2017-02-01 Form 460 - PS Fire ManagementRecipient Committee
Campaign Statement
Cover Page -Amended
Date Stamp !'
R!ICEI V
.------------,----------'Ty OF P. AL SPR I
SEE INSTRUCTIONS ON REVERSE
Statement covers period
07/01/2016 from _________ _
12/31/2016 through ________ _
1. Type of Recipient Committee: All Committees-Complete P•rts 1, 2, 3, •nd4.
0 Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
D Primarily Formed Ballot Measure
Committee
0 Recall
(AlaoC.,,.,,.,..Pat!S)
fill General Purpose Committee
fil Sponsored
0 SmaH Contributor Committee
0 Political Party/Central Committee
3. Committee Information
0 Controlled
0 Sponsored
(Also~Pat6)
D Primarily Formed Candidate/
Officeholder Committee
(Also Ccmplole Pad 7)
I.D.NUMBER
11-3652985
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Palm Springs Fire Management Association
STREET ADDRESS (NO P.O. BOX)
CITY
Palm Springs
STATE ZIP CODE
CA 92262
MAILING ADDRESS (IF DIFFERENT) NO. ANO STREET OR P.O. BOX
CITY STATE ZIP CODE
Palm Springs CA 92263
OPTIONAL: FW:. I E-MAIL ADDRESS
4. Verification
AREA CODE/PHONE
(
AREA CODE/PHONE
Date of election if applicable:
(Month, Day, Year)
2. Type of Statement:
D Preelection Statement
QI Semi-annual Statement
D Termination Statement
111 JAN
(Also file a Form 410 Termination)
D Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Cory Gorospe
MAILING ADDRESS
CllY
Cathedral City
NAME OFASSISTANTTI!EASURER, IF ANY
n/a
MAILING ADDRESS
CITY
OPTIONAL: FAX I E-MAIL ADDRESS
STATE ZIP CODE
CA 92234
STATE ZIP CODE
s
For Official Use Only
AREA CODE/PHONE
(
AREA CODE/PHONE
I have used all reasonable diligence in preparing and reviewing this statement and to the best
Executed on 01/24/2017
Oate
Executed on
Date
Execu1ed on
Dal&
Executed on
Date
8Y------,,s1g=na1ure="""'or""c,.,.ontroa="";ng,,..Dffi"'"'"'"""'h"">01oe.,,.,..,.~"""cru"'ddilll=.,.,.1e...,,,s,,..,1ate.,,...,.,Me:--:-a"'su,,.,,re,....,P"'"roix,ne="'n,..,.t-----
By _____ -=:-.....,..---,.,.,..,..,.,.,..,..,..,,..-=.,..,...,.,,,,....,...==-,--,=...,....=-=-=--.------
Signature of Controlling O!fice!lolder. Candida!e, Stale Measure Proponent
FPPC Form 460 (Jan/2016)
FPPC Advice: advlce@lfppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association
Contributions Received
1. Monetary Contributions................................................... Schedule A, Une 3 $
2. Loans Received................................................................ Schedule B. Ur,e 3
3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Unes 1 + 2 $
4. Nonmonetary Contributions............................................ Schedule c. une 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................. Add Lines 3 + 4 $
Expenditures Made
6. Payments Made................................................................ Schedule E, Line 4 $
7. Loans Made....................................................................... Schedule H, Une 3
8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6 + 7 $
9. Accrued Expenses (Unpaid Bills) .......................................... SchecluleF.Line3
10. Non monetary Adjustment... ...................................................... Sch«Jule c. Line 3
11. TOTAL EXPENDITURES MADE. ....................................... AddUnes8+9+10 $
Current Cash Statement
12. Beginning Cash Balance............................ Previous Summary Page, line 16 $
13. Cash Receipts ........................................................... CalumnA,Unr,3above
14. Miscellaneous Increases to Cash .................................. Schedule 1. Line 4
15. Cash Payments ......................................................... Column A, Line Babove
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, thensubtractUne 15 $
If this is a termination statement. Une 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedules. Part 2 $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents................................................ See instn.K:lions on re1111rse $
19. Outstanding Debts.............................. Add Line 2 + Line 9 in Column B above $
Amounts may be rounded
to whole dollars.
