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460 Pre-Election D Recipient Committee Campaign Statement Cover Page (Govemment Code Sections 84200-84216.5) 2005 SEP 2 9 Type or prlnt In Ink. blo: Date of election K appll (Month. Day, Year) Statement coye... period 1/1/05 CUPERTINO CITY C from o Quarlerly Statement o Special Odd-Vear Roporl o Supplemental p...locIIon Statement - Attach Fo,", 495 11/8/05 1Ype of Slatement: Ii2I Praelectlon Statement o SemHnnual Statement o Tonnlnatlon Statement (Also file a Fonn 410 Tennination) o Amendmont (Explein below) 2. 9/24/05 eomm..... - Comp.... P." 1, 2. 3. ød 4. o Primarily Formed Ballot Measure Committee a Controlled a Sponsored (A*lCompreœIPett6) through see INSTRUCTIONS ON REVERSE Type of Recipient Committee: All ~ Officeholder, Candidate Controlled Committee a State Candidate Election Committee a Recall (AJeoCompIefePM5) 1. o Primerlly Formed Candidatel OftIcehoider Committee (AJeo Com:JItIftPatl 7) o General Purpooe Commllteo a Sponaored a Small Contrlbutor Commllteo a PoIlttcal Parly/Cenlral Commll\ae Treasul'8r(s) NAME OF TREASURER Carolyn Krizek-Mahoney MAILING ADDRESS 10940 Miramonte Road .0. NUMBER 1279538 IF NO COMMITTEE) NAME 3. Committee Infonnatlon COMMITTEE NAME (OR CANDIDATE'S C~izens for Orrin Mahoney AR-êA CODE/PHONE 408-725-1767 ZIP CODE 95014 STATE CA CITY Cupertino ÑÃMEÕf SISTANT TREASORER, IF STREET ADDRESS (NO P.O. BOX) 10940 Miramonte Road ANY AREA CODE/PHONE 408-725-1767 CITY STATE ZIP CODE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) NO. AND S"T'iiËET OR P.O. BOX P.O. Box 1523 MAILING ADDRESS CODE/PHONE AREA ZIP CODE STATE CITY Cupertino OPTIONAL: FAX I E-MAIL ADDRESS orrin_for _councll@comcast.net Verification I have used all reasonable diUgence in preparing and revlewk1g tNs statement and to the best of my knowledge the infonnation contained herein and under penalty of perjury under the laws oHhe State of CalKomla that the foregoing is tnJo and c E·MAlL ADDRESS FAX CITY OPTIONAL: CODE/PHONE AREA ZIP CODE 95015 STATE CA 4. certify schedukts Is true and complete. By By 9/28/05 """ 9/28/05 ¡;;¡; Executed on Exocutod on Exocutod on Exocutod on FPt'C F_ "'IJonUIIY~ 8I1t1ASK-FPPC 11881271-3772) StatIt of California By By .... - COVER PAGE - PART 2 . I ==- of_ D SUPPORT D OPPOSE Recipient Committee ~pe or print In Ink. Campaign Statement Cover Page - Part 2 - 5. OflIceholder or Candldala Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF &ALLOT MEASURE Orrin Mahoney OFFICE SOUGHT OR HELD (INCLUDE LOCATIQNAND DISTRICT NUMBER IF APPUCABLE) BALlOT NO. OR LETIER JURISDICTION Identify the controlling officeholder, candld.te, or atate me.aura proponent, If any. NAME OF OFFICEHOLDER, CANDIOATE. OR PROPONENT DISTRICT NO. IF ANY OFFICE SOUGHT OR HELD 7. Primarily Formed Candldate/OflIceholder Committee Uot namea of omceholder($) or candlØt8(a) for which this committee I. primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDlOATE OFFICE SOUGHT OR HELO o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIOATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE Attach contlnuatlon ah.." If nec....ry Cupertino City Council RESIDENTlAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 10940 Miramonte Road Cupertino, CA 95014 - Related Committees Not Included In this Stelament: Uat any commlUaoo not Induded In tltls .statement that .re controlled by you or Ire ptlmarlly fonned to receive contTIbutlotu or make expenditures on bflhalf of your candldtlcy. COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROlLED COMMITTEE? DYES D NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CQDElPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROllED COMMITTEE? DYES D NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CQDeJPHONE FPPC Fo"" 410 (JanuafY'lOa) FPPC Tolf-Free ....lpllne: I88JASK-FPPC 11e8I275-3772) SåtI of c.urom" SUMMARY PAGE Statement cover. period f 1/1/05 rom Type or prlnt In Ink. Amounts may be rounded to whole doll..... Campaign Disclosure Statement Summary Page 9/24/05 through see INSTRUCTIONS ON REVERSE NAME OF FILER Citizens for Orrin Mahoney I.D. NUMBER 1279538 Calendar Year Summary for Candidates Running In Both the Stala Primary and General Elections Column B CALENOAR YEAR TOTAL TOOATE CollØßn A TOTAL THIS PERIOD (FROMATTACtEDSCI-EDlI..ES) Contributions Received to Date 71 $ $ through 6/30 1 Contributions Received $ Expenditures Made $ 20. 