Sunteți pe pagina 1din 9

Recipient Committee Campaign Statement Cover Page

GOVernmenl Cotle
Sections

Type

or

print

in Ink

bal II 1

p Ifr

l
a

l T Li C 1
Statement
covers

v 84216 842g0 perlotl


Oate of election If

applicable

qni

from

Month Day Year

M1

73

Elii 3 5

Page
For oaiciel

of
Use

9
Only

E 5

INSTRUCTIONS ON REVERSE

thFOOgh
all

UQ
1 z 6
aaa 4

f lP
2

Type

of

Recipient

Committee

eamPlale commmeee

rta P

ficeholtleu O Cantlidate GDntmlled Committee


OState Cantlidate Election GOmmlltee
O
Recall faso comprme Parcsl

Primarily FOrmetl Ballot Measure


Committee

Type of Statement vJ Preelection Statement


annual5latement Semi Termination Statement

puaderly Statement

O Conlrolle0

Spedal

Year Odtl

Report

O Sponsored
lam cpmpMrePane

Supplamenlal

Preelection

Also

flea Form 410

Termination

Allach Statement FOlm 495

Genaral Purpose COmmitlae

Amentlmenl

Explain below

O Sponsoretl

OSmaIICOnlribulorCOmmittee
O Political Party Committee Central
3

Primadly FOrmetl Gantlitlatel fseholder 0 Committee


faao ComPlam Pann

Committee Information
F LOMMITTF

D I

NuMaIOO
Vim

Treasureris
NAME OF TREASUREtt

cc

NAME

TOR

CANOIDPTPS

NAM IF NO COIAMH

I6E

7 U
PREA CODE PHONE

7 rrh L iJ C

2 t 12LCiY
MMLING ADDRF65

6TRyEET ADDREY59P D O Np OXD


CIl

Cn

aTATE

21P

CODE

vnanQ
IF DIFFERENT
ND

STATE

21P

CODE

PREA

PHONE COD

NPME OF ASSISTANT TREPSUNE

IY 9L F

c
AND

42

cuz a aa
MPILING

MAILG RE56 9ADp Gs LX


Y

STREET OR P ROX O

PODREfi

CITY

STATE

ZIP COUE

ANEA COOEPIIUNE

LIiY

RTATE

ZIP

CODE

AREA

PHONE

r71 g l7t
OPTIONAL FAK I GMPIL POORE66

Lg 9i
OVTIONPL
FA

MNL E AppRE66

Verification
I have used all reasonable under

tliligence

in

preparing

penally

of

perjury
on

untler the laws otthe State of California that Ne

I antl reviewing this statement antl lp the best of my knnwletlge the Information wnlainetl herein and in the attachetl schetlules Is true antl complete foregoing is bue and wrrect

certify

nea EXec

A ifr 1 2
pals pale
l1 cY

t v

0 G

ar

Lx I YI
big

lL t GL

SlgnalureolTmasuerorAaalaleMimssum

ExeIXRetl

an

RY

d tpmenim 6laleMeasureP CanQtlale mMtle NdImg OR RnpansAle OlAm Spansn

EXeCNetl

an

6 CV t
Dale Wye

ll n

aY

a7 t i
6 SlgrelvedGnlmling OlllteltoNar GNltlale
sum

eM Vm

EXecutetl

cn

aY

SlaleMeasum Landtlale ygneWeMCm4ding Ofiglpl4er Pmpmenl


FPPC

FPPC Fortn O6a

Januaryla6

FPPC 6 Ta4Free HelPline B661RSK 86613 3 p State of Calllornla

i
Type
or

print

In Ink

COVER PAGE PART2

Recipient Committee Campaign Statement


Cover

Page

Part 2
Page a

of

Officeholder

or

Candidate Controlled Committee

Primarily
NA

Formed Ballot Measure Committee

NAME OF OFFICEHOLDER OR

C7 s r
OFFIC SOUGHT OR HELD INCWDE LOG
ON AND DISTRICT NUMBER IF

ANDIDATE C

EOF BALLOT MEASURE

APPLICABLE

ORLET BALLOTNO

JURISDICTION

SUPPORT
OPPOSE

y
RESIOENTIAUBUSINESS
ADDRESS

I
NO AND STREET

O H
O

I C GL nGy r

STATE

ZIP

c1i

Itlenlify

M1O

confrolling pfflceholtlee

can

ate

or

state measure

proponent

If any

NAME OF OFFICEHOLDER CANDIDATE OR PROPONEN

Related Committees No Included in this Statement

i u any mmmees

nt not inclutled in Ibis sla6em that are conholled by you or are primarily armed fo receive o conlrihudons or make enpendhures on hehal yow untlidacy
COM EE NAME ID NUMBER