Column A
TOTAL nilS PERIOD
(FOOM ATTACHED SCHEDULES)
573.04
.12
573.16
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM from ___ 0_7_10_1_12_0_1_6 __
12/31/2016 through _______ _ Page ___ of __ _
$
$
$
$
$
$
ColumnB
CALENDAR YEAR
TOTAL TO DATE
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
11-3652985
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6130 7/1 to Dale
20. Contributions
Received $ ____ _ $ ____ _
21. Expenditures
Made $ ____ _ $ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
(If Sullject to VOiuntary E%pendlhNe UmlC)
Date of Election
(mm/dd/yy)
__ ..,____J __ _
__J__J __
Total to Date
$ _____ _
$ _____ _
•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 A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF cor.MITTEE, Al.80 ENTER LD. NUMBER) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(If 68.F-EMPLOYED, ENTER NAME
OF BUSINESS)
Schedule A Summary
1. Amount received this period -itemized monetary contributions.
•IND •COM
00TH •PTY •sec
•IND •COM
00TH •PTY •sec
•IND •COM
DOTH •PTY •sec
•IND •COM
00TH •PTY •sec
•IND •COM
00TH
OPTY •sec
SUBTOTAL$
SCHEDULE A
Statament covers period
07/01/2016 from ________ _
CALIFORNIA 460
FORM
~rough __ 1_~_3_1_n_0_1_6 __ Page ___ of __ _
AMOUNT
RECEIVED THIS
PERIOD
LO.NUMBER
11-3652985
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
*Contributor Codes
IND -Individual
(IF REQUIRED)
(Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ COM -Recipient Committee
(other than PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party 2. Amount received this period-unitemized monetary contributions of less than $100 ........................... $ ______ _
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ______ O_
SCC -Smal Contributor Committee
FPPC Form 460 tJan/2016)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE B -PART 1
Schedule B -Part 1
Loans Received
Amounts may be rounded
to whole dollars. Statement covers period
07/01/2016 from __ ..;.....;..;_.;.;....;;..;..;; __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE through __ 1_2/_3_1_/2_0_16 __ Page ___ of __ _
NAME OF FILER
Palm Springs Fire Management Association
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE,ALSO ENTER LD. NUWIER)
to IND O COM O 0TH O PTY O sec
to IND O COM O 0TH O PTY O sec
to IND • COM • 0TH O PTY O sec
Schedule B Summary
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER
l4'ME OF BUSINESS)
1~1
OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING
BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT
BEG~:.:~D THIS PERIOD THIS PERIOD• CLO~:R?6JHIS
•PAID
$ $
0 FORGIVEN
$ ___ _ , ___ _ s
DATE DUE
QPAID
$ s
0 FORGIVEN , ___ _ , ___ _
$
DATE DUE.
•PAID
$ *
0 FORGIVEN , ___ _
$
DATE DUE
SUBTOTALS $ $ $
$
$
$
$
INTEREST
PAIDTHIS
PERIOD
--~
AATE
__ %
RATE
__ %
RATE
(Enter (e) on
5-E, Line 3)
I.D.NUMBER
11-3652985
ORIGINAL
AMOUNTOF
LOAN
$
O,,.TE INCURRED
s
DAlE INCURRED
DAlE INCURRED
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
s
PER ELECTION"'
$
CALENDAR YEAR
s
PER ELECTION•
s
CALENDAR YEAR
$
PER ELECTION ..
s
1. loans received this period .................................................................................................................... $ -------1.JL-
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ......................................................................................................... $ --------1.11-
tContributor Codes
IND -Individual
COM -Recipient Committee (Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) .............................................................. NET $
Enter the net here and on the Summary Page, Column A, Line 2. (May1>aaneu-en...-i
*Amounts forgiven or paid by another party also must be reported on Sched~ A.
-If required.
(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: advlce@lfppc.ca.gov (866/275•3772)
www.fppc.ca-aov
SCHEDULEE Schedule E
Payments Made
Amounts may be rounded
to whole dollars. Statement covers period
07/01/2016 from _______ _
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
through __ 1_2/:_3_1/_2_01_6 __ Page ___ of __ _
NAME OF FILER
Palm Springs Fire Management Association
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
1.0.NUMBER
11-3652985
CMP campaign paraphernalia/misc. MBR member communications 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 t.v. or cable airtime and production costs
FIL candidate filing/baHot fees PHO phone banks TRC candidate travel, lodging, and meals
FND fundraising events POL polling and swvey research TRS stafffspouse travel, lodging, and meals
IND Independent expendHure 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
UT campaign literature and mailings PRT print ads WEB Information ted'lnology coats (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
0 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).) ............................................................................. $ _____ _
0 4. Total payments made this period. (Acid Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, line 6.) ........................... TOTAL $ _____ _
FPPC Form 460 (Jan/2016)
FPPC Advice: advlcet,fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
. . .
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association
DATE
RECEIVED
FULL NAME ANO ADDRESS OF SOURCE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
Attach additional information on appropriately labeled continuation sheets.
Schedule I Summary
Amounts may be rounded
to whole dollars. Statement covers period
07/01/2016 fiom _______ _
through __ 1_2/_3_1/_20_1_6 __
DESCRIPTION OF RECEIPT
SUBTOTAL$
1. Itemized increases to cash this period ............................................................................................................................ $ _____ .1_2_
2. Unitemized increases to cash of under $100 this period ................................................................................................. $ _____ _
3. Total of an 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
Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._12_
SCHEDULE I
CALIFORNIA 460
FORM
Page ___ of __ _
I.D.NUMBER
11-3652985
AMOUNT OF
INCREASE TO CASH
FPPC Form 460 {Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
.. R;"lcipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
nt covers period
06/30/2016
from----~::::::::::::::::::::::~~::::---_
1. Type of Recipient Committee: All Committees -complete Parts 1. 2, 3, and 4.
D Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
D Primarily Formed Ballot Measure
Committee
0 Recall
(Al.lo Q)mplele Pait 5)
~ General Purpose Committee
® Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
0 Controlled
0 Sponsored
(Also Complete Psrt6)
D Primarily Formed Candidate/
Officeholder Committee
(Also Comp/916 Part 7)
I.D. NUMBER
11-3652985
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Palm Springs Fire Management PAC
STREET ADDRESS (NO P.O. BOX)
300 N El Cielo Rd
CITY
Palm Springs
STATE ZIP CODE
CA 92262
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
P.O. Box 1761
CITY STATE ZIP CODE
Palm Springs CA 92263
OPTIONAL: FAX I E-MAIL ADDRESS
4. Verification
AREACODEJPHONE
760-323-8181
AREA CODE/PHONE
...
Date Stamp S
RECEWE.Ppo\1Ll r (
CALIFORNIA 460
FORM
F p I\ l M -> " n '"' ..
Date of election H appllcab~
(Month, Day, Year) tQ\l
2. Type of Statement:
D Preelection Statement
~ Semi-annual Statement
D Termination Statement
(Also file a Form 410 Termination)
D Amendment (Explain below)
Treasurer( s)
NAME OF TREASURER
Cory Gorospe
MAILING ADDRESS
68070 Madrid Rd
Cl1Y
Cathedral City
NAME OF ASSISTANT TREASURER, IF ANY
n/a
MAILING ADDRESS
Cl1Y
OPTIONAL: FAX I E-MAIL ADDRESS
~Mn: 09
Page ___ of __ _
For Official Use Only
D Quarterly Statement
D Special Odd-Year Report
STATE ZIP CODE
CA 92234 (760) 673-1896
STATE ZIP CODE AREA CODE/PHONE
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. I
certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on \ J 14 t I""\-BY---1--+--~......--i--.......+-,i--........--......------
Date
Executed on _____ _,,.08...,.te _____ _
Executed on-----_,,.0...,.,te _____ _
Executed on _____ ,..01 ... te _____ _
BY-----....,,,.--,-..,.,,....,....,,,......,,.,,,........,.,......,,......,,.,..,.....,,,..,...,,,_-.,,.....---,------Signature of Controlling Officeholder, Candidate, State Measure Proponent
By _______ s ... lg-na""tu_re_of.....,.Con ...... tro""ll, .... ng-.Offl ..... ce.,.h-,old..,...e-~""ca-n""dkl""a.,...te-,,s"'"m...,.te""'Me-,--asu-,-e""'Pro_p_011_e_m,-------
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gav
...
