Termination Amendment cipier t Committee
Campaign Statement
Cover Page
(Govemment Code Sections 84200-84216.5)
Type or print in ink.
SEE INSTRUCTIONS ON REVERSE
Statement covers period
through
1. Type of Recipient Committee: All Committees- Complete Parts 1,2, 3, and 4.
Officeholder, Candidate Controlled Committee
O State Candidate Election Committee
O Recall
(Aleo Complete Part 5)
[] General Purpose Committee O Sponsored
O Small Contributor Committee
O Political Party/Central Committee
3. Committee Information
I Date of election if appli
(Month, Day, Year)
2. Type of Statement:
'ERTINO CITY CL
[] Ballot Measure Committee
O Pdmadly Formed
O Controlled
O Sponsored
(Aisc Complete Part 6)
[] Primarily Formed Candidate/
Officeholder Committee
(Aisc Complete Part 7)
[] Preelection Statement
[] Semi-annual Statement
[~ Termination Statement
[] Amendment (Explain below)
COVER PAG~
/ of ~
NUMBER
COMMITTEE NAME (OR CANDIOATE'S NAME IF NO COMMITTEE)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE
Treasurer(s)
For Official Use Only
[] Ouaderly Statement
[] Special Odd-Year Report
[] Supplemental Preelection
Statement - Attach Form 495
NAME OF TREASURER
MAILING AODRESS
/o
AREA CODE/PHONE
CITY STATE ZIP CODE
NAME OF ASSISTANT TREASURER, IF ANY
REA CODE/PHONE
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 / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
Verification
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 true and complete. I
certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Treasurer
Executed on By
Date Signalure of Controlrmg O~icetloldef, Candidate, Stale Measure Protoonenl
Executed on By
Dale . Signatumol Con~rollk~g Officeholder. Candidate, Stale Measure Propoint FPPC Form 460 (J uned01)
FPPC Toll-Free Relpllne: 866/ASK-FPPC
Slate of Callfornle
ecipient Committee
Campaign Statement
Cover Page -- Part 2
Type or print in Ink.
COVER PAGE - PART 2
Page ~ of "~
5. Officeholder or Candidate Controlled Committee
NAME OF O,..~ICEHOLDER OR CAND,~IDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPUCABLE)
RESIDENTIAIJ~)USINESS ADDRESS {NO. AND STREE~ CiTY · STALE ZIP
6. Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER
IJURISDICTION I E] SUPPORT
I [] OPPOSE
Related CommiUees Not Included in ~is S~tement: L;s~.uyco~m~,..
not I~l~ ~ ~ls etate~nt that am ~n~ by y~ or ~ pHma~ly fo~ to re~i~
~ons or ma~ e~dl~m~ ~ ~aff of ~ cand~.
C~l ~=E~ I.D. N~BER
NAME OF TREASURER
COMMH i~-E ADDRESS
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
CONTROLLED COMMI~I'EE?
[] YES D.o
STREETADORESS (NO P.O. BO)~
CITY STARE ZIP CODE AREA CODE/PHONE
COMka I I ~:E NAME I I.D. NUMBER
NAME OF TREASURER I CONTROl.LED COMMITTEE?
[] YES [] NO
COMMITTEE ADDRESS STREET ADDRESS (NO RD. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
7. Primarily Formed Committee Llat names of offlceholder(s) or candidate(s) for
which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
)FFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
)FFICE SOUGHT OR HELD
[] SUPPORT
[] OPPOSE
[] SUPPORT
[] OPPOSE
r-i suPPORT
[] OPPOSE
[] SUPPORT
[] OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (Junef01)
FPPC Toll. Free Helpllne: 866/ASK-FPPC
State of California
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print In ink.
Amounts may be rounded
to whole dollars.
Statement covers period
,rom
through
SUMMARY PAGI~
Page ~ ol -~
NAME OF FILER
Contributions Received
1. Monetary Contributions ................... : .......................
Sd~d~e A. Une 3
2. Loans Received ...................................................... Sd~du~ B. U.e 7
3. SUBTOTAL CASH CONTRIBUTIONS ......................... ,,[ddL/nest+2 $ ~
4.' Nonmonetary Contn'butions .................................... ~ c,/./ne 3
5. TOTAL CONTRIBUTIONS RECEIVED ................. ~ ......... ~d/.~es3,4 $ (~
Column A Column B
I.D. NUMBER
Calendar Year Summm'y ~or Candidates
Running in Both the State Primary and
General Elections
111 I1~ 6/30 711 to {:)ate
20. Conlribulions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
Expenditures Made
6. Payments Made .......................................................
7. L~ans Made ...... .~a,~ ~. i ~n.
8. SUBTOTAL CASH PAYMENTS .................................... ~ddUnes 6 + 7
9. Accrued Expenses (Unpaid Bills) ............................... ScheduteE L/ne
10. Nonmonetary Ad]ustmenl .......................................... Sc~du~e C,
11. TOTAL EXPENDITURES MADE ................................ ,~dd U~es S + 9 +
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Sumnmq/ Page, Line 16 $
13. Cash Receipts ................................................... ~A. une,~abovs
14. Miscellaneous Increases !o Cash ........................... so,edSel, Une4
15. Cash Payments .................................................. C,o~umn ~. Uma above
16. ENDINGCASHBALANCE .......... ,~ddUnes ~2 + ~3+ ~4, ~ subtracfL~a 15 $
ff 8'Js Is a terminagon statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ........................... Sd~e~,~e ~. Pa, 2 $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ Se~k~slr~ctk~sonreverse $
19. Outstanding Debts ......................... Addl. lne2+UneglnColumnBabove $
To calculate Column B, add
amounts In Column A to the
corresponding amounts
h'om Column Bot your lasl
repod. Some amounts In
Column A may be negative
figures that should be
subtracted from previous
period amounts. I! this is
the first report being filed
for Ibis calendar year, only
cany over Ihs amounts
Irom Lines 2, 7, and 9 (ii'
any).
22. Cumulative Expenditures Made'
Date of Election Total to Date
(mm/dd/yy)
l/ / $
-/ i $
/ / $
/ ~ $
/ /.__ $
/ /.__ $
*Since Janua~/ 1, 2001. Amounts in this section may be
different bom amounts reported in Column B.
FPPC Form 460 (June/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC