460 1st Pre-election ecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
from 7/1/2009
through 9/19/2009
1. Type of Recipient Committee: Atl Commttbess - Complsb Parts 1, 2, 3, and 4.
0 Officeholder, Candidate Controlled Committee ^ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
Q Recall Q Controlled
(asocompbreFans) Q Sponsored
^ General Purpose Committee (asucompebPees)
Q Sponsored ^ Primarily Formed Candidate!
Q Small Contributor Committee Officeholder Committee
Q Political Party/Central Committee fasocomp/etePert ~
3. Committee Information I.D. NUMBER
1319770
Orrin Mahoney for Council - 2009
STREET ADDRESS (NO P.O. BOX)
10940 Miramonte Road
CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino CA 95014 408-725-1767
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
P.O. Box 1071
CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino CA 95015 408-725-1767
OPTIONAL: FAX / E-MAIL ADDRESS
V
COVER PAGE
Date of election if appll e SEP 2 4 2009 9 1 °~?
(Month, Day, Year) F r Official Use Only
11/3/2009 C PERTINO CITY CL RK
2. Type of Statement:
0 Preelection Statement ^ Quarterty Statement
^ Semi-annual Statement ^ Special Odd-Year Report
^ Termination Statement ^ Supplemental Preelection
(Also file a Form 410 Termination) Statement -Attach Form 495
^ Amendment (Explain below)
TreasurerQs)
NAME OF TREASURER
Carolyn Krizek-Mahoney
MAILING ADDRESS
F'.U. Box 1071
CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino CA 95014 408-725-1767
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4.
Verification
I have used all reasonable diligence in preparing and reviewing this statement and
Signahrte otContrdling Oficatwlder, Candidate, State Measure PmponeM
ecipient Committee type or print In Ink. COVER PAGE-PART2
Campaign Statement ~ ~ ~ ~ ~ ~ • 1
Cover Page -Part 2
Page 2 of ~
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Orrin Mahoney
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Cupertino City Council
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
10949 Miramonte Road Cupertino, CA 95014
Related Committees Not Included in this Statement: Lrstanycommltteea
not included !n this statement that are corWo/led by you or are pr/marlty formed to receive
conMbutlons or make expenditures on behalf of your cand/dacy.
COMMfrTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
^ YES ^ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
^ YES ^ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO.OR LETTER I JURISDICTION I ^ SUPPORT
^ OPPOSE
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 Llsr names of
oftlceho/der(s) or candidate(s) for which this committee Is prlmaNly funned.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT
^ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT
^ OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets H necessary
FPPC Form 460 (JanuarylOS)
FPPC Toll-Free Helpline: 8881ASK-FPPC (888/275-3772)
State of California
Campaign Disclosure Statement type or print in ink. SUMMARY PAGE
Amounts may be rounded Statement covers period ~ -
Summary Page to whole dollars. ~ ~ ~ '
from 7/1 /2009 • -
SEE INSTRUCTIONS ON REVERSE through 9/19/2009 page 3 of 7
NAME OF FILER
I.D. NUMBER
Orrin Mahoney for Council - 2009 1319770
Contributions Received Column A
T
T
T Column B Calendar Year Summary for Candidates
AL
FiISPERIOD
O
(FROM ATTACHED SCHEDULES) CALENDAR YEAR
TOTALTO DATE Runnin In Both the State Prima and
9 ry
General Elections
1. Monetary Contributions ........................................... scneduie A, Lines 1099.00
$ $ 1,099.00
2. Loans Received ...................................................... schedule e, Line 3
10 000.00
10,000.00
1/1 through 6/30 7!1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS ....................... .. Add Unes 1 + 2 $ 11,099.00 $ 11,099.00 20. Contributions
Received $ $
4. Nonmonetary Contributions .................................... scneduie c, one 3 0.00 0.00
21. Expenditures
5. TOTALCONTRIBUTIONSRECEIVED ...........................AddLiness+4 $ 11,099.00 $ 11,099.00 Made $ $
Expenditures Made
6. Payments Made ....................................................... schedule E, Line 4 $ 2,664.74 $ 2,664.74
7. Loans Made ............................................................. schedule H, Line 3 0.00 0.00
O [~1 IpT/1T111 /111[-U 1111\/•~I~•IT(- .... - w / n!'IQ 7d ~ 7 ~1'~1d 7d
V. ~7VUIV InLl,llJllrl'111YILIYIJ ................................. ... NQO LI/IBS Ot/ .D ~1~~ "" a ~1"" •••
9. Accrued Expenses (Unpaid Bills) ............................ ... schedule F, Line 3 0.00 0.00
10. Nonmonetary Adjustment ........................................ .. saxidu-e c, Line 3 0.00 0.00
11. TOTALEXPENDITURESMADE ................................ Addunesa+s+lo $ 2,664.74 $ 2,664.74
Current Cash Statement
12. Beginning Cash Balance ....................... Previous summary Page, Llne 1s $
13. Cash Receipts ................................................... caumn A, Line s above
14. Miscellaneous Increases to Cash ........................... scneduie /, Line a
15. Cash Payments .................................................. caumn a, Line s above
16. ENDING CASH BALANCE .......... Add ones 12 + 13 + 1a, then subtract Line 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 inshucdons on reverse $
19. Outstanding Debts ......................... aadune 2+une s in caumn a above $
o.oo
11,099.00
.01
2,664.74
8434.27
~~
0.00
10,000.00
To calculate Column B, add
amounts in Column A to the
corresponding amounts
from Column 8 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).
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made`
(KSUbJ~CttO VOIUnLryExplntlltunLlmlr)
Date of Election Total to Date
(mm/dd/yy)
-~~ $
-J-~ $
`Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 480 (January/OS)
FPPC Toll-Free Helpline: 886IASK-FPPC (866!275-3772)
chedule A Type or print In Ink. SCHEDULE A
nmounis may oe rounaea
Monetary Contributions Received
h
d
l Statement covers erlod
p
~
- ~
to w
ole
o
lars. •
,
'
from 7/1/2009 •
~ .
SEE INSTRUCTIONS ON REVERSE throu h 9/19/2009
9 4 7
Page Of
NAME OF FILER I.D. NUMBER
Orrin Mahoney for Council - 2009 1319770
~~ FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IFCOMMI7TEE
ALSOENTERI.D.NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER AMOUNT
RECEIVED THIS CUMULATIVETO DATE
CALENDAR YEAR PER ELECTION
TO DATE
RECEIVED , CODE* QF SELF•EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED)
of eus~NESSI
01ND
9/11/2009 Robert Adams ^
o~H Self-employed 250
00 250
00
11669 Olive Springs Ct ^ Armstrong Retirement . .
Cupertino, CA 95014 ^ Pn' Planning
^scc
^IND
California Apartment Association PAC OcoM
9/11/2009
980 Ninth Street Suite 200
^OTH 500.00 500.00
Sacramento, CA 95814 ^ Pn'
^scc
01ND
9/15/2009 Ram Gopal
r ^coM Self-em to ed
P y
250
00
250
00
1 f)2.
i1 S nR Anna Rlv
rl nnrN ...._ _ 1:
_.._ _ . . .
_
Cupertino, CA 95014 ~ Pn; ~.uNni u~ i~ oanCi y
^SCC
^IND
^COM
^ OTH
^ PTY
^SCC
^IND
^COM
^ OTH
^ PTY
^SCC
SUBTOTALS 1,000.00
Schedule A Summary
Amount received this period -itemized monetary contributions.
(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 $
1,000.00
99.00
'Contributor Codes
IND -Individual
COM - Reapient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
1,099.00
FPPC Fonn 460 (January/O5)
FPPC Toll-Free Helpllne: 865/ASK-FPPC (866/275-3772)
vnn nr nrlnf In Inlr
sclnedu~e a -Part 1 -~ ~- -- ~..--- --- ~~---•
Amounts may be rounded
Statement covers period
.
Loans Received to whole dollars. 7/1/2009 ~ ~
~ ~ •
from •
9/19/2009 5 7
5EE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER I.D. NUMBER
Orrin Mahoney for Council - 2009 1319770
FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER e
OUTSTANDING
BALANCE
AMOUNT
AMOUNT PAID
OUTS ANDING
BALANCEAT
INTEREST
ORIGINAL
CUMULATIVE
OF LENDER
(IFC.OMMnTEE, ALBO ENTER I.D.NUMBElZ) (IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS
PERIOD OR FORGIVEN
" CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS
NAME OFeuslNESSj THIS PERIOD PERIOD LOAN TO DATE
Orrin Mahoney Retired ^ PAID CALENDARYEAR
10940 Miramonte Road s 0 s 10,000.0 0% s 1,100.0 s 10,000.0
Cupertino, CA 95014 ^ FORGIVEN RATE PER ELECTION**
0.00 10,000.0 0 1/1/2010 0 7/16/09
s s s s s
t~ IND ^ COM ^ OTH ^ PTY ^SCC DATE DUE DATE INCURRED
^ PAID CALENDAR YEAR
s a % s s
^ FORGIVEN RATE PER ELECTION **
S S S s S
to IND rl COM n OTH f-'1 PTV rl SCC DATE DUE DATE INCURRED
^ PAID CALENDAR YEAR
S S % s S
FORGNEN
^ RATE
PER ELECTION **
S 3 S S S
t^ IND ^ COM ^ OTH ^ PTY ^SCC DATE DUE DATE INCURRED
SUBTOTALS S 10,000.00 S 0.00 S 10,000.00 S 0.00
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.) ................................................
Enter the net here and on the Summary Page, Column A, Line 2.
*Amounts forgiven or paid by another party also must be reported on Schedule A.
** If required.
(Enter(ejon
Sdbdub E, Lina 3)
10,000.00
tContributor Codes
0.00
............. NET ; 10,000.00
(Mey bs a negriive number)
SCHEDULER-PART1
IND -Individual
COM - Reapient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 480 (January/05)
FPPC ToIF-Fn3e Helpllne: 886/ASK-FPPC (886/275-3772)
chedule E Type or print In ink. Statement covers period ~ ~v
Pa menu Made Amounts may be rounded 7/1/2009 • • J ~ '
y to whole dollars.
from
9/19/2009 6 7
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER
I.D. NUMBER
Orrin Mahoney for Council - 2009 1319770
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CiVP campaign paraphernalia/misc. IvBR member communications RAD radio airtime and production costs
CNS campaign consultants NITG 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
ND 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 VVEB information technology costs (intemet, a-mail)
NAME AND ADDRESS OF PAYEE
QFCOMMnTEE, AL&O ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
City of Cupertino
10300 Torre Avenue FIL 1,950.00
Cupertino, CA 95ui4
County of Santa Clara Registrar of Voters
1555 Berger Dr # A LIT 292.00
San Jose, CA 95112
Kwik Copy
10675 S. De Anza Blvd LIT 404.24
Cupertino, CA 95014
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS 2,646.24
Schedule E Summary
1. Itemized payments made this period. (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 made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL S
2,646.24
18.50
0.00
2,664.74
FPPC Form 460 (January/OS)
FPPC Toll-Free Helpllne: 866/ASK-FPPC (866/275-3772)