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association PAC
Contributions Received
1. Monetary Contributions................................................... Schedule A, Line 3 $
2. Loans Received................................................................ Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $
4. Nonmonetary 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....................................................................... Scheoule 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 8 + 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
15. Cash Payments ...... .......... ..... .............. ............ .......... Column A, line B above
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15 $
If this is a termination statement, Une 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ ScheduleB, Part2 $
Cash Equivalents and Outstanding Debts
Amounts may be rounded
to whole dollars.
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHE0L/LES)
573.04
.12
573.16
18. Cash Equivalents................................................ See Instructions on reverse $
19. Outstanding Debts.............................. Add Line 2 + Line gin Column B above $
Statement covers period
06/30/2016
from--------::::==------
$
$
$
$
$
$
Column B
CALENDAR YEAR
TOTAL TO DATE
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
11-3652985
Calendar Year Summary for Candidates
Running In Both the State Primary and
General Elections
111 through 6130 7/1 to Date
20. Contributions
Received S-----$-----
21. Expenditures
Made $ ____ _ $ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expandituras Made*
(If Subject to Voluntary EKi,.ndlture Limit}
Date of Election
(mm/dd/yy)
___J___J __
___J___J __
Total to Date
$ _____ _
$ _____ _
*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 A SCHEDULE A
Monetary Contributions Received
Amounts may be rounded
to whole dollars. Statement covers period CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association PAC
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE *
Schedule A Summary
1. Amount received this period -itemized monetary contributions.
•IND •COM
DOTH •PTY •sec
•IND •COM
DOTH •PTY •sec
•IND •COM
DOTH •PTY •sec
•IND •COM
00TH •PTY •sec
•IND •COM
DOTH •PTY •sec
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER NAME
OF BUSINESSI
SUBTOTAL$
AMOUNT
RECEIVED THIS
PERIOD
(Include all Schedule A subtotals.) ......................................................................................................... $ _____ _
2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ ______ _
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ _____ D_
Page ___ of __ _
I.D.NUMBER
11-3652985
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
•contributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
www.fppc.c:a.gov
SCHEDULE B • PART 1
Schedule B -Part 1
Loans Received
Amounts may be rounded
to whole dollars. Statement covers period
from __ 0_6_/_30_/_2_0_16 __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association PAC
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
to IND 0 COM 0 0TH 0 PTY • sec
to IND •COM 0 0TH 0 PTY o sec
t • IND 0 COM 0 0TH 0 PTY • sec
Schedule B Summary
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED. ENTER
NAME OF BUSINESS)
a
OUTSTANDING
BALANCE
BEGINNING THIS
PERIOD
$
$
SUBTOTALS $
(c)
AMOUNT AMOUNT PAID OUTSTANDING
RECEIVED THIS OR FORGIVEN BALANCE AT
PERIOD THIS PERIOD• CLD~:R~6ciHIS
0 PAID
$ ___ _
0 FORGIVEN
$
DATE DUE
0 PAID
0 FORGIVEN
DATE DUE
0 PAID
$
0 FORGIVEN
$
•ATE DUE
$ $
1. Loans received this period .................................................................................................................... $
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ......................................................................................................... $
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) .............................................................. NET $
Enter the net here and on the Summary Page, Column A, Line 2. (May be• ,egat,ve ,umber)
•Amounts forgiven or paid by another party also must be reported on Schedule A.
