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2021-07-22 Form 460 - Palm Springs ForwardRecipient Committee Campaign Statement Cover Page [9��1�691:i�Iel1G]P6YU� �:7��1�:�9� Statement covers period from January 1, 2021 through June 30, 2021 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Part 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee m Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1399524 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Forward YES on Measure D 2017 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODEIPHONE Palm Springs CA 92262 # MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Date Stamp CITY 4F PC LM S©R(N( Date of election if applica (Month, Day, Year) November 7, 2017 JF'F1 JUL Z2 PH 2: 21 OF THE CITY Ct rF 2. Type of Statement: ❑ Preelection Statement ® Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) 4. Verification I have used all reasonable dili ence i preparing and reviewing this statement and to attached schedules is true and complete. I Executed on By Dale Signature of Controlling Officeholder, Candidate, Stale 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 Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) 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? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COVER PAGE - PART 2 Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE Measure D BALLOT NO. OR LETTER JURISDICTION 0 SUPPORT D Palm Springs, CA ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s) or candidate(s) for which this committee is primarily formed. COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE FPPC Form 460(Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period SUMMARY PAGE from ' SEE INSTRUCTIONS ON REVERSE through Page 3 of 4 NAME OF FILER I.D. NUMBER Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ 0 $ 0 0 0 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule e, Line 3 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 200.00 200.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3+4 $ 200.00 $ 200.00 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 0 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 0 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 211.35 13. Cash Receipts........................................................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 0 15. Cash Payments......................................................... Column A, Line 8 above 0 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 211.35 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 0 $ 0 $ 0 0 0 $ 0 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). 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) � 1 $ '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 C Amounts may be rounded SCHFnl11 F C Nonmonetary Contributions Received Statement covers period CALIFORNIA from January 1, 2021 FORM through June 30, 2021 Page 4 of 4 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Palm Springs Forward YES on Measure D 2017 1399524 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.O. NUMBER) * CODE (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF REQUIRED) NAME OF BUSINESS) (JAN 1 - DEC 31) m IND May 6, Chris Lucker ❑ COM Political Consultant FPPC Fee $200.00 $200.00 2021 ❑ OTH Lucker Anderson, LLC Palm SPrings, CA 92262 ❑PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)......................................................................................................................$ 2. Amount received this period — unitemized nonmonetary contributions of less than $100..................................$ 200.00 3. Total nonmonetary contributions received this period. 200.00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ 'Contributor Codes IND — Individual COM — Recipient Committee (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: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov