460 termination ecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Statement covers pertod
from
,h,ough
Date of election if eppllcebl
(Month, Day. Year)
DEC - 9 2003
)ERTINO
COVERPAGE
of
Olllcia[ Use Only
1. Type of Recipient Committee: All Committees - Comlplet* pm~lm 1, 2. 3. and 4.
vC~ Officeholder, Candidate Controlled Co?nmittee O State Candidale Election Committee
O Recall
[] Gene ral Purpose Committee
{~ Sponsored
O Small Contdbutor Commillee
(~ Political Party/Central Cof'n~niilee
[] BallotMeasure Committee C) Primarily Formed
C) Controlled
C) Sponsored
[] primarily Formed Candidate/
Otticeholder Committee
Type of Statement:
[] Preeleciion Statement
[] Semi-annual Slatement
~.. Te r m/nation Statement
[] Amendrm~nt (Explain below)
[] Ouadedy Slalement
[] Special Odd-Year Repod
[] Supplemenlal Preelection
Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
STATE ZIP CODE REA CODE/PHONE
NAME OF ASSISTANT TREASUReR, IF ANY ~
ZIP CODE
MAILING ADDRESS (IF DIFFERENTI NO. AND STREET OR P.O[ BOX MAILING ADORESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS OP¥1ONAL: FAX I E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement
. _
ecipient Committee
Campaign Statement
Cover Page-- Part 2
Type or print in ink.
COVER PAGE - PART 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER tF APPLICABLE)
RESIDENTIAL'BUSINESS ADDRESS (NO. AND STREET) ~ITY STATE ZIP
Related Committees Not Included in this Statement: Liatenycommlttees
not included In this statement that are controlled by you or ere primarily formed to receive
COMMIT[EE NAME I.D. NUMBER
NAME OE TREASURER CONTROLLED COMMII~rEE?
[] YES [] NO
COMMIT3~E ADORESS STREET ADDRESS (NO P.O. BO>
CITY STA31~. ZIP CODE AREA COD~JPHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
[] ~ES [] NO
STREET ADDRESS (NO P,O. BO~
COMMIIq'EE ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
6. Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER
JUR'SD'CT'ON [ ~OPPosESUPPORT
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER. CANDIDATE. OR PROPONENT
OFFICE SOUGHT OR HELD~r DISTRICT NO. IF ANY
7. Primarily Forn~d Committee List names of officeholder(s) or candidate(s) for
which this committee I, primarily formed.
NAME OF OFFICEHOLDER OR CANDIOATE
NAME OF OFFICEHOLDER OR CANDIDATE
[] SUPPORT
[] OPPOSE
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
[]SUPPORT
[]OPPOSE
NAME OF OFFICEHOLDER OR CAN01DATE r~SUPPORT
OPPOSE
NAME OF OFFICEHOLDER OR CANOIDATE [~SUPPORT
[~OPPOSE
Attach continuation sheets if necessary
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print In
Amounts may be rounded
to whole dollars.
thro.ghl /O?
NAME OF FILER
Contributions Received
1. Monetary Contributions ........................................... Schedule A, £ ~ne 3
2. Loans Received ...................................................... Schedule B. Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ........................ Add Lines I + 2
4. Nonmonetary Contributions .................................... Schedul, C. Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .,-: ....................... AddUnes 3 * 4
Column A
Column B
Expenditures Made
6. Payments Made ....................................................... Schedule E, Line
7. Loans Made ............................................................. Schedule H, Line
8. SUBTOTAL CASH PAYMENTS .................................... Add~.i~s 6 *
9. Accrued Expenses (Unpaid Bi[is) ............................... ScheduleF. Line
10. Nonmonetary Adjustment .......................................... Schedule C. Line
11. TOTAL EXPENDITURES MADE ................................ AddLines8+9* lO
Current Cash Statement
12. Beginning Cash Balance ....................... pre~ou$Sunlrnaq/Page, LinelS
13. Cash Receipts ................................................... CotumnA, Llne3above
14. Miscellaneous Increases to Cash ........................... Schedule I. Line 4
15. Cash Payments .................................................. ColumnA. LineSabove
16. ENDING CASH BALANCE .......... Add Lines 12+ 13+ t4. Ihen subtract Line ~ 5
If this is a terrnina~on statement, Line 16 must be zero.
$
To calculate Column B. add
amounts in Column A ~o the
corresponding amounts
trom Column B ol your last
report. Some amounls in
Column A may be negative
figures that should be
subtracted from previous
period amounts. Il Ihis is
the first report being Iliad
for this calendar year. only
carq/ over the amounts
Irom Lines 2. 7. and 9 (il
any).
20. Conlributions
Received
21. Expenditures
Made
Expenditure Limit Summary for State
Candidates
$ $
$ $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ Seek]s¢ructtonsoc3£eve~e $
19. Outstanding Debts ......................... AddUne2+LineginC~u~Tebove $
17. LOAN GUARANTEES RECEIVED ........................... SchedUle I~, Part 2 $
General Elections
22. Cumulative Expenditures Made'
Date ol Election
(mm/dd/yy)
__/
Tolallo Date
$
$
$
'Since January t. 2001. Amounts in this seclion may be
dilferenl trom amounts repoded in Column B
FPPC Form 460 (Jur~e/01)
FPPC Toll-Free Helpl[ne: 866/ASK-FPPC
SUMMARY PAGE
Calendar Year Summary for Candidates
Running in Both the State Primary and
chedule A Type or print In ink. SCHEDU{.E A
Monetary Contributions Received'i ,o whole dollar., from
Oscc
~COM
~OT~
~SCC
~OTH
~ PTY
~scc
~OTH
~ PTY
~scc
~cou
~OTH
~PTY
~scc
SUBTOTAL $ , ~,~t~ .,:
Schedule A Summary
1. Amount received this period- contributions of $100 or more.
(Include all Schedule A subtotals.) ........................................................................................................ $
2. Amount received this period - unitemized 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 $
[ 'Contribulor Codes
IND - Individual
COM - Redpient Commi~ee
(olher than PTY o¢ SCC)
OTH - Olhet
PTY- Political Parly
SCC- Small Contributor Con~nille o
FPPC Form 460 (June/Ol)
FPPC Toll-Free Helpllne: 8661ASK-FPPC
chedule B - Part 1
Loans Received
SEEINSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print In ink.
Amo~nts may be rounded
to whole dollars.
SCHEDULEB-P^RT1
Page ~ of ~
FULL NAME. STREET ADDRESS AND ZIP CODE
OF LENDER
IF AN INDIVIDUAL, ENTER
(.)
OUTSTANOING
AMOUNT
{c) (d)
OUTSTANDING
AMOUNT PAiD BALANCE AT
INTEREST
PAID THIS
I.D. NUMBER
t~.IND [] COM [] OTH E] pTY [] SCC
t~.IND [] COM [] O33"1 [] PTY [] SCC
OCCUPATION AND EMPLOYER
BALANCE
BEGINNING THIS
PERIOD
RECEIVED THIS
PERIOD
s ~
OR FORGIVEN CLOSE OF THIS
THIS PERIOD ' PF..RIOD
,?'2-~,/~
PERIOD
RATE
$. $
t[] IND [] COM [] OTC [] PTY [] SCC
SUBTOTALS $ $ /~Z~,)/' $ --~ $
Schedule B Summary so.~E.~.3)
1. Loans received this pedod .................................................................................................................... $ ~'
(Total Column (b) plus unitemized loans less than $100.)
2. Loans paid or forgiven this period - .............................. $ /~ ~
(Total Column (c) plus leans under $100 paid or forgiven.)
(Include leans paid by a third pa~ that are also itemized on Schedule A.)
3. Net change this peri~. (Subtract Line 2 from Line 1.) ............................................................... N~ $ ~/~ ~
Enter the net here and on the Summa~ Page, Column A, Line 2.
[ IfND~:~I~e~oM- .edplenl ~mml.ee (other Ih.n P~ o, SCC} OTH - Other p~- Polific., Pa~ SCC- Small Conlnbuto, ~i.ee~
LOAN TO DATE
FPPC Form 460 (June/D1)
FPPC TolI-Eree Helpllne: 866/ASK-FPPC