21 100.00 7,000.00 7,100.00 0.00 7,100.00 $ $ 100.00 7,000.00 7.100.00 0.00 7,100.00 $ $ Schedule A, Une 3 Schedule S, Une 3 AddUnes 1 + 2 SchedtIe C, Une 3 Add Unea 3 +., Monetary Contributions Loans Received .......... SUBTOTAL CASH CONTRIBUTIONS Nonmonetary Contributions .............. TOTAL CONTRIBUTIONS RECEIVED 1. 2. 3. 4. 5. Expenditure Limit Summary for SIaIa Candldalas $ $ 22. Cumulative Expenditure. Made· I" SUbtlCtto Yo...." exp.ncIIIan UnlIt) Total to Dete Date of Election (mmlddlyy) 2,892.53 0.00 2,892.53 1,415.80 0.00 4,308.33 $ $ 2,892.53 0.00 2.892.53 1.415.80 0.00 4,308.33 $ $ Schedule E, Une 4 Schedule H, Un. 3 Add Linea 6+ 7 Sc:heduIeF, Une3 Schedule C, Une 3 AddUnesS+9+ 10 Loans Made SUBTOTAL CASH PAYMENTS Accrued Expenses (Unpaid Bills) Nonmonetary Adjustment ........ TOTAL EXPENDITURES MADE Expenditures Made 6. Payments Made 7. B. 9. 10. 11 $ $ *Amounts In this section may be different from amounts reported in Column B. ---.-J---.-J_ To calculate Column 8, add amounts in Column A to the corresponding amounts from Column 8 of your last report. Some amounts In Column A may be negative figures that should be subtracted from previous period amounts. If this is the finll reporl being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (n any). $ 0.00- 7.100.00 0.00 2,892.53 4,207.47 $ $ PrevIous Summary Page, Line 16 Column A, Line J above Schedule f, Line 4 to Cash Current Cash Statement 12. Beginning Caah Balance 13. Cash Receipts ............... 14. Miecellaneous Increases 15. Cash Payments 16. $ Column A, Line ø above Add Lines 12 + 14, then subtract Line 15 Une 16 must be zero. 13+ ENDING CASH BALANCE If this is 8 termination statement, 0.00 $ Schedule B, Pert 2 7. LOAN GUARANTEES RECEIVED Cash Equivalents and Outstanding Debts 18. Cash Equivalents.. Soolnsl1ucllans 19. Outstanding Debts FPPC Fann 460 (January/OIS) FPPC Tol~Free Halplln.: 8661ASK-FPPC (866/275-3772) 0.00 8,415.80 $ $ on.....,.. 9 in CoIumt'l B above Add Line 2 + Line SCHEDULE A period Statement covers f 1/1/05 rom Type or print In Ink. Amounh mey be rounded to whole doll.rs. Schedule A Monetary Contributions Received P_~Of I.D. NUMBER 1279538 9/24/05 through SEE INSTRUCTIONS ON REVERSE NAME OF FILER CRizens for PER ELECTION TO DATE (IF REQUIRED) CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) AMOUNT RECEIVED THIS PERIOD IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER t<WIIE OF 8U5INE&S) Orrin Mahoney FULL NAME, STREET ADDRESS AND 21P CODE OF CONTRIBUTOR I CONTRIBUTOR (lFCOMUrm:E.ALSOëNTERl.D.NUMBER) CODE * DATE RECEIVED 100.00 100.00 100.00 Self-employed Armstrong Retirement Planning, LLC ~IND o COM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC Robert A Adams 11669 Olive Springs Ct Cupertino, CA 95014 9/19/05 ·Contrlbutor Codes IND -Individual COM - Recipient Commll\ae (other than PTY or SCC) OTH - Other (e.g.. business entity) PTY - Political Parly see - SmaH Contributor Committee 100.00 100.00 0.00 100.00 SUBTOTAL $ $ $ TOTAL $ Schedule A Summary 1. Amount received this period - itemized monetary contributions. (Include all Schedule A subtotals.) ............................................. Amount received this period - unRemized monetary contributions of les. than $1 00 Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A. Une 2. 3. FPPC Form 480 (JanuarylO6l FPPC Tol~Frao Helpline: 88BlASK-FPPC 188Bl275-37721 ) 1 period Stlltement cove,. 