460 Debt 1st Pre-Election COVER PAGE - LONG FORM
Recipient Committee O=e Stamp
Campaign S~ment - FORM
(G~mment C~e ~ns ~2~ - ~216.5) ~1 p~
~~ ~~"~~U SEP 2 8 2001
07/01/2001 ~,Y~
~ 09/~/~00~ ~/A
~. Type of R~ipient Comm~==: 2. Ty~ of S~tement:
~ ~, Ca~]da~ ~ P~ma~ ~o~ Candidate[ ~ P~le~ion Statem~t ~ Oua~e~y S~tement
~ntmil~ Commi~ ~holder Commi~ ~ Semi-annua~ S~tement ~ S~al ~d-Year
~ I~on S~tem~t ~ Supplemen~l Pro =~e~i~
~ ~llot ~easure ~mm~ee ~ General Pu~e C~m~ ~ ~e~ment (Explain ~ow) S~tement * A~ Form 495
O Primarily F~ O S~n~red
O ~ntmll~ O Broad
O
3. Commiffee Info~ation I''°'-~o~ Tmasure~s)
Commi ~Cee Dolly Sandova1
10720 Alderbrook Lane
STREET ~DD~E~ (NO P.O. BOX) ~TY STATE ZIP COOE AREA COD~HONE
10720 Alderbrook Lane San Jose CA 95014 (408)725-8939
CITY STATE Z~P COOE ARE~ COOEA:VrK)K~ NAME OF A~SI~TAJ~FF TRE/~URER, IF ANY
Cupertino CA 95014 (408) 725-8939
UNUNG ADORESS (iF DIFF~ NO. AND STREET OR P.O. ~OX ~NLING ~DORESS
( )
( ) /
S/CCW - PCAB05 01380 (Rev. 9/99) State of California Fair Political Practices Commission.
COVER PAGE - PART
Recipient Committee c., LIFO RNIA 4 6 0
Campaign Statement
Cover Page - Part 2
4. Gillc,~holder or Candidate Controlled Committee 5. Ballot Measure Committcc
Ms. Dolores Sand. oval
Santa Clara Cnty Brd of Sup, Dist 5 - Debt Retirement
RESIDENTIAL/~USINIESS ADORE~ (NO. AND STREET) cri'Y STATE Z~P COOE
Identify the controlling offlceheider, candidate, or state measure proponent, ff any.
10720 Alderbrook Lane Cupertino CA 95014 WEO~OF,C~XOFR. C~m~TEOR.~m~e~
Related Committees Not Included in this Statement: ust any comm~ees
not included in this consolidated statement that are controlled by you ~' which am p~fmarily OFRCE SOU(~T
I
formed to receive conb'ibotfons or to make expenditures on behalf of your candidacy.
~yn~ o.~ ~o.n.y sa_.~o~,~ .
uanuovax ]:or clCy counciz 853.028/1236761 6. Primarily Formed Committee
.~ME Or W;EASUOFH CONT~U~D ceMMn-r~? NAME Or OmoFHO~EH OR DANaEATE ~ SOuc+r~ OR HaD
;-Ct Hoard=man/Maria Smith
10720 Alderbrook T.ane
C~TY STATH ZIP COOE AREA COOE/PHON~ ~ OF OFFICEHOI..D~R OR CANDIDA"rE OFFICE ~OUGHT OR HELD
Cupertino C~ 95014 (408) '725-8939
7. Verifie~ation
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 tree 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 By
Executed on By
DATE ~GNATUR~[ OF CONTROLLING O~FICEHOLDER. CANDIDATE, STATE MEASURE PROPONENT
SUMMARY PAGE
Campaign Disclosure Statement ~ cove~ pe~od CA L IFOR~,I '~ 4 6 0
Summaqf Page ~ 07/01/2001 FORM
~ 09/22/2001 Page , 3 of 4
NAME OF FILER I.D. NUMBER
Ms. Dolores Sandoval, Dolly Sandoval for Supervisor - Debt Retirement Committee 990787
Contributions Received Column A Column B* Column C
TOTAL ]HIS PERIOD TOT/U. Pf~'VIO~S PERIOD TOTEM. TO DATE
(FROM ATTACHED SCHEDULES) (SEE NOTE ~LOMO (ADO COI.UMN~ A + B)
1. Monetary Contributions ................................................................... Schedule A, Line 3 $O . 00 $ 1,150. 00 $ 1,150.00
2. Loans Received .............................................................................. ,~hedule B, Line 7 0. O0 110,000.00 110,000.00
3. SUBTOTAL CASH CONTRIBUTIONS ................................................ AddLinesl+2 $ 0.00 $ 111,150.00 $ 111,150.00
4. Non-monetary Contributions ........................................................... Schedule C, Line 3 O . O0 O . O0 0. O0
5. TOTAL CONTRIBUTIONS RECEIVED ............................................... AddLines3+4 $ 0.00 $ 111,150.00 $ 111,150.00
Expenditures Made
6. Cash Payments .............................................................................. ScheduleE, Une4 $ 0.00 $ 180.65 $ 180.65
7. Loans Made .................................................................................... Schedule H, Line 7 O . 00 O . 00 0.00
8. SUBTOTAL CASH PAYMENTS .......................................................... AddLines6+7 $ 0.00 $ 180.65 $ 180.65
9. Accrued Expenses (Unpaid Bills) .................................................... Schedule F, Une 3 0.00 0,00 0.00
10. Nonmonetary Adjustment .............................................................. Schedule C, Line 3 O . O0 O . O0 0. O0
11. TOTAL EXPENDITURES MADE ................................................ AddLinesS+9+10 $ 0.OO $ 180.65 $ 180.65
Current Cash Statement
12. Beginning Cash Balance ........................................ Prev/ous Summary Page, Une 16 $ 3,182.61
· From previous statement Summary Page, Column C.
13. Cash Reoeipts ....................................................................... ColurnnA, Line3above 0.O0 However, if this is the first report filed for the calendar year,
Column B should be blank except for Loans Received (Line 2),
14. Miscellaneous Increases to Cash ................................................... Schedule I, Line 4 5.0 5 Loans Made (Line 7), and Accrued Expenses (Line 9).
15. Cash Payments ..................................................................... Column A, Line 8 above O . O0
16. ENDING CASH BALANCE ................ Add Lines12 +13 +14, then subtrect Line15 $ 3,187.66
If this is · Termination Statement, Line 16 must be zero.
Summary for Candidates in Both June
17. LOAN GUARANTEES RECEIVED ............................ Schedule B, Pa~t 1, Column (b) $ 0. O0 and November Elections
Cash Equivalents and Outstanding Debts 111 thru 6/30 711 to Date
18. Cash Equivalents .......................................................................................................... $ 0. O O 20. Contributions
Received $ 0 0
19. Outstanding Debts ........................................ Add Line 2 + Line 9 in Column C above $ 110,000. O 0 21. Expenditures
Made ..... $ 0 O
SICCW - PCAB0501380 (Rev. 9/99)
SCHEDULE I
Schedule, ~ ~o~mm ~ cA L I FO R NI~, 4 6 0
Miscellaneous Increases to Cash ~o~ o7/oz/~ooz F'OR~
through 09/22/2001 Page 4 of 4
NAME OF FILER LD. NUMBER
Ms. Dolores Sandoval, Dolly Sandoval for Supervisor - Debt Retirement Committee 990787
FULL NAME AND ADORESS OF SOURCE
D~TE 0~ C~MMITTEE. IN ADDISON TO C~MMfT'IT~ ~ AND ~ ENT~ LO. NUMBER DESCRIPTION OF RECEIPT AMOUNT OF
RECEIVED o~ ~ NO m. ~m~ H~S aEr~ ,~s~. Em~,¥mr~.~u~E~*s ~ & ,~O~ESS) INCREASE TO CASH
SUBTOTAL $ 0.00
Miscellaneous Increases to Cash Summa~,
1. Increases to cash of $ 100 or more this period .................................................................................... $ 0.00
2. Increases to cash under $100 this period.
(Do not itemize.) ................................................................................................................................ $ 5.05
3. Total of all interest received this period on loans made to others.
(Schedule H, Part II (b).) .................................................................................................................... $ 0.0 0
4. Total miscellaneous increases to cash this period.
(Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 15.) ........................... TOTAL $ 5.05