460 Recipient Committee Campaign Statement Debt Retirement 06-30-2009 Reci ientCommittee covERPAt
p Type or print in ink. e
Campaign Statement ~ ~ • 1
Cover Page ~
(Government Code Sections 84200-84216.5) J U L 2 9 2009
Statement covers period Date of election if appl cable:
(Month, Day, Year) P 9e 1 of 6
from 01/01/2009 For Official Use Only
CU ERTINO CITY CLE K
SEE INSTRUCTIONS ON REVERSE through 06/30/2009
1. Type of Recipient Committee: All Committees -Complete Parts 1, z, 3, and a. 2. Type of Statement:
?x Officeholder, Candidate Controlled Committee ? Primarily Formed Ballot Measure ? Preelection Statement ? Quarterly Statement
Q State Candidate Election Committee Committee ®Semi-annual Statement ? Special Odd-Year Report
Q Recall Q Controlled Termination Statement
(Also CompletePaR5) Q Sponsored ? ? SupplementalPreelection
(Also file a Form 410 Termination) Statement -Attach Form 495
(Also Complete Parrs)
? General Purpose Committee ? Amendment (Explain below)
Q Sponsored ? Primarily Formed Candidate/
Q Small Contributor Committee Officeholder Committee
Q Politit:al PartylCentral Committee (Also complefePan7)
3. Committee Information I.D. NUMBER Treasure s
990787
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER
Dolly Sandoval for Supervisor-Debt Retirement Committee
Ms. Dolly Sandoval
MAILING ADDRESS
10720 Alderbrook Lane,
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHO~
10720 Alderbrook Lane, Cupertino CA 95014 (408) 725-893
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Cupertino CA 95014 (408) 725-8939
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. 80X MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHO~
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
4. 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
Executed on ~ " ~ ~ d `~y By '
Date 31p eof reasurerorAssistantTreeaurer
, 1. ~i ~ '
Executed on By
Sig ofCantrollirgOfficeho er, didete,StateMeasureProponentorResponsibleOfficerofSponsor
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Date Signature ofConUOllingOfficeholder,Candidate,StateMeasureProponent FPPC F~ 't60 (Januaryl
FPPC Toll-Free Helpline: 8661ASH (865/275-37
:.ate of Califor
Type or print in ink. COVER PAGE-PART
Recipient Committee
Campaign Statement ' ~ ~ ~
Cover Page -Part 2
Page 2 of 5
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOTMEASURE
Dolores (Dolly) Sandoval
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ? SUPPORT
? OPPOSE
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
10720 Alderbrook Lane, Identify the controlling officeholder, candidate, or state measure proponent, if am
Cupertino CA 95014
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
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 OFFICE SOUGHT OR HELD DISTRICT N0. IF ANY
contr/butlons or make expenditures on behalf of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee usr names of
oflficeholder(s) or candidate(s) for which this committee is primarily formed.
? YES ? NO
COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
? SUPPORT
? OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
? SUPPORT
? OPPOSE
COMMITTEE NAME I.D. NUMBER
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ? SUPPORT
? OPPOSE
NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
? YES ? NO ? OPPOSET
COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary
FPPC Form 460 (Januaryl
FPPC Totl-Free Helpiine: 866/ASK-FpPC (8661275-37
ate of Califor
Campaign Disclosure Statement Type or print in Ink. SUMMARYPA~
Amounts may be rounded Statement covers period ~ -
Summary Page to whole dollars. ~ ~ '
from 01/01/2009 ~ -
SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 3 of 6
NAME OF FILER
I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990787
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDARYEAR
(FROM ATTACHEDSCHEDUIFS) TOTALTODATE Running in Both the State Primary and
General Elections
1. Monetary Contributions scnedu/eA, Linea $ $o.oo $ $o.oo
1/1 through 6/30 711 to Date
2. Loans Received scnedu/e e, Lrne 3 So. oo $110, 000.00
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 $ $0.00 $ $110,000.00 20. Contributions
Received $ $
4. Nonmonetary Contributions schedule c, Line 3 $o. oo $o. 00
21. Expenditures
5. TOTALCONTRIBUTIONSRECEIVED ................•..........Addl.ines3+4 $ $o.oo $ $110,000.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made scheau/eE,Line4 $ $o.oo $ $o.oo Candidates
7. Loans Made Schedule H, Line 3 $0.00 $0.00
_
8. SUBTOTAL CASH PAYMENTS Add Liness+7 $ $0.00 $0.00 ~.uriu~anve cxpendiiures made=
$ (If SubJect to Voluntary Expandlture Llmlt)
9. Accrued Expenses (Unpaid Bills) ...............................schedule l;Line3 $o.oo $0.00
Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................scnedu/ec,Line3 $o.oo $o.oo (mm/ddlyy)
11. TOTAL EXPENDITURES MADE ................................Addcinesa+s+lo $ $o.oo $ $o.oo ~
Current Cash Statement $
12. Beginning Cash Balance Previous summary Page, Line 16 $ $26, 013.97
To calculate Column B, add
13. Cash Receipts column a, Line 3 above $ o . o o amounts in Column A to the
corresponding amounts *Amounts in this section ma be different from amounts
14. Miscellaneous Increases to Cash schedule 1, Line 4 $5.81 from Column B of your last reported in Column B. y
15. Cash Payments column A,Linesabove $o.oo report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract line 15 $ $26, 019.68 figures that should be
subtracted from previous
If this is a termination statement Line 16 must be zero. period amounts. If this is
the first report being filed
17. LOAN GUARANTEES RECEIVED scnedu/e e, Part 2 $ $o.oo for this calendar year, only
carry over the amounts
Cash E uivalents and Outstandin Debts from Lines 2, 7, and 9 (if
q g any).
• $o.oo
18. Cash Equ?valentS See instructions on reverse $
19. OUtstanding Debts Add line 2 +Line 9 in Column B above $ $110, 000.00 FPPC Form 460 (January/~
FPPC Toll-Free Helpline: 8881ASK-FPPC (8881275-37'
Type or print in ink. SCHEDULER-PAR'
Schedule B -Part 1 Amounts may be rounded Statement covers period
Loans Received to whole dollars. ~ ' ' ~ ~
from 01/01/2009 ~
SEE INSTRUCTIONS ON REVERSE through 06/30/2009 page 4 of 6
NAME OF FILER
I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990787
FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT (c) OUTS ANDING INTEREST ORIGINAL CUMULATIVE
OF LENDER OCCUPATION AND EMPLOYER BALANCE AMOUNT PAID gALANCEAT
(IFSELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIO
(IFCOMMITTEE,ALSOENTERI.D.NUMBER) NAME OF BUSINESS) PERIOD THIS PERIOD"' PERIOD LOAN TO DATE
Ms. Dolores Sandoval Councilmember ? PAID CALENDAR YEP
City of Cupertino $ $ Szo,ooo.oo o~ $ Szo,aoo.oo $ So.
10720 Alderbrook Lane ? FORGNEN RATE PERELECTIOP
Cupertino CA 95014 5 Szo,ooo.oo $ So.oo S S 09/30/1999 $
t® IND ? COM ? OTH ? PTY ? SCC DATE DUE DATE INCURRED
Ms. Dolores Sandoval Councilmember ? PAID CALENDAR YEP
City of Cupertino $ $ 5zs,ooo.oo % Szs,ooo.oo So.
a s
10720 Alderbrook Lane ? FORGIVEN RA7e PERELECTIOP
Cupertino CA 95014 S Szs,ooo.oo S So.oo $ $ 02/29/2000 g
T® IND ? COM ? OTH ? PTY ?SCC DATE DUE DATE INCURRED
Ms. Dolores Sandoval Councilmember ? PAID CALENDAR YEP
City of Cupertino 5 $ Sao,ooo.oo % S Sao,ooo.oo S So.
10720 Alderbrook Lane ? FORGIVEN PERELECTIOP
Cu ertino CA 95014 Sao,ooo.oo So.oo
p g S g 5 11/06/2000 S
t® IND ? COM ? OTH ? PTY ?SCC DATE DUE DATE INCURRED
SUBTOTALS $ So.oo$ So.oo$ Ses,ooo.oo$ So.oo
(Enter (e)on
Schedule B Summary Schedule E, Line 3)
1. Loans received this period $ So. 00
(Total Column (b) plus unitemized loans of less than $100.) tContributor Codes
So. 00 IND-Individual
2. Loans paid orforgiven this period $ COM-Recipient Committee
(Total Column (c) plus loans under $100 paid orforgiven.) (other than PTY or SCC)
(Include loans paid by a third party that are also itemized on Schedule A.) OTH -Other (e.g., business entiq
PTY -Political Party
' S o . 00 SCC -Small Contributor Committer
3. Net change this period. (Subtract Line 2 from Line 1.) NET $
Enter the net here and on the Summary Page, Column A, Llne Z. (Maybeanegativenumper)
"Amounts forgiven or paid by another party also must be reported on Schedule A.
" If required FPPC Forr+~ X60 (January/l
FPPC Toll-Free Helpline: 888/ASK-F !886/275-3T
Type or print in ink. SCHEDULER-PAR'
Schedule B -Part 1 Amounts may be rounded Statement covers period ~ ~
Loans Received to whole dollars. ~ ~ '
from 01/01/2009
SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 5 of 6
NAME OF FILER
I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990787
IF AN INDIVIDUAL, ENTER a (b) (c) (d) (e? (gJ
FULL NAME, STREET ADDRESS AND ZIP CODE OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE
OF LENDER BALANCE RECEIVED THIS BALANCEAT
(IFCOMMITTEE,ALSOENTERI.D.NUMBER) (IFSELF-EMPLOYED, ENTER BEGINNING THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIO
NAMEOFBUSINESS) PERIOD THIS PERIOD" PERIOD LOAN TO DATE
Ma. Dolores Sandoval Councilmember
? PAID CALENDARYEP
City of Cupertino Slo,ooo.oo Sio,ooo.oo So,
S S $ g
10720 Alderbrook Lane FORGIVEN RATE
? PER ELECTIOP
Cupertino CA 95014 S>o,ooo.oo So.oo
g g S $ 11/13/2000 S
t® IND ? COM ? OTH ? PTY ?SCC DATE DUE DATE INCURRED
Ms. Dolores Sandoval Councilmember ? PpID CALENDAR YEP
City of Cupertino 6 S Sls,ooo.oo % S S>s,ooo.oo S So.
10720 Alderbrook Lane RAre
? FORGIVEN PERELECTIOi`
Cupertino CA 95014 S Sls,ooo.oo S So.oo 3 S 11/18/2000 S
1.
~ U IND ? COM ? OTH ? PTY ?SCC DATE DUE DATE INCURRED
? PAID CALENDARYEP
s a % s s
? FORGNEN RATE PER ELECTIOD
t? IND ? COM S $ S S S
? OTH ? PTY ?SCC DATE DUE DATE INCURRED
SUBTOTALS $ So.oo$ So.oo$ Sze,ooo.oo$ So.oo
(Enter (e)on
Schedule B Summary s~,ea~,leE,Line3,
1. Loans received this period $ so.oo
(Total Column (b) plus unitemized loans of less than $100.) tContributor Codes
2. Loans paid orforgiven this period $ So. oo IND-Individual
COM -Recipient Committee
(Total Column (c) plus loans under $100 paid orforgiven.) (other than PTY or SCC)
(Include loans paid by a third party that are also itemized on Schedule A.) OTH -Other (e.g., business entitJ
PTY -Political Party
3. Net change this period. (Subtract Line 2 from Line 1.) NET $ $o. oo SCC-Small ContributorCommittet
Enter the net here and on the Summary Page, Column A, Line 2. (Meybeanegaetl"e"°"'neo
"Amounts forgiven or paid by another parry also must be reported on Schedule A.
If required FPPC Forr* X60 (January/I
FPPC Toll-Free Helpline: 866/ASK-F '866/275-37'
Schedule I Type or print in ink. SCHEDU
Miscellaneous Increases to Cash Amounts may be rounded Statementcovers period
to whole dollars. ~ ~ ~ I ~
from 01/01/2009 ~
SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 6 of 6
NAME OF FILER
I.D. NUMBER
Dolly Sandoval for Supervisor-Debt Retirement Committee
990787
DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF
RECEIVED (IF coMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Itemized increases to cash this period $ so.oo
2. Unitemized increases to cash of under $100 this period $ s5. si
3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) $ so.oo
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) TOTAL $ Ss.ei
FPPC Fore 'SO (Januaryll
FPPC Toll-Free Helpline: 886/ASK-F. , ,866/275-3T