460 Debt 2nd Pre-Election COVER PAGE - LONG FORM
(Govemm,ntCodeSecUon$84200-84218.5, ~ ~: OCT ~ ~001
~ 10/20/2001 11/06/2001
1. Ty~ ~ Recipient Comm~c: 2. Ty~ ~ S~ement:
~ ~ho~er, Candidate ~ P~madly Fo~ Ca~idatel ~ P~el~i~ S~tement ~ Qua~dy S~tement
Con.lied CommiUee ~holder Commi~ ~ Semi-annual S~tement ~ S~al ~Year Re~
~ Te~ina~on S~tement ~ Supplemen~l P~I~
~ Ballot Measure ~mmi~ee ~ General Pu~e ~mmi~ee ~ Amendment (~plain bel~) S~ment - A~ Fo~ 495
O Pdmadly F~ O S~n~
O Controlled O B~d Ba~
O
~'.D. ~-- Tmasum~s)
3. Commi~ Infor,,,~on 990787
10720 Alderbrook Lane
10720 Alderbrook Lane San Jose CA 95014 (408)725-8939
C~ ~Am ~PCO(O ,RR~..A~ NAME~ASSI~ANT1REASURER. IFANY
Cupertino CA 95014 (408)725-8939
MAX. IN(;N)ORE~(IFmFFEREN~NO. ANO~'TRE~ORP.O. BOX MAIUNGAI)ORI~
( )
( ) - /
S/CCW - PCAB05 01380 (Rev. 9/99) State of California Fair Political Practices Commission.
COVER PAGE - PART 2
Recipient Committcc (-., [,, [~'0 P,~,, A 4 6 0
Campaign Statement r o i~ ~ ~
Cover Page- Part 2 IPeg- 2 of s
4. Officeholder or Candidate Controlled Committee 5. Ballot Measure Committee
NAME OF OFFICEHOLD~R OF CANDIDATE NAME OF BALLOT MEASURE
Ms. Dolores Sandoval
OFFICE -- OR HELD pNCLU[~ LOC~TION AND OIS~)CT NUMBER IF APPt. ICABLE) BN..LOT NO.. "',, t=~ I JUPd~DlCnON I r-~ ~,uPPoRT
Santa Clara Cnty Brd of Sup, Disc $ - Debt Retirement ~1o~
RE~DENT1At. JlaUSINES~ ADORESS (NO. AND eTRF-ET) ~ STATE Z3P COOE
Identify the Gontrolllng officeholder, candidate, or state measure proponent, if any.
10720 Alderbrook T.ane Cupertino C~ 95014 m~EO~OmC~OU~.~.C~mD~TEO~.mO~U~T
Related Committees Not Included In this Statement: Listenycommiffees
not included in Ihis consolidated statement that are controt/ed by you or which am primarily o~-nce ~OUCd4T OR HELD IDISTRICT NO. IF ~
formed to receive conttfbatfons or to make expend/tums on behalf of your cendidecy.
I
Primarily
Formed
Committee
o,~¥ uanaova~ zor c~cy comic±- asz025/z2367~[6'
Id ~o~=m~n/~ar'[a Smith
10720 ~'lderbrook ~.ane
Cupertino C~ 950[~ (&08) ?25-8939
7. 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 sch~ules
is true and complete. ! certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed o~ By
SIGNATURE OF CONTROt. LING OFFICEHOLDER, CAN01DATE. STATE MEASURE P~OPONENT
Executed mi By
SUMMARY PAGE
Campaign Disclosure Statement stw~~~ (:~L,rO~X,.~ 460
Summary Page ~o R ~ J
{/om 09/23/2001
thmmjh 10/20/2001 Page 3 ol S
NAME OF FILER MS. Dolores Sandoval, Dolly Sandoval for Supervisor - Debt Retirement I.D. NUMBER
Committee 990787
Contributions Received c~-m A Column S Calendar Year Summmy for Candidab~
TOT~k THi~ PEmOD C-~t. ENOAR ~ Running in ~ the State Primary and
(FROM ATTACHED SCHEDULES) TOTAL TO OAllE
1. Monetary Cont~butions ..................................... Schedule A, L/ne 3 $ 0.00 $ 1, :150. O0
2. Loans Received ................................................ ScheduleB, One? 0.00 110,000.00 111 mmugh 6/30 711 to Date
3. SUBTOTAL CASH CONTRIBUTIONS .................. Add L~es 1 + 2 $ 0.00 $ 1:11, ].50.00 Received .... $ 0 0
4. Non-monetary Contribulions ............................. Schedule C, Une 3 O. 00 O. 00 21. ~...~.~....r~.. $ 0 0
5. TOTAL CONTRIBUTIONS RECEIVED ................. Add Lines 3 + 4 S 0.00 $ 11:1,150. O0
Expenditures Made ~m umm sm..m~ bz stm
6. Cash Payments ................................................ ScheduleE, Line4 S 0.00 $ 180.65 C"-~'~' --
7. Loans Made ...................................................... Schedule H, Une ? 0.00 0.00 22, Cumulative Exanditure Mads*