1/1/05 ~pe or print In Ink. Amounts RIllY be rounded to whole dolJllrw. Schedule B - Part 1 Loans Received Ol~ S" Page _ I.D. NUMBER 9/24/05 from through SEE INSTRUCTIONS ON REVERSE NAME OF FILER Citizens for Orrin Mahoney II CUMlAATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR 2,000.00 PER ELECTlON- 2,000./00 1279538 ORIGINAL AMOUNT OF LOAN '1 INTEREST PAID THIS PERIOD OIIiIDING BALANCEAT CLOSE OF THIS 2.000.0 -L% RATE 2,000.00 1'1 AMOUNT PAID OR FORGIVEN THIS PERIOD * o PAID I o FORGIVEN _I (bl OUTStANDING AMOUNT BALANCE I RECEIVED THIS BEGINNING THIS PERIOD IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SElf.eMPLOYED, EHlER ...... OF 8UBINES8) FULL NAME, STREET ADDRESS AND ZIP CODe OF LENDER (IF COMMITTEE. ALSO EN1'ER I.C. NUMBER) Retired Orrin Mahoney 10940 Miramonte Road Cupertino, CA 95014 I 8/11/05 DATE INCURRED 0.00 12/01/05 DATE DUE 2,000.00 0.00 I I CALENDAR YEAR 7,000.00 PER ELECTlON- 7,000.00 5,000.0 -L% RATE 5,000.00 o PAID Retired o scc o P1Y o OTH Orrin Mahoney 10940 Miramonted Road Cupertino, CA 95014 o COM ti! IND I FORGIVEN o 9/22/05 DATE INCURRED 0.00 12/01/05 DATE DUf 5,000.00 0.00 I I I ti! INO CALENDAR YEAR I _% RATE o PAID o SCC o OTH 0 P1Y o COM PER ELECT1ON- o FORGIVEN DATE INCURRED I DATE DUE I o OTH 0 P1Y 0 see o COM to IND $ 0.000 (EntIr(ë)""õfl smecu.E,1.ine3) 7,000.00 0.00 $ 7.000.00 $ $ SUBTOTALS 7,000.00 $ Schedule B Summary Loans received this period (Total Column (b) plus unitemized loans of less than $100.) 1. tcontributor Codes IND -Indhlldual COM-Recipient Committee (other than PTY or SCC) OTH - Other (e.g" busine.. entity) PTY - Pol"ical Parly SCC- SmaH ContrlbutorCommltlee 0.00 $ Loans paid or forgiven this period (Total Column (C) plus loans under $1 00 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 2. 7,000.00 (May be . negaIIYe number) $ NET Net change this period. (Subtract Line 2 from Line 1.) Enter the net here and on the SummaI)' Page, Column A, Line 2. 3. FPPC Fonm 480 (JanueryI05) FPPC Tol~F"", Helpline: 8861ABK·FPPC (86812715-3772) be I8porled on Schedule A. must also parly pakf by another *Amounts forgiven or - II required. -_.~~. ~ from _ 1/1/05 _ through 9/24/05 _ P_ L of L I.D. NUMBER 1279538 ~pe or prlnt In Ink. Amount. may be rounded to whole dolla,.. Schedule E Payments Made see INSTRUCTIONS ON REVERSE NAME OF FILER Citizens for Orrin Mahoney Otherwise, describe the payment. RAe radio airtime and production cos, RFD returned contributions SAL campaign workers' salaries 18. tv. or cable atrttme and production cosm 1RC candidate trallOl, lodging, and meals TRS stetllspouse trallOl, lodging, and meals TSF transfer between committees of the same candldøte/sponsor VOT voter registration VÆB Information technology coste (Intemet, e-mail) ts codes accucstely describes the payment, you may enter the code. ~ member communtcatlons MTG meetings and appearances CFC office expenses FEr petition circulating PI-() phone banks POL polling and survey research POS postage, delivery and messenger services PRO profenlonal services (legal, accounting) I'R1' print ads (explain)" CODES: If one of the following c.:M' campaign paraphernalia/misc. o¿s campaign consultants C1B contribution (explain nonmonetary)'" eve civic donations AL candidate fillngiballol lees FNJ fundralslng ovents N) independent expenditure supporting/opposing others LEG legal defense LIT campaign literature Bnd mailings NAME AND ADDRESS OF PAYEE (IF COMMITTæ,ALSO em;R tD.1oUeER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID City of Cupertino Filing Fee 10300 Torre Avenue FIL 1,680.00 Cupertino. CA 95014 County of Santa Clacs Registrar of Voters Mailing List 1553 Berger Drive, Bldg. 1 LIT 124.00 San Jose. CA 95108 Califomia Voter Guide Slate Card 1954 WQ. Carson Street, Suite B LIT 350.00 Torrance, CA 90501 SUBTOTAL$ 2,154.00 ...........$- 2.861.03 ...........$- 31.50 ...........$- 0.00 TOTAL $_ 2,892.53 FPPC Fonn 480 (JenueryIOS) FPPC Tol~F... HelpUno: BBSlASK·FPPC (8881276-3772) be .umm.rlzed on Sch.dule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) 2. Unitemized payments made this period of under $100 ............................ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 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.) that are contribution. or Independ.nt .xpendltu.... mu.t .1.0 P.ymenta SCHEDULE E (CONT.) Stetement cove... pertod ·R~NIA 46 . 1/1/05 from _ - through 9/24/05 pago~ Of~ - I.D. NUMBER 1279538 Type or prlnt In Ink. Amounts nwy be rounded to whole dolle... Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Citizens for Orrin Mahoney costs NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE. ALSO ENTER I.D. NJMBER) The Early Voter Slate Card 1954 W. Carson Street, Suite B LIT 300.00 Torrance. CA 90501 Kwlk þopy . ~ I Fundraiser Envelopes I 0 (01 r; :,:>, DeAm.C<. -e, \Vd LIT 270.63 Cut'~ý-i-Ùl0) cA "1:50\ I\- Klnko's Posters 249 California Avenue LIT 136.40 Palo Alto, CA 94306 Otherwise, describe the payment. RAe radio airtime and production RFD returned contributions SAL campaign workers' salaries 16. t.v. or cable airtime and production costs TRC candidate travel, todging, and meals 1RS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration V'ÆB Information technology costs (Internet, e-mail SUBTOTAL $ 707.03 FPPC Fonn 460 (Janu.rylO&) FPPC Tol~F_ Helpline: S861ASK-FPPC (11881275-3772) the payment, you may enter Þ.eR member communications MTG meetings and appearances OFC office expenses PET petlUon circulating PHJ phone banks POL polling and survey research POS postage, delivery and messenger services PR) professional 881Vi..s (legal, accounl'ng) FRT print ads code. the Payments that are contributions or Independent .xpendltu.... must .180 be summarized on Schedule D. If one of the following codes accurately describes campatgn paraphernalia/misc. campatgn consultants contribution (explain nonmonetary)* civic donations candidate ftllng/ballot foes fundraislng events independent expenditure supporting/opposing others legal defense campaìgn Itterature and mailings (explaln)* CODES CMP CNS CTB CVC FIL F\ID NJ lEG lIT Statement coven period from _ 1/1/05 - through 9/24/05 Pago~ ofL - I.D. NUMBER 1279538 'TYpe or prlnt In Ink. Amounts mIIY be rounded to wholo dolla... Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Citizens for Orrin Mahoney code. (0) Ib) 10) Id) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE. ALSO ENTeR to. NUMBER) DESCRIPTION OF PAYMENT BALANCE SEGINNING THIS PERK>D THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD America's Campaign Store CMP P. O. Box 1612 275.80 275..80 0.00 275.80 Jeffecsonville, IN 47131-1612 Sneaky Puppy Design LIT 1033 Cranberry Drive 1,000.00 1.000.00 0.00 1,000.00 Cupertino, CA 95014 B & R Printers LIT 1855 Dobbin Drive 140.00 140.00 0.00 140.00 San Jose, CA 95133 . - ,- ~__L --- _u................___ -_.ndependent.xpendltu.... muatatso be SUBTOTALS $ $ 1,41 - - Otherwise, describe the payment. RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TB. t.v. or cable airtime and production costs TRC candldale travel, lodging, and meals 1RS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration \^,,£B mol tlon technoll payment, you may enter member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) pont ads the CODES: If one of the following codes accurately describes the ()JP campaign paraphernalia/misc. ÞÆR CNS campaign consultants MTG CTB contribution (explain nonmonetary)- ŒC eve civic donations PET FIL candidate ftllnglballot fees I'tD FN) fundraiaing events POL NJ Independent expendKure supporting/opposing othera (explaint P05 LEG legal defense PRO UT campaign lite..ture and melllngs PRT 1,415.80 $ 0.00 $ 1,415.80 .. INCURRED TOTALS $ _ ,415.80 ............. PAID TOTALS $ _ 0.00 .............................NET$-g¡ 1,415.80 . nepttve numtler FPPC Fonn 480 (JanueryI05) FPPC Tol~F.... Helptlne: II66IABK-FPPC (8581275-3772) $ Schedule F Summary 1. Total accrued expenses Incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)....... 2. Total accrued expenses paid this period. (Include all Schedule F. Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unltemized payments on accrued expenses under $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) 1,415.80 $ SUBTOTALS IlIfIUMrtud on Schedule D.