2021-07-29 Form 460 - PS Fire ManagementRecipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
State ent overs period
from 7-1
through �10
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
O State Candidate Election Committee Committee
O Recall O Controlled
(Also Complete Part5) O Sponsored
(Also Complete Pert 6)
❑ General Purpose Committee
a Sponsored ❑ Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part7)
3. Committee Information I.D. NUMBER
/z y1P8 9
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
PA IA4 — r
CITY
A
ZIP CODE
AAR/EACODE/PHONE
/,r..
/� q
STD."A/ s
//�STATE
(r,Q9Z2�Z
(�
MAILING ADDRESS (I DIFFER NT) NO. AND STREET OR P.O. BOX
f
13aJC / 7b
/
CITY
STATE
ZIP CODE
AREACODE/PHONE
NAL:FAX/
4. Verification
Date of election if applicable:
(Month, Day, Year)
2. Type of Statement:
❑ Preelection Statement
Date Stamp
P;E:CEiV
CITE' OF PALM
2021 JUL 29 1
OFFICE OF THE CITY CI_Ei
Semi-annual Statement
Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
COVER PAGE
of 3
Official Use Only
❑ Quarterly Statement
❑ Special Odd -Year Report
NAME OF TREASURER
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
M fa/,s'pi;nq s �,� SZ z
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/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 perjury under the laws of the State of California that the foregoing is true and correct.
�� �
Executed on 3& 9 / By
Dale Signatu o easurer or AAistant Treasurer
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Dale Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE
Summary Page to whole dollars. Statemen co ers period - I
g from —
SEE INSTRUCTIONS ON REVERSE through "' z� Page 2 of
NAME OF FILER I.D. NUMBER
/Z����1
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTAL THIS PERIOD CALENDAR YEAR
(FROM ATTACHED SCHEDULES) TOTAL;DATE Running in Both the State Primary and
General Elections
1. Monetary COntrlbUtlOr1S................................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date
2. Loans Received................................................................ Schedule B, Line 3
20. Contributions
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $
4. Nonmonetary Contributions ............................................ Schedule c, Line 3 21, Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3 + 4 $ $
Made $ $
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
10. Nonmonetary Adjustment......................................................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE....................................Add Lines 6+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
$ Shy. /1/
15. Cash Payments......................................................... column A, Line 8 above
16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ J
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule e, 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 $
, /Z
To calculate Column B,
add amounts in Column
Ato 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).
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made'
(if Subject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mm/dd/yy)
$
"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 I Amounts may be rounded SCHEDULE I
Miscellaneous Increases to Cash to whole dollars. Statement covers period
from
through 3o Z/ Page of
SEE INSTRUCTIONS ON REVERSE g
NAME OF FILER I.D. NUMBER
A S l,..475
DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Scheduleu /Z
1. Itemized increases to cash this period . ........................................................................................................................... $
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
SummaryPage, Line 14.)............................................................................................................................. TOTAL $
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov