................................................ See Instructions on reverse $ 19. Outstanding Debts.............................. Add Line 2 + Line gin Column B above $ Statement covers period 06/30/2016 from--------::::==------ $ $ $ $ $ $ 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 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.D. NUMBER 11-3652985 Calendar Year Summary for Candidates Running In Both the State Primary and General Elections 111 through 6130 7/1 to Date 20. Contributions Received S-----$----- 21. Expenditures Made $ ____ _ $ ____ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expandituras Made* (If Subject to Voluntary EKi,.ndlture Limit} Date of Election (mm/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 {Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275•3772) www.fppc.ca.gov Schedule A SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Association PAC DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * Schedule A Summary 1. Amount received this period -itemized monetary contributions. •IND •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec •IND •COM 00TH •PTY •sec •IND •COM DOTH •PTY •sec IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESSI SUBTOTAL$ AMOUNT RECEIVED THIS PERIOD (Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ 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 $ _____ D_ Page ___ of __ _ I.D.NUMBER 11-3652985 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) •contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.c:a.gov SCHEDULE B • PART 1 Schedule B -Part 1 Loans Received Amounts may be rounded to whole dollars. Statement covers period from __ 0_6_/_30_/_2_0_16 __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Association PAC FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) to IND 0 COM 0 0TH 0 PTY • sec to IND •COM 0 0TH 0 PTY o sec t • IND 0 COM 0 0TH 0 PTY • sec Schedule B Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESS) a OUTSTANDING BALANCE BEGINNING THIS PERIOD $ $ SUBTOTALS $ (c) AMOUNT AMOUNT PAID OUTSTANDING RECEIVED THIS OR FORGIVEN BALANCE AT PERIOD THIS PERIOD• CLD~:R~6ciHIS 0 PAID $ ___ _ 0 FORGIVEN $ DATE DUE 0 PAID 0 FORGIVEN DATE DUE 0 PAID $ 0 FORGIVEN $ •ATE DUE $ $ 1. Loans received this period .................................................................................................................... $ (Total Column (b) plus unitemized loans of 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.) 3. Net change this period. (Subtract Line 2 from Line 1.) .............................................................. NET $ Enter the net here and on the Summary Page, Column A, Line 2. (May be• ,egat,ve ,umber) •Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. $ e INTEREST PAID THIS PERIOD __ % RATE $ ___ _ __ % RATE $ ___ _ __ % RATE $ ___ _ Page ___ I.D. NUMBER 11-3652985 ORIGINAL AMOUNT OF LOAN DATE INCURRED $ DATE INCURRED DATE INCURRED of ___ g CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR $ PER ELECTION" $ CALENDAR YEAR PER ELECTION•• $ CALENDAR YEAR $ PER ELECTION tt (Enter (e) on Schedule E, Line 31 tContributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH -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 -------------------··-------·--· -----------------·----· SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE throu Page ___ of __ _ NAME OF FILER Palm Springs Fire Management Association 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 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 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 COMMITTEE, ALSO ENlER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID * 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: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov S'chedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management Association PAC DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER I.D. NUMBER/ Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ ______ ._1_2 2. Unitemized increases to cash of 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 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._12_ I.D.NUMBER 11-3652985 of __ _ AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from ___ 0_1_/_0_11_2_0_1 _6 __ 06/30/2016 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 0 Recall (Also Complete Pa~ 5) ~ General Purpose Committee ® Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information D Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored i'.~lso Complele Part 6) D Primarily Formed Candidate/ Officeholder Committee (Also Comp/ele Parl 7) LD. NUMBER 11-3652985 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 CITY Palm Springs STATE ZIP CODE CA 92262 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 1761 CITY Palm Springs OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification STATE CA ZIP CODE 92263 AREA CODEIPHONE 760-323-8181 AREA CODEIPHONE Dale Stamp RECEIVED ClTY F PALH SPRiNC~, Date of election if appliGf.L)J9,: (Month, Day, Year) ZU JO Page __ _ of __ _ UG -4 AH II : 01 Jt, ES THOHP:)Oi, ITV CLERK 2. Type of Statement: For Official Use Only D Preelection Statement ~ Semi-annual Statement D Termination Statement Quarterly Statement Special Odd-Year Report (Also file a Form 410 Termination) D Amendment (Explain below} Treasurer(s) NAME OF TREASURER Cory Gorospe MAILING ADDRESS 68070 Madrid Rd CITY Cathedral City NAME OF ASSISTANT TREASURER, IF ANY n/a MAILING ADDRESS CITY OPTIONAL: FAX I E-MAIL ADDRESS STATE ZIP CODE AREA CODE/PHONE CA 92234 760-673-1896 STATE ZIP CODE AREA CODE/PI-IONE I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge e information contained herein and in the attached schedules is true and complete. I certify under penalty of pe~ufY und.er the laws of the State of California that the foregoing is tru nd correct. Executed on b 14 \ l \a BY---+--++--++--...,,+-..,...-,H,----,-.,..,......,-=---------Date Executed on ------=D"'"a,,..te _____ _ Executed on ------,0,-8,,..te _____ _ E,cecuted on ------,D,-a.,..te _____ _ 9 Y-------:::S,,..ign_a.,.lu-~-o""'rc""o"""'nt,-r~""'r;--ng"""O""ffi'""1ce""'h"°'o~"'"e-~""c:-an-,d'"'id.,.ate-,-:::S:-rat,-e""'M,-ea'"'s""u,,.,.,e""Pr"'op'"'o'""ne'°"'n"'"t ----- BY-----~s-,gn-a-tu-,e-0.,.fC,,..o-nt-,~.,..1,-ng-O""ffi-,ce_h_ol-de-,.-,c-an...,d'""'id-at-e,..,.S-ta-te.,.M'""ea_s_u,-e"'"P,-opo-ne_n_t ----- FPPC Form 460 (Jan/2016) FPPC Advice: advice@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 PAC Contributions Received 1. Monetary Contributions................................................... Schedule A, Una 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 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedul& H, Line 3 B. SUBTOTAL CASH PAYMENTS .......................................... Add Lines ti+ 7 $ 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 $ Current Cash Statement 12. Beginning Cash Balance............................ Previous Summa,y Page. Line 16 $ 13. Cash Receipts ........................................................... Column A, Une 3 above 14. Miscellaneous Increases to Cash .................................. Scheduler, Line 4 15. Cash Payments ...... ..... .... .......... .... ..... ..... .... .... ...... .... Column A. Line B above 16. ENDING CASH BALANCE .................. Add Unes 12 + 13 + 14, then subtract Une 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................................................ 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) 572.74 .30 573.04 SUMMARY PAGE Statement covers period 01/01/2016 rrom ________ _ CALIFORNIA 460 FORM 06/30/2016 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 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.D. NUMBER 11-3652985 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 711 to Date 20. Contributions Received $ ____ _ $ ____ _ 21. Expenditures Made $-----$ ____ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Mada* (H SubJ-ct to Voluntary Expenditure Umll) Date of Election (mm/dd/yy) __J___J __ __J___J __ Total lo Date $ _____ _ $ ___ _ *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 A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management PAC Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.