Third Pre-Election Amendment ecipient committcc
campaign statement
cover Page
(Governmenl Code Sections 84200-842t6.5)
SEEINSTRUCTIONS ON REVERSE
Type or print in ink,
Statement covers period
,,om .YC
through
Date ol election il apptic
(Month. Day. Year)
1. Type of Recipient Committee: A. Committees- Complete parts 1, 2, 3, and 4.
.~Officeholder. Candidate Controlled Committee [] BailotMeasure Committee
O State Candidate Election Committee C) Primadfy Formed
0 Recall
[] General Purpase Committee 0 Sponsored
O Small Con~butor Committee
O Political Pan'y/Contral Committee
0 Controlled
0 Sponsored
[] Primarily Fommd Candidate/
Officeh~der Committee
PERTINO CITY CL
ll.D.NUMBER
3. Committee Information
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
STREET ADDRESS (NO P.O. BOX)
AREA CODE/PHONE
2. Type of Statement:
I~1 Preelection Stalement
[] Semi.annual Statement
[~ Termination Statement
.~[ Amendment (Explain below)
Treasurer(s)
[] Quarterly Statement
[] Special Odd-Year Repod
[] Supplem~tal Preolection
Statement - Attach Fom~ 495
Only
NAME OF TREASURER
MAILING ADDRESS
CITY STATE ZIP CODE
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER. IF ANY
STATE ZIP CODE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E-MAlL ADDRESS OPTIONAL: FAX I E-MAIL ADORESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and lo Ihe bell of my knowledge the information contained herein and in the atlached schedules is flue and complete. I
certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct..
Dele ~ / -- ~ . r /9 .~S~natureofTr~m'a~s~slanlrrd~u~m'
Execuled on By
Executed on By
Oma
FPPC Folm 460
ecipient Committee
Campaign Slatement
Cover Page-- Part 2
Type or print in ink.
COVER PAGE - PART 2
Page '~ of ~
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEH0~)ER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL./~USINESS ADDRESS (NO. AND STREET) CITY STATE
6. Ballot Measure Committee
ZIP
NAME OF BALLOT MEASURE
BALLOT NO. OR LE~rER
OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE. OR PROPONENT
Related Committees Not Included in this Statement: List any commlttees
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.
~ENAME NUMBER
NAME OF TREASURER CONTRO~J. ED COMMI'I-rEE?
OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
7. Primarily Formed Committee List names of officeholder(s) or candidate(s) for
COMk~;; EE ADDRESS
[--~ YES ~'~ NO
STREET ADDRESS (NO P.O. BO~
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER
COMMITTEE ADDRESS
CONTROLLED COMMIT[EE?
E] YES [] .0
STBEETADORESS (NO P.O..O>
which this committee ts primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
[] SUPPORT
O OPPOSE
[-]SUPPORT
[]OPPOSE
[~SUPPORT
E]OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E]SUPPORT
[~OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE
Attach continuation sheets if necessary
FPPC Form 460 ($urte/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
Slate of Callf~la
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type et print In Ink.
Amounts may be rounded
to whole dollars.
Statement covers period
,rom 2t oct~ ~/
through / /'")OU- ~'c~-2)
Page__ of
SUMMARY PAGE
HAME OF RI. ER
Contributions Received
1. Monetary Contributions ..................... ....................... Sct~da~a. Une3
2. Loans Received ...................................................... scheo'~e e. L~e 7
3. SUBTOTAL CASH CONTRIBUTIONS ......................... addZJnes t+2
4.' Nonmonetary Contributions .................................... Schedule C. Une $
5. TOTAL CONTRIBUTIONS RECEIVED ................. ; ......... RdEUnos 3 + 4
Column A
(~:)M AttACHED SC~_IXJU~)
Column B
Ca~ENOAR YEaR
TOTAL TO DAIE
$ /'~3~
I.D. NUMBER
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
Expenditures Made
6. Payments Made ....................................................... ~ E. ~ 4
7. Loans Made ............................................................. Schedu~ ~ Une 7
8. SUBTOTAL CASH PAYMENTS .................................... A~dUnes ~ +
9. Accrued F_.xpensea (Unpaid Bills) ............................... Schadu/e F. L/ne
10. Nonmonetary Adjustment .......................................... Sct~du~e C. L, he
11. TOTAL EXPENDITURES MADE ................................ agd Unes e + 9 + Io
Current Cash Statement
12. Beginning Cash Balance ....................... Prevloussumma.'yPage. line 16
13. Cash Receipts ................................................... ~a. une 3above
14. Miscellaneous Increases to Cash ........................... Schedu~ I, Une4
15. Cash Payments .................................................. C,~um,,4. Une SsUove
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Une 15
ff INs Is a termination statement, Line 16 must be zero.
s ~3 ~
s 0
17. LOAN GUARANTEES RECEIVED ........................... Sd~edu/e a. Pa~ 2 $ C~
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ See,~sm~ons on ,'eve~e $ ~)
19. Outstanding Debts .........................AddUne2+Une9inCodumnBabove $ (~
To calculate Column B, add
amounts In Column A to the
corresponding amounts
from Column B of your last
repro1. Some amounts In
Column A may be negative
tigunes Ihal should be
subtracted from previous
pedocl amounts. Ii ~is Is
the first report being tiled
lot fi'ds calendar year. only
carry over the amounts
from Lines 2. 7. and 9 (il
any).
t/1 Ih~ 6/30
20. ContribuUon$
Received $ S
21. Expenditures
Made S $
711 Io Date
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
~f suUlect to vduam~ E~aeoatu~ Uae)
Date o! Election
(mrn/dd/yy)
1 / $
Total to Date
$
FPPC Form 460 (June/0l)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
'Since January 1, 2001, Amounts in this section may be
different from amounts reported in Column B.
chedule B - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
FUU. ~E, S~E~ ~E~ ~D ~P ~E
Statement covers period
from ~ ~'1] ~ ~'
through )~U /) '~r,,~/'
Type or print in ink.
Amounts may be rounded
to whole dollars.
OF LENDER
~1~ COI~,STTEF. ALSO ENt'r~ LO. NUMBER)
to IND DCOM []O'IH [] PTY [] SCC
IF AN INDIVIDUAL. ENTER
OUTSTANDING
{c) OUTST~J~IDING
AMOUNT PAID INTEREST
(b)
AMOUNT
BALANCE AT
CLOSE OF THIS
,
DATE DOE
$
$
DATE DUE
$
$
BALANCE
BEGINNING THIS
PERIOD
SCHEDULE B - PART 1
P,geo,
I.D. NUMBER
P) (g)
ORIGINAL CUMULATIVE
rlCO~ []oTH []Fry nscc
tO
OCCUPATION AND EMPLOYER
RECEIVED THIS
PERIOD
OR FORGIVEN
THIS PERIOD *
PAID
[] FORC~VEN
[] PAID
$
[] FORGIVEN
$
DATE DUE
SUBTOTALS $ $ $ $
PAID THIS
PERIOD
RATE
AMOUNT OF
LOAN
DATE INCURRED
DATE INCURRED
DATE INCURREd)
CONTRIBUTIONS
TO DATE
CALENDAR 'YEAR
$
PER ELECTION**
$
CALENDAR YEAR
$
PER ELECT1ON **
CALENDAR ~
$
PER ELECltON *~
Schedule B Summary
1. Loans received this period .................................................................................................................... $
(Total Column (b) plus unitemized loans 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 Summmy Page, Column A, Line 2.
(EmM (e)m
'Amounts Iorgiven or paid byJ
another party also must be J
repoded on Schedule A. I
*' If required. J
[t C~ldlx~x Cod~s ]
IND- Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee
FPPC Form 460 (June/Oil
FPPC Toll-Free Helpltne: 8661ASK-FPPC
S heduJe E
Payments Made
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from (~)C~"~ ~'~ [/ ~ /
through /~(/ // ~*~C) l
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
c;~u contdlx~on (explain nom'~netary)'
CVC civic donations
F1L candidate liang/oa~ot fees
FND fundmiMng eVents
independent expenditure supporting/opposing others (explain)'
LIT campaign litamture and mellings
MBR member communications
MTG meetings and appearances
DFC office expenses
PET petition circulating
PHO phone banks
PO(. polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
I-'ri/ pdnt ads
SCHEDULE E
I.D. NUMBER
PAD radio atrfime and production costs
FFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable alrtlrne and production costs
TRC candkJata travel, lodging, and meals
TRS sfafl/spousa travel, lodging, amd meals
TSF transler between committees of the same candidate/sponsor
VDT voter registration
WEB informafion technology costs (Internal, e-mail)
NAME AND ADDRESS OF PAYEE
i~ Co~,eart-rE~ .~_so Em'se t.D. mJMaER] CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
* Peymenl~ that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS
Schedule E Summary
1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $
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 madethis period. (Add Lines 1,2, and 3. Enter here and on the summary Page, Column A, Line 6.) ' TOTAL $ ~"~ ' ~'7...--
FPPC Form 460 (Junefl)l)
FPPC Toll-Free Helpline: 8661ASK-FPPC
S( heduie I Ty.e or print In Ink, SCHEDULE I
Miscellaneous Increases to Cash Amounts may be rounded Sta{=.entcovers period
SEE ,NSTRUC13ONS ON REVERSE through /t~ IJ 6 ~'C~z:) / page ~ ~ of ~
NAME OF FILER LO. NUMBER
DATE FULL NAME AND AODRESS OF SOURCE DESCRIPTION OF RECEIPT AMOUNT OF
RECEIVEO (IF COk~dlTrEE. ~ ENTER LO. NUM6ER} INCREASE TO CASH
Attach additional information on approprfately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Increases to cash of $100 or more this period ........................................................................................................... $
2. Unitemized increases to cash 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 $
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 8661ASK-FPPC
chedule A Type or print in ink. SCHEDULE A
Monetary Contributions Received Amounts may De rounaea Statement covers period
t° wh°le d°llars' from ~0,~ ~ i/-~.~O/ ij it
SEE INSTR~T~S ~ REVERSE through ~ / ) Page
N~E OF RLER I.D. NUMBER
i ·
IF AN INDIVIDUAL, ENTER ~ C~U~TIVE TO DA~ PER ELECTION
~ F~ NAME, STRE~ ADDRESS AND ZIP CODE OF CONTRIB~OR CONTRIB~OR ~UPATION AND EMPLOYER RECEIVED ~IS C~ENDAR YEAR TO
RECEIVED (F~OE~I.O.~R} CODE * (IF~O~O, ENTERN~ PERIOD (JAN. 1 - DEC. 3~) (IF RE~IRED)
DCOM
~OTH
~ PTY
~scc
~IND
~M
DOTH
~P~
DSCC
Q~ND
DCOU
DOTH
: ~ PTY
Dscc
~IND
Dcou
~OTH
~PTY
Dscc
SUBTOTAL $
Schedule A Summary
1. Amount received this period - contributions of $100 or more.
(Include all Schedule A subtotals.) ........................................................................................ i ................
2. Amount received this period - unitemized contributions of less than $100 .............................................
3. Total moneta~/contributions received this period. .
(Add Lines I and 2. Enter here and on the Summary Page, Column A, Line 1 .) TOTAL
'Contributor Codes
IND - Individual
COM - Recipient Committee
(other than PTY or SCC)
OTH - Other
PTY - Political Parly
SCC - Small Contributor Committee
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 8661ASK-FPPC