2017-01-31 Form 460 - Middleton✓'
C
COVERPAGE ..--R I . ec p1ent ommittee
Campaign Statement
Cover Page
Sta11ement covers pa-lod
from 7/1/2016
SEE INSTRUCTIONS ON REVERSE through 12/31/2016
1. Type of Recipient Committee: All cammm--Complete Parts 1, 2, 3, and 4.
3,
liZI Officeholder, Candidate ControDed Committee
0 state Candidate Election Committee
0 Primarily Formed BaDot Measure
Committee
Q Recall 0 Controlled
(llw) Comp/ti, PM') 0 Sponsored
(NsoCompeePall6J • General Purpose Committee
0 Sponsored • Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Alm Cootjllele Pet! lJ
Committee Information , 1.0. NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Lisa Middleton for Palm Springs City Council 2017
STREET ADDRESS (NO P.O. BOX)
CrTY
Palm Springs
STATE ZIP CODE
CA 9224
MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX
CITY STATE ZIP CODE
Palm Springs CA 92263
OPTIONAL: FAX/ E-MAILADORESS
.a.REA CODE/PHONE
AREA CODE/PHONE
4. Verification
Date Stamp j.v ",
RECEIVED
CALIFORNIA 460
G FORM
Ty OF PJ\LH SPRIN ,.:: 1 (:,_
Date of election if apptlcable: : 111 JAN 31 Page of
( Month, Day, Year) PH 2: I I For Official Use Only
OF ICE OF ThE CiTY CL[/ '{•V •I
2. Type of Statement:
QI Preelection Statement
D Semi-annual Statement
• Termination Statement
(Also file a Form 410 Termination)
D Amendment (Explain below)
Treasurer(&)
NAME OF TREASURER
David Baron
MAILING ADDRESS
CITY
Palm Springs
NAME OF ASSISTANT TREASURER, IF All'f
James Williamson
MAILING ADDRESS
ci'i'Y
Palm Springs
OPTIONAL: FAX/ E-MAIL ADDRESS
• Quarterly Statement
• Special Odd-Year Report
STATE ZIPCOOE
CA 92262
STATE ZIP CODE
CA 92262
AREACOOEIPHONE
AREA COOE/PHONE
I have used an 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 lav.,; of the state of Califomla that the foregoing is true and correct.
Elcllcuted on Jan 30, 2017
Data
Executed on Jan 30, 2017
Data
Emcutedon bate
Elcecutedon bate
By _____ s"'liinai ...... 111e-o1...,eo=nk-,ali,g,,......,Officaho:,::o-..,....lder..-,,Ca,....n&L ...... te-.""s1a-. .. --=""'..--.... ""',.."'"P"",o""po""n~1111~1-----
By _____ s"'11111 ...... atu-... -0""1Co-nk...,oiiiiiii-Oflic"'=""aha ........ ldei:...-.C ... lllld_,,.,0..,.at1-.""sta-.le-=Me=-.,,,,.,..,.,Prop-ane""'nte-.------
FPPC Form 460 {Jan/2016)
FPPC Advice: advke@fppc.ca.p (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
Lisa Middleton
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Palm Springs City Council Member
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
Palm Springs CA 92264
Related Committees Not Included In this Statement: ua, any comm,,,_
not Included In this srarement dlar an, controlled by you or are prlmarffy fonned to recetve
contrlbudons or mall:e upendffur• an IHIINllt of your candacy.
COMMITTEE NAME 1.0.NUMBER
NAME OF TREASURER CONTROLLED COMPJITTEE?
0 YES ONO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME LO.NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
0 YES ONO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
CALIFORNIA
FORM
Page _2_ or_b_
6. Prlmarlly Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER JURISDICTION 0 SUPPORT
0 OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, If any,
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFACE SOUGHT OR HELD
7. Prlmarlly Formed CandldatelOfflceholder Committee us1 -• or
af'llc.tialder(s} or candldate(.s) tar which this committee t. prlmwlly fonned.
NAME OF OFACEHOLOER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
D OPPOSE
NAME OF OFRCEHOLDER 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.1ov (866/275-3772)
www.fppc.ca.1ov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
Amounts may be rounded
to whole dollani.
Column A
TOTAL llllS PERIOD
Statement covers period
from ___ 7_/1_/2_0_1_6 __
through __ 1_21_3_11_2_01_6 __
SUMMARY PAGE
CALIFORNIA 460
FORM
3 b Page ___ of __ _
1.0.NUMBER
Columns Calendar Year Summary for Candidates
CALENDAR YEAR
(FROM ATTACHEO SCHEDULES) lOTALlO~TE Running In Both the State Primary and
1. Monetary Contributions ................................................... Schedule A. Line3 $
2. Loans Received................................................................ Schedules. Line 3
3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Linn 1 + 2 $
4. Non monetary Contributions............................................ Scheritle c, Lme 3
5. TOTAL CONTRIBUTIONS RECEIVED ................. '" ................ Add Lines 3 + 4 $
Expenditures Made
6. Payments Made................................................................ Sohec/u/e E. Line 4 $
7. Loans Made....................................................................... Schedule H. Line 3
8. SUBTOTAL CASH PAYMENTS .......................................... Add Lina 15 + 7 S
9. Accrued Expenses (Unpaid ems) .......................................... schedule F. Line 3
1 O. Nonmonetary Adjustment... ...................................................... Schedule c. Line 3
11. TOTAL EXPENDITURES MADE ........................................ Add Lines s + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance .............. .............. P.revious Summery Page, Line 16 $
13. Cash Receipts........................................................... Column A, Une 3 above
5,200.00 $ 5,200.00
0.00 0.00
5,200.00 $ 5,200.00
0.00 0.00
5,200.00 $ 5,200.00
3,863.16 $ 3,863.16
0.00 0.00
3,863.16 $ 3,863.16
636.95 636.95
0.00 0.00
4,500.11 s 4,500.11
0.00
5,200.00
To calculate Column B,
add amounts in Column
General Electlons
111 lhl'ough 6/30 7/1 ta Date
20. Contributions
Received $ $
21. Expenditures
Made s $
Expenditure Umlt Summary tor State
Candidates
22. Cumulative Expenditures Made"
(ll' SUbject to VolUnta,y Expendllure Llllllt)
Date of Election
(mm/ddfyy) __ _,/ __ _,(
__ _,, __ _,/
Total to Date
$ _____ _
$ _____ _
14, Miscellaneous Increases to Cash ..... ............. ................ Schedule ,. Line 4
A to the corre&ponding •Amounts in this section may be different from amounts
amounts from Column B reported in Column B.
15. Cash Payments......................................................... Column A, Line s abowi
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, th"" subtract Line 15 $
of your last report Some amounts In Column A may
be negative ngures that
3,863.16
1,336.84
should be subtracted from
If this fs a tenn/natlon statement. Una 16 must be zero. previous period amounts. If ---------------------------------t this is the first report being
_1_1._L_o_A_N_o_u_A_R_A_N_TE_E_s_R_E_c_E_IV_E_o_ ... _ •. _ ... _ ... _ ... _ .. _ ... _ ... _ ... _ ... _ ... _. _s_oh_e_r1u1e_s_. P_art_2_s ______ 0_.oo _ _. :: =r~~c::~~=:~~:~ts
Cash Equivalents and Outstanding Debts tram Lines 2 , 7, and 9 (if any).
18. Cash Equivalents................................................ See Instructions on 191111159 S 0.00
19. Outstanding Debts.............................. Add Line 2 + Line 9 in Column B abow $ 636.95 FPPC Fonn 460 (Jan/2016)
FPPC Advice: aclviClll@lfppc.ca.gov (866/27>3n2)
www.fppc.ca.aov
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
nFCOMMITTEE.ALSOENTER lD. NUMBER) CODE•
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SeLF-E"'1PLOYED, ENTER NAME
OF BUSINESS)
1217/2017
12/14/2017
Lisa Middleton
840 E. Biltmore Place
Palm Springs, CA 92264
James Williamson
1455 N.VineAve
Palm SpringsCA 92262
Schedule A Summary
~IND •COM
DOTH •PTY •sec
~IND •COM
OoTH
OPTY •sec
•IND •coM
00TH •PTY •sec
•IND •COM
00TH
OPTY •sec
DINO •COM
00TH •PTY •sec
Strategic Consultant,
Kors Williamson &
Associates
SUBTOTAL$
SCHEDULE A
Statement covers period
7/1/2016 fiom _______ _
CALIFORNIA 460
FORM
through __ 1_21_3_1_/20_1_6 __ Page 4-b of __ _
AMOUNT
RECEIVED THIS
PERIOD
200.00
5,000.00
I
1.0. NUMBER
CUMULATIVE TO DATE
CALENDAR VEAR
(JAN.1 -DEC. 31)
200.00
5,000.00
PER ELECTION
TO DATE
(IF REQUIRED)
*Contributor Codes
IND -Individual 1. Amount received this period -itemized monetaiy contributions.
(Include all Schedule A subtotals.) ......................................................................................................... $ ___ s_,2_0_0._00_ COM -Recipient Committee
{other then PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $1 oo ........................... $ _____ o._o_o
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ____ s,_20_0_._oo_
sec -SmaH Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@lfppc.ca.1ov (866/275-3772)
www.fppc.ca41ov
SCHEDULEE
Schedule E
Payments Made
Amounts may be rounded
to whole dollar•. statement covers period
7/1/2016
CALIFORNIA 460
FORM from _______ _
SEE INSTRUCTIONS ON REVERSE
12/31/2016 through ______ _
NAMEOFRLER I.D.NUMB
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP campaign paraphernalia/misc. MBR member corrmunications 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 tv. or cable airtime and production costs
FIL candidate fiMng/ballot fees PHO phone banks TRe candidate travel, lodging, and meals
FND fundraising events POL potting and suNey 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-maU)
NAMEAtDADDRESS OF PAYEE
AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUW!ER) CODE OR DESCRIPTION OF PAYMENT
Bluhost Domain registration/web-hosting
560 Timpanogos Parkway WEB 113.16
Orem, UT 84097
Brighthaus Marketing Logo, website development
3,750.00 125 E Tahquitz Canyon Way Ste 203 CMP
Palm Springs, CA 92262
"' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3,863.16
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ ___ 3 ,_86_3_·_16_
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).) ............................................................................. $ _____ _
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ ___ 3_•86_3_· 1_6_
FPPC Form 460 (Jan/2016)
FPPC Advice: advlc:e@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULEF
Schedule F
Accrued Expenses (Unpaid BIiis)
Amounts may be rounded
towholadollss. . Statamant cov.s period
7/1/2016 from ______ _
C/ll\F-ORNIA 460
F0Rfv1
12/31/2016 through _____ _
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER I.D.NUMSER
CODES: If one of the following codes accurately describes the payment, you may enter the code. OthefWise, describe the payment
CMP campaign paraphernalia/misc. MBR member communications RAO radio airtime and productlon coals
CNS campaign consulanta MTG meetings and appearances RFD returned contributions
CTB contribution ( explain nonmonetaryr OFC office expenses SAL campaign 'Mlrkffl' ularles
eve civic donations PET petition circulating TEL tv. or cable airtime and production costs
FIL candidate fllinglballot fees PHO phone banks TRC candidate travel, lodging, and meals
FNO fundraislng events POL poHlng and survey research TRS staff/spouse travel, lodging. and meals
IND independent expenditure supporting/opposing others {explain)" POS poetage, delivery and messenger services TSF transfer betwaen committees of the same candidate/8p0n80r
LEG legal defense PRO professional services (legal, ac:counting) VOT voter registration
UT campaign literature and mailings PRT print ads WEB information technology c:osts {Internet, e-mail)
NAMEANOADORESSOFCREDITOR
(IF COMMITTEE.ALSO ENTER LO. NUMBER)
Lisa Middleton
840 E.Biltmore Place
Palm Springs, CA 92263
Lisa Middleton
840 E.Blltmore Place
Palm Springs, CA 92263
• Paymern that ant conlribulior. or Independent aiqiendit!IH mUlt allo be
eumme11iz.d on~ D.
Schedule F Summary
CODEOR (a)
OUTSTANDING DESCRIPTION OF PAYMENT BALANCE BEGINNING
OF THIS PERIOD
Reimburseable airfare
to Victory Fund confer 0.00
Secretary of State 0.00 filing, Fann 410
SUBTOTALS$ 0.00 S
(ltt tel Id)
AMOUNT INCURRED AMOUNT PAID OUTSTANDING
TitSPERIOD THIS PERIOD BALANCE AT CLOSE
{Al.SO REPORT ON 1:J OF THS PERIOD
586.95 o.oo 586.95
50.00 0.00 50.00
636.95 $ 0.00 $ 636.95
1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for
accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................... NCURRED TOTALS$ ____ 636_.9_5_
2. Total accrued expenses paid this period. {Include all Schedule F, Column (c) subtotals for payments on
accrued expenses of $100 or more, plus total unitemiZed payments on accrued expenses under $100.) ................................... PAID TOTALS$ ____ o_.oo_
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 636 95 on the Summary Page, Column A, Line 9.) ····-·· .................................... _ .• , ... Mlll ••••••••• u .............................. -.. ••• -••• _ ........................... _ •• , ____ , ............................... NET$~ Ml¥ be• negatl<ellllnber
FPPC Form 4liO (Jan/2016)
FPPC Advice: 11dvlcdPfltl»c.ca.p (lll/ffl-31772)
www.fppc.ca-1ov
') 0J"" I J..--,
_.)
•,. Statement of Organization
Recipient Committee
I SlatementlWe 0 lnllllll
Nlll ~quailed • or
12 ,14 _,2016
Dell, quellled • coll'IIIIIIBe
1. Committee In nnat1on
MM£ OFCDMIIIITTU
0 Amend,._
List 1.0. number:
•-------
--.J l
Date qualifted as committee
{lfllPflkllltl
Lisa Middleton For Palm Springs City Council 2017
STlll!ET ADOIIESS INO P.O. BOIO
840 E. Bilbnore Place
Cl1'Y ZIPCOOE
RECEIVED AND FILED
in the office of the Secretary of State
of the State of Califomia
. _____ ,.....,..
Jr.HES ltfUiii'SV: __ 1 Cl} Y CLER~
DatltofTermlnatlDn
2. Treasurer and Other Prlndpal Officers
~E Of Till,lSUIElt
David Baron
5111£ETADDftSS(NOP.Q. BOll)
1800 E Tahquilz Canyon Way
CIIY $'111,Tt ZIPCODr
Palm Springs CA 92262
Palm Springs CA 92264 (760)330-7023 James WUliamson
MAIi.iii& ADDIIESilll' DIFFEIIENt) STIRTAOOIIESSINOP.O. IOlQ
PO Box 4109, Palm Springs. CA 92263 1455 N.Vine Ave
CITY srm ZIP CODE
Palm Springs CA 92262
COUNTY OF DOMICILf .IJIIISOICTION WtlER£ COMMlfflE IS ACTIIIE
stnET ADOlESS (NO P-O-80XJ
Attacb additional infarmotion on appropriately labeled continuation sheets.
an ZIPCOOE
Executed on ------:r-E ---av ------~SIG~U~iMl~£~0F~CDN""'1T11,.,.IIOl.""'IJN6~'""'0l''""l'ICEHOUIEll."""""'~--CANDl~D.ffl.--=''""'OR ... S'IIQl!.......,MEASU,....... ... lll!_l'llOPO ____ NiNT ______ _
----.. -.... -----av ______ --:==~=~==~~==~~-,,,..,. ..................... ---------· s SIGW.TUIE OF Q)lffllOWN8 OFFIC£liOI.DEI, CAIIOIDAJE, OIi ST,\Tl MIASUK PIIOPOll£NT
C'.' 0 --.--1 --"'T\ c::11 -i -('"") --<:
f'TI :JC
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("") :J» :.C<
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CJ Ct ;t{
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f"'l .....
CD D .... •~' r ~-.
Alll"A~IIOII£
(760)322-2275
(760)537-0060
AIIEA CODf/llHONI
-~. ..
Statement of Organization
Recipient Committee
INSTRUCTIONS ON IIMRSE
COMMITTEE fllo\ME
CALIFORNIA 41 Q
FORM
1.0.MUMIEI
• All cammtttees must list the financial Institution where the campaign bank acc.oant is located.
NAME Of FINANCIAL IN$TITUTION IIANll:ACCOUNl' HUMID
ADDlll!SS CITY STATE ZIP CODE
• 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 vear of the election. .
• Ust 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/STAT£ MEASURE PROPONENT
LJSA fV\\b ~ t..E 7'{;,;-.1
ELECTIVE OFFICE SOUGHT OR HElD
(INClUD£ DISTRICT NUM8ER IF APPUCAILE)
l'AL-Nt sflf,/f'I «$1 l!t1V CO(J.NCll-MaAiSER
YEAR OF ELECTION PARTY
-2.ol"T-
[D-,rc;i;'pamsan
• Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANOll>ATE(S) NAME OR MEASURE(SJ FUU TITLE (INCt.UOE BALLOT NO. OR lETT£Rl CANDIDA1£1SI OFFICE SOUGHT OR HELD or MEASURE(SI JUR1S01a10111
(INCLUDE OISTRla NO~ CITY OR cou~ AS APl'UCABLEl
FPPC Farrn 410 (Jan/2016)
FPPC Adwk:e: adukeOfppc.ca.pv (866/275--3772)
www.fppc:.e&1DV
.
Statement of Organization
Recipient Committee
Date Stamp
RECEIVED
I
CALIFORNIA 41 Q
FORM
Statement Type '3 lnfflal
Nol yet qualified O or
_12 _ _,,_14 _ _,/2016
Date quallfted as committee
1. ·.· Comrnittee Information
NAME OF COMMITTEE
0 Amendment
List 1.0. number:
•--------
__ _,, I
Date quillified as committee
lllaPfllkableJ
Lisa Middleton For Palm Springs City Council 2017
STREET ADDRESS INO P.O. BOX)
840 E. Biltmore Place
0 Termination -See Part S
List I.D. number:
# _______ _ __ _,, __ _,,_
Dam of Termination
CiT Y OF PALM SPR HG:.
1111 DEC 27 PH 2: 21
Jt, ME 5 T HO h P S t
CITY CLER I<.
2. Treasurer and Other Principal Officers
NAME OF TIWURER
David Baron
STIIEET ADDIESS (NO P.C>, BOX)
1800 E Tahquitz Canyon Way
CIT'/ $TATE ZIP CODE
Palm Springs CA 92262
Cm' ZIP CODE AREA CODE/PHONE NAME OF ASSISTANTTltASURER, IF ANY
Palm Springs CA 92264 (760)330-7023 James Williamson
MAIUNli ADDRESS !IF OIFFERENn STREET ADDIESSl'-10 P.O. &OX)
PO Box 4109, Palm Springs, CA 92263 1455 N.Vine Ave
FAX/ E·MAll ADDRESS CITY STATE ZIP CODE
Palm Springs CA 92262
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(SI
STREET ADDRESS (NO P.D, BOX)
CITY STATE ZIP CODE
Attach additional information on appropriately labeled continuation sheets.
3. \lerifttation ·. . . . . · · · . . · .
For Offlcial Use Only
AREA CODE/PHONE
(760)322-2275
AREA CODE/PHONE
(760)537-0060
AREA CODE/PHDNE
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 he laws of the State of California that the foregoi i rue and correct.
Executed on
Executed on
Executed on
/~ '/(,. 1(,,
SIGNAJUAE OF CONTRDlllNli DHICEHOI.DER, CANDIDATE, Dk STATE MEASURE PRDl"DNENT
-------,o""AT""E ----By --------SIG_IIA_ru_RE_D_F_CD_NT_R,..Ol_U_NG_O_F_FICE_HO_LD(_R,_CA_ND-IIIA-JE-,0-R-ST.-~-e M-EA-Sll-RE_P_IIO_PO_N_ENT _______ _
---------By ________ ==.,,.,,.._,.,.,~...,.,.,.----..-..,...,.,,.,..-.--,..,.,.... ....... ____ ,,__...,..,. ________ _
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/2016)
FPPC Advice: advlce~ppc.ca.,av (866/275-3772)
www.fppc.ca,gov
1.--' ,.
~-
Candidate Intention Statement
Check One: Htnitial •Amendment (Explain) ____________ _
1. andldate Information:
Date stamp i
RECEIVE
CITY OF PALH s
2111 DEC -5 PH
' CALIFORNIA 501
FORM
I/
NAME OF CANDIDATE {Last, Flrlt, Middle lnRial) DAYTIME TELEPHONE NUMBER FAX NUMBER (op!IOnal) E-MAIL (opUonal)
lisamiddletonps@idoud.com MIDDLETON, LISA J
STREET ADDRESS
POBOX5535
OFFICE SOUGHT (POSITION TITLE)
City Council
OFFICE JURISDICTION
0 State (Complete Part 2.)
II City D County D Multi-County:
( 760 ) 330-7023
CITY
Palm Springs
AGENCY NAME
Palm Springs, CA
Palm Springs, CA
(Name ol Multi-County Ji.icilcilon)
2. State candidate Expenditure Limit Statement:
(Ca/PERS and CBISTRS c:andid'ates, judges, judicial candidates, and candidates lbr laca/ offlc:es do nat comp/eta Part 2.)
-=----=-,,....,... Primary/general election (Year at Elactbn)
(Check one bell)
.....,(Ve,..,...ar---,,ar=E1e....,ct1on,,.......,...1 Special/runoff election
DI accept the voluntary expenditure ceiling for the election stated above.
D I do not accept the voluntary expenditure ceiling for the election stated above.
Amendment
STATE
CA
ZIP CODE
92263
DISTRICT NUMBER, ff applcable. • NON-PARTISAN
n/a PARTY:
2017
('tear of Elecllonl
0 I did not exceed the expenditure ceiling in the primary or special election held on: __J__J __ and I accept the voluntary expenditure ceiling for
the general or special run-off election.
(Met1r. If applicable) • On --1--1___, I contributed personal funds in excess of the expenditure ceiling for the election stated above.
3. Verification:
I certify under penalty of perjury under the laws of the St ....... ,...__,,._lif9mia that the foregoing is true and correct .
.> ~.ILL'f<\.~-L.__
December 5, 2016 Executed on ___________ _
(mcmlh, day, year) (Candidate) FPPC Form 501 (.lan/2016)
FPPC Advice: advlce@fppc.ca.ll)V (866/27S-3n2)
wwwJppc.ca.1ov