•. NUMBER) CODE * IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER IIF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Schedule A Summary 1. Amount received this period -itemized monetary contributions. •IND •COM 00TH •PTY •sec •IND •COM DOTH •PTY •sec •IND •COM Dorn •PTY •sec •IND •COM 00TH •PTY •sec •IND •COM DOTH •PTY •sec SUBTOTAL$ SCHEDULE A Statement covers period CALIFORNIA 460 FORM from ___ 0_1_/0_1_/2_0_1_6 __ through __ 0_6_/3_0_/2_0_1_6 __ 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) •contributor Codes IND -Individual (Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ COM -Recipient Committee (other than PTY or SeC) 0TH -Other (e.g., business entity) PTY-Political 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/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca .gov SCHEDULE B -PART 1 Schedule B -Part 1 Loans Received Amounts may be rounded to whole dollars. Statement covers period from __ 0_1_/0_1_/2_0_1_6 __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through __ 0_6_/3_0_/_20_1_6 __ Page ___ of __ _ NAME OF FILER Palm Springs Fire Management PAC FULL NAME, STREET ADDRESS AND ZIP CODE Of LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMF'LOYeo. eNTER NAME OF BUSINESS) le) OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT (IF COMMITTEE, ALSO ENlER I.D. NUMBER) BEG~:~~ioTHIS PERIOD THIS PERIOD• CLO~:R?6ciHIS 0 PAID $ , ___ _ 0 FORGIVEN to IND O COM O 0TH O PTY O SCC $----$ ___ _ $ DATE DUE 0 PAID $ $ 0 FORGIVEN $ ___ _ to IND O COM O 0TH O PTY O SCC S----$ DATEOUE 0 PAID s $ 0 FORGIVEN to IND O COM O 0TH O PTY O SCC $ ___ _ $ ___ _ $ DATE DUE SUBTOTALS $ $ $ 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 ......................................................................................................... $ (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 $ Enter the net here and on the Summary Page, Column A, Line 2. (Maybeanoga1ivom.rnber) •Amounts forgiven or paid by another party also must be reported on Schedule A. •• If required. $ INTEREST PAID THIS PERIOD __ % RATE $ ___ _ __ % RATE $ __ % RATE $ ___ _ 1.0.NUMBER 11-3652985 ORIGINAL AMOUNT OF LOAN $ ___ _ DATE INCURRED s DATE INCURRED $ DATE INCURRED CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR $ ___ _ PER ELECTION .. CALENDAR YEAR $ PER ELECTION•• $ CALENDAR YEAR $ PER ELECTION'"' $ ___ _ (Enter (e) on Schedule E, Line 3) tContributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party sec -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Management PAC Amounts may be rounded to whole dollars. Statement covers period from __ 0_1_/0_1_/2_0_1_6 __ through __ 0_6_/3_0_/2_0_1_6 __ SCHEDULE E CALIFORNIA 460 FORM Page ___ of __ _ I.D. NUMBER 11-3652985 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB eve FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary}* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENlER LD. NUMBER) MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID SUBTOTAL$ 0 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ a 2. Unitemized payments made this ~eriod of under $100 .......................................................................................................................................... $ _____ _ a 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _ a 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 PAC DATE RECEIVED FULL NAME ANO ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER I.•. 