** If required.
$
e
INTEREST
PAID THIS
PERIOD
__ %
RATE
$ ___ _
__ %
RATE
$ ___ _
__ %
RATE
$ ___ _
Page ___
I.D. NUMBER
11-3652985
ORIGINAL
AMOUNT OF
LOAN
DATE INCURRED
$
DATE INCURRED
DATE INCURRED
of ___
g
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
$
PER ELECTION"
$
CALENDAR YEAR
PER ELECTION••
$
CALENDAR YEAR
$
PER ELECTION tt
(Enter (e) on
Schedule E, Line 31
tContributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
0TH -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
-------------------··-------·--· -----------------·----·
SCHEDULE E
Schedule E
Payments Made
Amounts may be rounded
to whole dollars. Statement covers period CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE throu Page ___ of __ _
NAME OF FILER
Palm Springs Fire Management Association PAC
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
I.D. NUMBER
11-3652985
CMP campaign paraphernalia/misc. MBR member communications 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
CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs
FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals
FND fundraising events POL polling and survey 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-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENlER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
0 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).) ............................................................................. $ _____ _
0 4. Total payments made this period. (Add Lines 1, 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
S'chedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management Association PAC
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE. ALSO ENTER I.D. NUMBER/
Attach additional information on appropriately labeled continuation sheets.
Schedule I Summary
Amounts may be rounded
to whole dollars.
DESCRIPTION OF RECEIPT
SUBTOTAL$
1. Itemized increases to cash this period ............................................................................................................................ $ ______ ._1_2
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
Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._12_
I.D.NUMBER
11-3652985
of __ _
AMOUNT OF
INCREASE TO CASH
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from ___ 0_1_/_0_11_2_0_1 _6 __
06/30/2016 through ________ _
1. Type of Recipient Committee: All Committees-Complete Parts 1, 2, 3, and 4,
D Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
0 Recall
(Also Complete Pa~ 5)
~ General Purpose Committee
® Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
D Primarily Formed Ballot Measure
Committee
0 Controlled
0 Sponsored
i'.~lso Complele Part 6)
D Primarily Formed Candidate/
Officeholder Committee
(Also Comp/ele Parl 7)
LD. NUMBER
11-3652985
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Palm Springs Fire Management Assoc. PAC
STREET ADDRESS (NO P.O. BOX)
300 N El Cielo Rd
CITY
Palm Springs
STATE ZIP CODE
CA 92262
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
P.O. Box 1761
CITY
Palm Springs
OPTIONAL: FAX I E-MAIL ADDRESS
4. Verification
STATE
CA
ZIP CODE
92263
AREA CODEIPHONE
760-323-8181
AREA CODEIPHONE
Dale Stamp
RECEIVED
ClTY F PALH SPRiNC~,
Date of election if appliGf.L)J9,:
(Month, Day, Year) ZU JO
Page __ _ of __ _
UG -4 AH II : 01
Jt, ES THOHP:)Oi,
ITV CLERK
2. Type of Statement:
For Official Use Only
D Preelection Statement
~ Semi-annual Statement
D Termination Statement
Quarterly Statement
Special Odd-Year Report
(Also file a Form 410 Termination)
D Amendment (Explain below}
Treasurer(s)
NAME OF TREASURER
Cory Gorospe
MAILING ADDRESS
68070 Madrid Rd
CITY
Cathedral City
NAME OF ASSISTANT TREASURER, IF ANY
n/a
MAILING ADDRESS
CITY
OPTIONAL: FAX I E-MAIL ADDRESS
STATE ZIP CODE AREA CODE/PHONE
CA 92234 760-673-1896
STATE ZIP CODE AREA CODE/PI-IONE
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge e information contained herein and in the attached schedules is true and complete. I
certify under penalty of pe~ufY und.er the laws of the State of California that the foregoing is tru nd correct.
Executed on b 14 \ l \a BY---+--++--++--...,,+-..,...-,H,----,-.,..,......,-=---------Date
Executed on ------=D"'"a,,..te _____ _
Executed on ------,0,-8,,..te _____ _
E,cecuted on ------,D,-a.,..te _____ _
9 Y-------:::S,,..ign_a.,.lu-~-o""'rc""o"""'nt,-r~""'r;--ng"""O""ffi'""1ce""'h"°'o~"'"e-~""c:-an-,d'"'id.,.ate-,-:::S:-rat,-e""'M,-ea'"'s""u,,.,.,e""Pr"'op'"'o'""ne'°"'n"'"t -----
BY-----~s-,gn-a-tu-,e-0.,.fC,,..o-nt-,~.,..1,-ng-O""ffi-,ce_h_ol-de-,.-,c-an...,d'""'id-at-e,..,.S-ta-te.,.M'""ea_s_u,-e"'"P,-opo-ne_n_t -----
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management PAC
Contributions Received
1. Monetary Contributions................................................... Schedule A, Una 3 $
2. Loans Received................................................................ Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $
4. Nonmonetary 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....................................................................... Schedul& H, Line 3
B. SUBTOTAL CASH PAYMENTS .......................................... Add Lines ti+ 7 $
9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3
10. Nonmonetary Adjustment... ...................................................... Schedule c, Line 3
11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance............................ Previous Summa,y Page. Line 16 $
13. Cash Receipts ........................................................... Column A, Une 3 above
14. Miscellaneous Increases to Cash .................................. Scheduler, Line 4
15. Cash Payments ...... ..... .... .......... .... ..... ..... .... .... ...... .... Column A. Line B above
16. ENDING CASH BALANCE .................. Add Unes 12 + 13 + 14, then subtract Une 15 $
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule B, 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 $
Amounts may be rounded
to whole dollars.
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
572.74
.30
573.04
SUMMARY PAGE
Statement covers period
01/01/2016 rrom ________ _
CALIFORNIA 460
FORM
06/30/2016 through _______ _ Page ___ of __ _
$
$
$
$
$
$
Column B
CALENDAR YEAR
TOTAL TO DATE
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
11-3652985
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
111 through 6/30 711 to Date
20. Contributions
Received $ ____ _ $ ____ _
21. Expenditures
Made $-----$ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Mada*
(H SubJ-ct to Voluntary Expenditure Umll)
Date of Election
(mm/dd/yy)
__J___J __
__J___J __
Total lo Date
$ _____ _
$ ___ _
*Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 IJan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management PAC
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.•. NUMBER) CODE *
IF AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
IIF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
Schedule A Summary
1. Amount received this period -itemized monetary contributions.
•IND •COM
00TH •PTY •sec
•IND •COM
DOTH •PTY •sec
•IND •COM
Dorn •PTY •sec
•IND •COM
00TH •PTY •sec
•IND •COM
DOTH •PTY •sec
SUBTOTAL$
SCHEDULE A
Statement covers period
CALIFORNIA 460
FORM from ___ 0_1_/0_1_/2_0_1_6 __
through __ 0_6_/3_0_/2_0_1_6 __ Page ___ of __ _
AMOUNT
RECEIVED THIS
PERIOD
I.D. NUMBER
11-3652985
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
•contributor Codes
IND -Individual
(Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ COM -Recipient Committee
(other than PTY or SeC)
0TH -Other (e.g., business entity)
PTY-Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ ______ _
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ______ o_
sec -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca .gov
SCHEDULE B -PART 1
Schedule B -Part 1
Loans Received
Amounts may be rounded
to whole dollars. Statement covers period
from __ 0_1_/0_1_/2_0_1_6 __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE through __ 0_6_/3_0_/_20_1_6 __ Page ___ of __ _
NAME OF FILER
Palm Springs Fire Management PAC
FULL NAME, STREET ADDRESS AND ZIP CODE
Of LENDER
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMF'LOYeo. eNTER
NAME OF BUSINESS)
le)
OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING
BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT
(IF COMMITTEE, ALSO ENlER I.D. NUMBER) BEG~:~~ioTHIS PERIOD THIS PERIOD• CLO~:R?6ciHIS
0 PAID
$ , ___ _
0 FORGIVEN
to IND O COM O 0TH O PTY O SCC
$----$ ___ _ $
DATE DUE
0 PAID
$ $
0 FORGIVEN
$ ___ _
to IND O COM O 0TH O PTY O SCC
S----$
DATEOUE
0 PAID
s $
0 FORGIVEN
to IND O COM O 0TH O PTY O SCC
$ ___ _ $ ___ _
$
DATE DUE
SUBTOTALS $ $ $
Schedule B Summary
1. Loans received this period .................................................................................................................... $
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period ......................................................................................................... $
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) .............................................................. NET $
Enter the net here and on the Summary Page, Column A, Line 2. (Maybeanoga1ivom.rnber)
•Amounts forgiven or paid by another party also must be reported on Schedule A.
