460 Debt Retire Semi-Annual
COVER PAGE - LONG FORM
lE @te~1 WI
Recipient Committee
Campaign Statement
6
!:..of
Official Use Only
2005
JUL 2 8
84216.5)
(Government Code Sections 84200
A
Date of Election if 81
Statement covers period
UPERTINO CITY CUERK
(IIonth, Day, Year)
01/01/2005
from
o Quarterly Statement
o Special Odd-Year Report
o Supplemental Pre-election
Statement - Attach Form 495
2. Type of Statement:
o Pre-election Statement
~ Semi-annual Statement
o Termination Statement
o Amendment (Explain below)
06130/2005
1. Type of Recipient Committee
III Officeholder, Candidate Controlled Committee D Ballot Measure Committee
o State Candidate Election Committee 0 Primarily Formed
o Recal 0 Controlled
o Sponsored
through
o Primarily Formed Candidate
Officeholder Committee
D General Purpose Committee
o Sponsored
o Small Contributor Committee
o Political Party/Central Committee
Treasurer(s)
NAME OF TREASURER
Dolly Sandoval
1.0. NUMBER
990787
Information
COMMITTEE NAME
Dolly Sandoval for Supervisor
Committee
Committee
3.
Retirement
Debt
STREET ADDRESS
10720 Alderbrook Lane
AREA CODE/PHONE
408) 725-8939
ZIP CODE
95014
STATE
CA
CITY
c(/P f.6Z:ï1 N':>
NAME OF ASSISTANT TREASURER. IF ANY
AREA CODElPHQNE
(408)725-8939
ZIP CODe
95014
STREET ADDRESS (NO P.O. BOX)
10720 Alderbrook Lane
CITY STATE
Cupertino CA
STREET ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
AREA CODElPHONE
(
ZIP CODe
STATE
STREET ADDRESS
CITY
OPTIONAL: FAXlE-MAIL ADDRESS
AREA CODE/PHONE
ZIP CODe
STATE
CITY
OPTIONAL: FAXIE-MAIL ADDRESS
() /
knowledge the information contained herein and in the attached schedules
MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR
ey
Executed on
SIGNATURE OF CONTROLLING OFFICEHOlDER, CANDIDATE, STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
State of California Fair Political Practices Commission.
By
By
DATE
Executed on
DATE
PCAB05 01380 (Rev. 9/99)
Executed on
SlCCW
COVER PAGE - PART 2
Recipient Committee \LIFOR:-;I \ 4 t ~
Campaign Statement OK\l
Cover Page - Part 2
Page 2 of 6
5. Officeholder or Candidate Controlled Committee 6. Ballot Measure Committee
NAME OF OFFICEHOlDER OF CANDIDATE NAME OF BALLOT MEASURE
Ms. Dolores Sandoval
OFFICE SOUGHT OR HELD (INClUOE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTEA JURISDICTION D SUPPORT
Board of Supervisors, District 5, Santa Clara County o OPPOSE
RESIDENTIALJBUSINESS ADDRESS {NO. AND STREET} CITY STATE ZIP CODE Identify the controlling offiçeholder, candidate. or state measure proponent. if any.
10720 Alderbrook Lane Cupertino CA 95014 NAME OF OFFICEHOlDER, CANDIDATE OR, PROPONENT
DISTRICT NO. IF ANY
OFFICE SOUGHT OR HELD
Related Committees Not Included in this Statement: List any committees
not included in this consolidated statement that are controlled by you or which are primarily
formed to receive contributions or to make expenditures on behalf of your candidacy.