OFFICE SOUGHT OR HELD

DISTRICT NO

Nv

NAMEOFTREASUREfl

CONTROLLEDCOMMITTEE
YES

tee Formed CandidatelOfficeholder Commi usf names pnieehal eys or candmafe or whmn mis mmmhfee is primary mrmea sl

arily PPIq
NAME

pr

NO

OF OFFCE

ER OR

CANDIDATE

OFFICE SOUGHT OR HELD

COMMITTEEADDRE55

STREETA

E55

NO

O P

BO

SUPPORT

OPPOSE

GITT

STATE

ZIP CODE

PHONE AREA CODE

NAME OF OFFICEHOLDER OR CANDIDA

OFFICE SOUGHT OR HELD

sUPPURT OPPOSE

COMMITTEENAME

LO

RER NAME OF OFFICEHOLDER OR CANDIDATE

OFFICE SOU

OR HELD

SUPPORT

OPPOSE

NAME

OF TREASURER

CONTROLLED COMMA

NAME OF OFFICEHOLDER OR CANDIDATE

OFFICE SOUGHT OR HELD

PORT
OPPOSE

I
COMMITTEEADORE55 STREETADORE55

TES

NO

O NO P BOX

CITY

sTATE

ZIP CDOE

AREA COOEIPHONE

aeh p confinndlfon sheets iI n SSdry

FPPL Form 4601January106 FPPL 3 A6K 3169 Free FPPL Toll Helpllne 666 1866 Stafe I California

Campaign Disclosure Statement Summarypage

TYPa

or

pdnl

In Ink

SUMMARY PAGE Statement


from
covers

Amounts may be muntletl

to whole tlollars

perlatl

03

sEE IN6TRUCTIONS nN REVERSE


NNME OF FILER

lbrpugh

8 U

Pdge
ID

J
NUMBER

of

1
CPIUmnA ColumnB
a e ToTnvoare

10 7 7
Calendar Year

Contributions Received
1

Summary for Candidates

aeERba x k

IrRnanvnweowxeoutESl

Running

in Bolh the State

Primary
7n

and

General Elections Monetary Contributions


Loans Received
SUBTOTAL CASH CONTRIBUTIONS
scnadwa a uneJ
scrvcdwa

Nly
to

2 3
4

tinee

z Addunesf
schedme

Gf

9 00 r 6 7
C
7 i

000
g

Iame6rv

arao

m Data

Y7jl r

zD Contributions Receivetl 21

Nonmonetary

Contributions

c uneJ

Expentlitures
Matle

TOTAL CONTRIBUTIONS RECEIVED

Am usesJ a

Expenditures Made
B
7

Expenditure Limit Summary


soneeme E unea
scneeme r uneJ Aaa uaessv

for State

Payments Made
Loans Made

33

59

8lc

Candidates

e 9

SUBTOTALCASH PAYMENTS
Accruetl

vim 33 l 5

S9 i 9N
4 R7l

Z2 Cumuletlw

Ezpantlltures Matle umul cuavolaoervewaoana msaal


Total to Bate

Expenses Unpaid Bills

scbeeure r uaeJ smcemequneJ

7
5

Date of Eledlon

ustment 10 NOnmoneta ry Ad I

Otltyy mm

tD e 11 TOTAL EXPENDITURES MADE Add unese

10

4U

IZ

3 g

Current Cash Statement


12

Beginning

Cash Balance

Previouaummary Pape line is


Commn A tinaJ shove iinee schedWe
cmumn

y
To calwlafe Column B atltl

13 Gash

Receipts

y09 I a Dip JJ S i3

amounts In Column Alo the


comes p Dntlin 9 amounts from Column BOf your last epod some amounts in

Amounts in section may be tliperenlfmmamounts his

14 Miscellaneous Increases fo Cash 15 Cash

repodetlinCOlumn

Payments

A uae dafiove
oae is

ti y

Am 1J t 16 ENDINGCASHBALANCE neslz then sabran


It this is a fenninarion statement Llne 16 must be
zem

o S 03

ColumnA may be negative figures that shpultl be

subtracletl from previous

penotl
g

amounts

If this is 61etl

the first

report being

17 LOAN GUARANTEES RECEIVED

e schedu e Pan z

for this wlentlar year only carry over the amounts

Cash Equivalents and Outstanding Debts


18 Cash

ernY
on rererse

ones z 7 antl s

pr

Equivalents
Atltlfine

see

msrmnroea

OUtslandleg 19 Debts

NLlne9in COlumneabove

FPPC Form d6D lJanuaryl051


FPPC ASK FPPC Toll Helpllne 666 16 6 613 7 5 Free J772

r
Schedule A Moneta ry Contributions Received
Typa
Amounts
or

s
print
in ink Statement
covers

SCHEDULE

to whol

may

be rountlea tlollars

parlotl

from

SEE IN6TRUCTIONS Orv REVERSE


NAME OF FILER

through

PagO
O I

of f
PER ELEQION
TO DATE

CMG ce
I
DATE RECEIVED

NUM9ER

7 I ao 1 9
IF AN

FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRm VTOR


AECOUfwITiEEALSOEMEaI V NVNOER

CONTRIBUTOR
CODE

INOIVIOVAL

ENTER

AMOUNT

CUMVLATIVETOOATE
CALENDAR TEAR

OCCUPATION ANO EMPLOYER

RECEIVED THIS PERIOD

U
O

EmvBVSMESSiTERxnME aFSELr
u Ctev 1o i o
c

DEC 1 JAN a1

QF REpOIRED

IND
com
OTH

zuTS

377vF1

CgzPumcP l

CZe q lsry

scc
D COM

jU

UL

V t l art

Sl

rir cLL O Y Zancn CJc

J FG Yt
9174

onl Prv scc pmo

0
i

a5

a
O

3
a
7GV ra

oTH
PTV

4 a S

o vJ onca

scc

lli

YI yd
OG

Oh CICJ

INo COM

a
4110

E1TH
PTY

NrJ rive ec

scc gnvo

lo
1
C

2J iin Gte 43J

H Do
PTV

uza u

s3o0
SUBTOTALS

Schedule A

Summary
period
itemized

comdbmor cotlea

1 Amount received this

monetary

contributions

Intliviaual IND

Include all ScheduleAsubtotals


2 Amount received this

3U 7
100
TOTAL

unitemized period monetary


on

contributions of less than

Recipient COM COmmRtee tother than PTY or SCC T er e g husmess en6ry


PTV PVllocal

Pee Y

3 Total

monetary

contributions received this the

Add

Lines 1 and 2 Enter here and

period Summary Page

shall scc confnhxtBrcommlllee

Column A Line

71 C J
FPPC Form 460 FPPC Toll Free

g6 January

Helpllne

FPPC fi6filA5K

2 3 5 86612

Schedule A

Continuation Sheet

rprmunmK Typ
Amounts may be round tl towhole JOllars from

scHeouLeA coNTl
statement
covers

Monetary

Contributions Received

period
I

through
NAME OF FILER

Page of
I

l J
FULL NAME STREET ADDRESS AND ZIP CODE OF AL5o NOMBERI OrcoMMn1EE EN1ERI0

Dn

NUMBER

OgTE DECEIVED

CONTRIBUTOR

CONTRIBUTOR CODE

IF qN INDNIDUAL ENTER OCCUPATIONgNO EMPLOYED


pE Sete Emearvnue emvmven oeausi ssl

AMOUNT
CEIVEO R THIS PERIOD

CUMULATIVETOOATE CALENDAR YEAR

PER

ELECTION

TO DATE

0EC 1 JAN 31

gF REQUIRED

O
nn
CC

r J

G n lh l YTCx v t1 n X7 Cx
zind
a i 41786
P

O BOTH PTV SCC gN0 FV COM

M d1 ntin UJ G

f O6

Ss IO

12GA LiVJ1C S QJG 0 fl ti YYL 8 cam FYI

y q
J r
t

Pn
scc INU COM
oTH

L U J li

91767

00

X3vt d h
7

Sri

tc7 9

scc

t C Vo 7 i iilYppL vlSt i C Lam jCPNef h4OC10


w a ecv c2ixh r u v aT O C o i aAa J t LOeL evm r 7

coM
6TH PTY
SCC

D
COM oTH
PTy

lb ip

9 5
SUBTOTAL

scc

w4S

Contributor Gotles

Intllvidual INo

Recipient COM Committee other than PTV or SCC OTH Other eg business entity Pollllcal PTV Party
Small SCC Confdbulor Gommigee FPPC Toll e Fr

FPPC Form 060

06 January

FPPC ASK 3 666 6 Helpllne 6662

r
Schedule A

Continuation Sheet

or Typ print in ink


Amounts may be roundetl to whole tlollars Statement
covers

SCHEOULEA

CONY

Moneta ry Contributions Received

periotl

from

tbrougM1
NAME OF FILER

Page of
I D NUMBER

9i as
pA RECEIVED FULL NAME STREET ADORE56 ANO ZIP CODE OF CONTRIBUTOR xuueep OFeonMmEEUmEmEaLO
IF AN INDIVIDUAL ENTER

AMOUNT
RECEIVED THIS PERIOD

CUMUtATIVETO DATE

PER ELECTION

CONTRIBUTOR

COOE

OCCUPATIDNAND EMPLOYER EmE6rvRNE aFBE1FENFmvEn


OFBx31XESS1

CALENDAR

YEAR

TO DATE

DEC 1 JAN Ji

IF REDUIRED

I 11 x
ioll

c rLD ye
036 x
r

J000CIa m aa C
L

NJD pCOM

zJh

OTH

sG

PTY
SCC

7AiJiGaZ U
4 5 3PE

IkGtl gaazls
9ava

IND pcoM
oTH

v i3 vaa
vc

O p

PTY SDo IND

7 I w

aae o v4 Cs
U l3o

ppTY

tMi T
pcoM
PTY SCC IND COM
OTH PTY SCC

i ce acc cS
y1767

a YY2 Ghl

SUBTOTAL

Q sj

Contributor Codes Indlvitlual IND


COM

OTH

Recipient Commillee other Ihan PTY or SCC ONer e g business entity


FPPC Form O60
Free FPPC FPPC Toll Helpllne BBBIASK

Political PTY Pady Small SCC ConlnbulBr Commillee

Janueryl0fi 2 fi3 6662

Schedule B 1 Part Loans Received

Type

or

prlnl

In ink

SCHEDULE a PARTi
statement
from
covers

Amounts may be rounded to whole dollars

periotl

SEE

INSTRUCTIONS ON REVERSE

Through

Page
O I NUMBER

NAME OF RLER

FULL

NAME STREET
OF

qOa RE55 ANO ZIP CODE

LENDER xuuBER pFCaNmnTEEAL50elaEaip I

OCCUPAITION

OUTSTANDING
AND

LMPLOYER

gMOUNT

tIFS qLMEaFeuslrvessl

EUpLavE4 uTeq

DALANCE BEGINNING THIS


PERT D

gMOUNTPAID
OR FORGIVEN THIS

OUTSTANDING
BALANCEAT
CLOSE

INTEREST
PAID THIS

ORIGINAL AMOUNTOF LOAN

CUMULALIVE

IVED ftECF THIS PERI00

CONTRIBUTIONS TO DATE
CPLENOARYEAR

PERIOD

OOFOTHIS
U Q

PERI00

fit G

1 c t j1 l C7 M vt ty
NQ
I AND

9
CC

PAIO
i
FORGIVEN

y FnTE

crJ DL

y
PER

I q

ELECTION

COM

OTH

pTT

2 luillC s

DOO

s PATE pVE
PAIp

2LY
GATE INL RREO

CALENDARVFAR

b
PAfE

f pEN ELELTION

FORGIVEN
f
S

3 OAiE OUE OATEINCURREp

t0

IND

COM

OTH

PTY

SCC
PAID

CnLENOAq YEAR

3
gArE

3 pEfl

N FORGIVF
E f
s

ELECtION

iD

f oaiEpuE
OATEINCUafleO

IND

COM

OTH

PTY

sCC

SUBTOTALS

CI Oc

j E

GOG

Schedule B
7

Summary
period
G7 U C

6s a
icpmdbptpr cotles
Intlividual IND

Loans received this

Total Column b plus unitemized IDans of less than 100


2

Paid orlOrgiven this perlOd Total Column c plus loans under 100 paid orforgiven Include loans paid by a third pady that are also itemized
Net than 9 ethis P eriod Subtract Line2from Line i Enterthe net here and on the Summary Page Column forgiven
or

