2019-01-30 Form 460 - Palm Springs ForwardRecipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON R EV ERS E
Statement covers period
July 1 I 2018
from -----------
December 3 1 I 20
through ---------
1. Type of Recipient Committee: All Committees-Comploto Parts 1, 2, 3, and 4.
D Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
0 Recall
(Also Comploto Pan S)
D General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3 . Committee Information
li2l Primari ly Forme d Ballot Measure
Committee
0 Controll ed
0 Sponsored
(Also Comploto Pan 6!
D Primari ly Formed Can didate/
Offi ce holder Committee
(Also Comp/oto Pan 7)
COMMITIEE NAME (OR CANDIDATE'S NAME IF NO COMMITIEE)
P a lm Springs Forward Yeas on Measu re D 2017
STREET ADDRE SS (NO P.O. BOX)
CITY
Palm Springs
STATE
CA
ZIP CODE
92262
M AILING A DDR ESS (IF DIF FERENT) NO. A ND STREET OR P.O . BOX
CITY STATE ZIP CODE
OPTION AL: FAX I E-MAIL ADDRESS
4 . Ve r ificat ion
AREA COD E/PHONE
AREA CODE/PHONE
COVER PAGE
Date Stamp
CALIFORNIA 460
FORM -• I t 1
• L
Date of el ection If appllcable2· 19 J O
(Mon th. Day, Year) J:,:~
Page ___ of 3
P ; ; 12 : l l llr-----::----::-:c:-:-:-:-,----,-...,.....----i For Official Use Only
2. Typ e of State m ent:
D Preelec tion Statement
li2l Semi-annual Statement
D Termina tion Statement
(Also file a Form 410 Termination)
D Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
John S hay
CITY
Palm Springs
NAME OF ASSISTANT TREASU RER , IF ANY
MAILIN G ADDRESS
CITY
OPTION AL: FAX I E·M AIL ADDRESS
STATE
CA
STATE
D Quarterly Statem en t
D Special Odd -Year Report
ZIP CODE
92262
ZIP CODE
AREA CODE/PHONE
AREA CODE/PHON E
I have used a ll re aso nable diligence in preparing and reviewing this s tatement and to the best of my knowledge the inform ation contained herei n and in the attached schedules is true and co mplete.
certify under penalty of perjury under the laws of th e State o f Ca lifornia th at th e foregoing is true an d
Jan uary 30, 2019
Executed on ------==-------Oate
Executed on
Date
Executed on
Date
Executed on
Date
By --,.Si,.,'gna=tu:::re""'o""f c""on"'tr:::ol::::lln""o""o""ffice=ho::-:ld;:'er'"". c"'a""nd""ld::-:D:::-Io ,""s"'ta""te...,.M:-::ea::-:s""ur::-e "'-Pro""po=ne""nt"'or.,-;R:;-:e:::spo=ns""tb:::-le""Offi""t::-:ce-:-r o:;f""spo=ns""or,--
BY -----~Si~g=-=na:::t~u,-:-eo:;f~Co::-:n:::trol~17ong::-:O~n~oc"'oh""ot:::-do:::-~-;;C::-:an::-:d~oda"'to~.~St"'at-:-eM:-::e::-:a:::su:::~~P~ro""po::-:ne:::n:::t -------
BY -----~S~ig::-:na:::t~u,-:-eo:;f~Co::-:n:::trot~t7ong::-:O~n~oc"'oh""ot:::-do:::-~-;;C::-:an::-:d~oda"'te~.~St"'at-:-eM:-::e::-:a:::su:::~~P~ro""po::-:ne:::n:::t -------
FPPC Form 4 60 (J an /2016)
FPPC Advice: a dvice@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)
RESIDENTIAUBUSINESS 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 behaff of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
0 YES ONo
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
0 YES 0NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
Measure D 2017
BALLOT NO. OR LETTER JURISDICTION 0 SUPPORT
0 OPPOSE D Palm Springs Riverside CTY
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 List names of
offlceholder(s) or candldate(s) for which this committee Is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
D OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
D OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (Jan/2016)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTI ONS ON REVERSE
NAME OF FILER
Palm Springs Fo rwa rd Yes on Measure D 2017
Contributions Received
Amounts may be rounded
to whole dollars.
ColumnA
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDU LES)
0
1 . Monetary Contributions ................................................... Schedule A. Line 3 s
0
2 . Loans Received ................................................................ Schedule B , Line 3
3 . SU BTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 s
4 . N onmonetary Contri butions............................................ Schedule c . Line 3
5 . TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4
0 s
Expenditures Made
6. P ayments Made................................................................ Schedule E. Line 4 S 0
7 . Loans Made....................................................................... Sched ule H , Line 3 0
8 . SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 S 0
9 . Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3 0
10. Nonmonetary Adj ustment... ...................................................... Sch edule C, Line 3 0
11 . TOTAL EXPENDITURES MADE. ....................................... Add Lines 8 + 9 + 10 S 0
Current Cash Statement
12. Beginni ng Cash Balance ............................ Previous Summary Page, Line 16 S
13. Cash Receipts ............. ....................... ...... ................. Column A , Line 3 above
14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4
261.35
0
0
15. Cash Payments ... .................... .................. ........ ........ Column A, Line 8 above
16. END ING CASH BALANCE .................. Add Lines 12 + 13 + 14, t hen s ubtract Line 15 S 261 .35
0
If this i s a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule S , Part2 S
0
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ See instructions o n reverse S 0
19. Outstanding Debts .............................. A dd Line 2 +Line 9 in Colum n B above S 0
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM July 1, 2018
from----------
s
s
s
s
s
s
Column B
CALENDAR YEAR
TOTAL TO DATE
To ca lculate Co lumn B.
add am ounts in Col umn
0
0
0
0
0
0
0
A to the corre spon ding
amo unts from C olu mn B
of your last report. Som e
amounts in Column A may
be negative figure s that
shou ld be subt racted from
previ ou s period amoun ts . If
th is is the first report being
filed for th is calendar year,
onl y carry over th e amounts
fro m Lines 2 , 7, and 9 (if
any).
December 31 , 2C 3 3 Page ___ of __ _
I.D. N UMBER
1399524
Calendar Year Summary for Candi dates
Running in B oth the State Primary and
General Elections
111 t hrough 6130 711 to Dat e
20 . Contribution s
Received S ------
$ ____ _
2 1. Expend iture s
Made $ ______ _ $ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Mad e'
(If S ubject t o Vo lu ntory Expend iture Limit )
Dat e of Election
(mm /dd/yy)
Tota l to Date
$ ____ _
$ ____ _
'Amounts in this section may be different from am ounts
reported i n Column B.
FPPC Form 460 (J an/2016)
FPPC Advice : advice@fppc .ca .gov (866/275-3772)
www.fppc.ca.gov