7. Primarily Formed Committee
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPf'ORT
o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT
o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT
o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT
o OPPOSE
COMMITTEE NAME .D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODElPHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
-
CITY STATE ZIP CODE AREA CODElPHONE
SUMMARY PAGE
Campaign Disclosure Statement Statement covers period lOt]
Summary Page from 01/01/2005
throughO 613 0 /2 0 0 5 Page 30f 6
NAME OF FILER Ms. Dolores Sandoval Dolly Sandoval for Supervisor - Debt Retirement LD. NUMBER
Committee 990787
Contributions Received Column A Column B Calendar Year Summary to< Candidates
TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and
(FROM ATTACHED SCHEDULES) TOTAL TO DATE
1. Monetary Contributions .........................._.......... Schedule A, Line 3 0.00 0.00 General Elections
$ L
2. Loans Received ................................................ Schedule B, Line 7 0.00 110.000.00 1/1 through 6/30 7/1 to Date
20. Contributions
3. SUBTOTAL CASH CONTRIBUTIONS ........... ...... Add Lines 1 + 2 $ 0.00 $ - 110.000.00 Received.... f;
4. Non-monetary Contributions.. ....................... .. Schedule C, Line 3 0.00 0.00 21. Expenditures
Made .......... $
5. TOTAL CONTRIBUTIONS RECEIVED ......... ....... Add Lines 3 + 4 $ 0.00 L 110,000.00
- -
Expenditures Made Expenditure limit Summary for State
6. Cash Payments ............................................. .. Schedule E. Line 4 $ 0.00 $ 0.00 Candidates
7. Loans Made .....h... .... ...................................... Schedule H, Line 7 0.00 0.00 22. Cumulative Expenditure Made*
(If Subject to Voluntary Expenditure Limit)
8. SUBTOTAL CASH PAYMENTS ............................ Add Lines 6 + 7 $ 0.00 $ 0.00
Date of Election Total to Date
9. Accrued Expenses (Unpaid Bills) .................. ... Schedule F, Line 3 0.00 0.00 (mmlddlyy)
10. Nonmonetary Adjustment ... ............................ Schedule C, Line 3 0.00 0.00
11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ 0.00 $. 0.00
Current Cash Statement
12. Beginning Cash Balance .......... Prewous Summary Page, Line 16 $ 23.864.31
13. Cash Receipts ...... .................................. Column A, Line 3 above 0.00
14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 11.84
15. Cash Payments ....................................... Column A. Line 8 above 0.00
16. ENDING CASH BA.-(tI!¡es 12 + 13 + 14. then subtract Line 15 $ 23.876.15
If this is a Termination Statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED Schedule B, Part 1. Column (b) $ 0.00
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........ .............. ..................... ............. ....................$, 0.00
19. Outstanding Debts ... ...... Add Line 2 + Line 9in Column C above $ 110,000.00
S/CCW - PCAB05 01380 (Rev. 9/99)
SCHEDULE B - Part
S1a1ement covers period
Schedule B - Part
Loans Received
6
4 of
Page
.D. NUMBER
01/01/2005
througlL 06/3 0 /2005
Retirement
from
{gJ
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
990787
{n
ORIGINAL
AMOUNT OF
LOAN
{.J
INTEREST
PAID THIS
PERIOD
OUTSTANDING
BALANCE AT
CLOSE OF THIS
"
Debt
{o¡
AMOUNT PAID
OR FORGIVEN
THIS PERIOD
for Supervisor
(b)
AMOUNT
RECEIVED THIS
PERIOD
oUTsriNDING
BAlANCE
BEGINNING THIS
"
Dolly Sandoval
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF·EMPLOYED, ENTER
NAME OF BUSINESSI
Councilmember
Dolores Sandoval
Committee
NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTER
Ms
NAME OF FILER
FULL
$
$ 20,000
0.000
RATE
$ 20,000
Q
PAID
o
.0. NUMBER)
Ms Dolores Sandoval
10720 A1derbrook Lane
Cupertino CA 95014
PER ELECTION
%
$
o FORGIVEN
Cupertino
City of
$
CALENDAR YEAR
09130/1999
DATE INCURRED
Q
$
12131/2005
DATE DUE
o
$
o
$
$ 20.000
o PTY 0 sec
Sandoval
o COM 0 OTH
Ii IND
PAID
o
Dolores
Continued
Ms
PER ELECTION
$
$ 25.000
%
Q....QQQ
RATE
$ 25.000
o
FORGIVEN
$
o
$
CALENDAR YEAR
02/29/2000
DATE INCURRED
Q
$
12/31/2005
DATE DUE
o
PAID
$
o
o
$
$ 25.000
OpTY Osee
Dolores Sandoval
Continued Continued
COM 0 OTH
o
IND
o
Ms
PER ELECTION
$
$
$ 40.000
0.000 %
RATE
o
$
$ 40.000
12/31/2005
DATE DUE
o
o
FORGIVEN
$
o
$
o
$
$ 40.000
o PTY 0 SCC
D COM 0 OTH
o IND
0.00
$
00
85,000
$
0.00
$
0.00
SUBTOTAL $
Schedule B Summary
1. Loans
00
o
$
received
(b) plus in itemized loans
this period
less than $100.
