1st 460 Semi-annual amendment B
in ink.
Type or print
Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
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Palle
Date of election if ap
(Month, Day, Ye,
covers period
1~C1
Official Use Only
Foc
Statement
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cuF1ERTINO CITY CLEIIIK
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from
Quarterly Statement
Special Odd-Year Report
Supplemental Preelection
Statement· Attach Form 495
o
o
o
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2. Type of Statement:
Preelection Statement
Semi-annual Statement
Termination Statement
(Also file a Form 410 Termination)
Amendment (Explain below)
o
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o
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and 4.
Measure
through
Committees - Complete Parts 1, 2, 3,
D Primarily Formed Ballot
Committee
o Controlled
o Sponsored
(A/so ComplelePart6)
SEE INSTRUCTIONS ON REVERSE
Committee:
~ Officeholder, Candidate Controlled Committee
o State Candidate Election Committee
o Recall
(A/sa Complele Part 5)
AI
Recipient
Type of
1.
'J
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OY,!
Primarily Formed Candidatel
Officeholder Committee
(A/so Comp/efe Part 7)
o
D General Purpose Committee
o Sponsored
o Small Contributor Committee
o Po1Jtical Party/Central Committee
Treasurer(s)
NAME
37'1
.0. NUMBER
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Committee Information
(OR CANDIDATE'S NAME
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COMMITTEE NAME
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AREA CODE/PHONE
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STATE
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NAME OF/ASSISTANT TREASURER, IF ANY
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STREET ADDRESS (NO P.O.
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CITY' STATE ZIP CODE
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MAILING ÄDDRESS {IF DIFFERENT) NO. AND STREET OR P.O. BOX
MAILING ADDRESS
AREA CODE/PHONE
ZIP CODE
STATE
CITY
AREA CODE/PHONE
ZIP CODE
STATE
CITY
certify
E-MAil ADDRESS
the information contained herein and in the attached schedules is true and complete.
FAX
OPTIONAl:
Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge
under penalty of perjury under the laws of ttr State of California that the foregoing is true and correct.
(
By
By
E-MAil ADDRESS
FAX
Executed on
OPTIONAL:
4.
Signature of
By
By
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Executed on
Executed on
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
-.:{('~ L'vA'\.-\
CODES If one 01 the 10
........ ~.." ~"~ ~
from '/Ifc\...} _
through (, I>,~ ( ''''¡ _ Page ~ of ~
.0. NUMBER
Y¡-7 ; 7 '1
Type or print In ink.
Amounts may be rounded
to whole dollars.
Otherwise, describe the payment.
RAD radio airtime and production costs
RFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
ìRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VaT voter registration
WEB '-fe
the payment, you may enter the code.
~ member communications
MTG meetings and appearances
OFC office expenses
Æf petition circulating
PHO phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
PRT print ads
,
li.-j"L
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)'
civic donations
candidate fiJinglballot fees
fundraising events
independent expenditure supporting/opposing others
legal defense
campaign literature and mailings
eM'
CNS
ClB
CVC
FIL
FND
N:J
LEG
LIT
(explain)
NAME AND ADDRESS OF PAYEE
,If COMMITTEE. ALSO ENTER W. NUMBER) CODE "OR DESCRIPTION OF PAYMENT AMOUNT PAID
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* Jfayments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ ,.-<
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SUBTOTAL $
summarized on Schedule D.
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$
$
$
TOTAL $
*
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.)
2. Unitemized payments made this period 0lunder$100 ............................
3. Totai interest paid this period on loans. (Enter amountfrom Schedule S, Part 1, Column (e).)
4. Total payments made this period. (Add Lines 1. 2. and 3. Enter here and on the Summary Page, Column A, Line 6.)
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866'ASK-FPPC (866/275-3772)
SCHEDULE E
.
Page~ of-L
.D. NUMBER
~7?'7
Statement covers period
from 1/1 10 \f
through b " f,'i
Type or print in ink.
Amounts may be rounded
to whole dollars.
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
describe
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet,
NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
(IF COMMIITEE, ALSO ENTER 1.0. NUMBER)
A A <f Ý è~l«M"~'-kr :rVl\O \"~\lo\fVC-t- \""'\ - F"of.'-t 1¡O'Ý
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) t' l.J\A(~~ l"hc! "" ,\1 fc0 + :fell ",.('" -rC<.--vJ lc~", - prof' t- o-v
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'* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Vðn~
e-mai
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK·FPPC (866/275-3772)
the payment
Otherwise,
RAD
RFD
SAL
1EL
me
1RS
TSF
VOT
WEB
you
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
the code.
may enter
the payment,
MBR
MfG
OFC
ÆT
FH>
PQ
POS
PRO
PRT
CODES:
ctvP campaign paraphernalia/misc.
CNS campaign consultants
ere contribution (explain nonmonetary)
evc civic donations
FIL candidate fiHnglballot fees
FND fund raising events
\NO independent expenditure supporting/opposing others (exptain)*
LEG legal defense
LIT campaign literature and mailings