(If Subjed to V~lunta~ Expenditure Limit)
8. SUBTOTAL CASH PAYMENTS ............................ Add Lines 6 + 7 $ 0.00 $ 180.65
Date d Eleclion T~,al ~o Date
9. Accrued Expenses (Unpaid Bills) ...................... Schedule F, Une $ 0 o 00 0.00 (mnVdd/yy)
10. Nonmonetary Adjustment ................................ Schedule C,/-~e 3 0.00 0.00
11. TOTAL EXPENDITURES MADE .................. AddLinesS+9+10 $ 0.00 $ 180.65
Currant Cash Statement
12. Beginning Cash Balanoa .......... Prev~us Summary PaGe, L/ne 18 $ :3,187. (;6
13. Cash Receipts ......................................... Co/utah A, Line 3 above 0.00
14. Miscellaneous Increases to Cash ..................... Schedule I, Une 4 28.3:1
15. Cash Payments ....................................... ~o~zmn A, Line 8 above 0.00
16. EHDIN~ CASH RA~ .... ~$$12+13+14, thensubtracfUnel~ $ 3,215.97
if this is s Termination Statement, I~ne 16 must be zero.
I?. LOAN GUARANTEES RECEIVEDSchedu/e B, Part ~, Column (b) $ O . O0
Cash Equivalenb and Outstandin~ Debts
18. Cash Equivalents ................................................................................ $. 0.00
19. Outstanding Debts .......... Add Line 2 + Line g in Column C above S 110,000.00
S/CCW - PCAB05 01380 (Rev. 9/99)
SCHEDULE B - Part Ill
Schedule B- Part ,,, sme--nt=o~p~k,d CALIFORNIA460
Annual Report of Outstanding Loans Received m,,,, 09/23/2001
through 10/20/2001 Paga 4 of 5
NAMEOFFILER MS. Dolores Sandoval, Dolly Sandoval for Supervisor - Debt Retirement I.D. NUMBER
Committee 990787
FULL NAME OF LENDER ORIGINAL DATE OF LOAN AMOUNT OF ORIGINAL LOAN UNPAID PRINCIPAL UNPAID INTEREST
Ms. Dolores Sandoval 09/30/1999 20,000.00 20,000.00
(Continued) 02/29/2000 25,000.00 25,000.00
(Continued) 11/06/2000 40,000.00 40,000.00
(Continued) 11/13/2000 10,000.00 10,000.00
(Continued) 11/18/2000 15,000.00 15,000.00
SUBTOTAL $ 110, ooo. oo
Annual Report d Outstanding Loans Summary
I. Total outstanding loans this period.
(Enter here and on the Summary Page, Column C, Linc 2.) ............................................................... TOTAL $ 110,oo0.0o
SCHEDULE I
Schedule I SI=t..~ ¢OVM~ peltOd CALl FORN IA 4 6 0
Miscellaneous Increases to Cash FORM
from 09/23/2001
through 10/20/2001 Page. , 5 of 5
NAME OF FILER MS. Dolores Sandoval, Dolly Sandoval for Supervisor - Debt Retirement I.D. NUMBER
Committee 990787
FULL NAME AND ADDRESS OF SOURCE
DATE ~F COMMITTEE. I~ ADorrlo~ TO COMVdTI~E'~ NAME N~ID a~ORES$. ENI~tR I.D. NUMBER DESCRIPTION OF RECEIPT AMOUNT OF
RECEIVED OR, ;F NO t.o. NtJ~aER H~S BEEN ASS~C4~F-D, ENTER I~E~SURER'$ NNaE & N3ORF-SS) INCREASE TO CASH
SUBTOTAL $ o.00
Miscellaneous Inct~,,,ases to Cash Summary
I. Increases to cash of $] 00 or mom this period .................................................................................... $ o. 00
2. Increases to cash under $100 this period.
(Do Rot itemize.) ................................................................................................................................ $ 2 8.3 3.
3. Total of all inmrcst rcceivcd this period on loans made to others.
(Schedule H, Part II Co).) .................................................................................................................... $ o. o 0
4. Total miscellaneous increases to cash this period.
(Add Lines I, 2, and 3. Enter hem and on thc Summary Page, Linc 15.) ........................... TOTAL $ 28.31