2004-10-05 Form 460 - PS Fire Management' Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Type or print in ink.
Statement covers period Date of election if applicable:
(Month, Day, Year)
Date S1amp
of __ _
from 7-l -0~ For Official Use Only
SEE INSTRUCTIONS ON REVERSE through 9 -3 0 -0 :J
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
• Officeholder, Candidate Controll ed Committee
O State Candidate Electi on Committee
0 Recall
(Al!O Complete Plllt 5)
( General Purpose Committee
0 Sponsored
~ Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
O Ballot Meas ure Committee
0 Primarily Form ed
0 Controlled
0 Sponsored
(Also Complote Part 6)
O Primari ly Formed Candidate/
Officeholder Committee
(Also Complote Port 7)
I.D. N U MBER
-;3" ':) z. r
COMMITTEE NAME (OR CANDIDATE'S NAM E IF NO COMMITTEE)
PA'-M s~~ 11v6'S r,f:?_.£ /'-1€,/1-,r A S.Soc.. -PA<:_
STREET ADDRESS (NO P.O . BOX)
?... ...
C ITY STATE ZIP CODE
MAILING ADDRESS (IF DIF FERENT) NO. AND STREET OR P.O. BOX
N;M'!\~-~~u~R.'TJY CA
NA
~
MAILING ADDRESS
r.•TY STATE Z IP CODE A REA CODE/PH ON E C ITY STATE ZIP CODE AREA CODE/PHON E
P;&:H--~ ~d;.INGS ~ tj_?2~'3
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
i have u sed all reas onable dilig ence in preparing and reviewing thi s statement and to the best of my kn owl ed ge the information contained herein and in the attached schedules is true an d complete.
certify under penalty of perjury under th e laws of th e State of California that the
Assistant Treasurer
Executed on ------::::Date-.--------
Executed on ------;;Da1o:c,--------
Executed o n ------;;Oa:-.te-:---------
By ---,S;::;-lgna--.-ture--of""'Con:e-:lrcl=11ng=Offlceholder:::-,-.-,--.""Gandlda,......,=1e--:, Sta=1e...,.Me=-=-........,::-:---,Pr:::--:cpo,=..,:::-1:-.or-::::R:-.espons=:;;lble:::-;,Offloer=:-.o1~s .. ponsor==---
By ______ :::,---.--=::--:--:::---::c::--.-.-:----::::---:;~-=-c::-,-::-:-::-:c:-:=::-:-::-------
Signature cl Controlling~. Candidate , Slate Mea,ue Proponent
BY ------:::--.----:-:::--:--:::--=:-:--:-:---:::---::~-=-c--:-c--.::---:--------SlgnaCUte of Conlrolllng ~. Condldate, State Meas<.re Proponent FPPC Fonn 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
State of Callfomla
' '"1'
ScheduleA
Monetary Contributions Rece_ived
SEE INSTRUCTIONS ON REVERSE
r-JAME OF FILER
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Sac. -PA'-
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CO•E OF CONTRIBUTOR CONTRIBUTOR IF AN INDMDUAL. ENTER
OCCUPATION AND EMPLOYER
(IFSELF<MPLOYED, ENTER NAME (IFCOMMITTEE,ALSOerrERID.NUMBER) CODE *
(
ichedule A Summary
. Amount received this period -contributions of $100 or more.
•IND •COM
00TH,
OPTY •sec
DINO •COM
00TH •PTY •sec
•IND •COM
00TH.
OPTY •sec
•IND •COM
00TH
OPTY •sec
•IND •COM
DOTH •PTY •sec
OF BUSINESS) •
SUBTOTAL$
SCHEDULE A
Statement covers period
from 7-)-0 r CALIFORNIA 460
FORM
through q-;3. 0 -0 </ Pag•-~-oi __ _
AMOUNT
RECEIVED THIS
PERIOD
I.D. NUMBER
I-3,:::i-2 9 fS-
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TODATE
(IF REQUIRED)
•contributor Codes
(Include all Schedule A subtotals.) ............................................................................................. , .......... $ _____ _
IND-Individual
COM-Recipient Committee
(other than PTY or SCC)
OTH-Olher . Amount received this period -unitemized contributions of less than $100 ........... , ................................. $ ______ _
. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ ____ __.:__
PTY -Political Party .
SCC-Sma_ll ConlributorCommlttee
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
• • t,.:..
Type or print In Ink. Camp'aign Disclosure Statement
Summ;uy Page Amounts may be rounded
to whole dollars •. Statement covers period
tram 7-I -t) <f
SUMMARY PAGE
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
fSo<:..
Contrib!Jtions Received
1. Mon~tary Contributions .......................................... . Schedule A, Una 3 $
~. Lo~n§ Received ............................. :........................ Schedule B, Une 3
-, , SU!jTOTAL CASH CONTRIBUTIONS·......................... Add Unes 1 + 2 $
' ~onmonetary Contributions .................................... schedule c, Une 3
5. TOTAL CONTRIBUTIONS RECEIVED ........................... AddUn•s3+4 $
• •· .••• _, -••r<\ •
Expen~it'.'res Made
6. Pay~ents Made ....................................................... Schedule E, Una 4 $
7. Loaris Made............................................................. Schedule H, Une 3
8. SUBTOTAL CASH PAYMENTS .................................... Add Unes 6 + 7 $
9. Accrued Expenses (Unpaid Bills) ............... ___ .. scheduleF,Un•3
10. !'!pnmonetary Adjustment .......................................... Schedule c, Une 3
11. TOTAL!=)(PENDITURESMADE ................................ AddUnes8+9+10 $
C!Jrren* G~sh Statement
-~~ 12. Beginnin~ Cash Balance ....................... Previous Summary Page, Une 16
1
:: _)ca~h Receipts ................................................. :. CoiumnA,Une3above
14. Mi~cellan':ous Increases to Cash ........................... Schedule I, Line 4
15. Cash Paymen~s .................................................. Column A, Line 8 ebove
16. !=f'IDI~~ CI\Slj BALANCE .......... Add Unes 12 + 13 + 14. /hen sub/met Une 15
If th[s /~ a termination statement, Une 16 must be zero.
fl', LCM! GUARANTEES RECEIVED ........................ :·· Schedule S. Part 2
¢-~s~. fq'!J!V~l~n*5 and Outstanding Debts
18. Ca~h ~quiya,lents ........................................ See inslructions-on reverse
19. Outstanding Debts ......................... Add Un• 2 + Un• 9 In Column B above ...
$
$
$
$
$
ColumnA
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
;1lk
Lf9'a-?
through 9-3o-0 cf Page __ _ of __ _
$
Columns
.CALENDAR YEAR
TOTAL TODATE
$ _____ _
$ _____ _
$
$
$
To calculate Column B, add
amounts in Column A to the
corresponding amounts
from Column B of your last
report. S9me amounts in
Column A may be negative
figures that should be
subtracted from previous
period amounts. If this Js
the first report being filed
for this calendar year, only
carry over· the amounts
from Line~ 2, 7, and 9 (if
any).
I.•. NUMBER
1 J-~r::;.9f
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 M;:ide•
(If SubJect ta Voluntary Expondlturo"Umlt)
Date of Election . Tota] to Date
(mm/dd/yy)
__j $
__j $
~ $
__j $
__j $
__j $
•since January 1, 2001. Amounts In this section may be
different from amounts reported In Column B.
FPPC Fann 46D (June/D1)
FPPC Toll•Free Helpline: 866/ASK-FPPC