•• If required.
$
INTEREST
PAID THIS
PERIOD
__ %
RATE
$ ___ _
__ %
RATE
$
__ %
RATE
$ ___ _
1.0.NUMBER
11-3652985
ORIGINAL
AMOUNT OF
LOAN
$ ___ _
DATE INCURRED
s
DATE INCURRED
$
DATE INCURRED
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
$ ___ _
PER ELECTION ..
CALENDAR YEAR
$
PER ELECTION••
$
CALENDAR YEAR
$
PER ELECTION'"'
$ ___ _
(Enter (e) on
Schedule E, Line 3)
tContributor Codes
IND -Individual
COM -Recipient Committee
(other than PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party
sec -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management PAC
Amounts may be rounded
to whole dollars.
Statement covers period
from __ 0_1_/0_1_/2_0_1_6 __
through __ 0_6_/3_0_/2_0_1_6 __
SCHEDULE E
CALIFORNIA 460
FORM
Page ___ of __ _
I.D. NUMBER
11-3652985
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 ENlER LD. NUMBER)
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE OR
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
Schedule E Summary
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
SUBTOTAL$
0 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _
a 2. Unitemized payments made this ~eriod of under $100 .......................................................................................................................................... $ _____ _
a 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _
a 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Management PAC
DATE
RECEIVED
FULL NAME ANO ADDRESS OF SOURCE
(IF COMMITTEE. ALSO ENTER I.•. NUMBER]
Sun Community Federal Credit Union
425 N Civic Dr
Palm Springs, Ca 92262
Attach additional information on appropriately labeled continuation sheets.
Schedule I Summary
Amounts may be rounded
to whole dollars. Statement covers period
from __ 0_1_/0_1_/2_0_1_6 __
through __ 0_6_/3_0_12_0_1_6 __
DESCRIPTION OF RECEIPT
SUBTOTAL$
1. Itemized increases to cash this period ............................................................................................................................ $ ______ ._3_0
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
Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ ._30_
SCHEDULE I
CALIFORNIA 46 0
FORM
Page ___ of __ _
I.D. NUMBER
11-3652985
AMOUNT OF
INCREASE TO CASH
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
•. Statement of Organization
Recipient Committee
Statement Type D Initial
Not yet qualified D or
----1/---1
Date qualified as committee
'21 Amendment
list 1.0. number:
# 113652985
--l---1!
Date qualified as committee
(If applicable)
D Termination -See Part 5
List J, D. number;
# ________ _
--/--I--
Date of Termination
IJate Stamp
CEIVED AND FILE
in e office of the Secretary of Stat
of !he Slate of Catrfomia
FEB 112016
~rt¢onjm1tt~et-l'nfc,rmati6ri.iiw&~~fB~t1t'i,~f:#f~J'#**~tl:1Nl$iF~t,ir,1V~[q~,~~t1~;~1i~t,$, .-.,~;ffiiilUiifii11~UQ!b~r:,e~iQ~tp~l,,Qffi~g~~f,:i1[IT~iJ~!~i'.t~~;, ..