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 from __ 0_1_/0_1_/2_0_1_6 __ through __ 0_6_/3_0_12_0_1_6 __ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ ______ ._3_0 2. Unitemized increases to cash of 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 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._30_ SCHEDULE I CALIFORNIA 46 0 FORM Page ___ of __ _ I.D. NUMBER 11-3652985 AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov •. Statement of Organization Recipient Committee Statement Type D Initial Not yet qualified D or ----1/---1 Date qualified as committee '21 Amendment list 1.0. number: # 113652985 --l---1! Date qualified as committee (If applicable) D Termination -See Part 5 List J, D. number; # ________ _ --/--I-- Date of Termination IJate Stamp CEIVED AND FILE in e office of the Secretary of Stat of !he Slate of Catrfomia FEB 112016 ~rt¢onjm1tt~et-l'nfc,rmati6ri.iiw&~~fB~t1t'i,~f:#f~J'#**~tl:1Nl$iF~t,ir,1V~[q~,~~t1~;~1i~t,$, .-.,~;ffiiilUiifii11~UQ!b~r:,e~iQ~tp~l,,Qffi~g~~f,:i1[IT~iJ~!~i'.t~~;, .. NIIWIEOFCOMMITTEE NAME OF TREASURER Palm Springs Fire Management Assoc. PAC Co .::..::.:..1.---=:...=.::-=.::.i:..::..._ __________________ .g~-J;..llA'I' STREET ADDRESS !NO P,O. SOX) 68070 Madrid Rd STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 300 N El Cielo Rd Cathedral City CA 92234 (760)673-1896 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANTTREASURER, IF ANY Palm Springs CA 92262 (760)323-8181 MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) PO Box 1761, Palm Springs, CA 92263 fAX / E-MAIL ADDRESS CITY STATE ZIP CODE A~ EA CODE/PHONE COUNTY OF DOMICILE JURISDICTION WH[RE COM MITTE( 15 ACTIVE NAME OF PRINCIPAL OfFICER(S) STRHT ADDRESS (NO P,0, SOX) CIH STATE ZIP CODE AR[A CODE/PHONE Attach additional information on appropriately labeled continuation sheets. ~•ifiY,,t,J .. ~--· .. 9hii1a~,,rfflli.~'lflWiz,~tttrt-~'.l-~~itt;stE\l2l55k?ttittfo:?.~1t~~t;!~iii~~~~ :,,~tru'.i~~t~tf!!:ttrf0+iwrtn•ffl1;\111l*1lf1~-·-. "' ,Jiffilw:llim'~'filt&1t\t,;/ 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 Cal'fornia that th rue and correct. Executed on 02/01/2016 DATE Executed on OAH Executed on DAH EKecuted on DATE By----------------------------------------SIGNATURE OF CONTROLLING DFFICEHOLDrn, CANDIDATE, OR STATE MEASURE PROPONENT By -----------:'""'"'c=,,,,..,..,..,.:-::------:c,:-:-:--:--,-.,,.-------------=-----,,,.,-=-::,,=,.,,-,.,.,...---------s1GNATURf OF CONTROLllNG Off!CEHOLDER, CANDIDATE, OR >TATE MEA>URE PROPOIIENT .... _ ..... _ . FPPC Form 410 (Jan/20161 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 thefinandal institution where the campaign bank account is located. NAME Of FINANCIAL INSTrTUTION AREA CODE/PHONE ADDRESS CITY Controlled Committee BANK ACCOUNT NUMBER STATE ZIP CODE CALIFORNIA 410 FORM LD. 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. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE/0 FflCEHOLDER/STATE ME/I.SURE PROPONENT II NCLUDE D\STRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTV 0 Nonpartisan D Nonpartisan Primarily Farmed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(SJ FULL TITLE (INCLUDE SAllOT NO, OR LETTER) CANDIDATE(SI OFFICE SOUGHT 0~ HELO OR MEASURE(S)JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPUCMLE) . FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov -Stafement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Management Assoc. PAC l~i!!iti~Qm~lt~·-~-; -~:··-;:· :~ ···-~-:t!w.~~~~~~!~t:~t~l~i!~i~ttti~~t~i1:~1i~b~:1~~-tirji~1jli~~it :r--1~~: I:·:! : ··:·. CALIFORNIA 41 Q FORM I.D. NUMBER 113652985 Gi.:neral Purpo,e Committe;, Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITV Committee O COUNTY Committee O STATE Committee PROVIDE BRIEF DESCRIPTION OfACTl'IITY Sponsored Committee List additional sponsors on an attachment. NAME Of SPONSOR INDUSTRV GROl)P OR AFFILIATION OF SPONSOR STREET ADDRESS NO.ANDSTREH CITY STATE ZIPCDOE Small Contributor Committee •--1--il Date qualified ~'.\~I!11Dl~•RIR~.0M!timl~~!:ri!~3l~~~l-i,.~~~~~~t~·~~~.r~~,~~~~-~~~~r;~~-Pl~~Q~il~wH~tiP,l~~~~!~~e~i~~~~~i,(m:®.~1§t1i:m~:~j~~lli~l~,h~~~:!m~tffi§~~~ll1~&,l!:m • 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 18521.5. FPPC Form 410 (Jan/Z016) FPPC Advice: advice@fppc:c:a.gov (866/2.75-3772) www.fppc.c:a.gov