Loans

Recipient COM COmmiltee


other
on man PTY
or

SCC

Schedule

A
NET

OTH

Other e business entity g

Political PTY

Party

GrjG
tl num Mj

Small SCC cpnmbmorcpmmivee

A Line 2
Schedule A

Amounts

paitl by

another party also

must

be

reported

pn

required I
FPPC Toll Free

FPPC Form 466

O6 January

FPPO YT6 Helpline 666IASK 866 3 i

e SChedU E

Type
to

or

pNnl

in ink

CONL SGHEDULEE
nl Stalem
rem
ry

OntinUatlOn C Stleet Payments Made


SEE

Amountsmay

be rountletl

sovers

riod p
a

dellan vTOl

INSTRUCTIONS ON

REVERSE

through

Paga

or

NAME OF FILER

LD NUMBER

cz L ru
CODES If
CMP
gJS
one

t o
describes the
MnR

cP 6679
payment
you

of the

following

codes

accurately

enter may

the code

Otherwise describe
RAD

the

payment

campaign parapherna6almisc

member communicagons

campaign

consultants

MiG
OFC
rET

meegngs entl appearances


othce expemes

CTB CVC FIL PT1D PD LEG lrT

coMribWon explain nonmonelery tlvic tlonations cardidate filinglhaeot fees

retlio a1Nme entl yrotluGiori costs 0 FY retumetl borddbugens SAL campaign workers salaries

events funtlralsinB Intlepentlenl expentlilure aupPoNinglopposirg


legal tlelense
campaiyn
Itlerature entl

PFIO POL
oNers

explain

OS

mailings
NAME ANO ADpRESS OF PATEE i PE COMMIREE AL60 EMF 14 NpMPEPj

H70 it2T

ion ulating petl tl phone banks poNng entl survey research aye pos delivery and messenger services professional services legal accounlinB
print etls
CODE OR

TEL
TRC

Lv or cable eldlme entl

producfion

Pnsls

11iS

cantlltlale travel bilging erM meals slaHlspouse travel IOtlBing end meals

TSF translar behvaen rommidees of the eme caMitlale sponsor VOT voter reglafrzllon VJFB Informa8on IePlmology coals InlerneL a mall
DESCRIPTION OF

PAYMENT
ecC eh P r
P

AMOUNT PAID

aim
i c a

y 1A

G u t F L c2Nl

0 71 q 79
l

t 14
96eZTI

L if

2i r

uPi i ip i2 c

s pr w

1 N uea Y er

3 S3

fa l S
RPev i2PPa C C vt

CL C

rO G

z c
3ai

p iaau z euf

tuc c y Ce L r5titeei

a rC
Nce

C15QSf
1 06

fey m rnc aG
x

p
also

5 I

L 8

Payments thataro contributions

or

pantlent Ind expentlitums must

bd summetlxed

on

Schedul D

5 SUBTOTAC
fPPL TOl4Free

PPC F FOrm 088 tJanuaryl06 FPPO Helpline 6861ASK B6GI276J7t2

Schedule I

Type

or

prlnl

in lnk

SCHEDULEI

Miscellaneous Increases to Cash

Amounts may be rpuntletl to wholo tlallars

covers Stslemen parlotl


I
r

from

SEE INSTRUCTIONS ON REVERSE


NAME

Jh Ihr011

PdtJB
I

ef2
G

OF FILER

J
GATE RECEIVED

LLB R CT

y7
V
rvuuecn 1

V M
OE6CRIPTION OF RECEIPT

FALL

NAME ANO NOORESS OF SOURCE

pE muniTie ENtEa LO pl50

AMOONT OF INCREASE TO CASH

t 1l LyC Da
V

L Soy 64i 6

7Ui
L GG 9r

I T

fJ L C a rrc Z

Attach additional information

on

appropnafely labeled continuation sfioets

SUBTOTAL E

Schedule I

Summary
period 100
on

7 Itemized increases to cash this

r5 G
this

2 Unitemized increases to cash of under


3 Total of all interest received this

period
Schedule H
Column

period

loans made to others

e
TOTAL

4 Total miscellaneous increases to cash this

period Add

Lines

1 2

and 3 Enter here and on the

Summary Page

Line

14

o5 r
FPPC T014Free FPPC Form fi0 January105 AS Helpllne 066 WFPPC 06fi 07931 5 2

S-ar putea să vă placă și