NIIWIEOFCOMMITTEE NAME OF TREASURER
Palm Springs Fire Management Assoc. PAC Co
.::..::.:..1.---=:...=.::-=.::.i:..::..._ __________________ .g~-J;..llA'I'
STREET ADDRESS !NO P,O. SOX)
68070 Madrid Rd
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
300 N El Cielo Rd Cathedral City CA 92234 (760)673-1896
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANTTREASURER, IF ANY
Palm Springs CA 92262 (760)323-8181
MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX)
PO Box 1761, Palm Springs, CA 92263
fAX / E-MAIL ADDRESS CITY STATE ZIP CODE A~ EA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WH[RE COM MITTE( 15 ACTIVE NAME OF PRINCIPAL OfFICER(S)
STRHT ADDRESS (NO P,0, SOX)
CIH STATE ZIP CODE AR[A CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
~•ifiY,,t,J .. ~--· .. 9hii1a~,,rfflli.~'lflWiz,~tttrt-~'.l-~~itt;stE\l2l55k?ttittfo:?.~1t~~t;!~iii~~~~ :,,~tru'.i~~t~tf!!:ttrf0+iwrtn•ffl1;\111l*1lf1~-·-. "' ,Jiffilw:llim'~'filt&1t\t,;/
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 the laws of the State of Cal'fornia that th rue and correct.
Executed on 02/01/2016
DATE
Executed on
OAH
Executed on
DAH
EKecuted on
DATE
By----------------------------------------SIGNATURE OF CONTROLLING DFFICEHOLDrn, CANDIDATE, OR STATE MEASURE PROPONENT
By -----------:'""'"'c=,,,,..,..,..,.:-::------:c,:-:-:--:--,-.,,.-------------=-----,,,.,-=-::,,=,.,,-,.,.,...---------s1GNATURf OF CONTROLllNG Off!CEHOLDER, CANDIDATE, OR >TATE MEA>URE PROPOIIENT
.... _ ..... _ . FPPC Form 410 (Jan/20161
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca .gov
, Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Palm Springs Fire Management Assoc. PAC
• All committees must list thefinandal institution where the campaign bank account is located.
NAME Of FINANCIAL INSTrTUTION AREA CODE/PHONE
ADDRESS CITY
Controlled Committee
BANK ACCOUNT NUMBER
STATE ZIP CODE
CALIFORNIA 410
FORM
LD. NUMBER
113652985
• 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 year of the election.
• List 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/0 FflCEHOLDER/STATE ME/I.SURE PROPONENT II NCLUDE D\STRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTV
0 Nonpartisan
D Nonpartisan
Primarily Farmed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(SJ FULL TITLE (INCLUDE SAllOT NO, OR LETTER) CANDIDATE(SI OFFICE SOUGHT 0~ HELO OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPUCMLE)
. FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
-Stafement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Palm Springs Fire Management Assoc. PAC
l~i!!iti~Qm~lt~·-~-; -~:··-;:· :~ ···-~-:t!w.~~~~~~!~t:~t~l~i!~i~ttti~~t~i1:~1i~b~:1~~-tirji~1jli~~it :r--1~~: I:·:! : ··:·.
CALIFORNIA 41 Q
FORM
I.D. NUMBER
113652985
Gi.:neral Purpo,e Committe;, Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITV Committee O COUNTY Committee O STATE Committee
PROVIDE BRIEF DESCRIPTION OfACTl'IITY
Sponsored Committee List additional sponsors on an attachment.
NAME Of SPONSOR INDUSTRV GROl)P OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.ANDSTREH CITY STATE ZIPCDOE
Small Contributor Committee •--1--il
Date qualified
~'.\~I!11Dl~•RIR~.0M!timl~~!:ri!~3l~~~l-i,.~~~~~~t~·~~~.r~~,~~~~-~~~~r;~~-Pl~~Q~il~wH~tiP,l~~~~!~~e~i~~~~~i,(m:®.~1§t1i:m~:~j~~lli~l~,h~~~:!m~tffi§~~~ll1~&,l!:m
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (Jan/Z016)
FPPC Advice: advice@fppc:c:a.gov (866/2.75-3772)
www.fppc.c:a.gov