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Home My WebLink About2019-07-31 Form 460 - Palm Springs ForwardCOVER PAGE Recipient Committee Campaign Statement • Cover Page Date Stamp CALIFORNIA 46 0 FORM , ..------------~ ECEIVED Statement covers period Date of election if applicable Page ___ of __ _ from __ 1_11_12_0_1_9____ (Month, Day, Year) JUL ,3 1 2QJ g Fo r Official Use Only SEE INSTRUCTIONS ON REVERSE 6/30/2019 through ________ _ Y: ............................. . 1. Type of Recipient Committee : All Committees-Complete Parts 1, 2, 3, and 4. 2. Type of Statement: D Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee D Primarily Formed Ba llot Measure Committee D Preelection Statement ~ Semi-annual Statement D Term ination Statement D Quarterly Statement 0 Recall 0 Controlled D Special Odd-Year Report (A&o Complete Pert 5) D General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee lnfonnation 0 S ponsored {Also Complete Part 6/ D Pri marily Formed Candidate/ Officeholder C ommittee (Also Complete Part 7) COM MITTEE NAME (OR CANDIDATE"S NAME IF NO COMMITTEE) Palm Sprin gs Forward YES on Measure D 2017 STREET ADDRESS (NO PO BOX) CITY STATE ZIP CODE Palm Springs CA 92262 MAILING ADDRESS (IF DIFFERENT ) NO AND STREET OR P 0 . BOX CITY STATE Z I P CODE OPTIONAL: FAX/ E-MAIL ADDRESS 4 . Verification AREA CODE/PHONE AREA CODE/PHONE (Also file a Form 41 O Termination) D Amendment (Ex pla in be low) Treasurer(s) NAME OF TREASURER John Shay MAILING ADDRESS CITY Palm Springs NAME OF ASSISTANT TREASURER, IF AN Y MA ILING ADDRESS C ITY OPTIONAL. FAX/ E-MAIL ADDRESS STATE CA STATE ZIP CODE 92262 ZIP CODE AREA CODE/PHONE AREA CODE/PHONE I have used all reasonable d il igence in preparing and reviewi ng this statement and to the best of July 3 1, 2019 Executed on -----...,,..--------Date Exec uted on Date Executed on Date Exec uted on Date By -..,,........,.-..,..,,,-,-"""°"...,.,,......,....,...,.....,..-,..,...,.....,,,,....,.....,..,..---,,,---,---,,--.......,~------s;gnature of Controlling Officeholder, Candidate. State Measure Proponent or Responsible Officer of Sponsor BY-------,,,---,--.....,..,,,,....,-.,,-,=-,-.-...,,.......,,.,,-,--=-.,.....,-:-----=---------Signature of Controll ing Off,ceholder. candidate. State Measure Proponent By _________________________________ _ Signature of Controlilng Officeholder. Candidate. Sta te Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice : 11dvice@f00c.c11.,zov (866/275-3772) Recipient Committee Campaign Statement Cover Page -Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT DR HELD QNCLUDE LOCATION AND DISTRICT N,UMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO. AND STREE1) CITY STATE ZIP Related Committees Not Included in this Statement: List any committees not Included In this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 0 YES •NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE · ZIP CODE AREA CODE/PHONE COMMITTEE NAME LO.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? •YES •NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE Measure D 2017 BALLOT NO. OR LETTER D JURISDICTION Palm Springs Riverside CTY i2I SUPPORT 0 OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, _CANDIDATE, OR PROPONENT OFFICE SOUGHT DR HELD l°ISTRICTNO. IFANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candldate(s) for which this committee Is prlmarlly formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE Attach continuation sheets If necessary 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 Forward YES on Measure D 2017 Contributions Received 1. Monetaiy Contributions ................................................... ScheduleA.Llne3 2. Loans Received ................................................................ ScheduleB,Llne3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. AddLlnes1+2 4. Nonmonetaiy 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 ....................................................................... ScheduleH,Llne3 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3 10. Nonmonetaiy Adjustment.. ....................................................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE ........................................ Add Lines B + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Une 16 $ 13. Cash Receipts ........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. schedule/, Llne4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtrnct Line 15 $ If this is a termination statement, Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ ScheduteB, Part2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ Seelnstroctlonsonravarse $ 19. Outstanding Debts ............... ., ............. AddL/ne2+Llne9/nColumnBabove $ Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0 0 0 $50.00 0 0 0 0 $50.00 $261.35 0 0 $50.00 $211.35 0 0 0 SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM 1/1/2019 from ________ _ 6/30/2019 3 4 through _______ _ Page ___ of __ _ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE 0 0 0 0 $ $50.00 0 $ 0 0 0 $ $50.00 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 1399524 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ ____ _ $ ___ _ 21. Expenditures Made $ ____ _ $ ___ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) Total to Date $ ____ _ $ ____ _ *Amounts in this section may be different from amounts reported In Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advJce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov .. Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Forward YES on Measure D 2017 Amounts may be rounded to whole dollars. Statement covers period 1/1/2019 from, ________ _ 6/30/2019 through, _______ _ SCHEDULE CALIFORNIA 460 FORM 4 4 Page, ___ of __ _ 1.D. NUMBER 1399524 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 ENTER 1.0. NUMBER) MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) PRT print ads CODE OR 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 Secretary of State Annual filing fee FIL $50.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $50.00 Schedule E Summary $50.00 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).) ............................................................................. $---~-- $50.00 4. Total payments made this period. (Add Lines i, 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