2019-07-31 Form 460 - Palm Springs ForwardCOVER PAGE
Recipient Committee
Campaign Statement
• Cover Page
Date Stamp
CALIFORNIA 46 0
FORM
, ..------------~ ECEIVED
Statement covers period Date of election if applicable
Page ___ of __ _
from __ 1_11_12_0_1_9____ (Month, Day, Year) JUL ,3 1 2QJ g Fo r Official Use Only
SEE INSTRUCTIONS ON REVERSE
6/30/2019 through ________ _ Y: ............................. .
1. Type of Recipient Committee : All Committees-Complete Parts 1, 2, 3, and 4. 2. Type of Statement:
D Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
D Primarily Formed Ba llot Measure
Committee
D Preelection Statement
~ Semi-annual Statement
D Term ination Statement
D Quarterly Statement
0 Recall 0 Controlled
D Special Odd-Year Report
(A&o Complete Pert 5)
D General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3. Committee lnfonnation
0 S ponsored
{Also Complete Part 6/
D Pri marily Formed Candidate/
Officeholder C ommittee
(Also Complete Part 7)
COM MITTEE NAME (OR CANDIDATE"S NAME IF NO COMMITTEE)
Palm Sprin gs Forward YES on Measure D 2017
STREET ADDRESS (NO PO BOX)
CITY STATE ZIP CODE
Palm Springs CA 92262
MAILING ADDRESS (IF DIFFERENT ) NO AND STREET OR P 0 . BOX
CITY STATE Z I P CODE
OPTIONAL: FAX/ E-MAIL ADDRESS
4 . Verification
AREA CODE/PHONE
AREA CODE/PHONE
(Also file a Form 41 O Termination)
D Amendment (Ex pla in be low)
Treasurer(s)
NAME OF TREASURER
John Shay
MAILING ADDRESS
CITY
Palm Springs
NAME OF ASSISTANT TREASURER, IF AN Y
MA ILING ADDRESS
C ITY
OPTIONAL. FAX/ E-MAIL ADDRESS
STATE
CA
STATE
ZIP CODE
92262
ZIP CODE
AREA CODE/PHONE
AREA CODE/PHONE
I have used all reasonable d il igence in preparing and reviewi ng this statement and to the best of
July 3 1, 2019
Executed on -----...,,..--------Date
Exec uted on Date
Executed on Date
Exec uted on Date
By -..,,........,.-..,..,,,-,-"""°"...,.,,......,....,...,.....,..-,..,...,.....,,,,....,.....,..,..---,,,---,---,,--.......,~------s;gnature of Controlling Officeholder, Candidate. State Measure Proponent or Responsible Officer of Sponsor
BY-------,,,---,--.....,..,,,,....,-.,,-,=-,-.-...,,.......,,.,,-,--=-.,.....,-:-----=---------Signature of Controll ing Off,ceholder. candidate. State Measure Proponent By _________________________________ _
Signature of Controlilng Officeholder. Candidate. Sta te Measure Proponent
FPPC Form 460 (Jan/2016)
FPPC Advice : 11dvice@f00c.c11.,zov (866/275-3772)
Recipient Committee
Campaign Statement
Cover Page -Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT DR HELD QNCLUDE LOCATION AND DISTRICT N,UMBER IF APPLICABLE)
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREE1) 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?
0 YES •NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE · ZIP CODE AREA CODE/PHONE
COMMITTEE NAME LO.NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
•YES •NO
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
D
JURISDICTION
Palm Springs Riverside CTY
i2I SUPPORT
0 OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, If any.
NAME OF OFFICEHOLDER, _CANDIDATE, OR PROPONENT
OFFICE SOUGHT DR HELD l°ISTRICTNO. IFANY
7. Primarily Formed Candidate/Officeholder Committee List names of
officeholder(s) or candldate(s) for which this committee Is prlmarlly 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
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.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
" Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Forward YES on Measure D 2017
Contributions Received
1. Monetaiy Contributions ................................................... ScheduleA.Llne3
2. Loans Received ................................................................ ScheduleB,Llne3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. AddLlnes1+2
4. Nonmonetaiy 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 ....................................................................... ScheduleH,Llne3
8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6 + 7 $
9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3
10. Nonmonetaiy Adjustment.. ....................................................... Schedule c, Line 3
11. TOTAL EXPENDITURES MADE ........................................ Add Lines B + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous summary Page, Une 16 $
13. Cash Receipts ........................................................... Column A, Line 3 above
14. Miscellaneous Increases to Cash .................................. schedule/, Llne4
15. Cash Payments......................................................... Column A, Line 8 above
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtrnct Line 15 $
If this is a termination statement, Une 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ ScheduteB, Part2 $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ Seelnstroctlonsonravarse $
19. Outstanding Debts ............... ., ............. AddL/ne2+Llne9/nColumnBabove $
Amounts may be rounded
to whole dollars.
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
0
0
0
$50.00
0
0
0
0
$50.00
$261.35
0
0
$50.00
$211.35
0
0
0
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM 1/1/2019 from ________ _
6/30/2019 3 4 through _______ _ Page ___ of __ _
$
$
$
Column B
CALENDAR YEAR
TOTAL TO DATE
0
0
0
0
$ $50.00
0
$ 0
0
0
$ $50.00
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
1399524
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 Made*
(If Subject to Voluntary Expenditure Limit)
Date of Election
(mm/dd/yy)
Total to Date
$ ____ _
$ ____ _
*Amounts in this section may be different from amounts
reported In Column B.
FPPC Form 460 (Jan/2016)
FPPC Advice: advJce@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
..
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Forward YES on Measure D 2017
Amounts may be rounded
to whole dollars.
Statement covers period
1/1/2019 from, ________ _
6/30/2019 through, _______ _
SCHEDULE
CALIFORNIA 460
FORM
4 4 Page, ___ of __ _
1.D. NUMBER
1399524
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 ENTER 1.0. NUMBER)
MBR member communications
MTG meetings and appearances
OFC office expenses
PET petition circulating
PHO phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
PRT print ads
CODE OR
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
Secretary of State Annual filing fee
FIL $50.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $50.00
Schedule E Summary
$50.00
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).) ............................................................................. $---~--
$50.00
4. Total payments made this period. (Add Lines i, 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