(Total Column
00
o
$
2. Loans paid or forgiven this period
loans under $100 paid or forgiven
that are also
plus
(c)
(Total Column
00
o
$
NET
itemized on Schedule A.
Line 2
(Subtract Line 2 from Line
Enter the net here and on Column A,
)
1
third party
the Summary Page,
(Include loans paid by a
this period.
Net change
3.
SCHEDULE B - Part
Statement covers period
(Continuation Sheet)
Schedule B - Part
Loans Received
01/01/2005
from
6
page----2 of
.D. NUMBER
through_ 0613 0 /2 005
(,)
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
990787
(I)
ORIGINAL
AMOUNT OF
LOAN
(.)
INTEREST
PAID THIS
PERIOD
Debt Retirement
OUTS1ANDING
BALANCE AT
CLOSE OF THIS
(0)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD
for Supervisor
(b)
AMOUNT
RECEIVED THIS
PERIOD
.,
OUTSTANDING
BAlANCE
BEGINNING THIS
Dolly Sandoval
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPlOYED, ENTER
NAME_Qf BUSINESS:
Dolores Sandoval
Committee
FUll NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
F COMMITTEE, ALSO ENTER
Ms
NAME OF FILER
o
.0. NUMBER)
Sandoval
Continued
Dolores
Continued
Continued
Ms
PAID
PER ELECTION
,
10,000
0.000 %
RATE
10,000
,
o
FORGIVEN
o
,
11/13/2000
DATE INCURRED
o
,
12131/2005
DATE DUE
o
,
o
,
$ 10.000
SCC
DpTY 0
o COM D OTH
D INO
CALENDAR YEAR
PAID
o
Dolores Sandoval
Continued Continued
Continued Continued
Ms
PER ELECTION
,
,
$ 15,000
11/18/2000
DATE INCURRED
0.000 %
RATE
o
,
15,000
12/31/2005
DATE DUE
,
o
o
FORGIVEN
o
,
o
,
$ 15,000
SCC
DpTY 0
o COM 0 OTH
IND
o
CALENDAR YEAR
,
,
o PAID
%
RATE
$
PER ELECTION
FORGIVEN
o
,
DATE INCURRED
,
DATE DUE
,
,
,
o PTY 0 see
o CCM 0 DTH
IND
o
CALENDAR YEAR
,
$
PAID
o
%
RATE
,
PER ELECTION
FORGIVEN
o
,
DATE INCURRED
,
DATE DUE
,
,
,
DpTY 0
OOTH
OeOM
o
CALENDAR YEAR
,
,
%
PAID
o
SCC
IND
PER ELECTION
RATE
,
,
o FORGIVEN
,
0.00
,
$
DATE DUE
000.00
25
$
0.00
,
$
0.00
,
,
SUBTOTAL $
SCC
DpTY 0
o COM 0 OTH
o INO
SCHEDULE
Statement cover.; period
Schedule
Miscellaneous Increases to Cash
6
Page~ of
1.0. NUMBER
01/01/2005
through. 0613 0 /2005
Retirement
from
NAME OF FILER
990787
AMOUNT OF
INCREASE TO CASH
Debt
DESCRIPTION OF RECEIPT
for Supervisor
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS. ENTER I,D. NUMBER
OR, IF NO !.D. NUMBER HAS BEEN ASSIGNED, ENTER TREASURER'S NAME & ADDRESS)
Sandoval
Dolly
Dolores Sandoval
Committee
Ms
DATE
RECEIVED
00
o
SUBTOTAL $
0.00
11.84
$
$
0.00
11.84
$
$
TOTAL
15.
Line
Miscellaneous Increases to Cash Summary
1. Increases to cash of $100 or more this period. ..
2. Increases to cash under $100 this period.
(Do not itemize.) ...............................................
Total of all interest received this period on loan
(Schedule H, Part II (b).) ...................................
Total miscellaneous increases to cash this period.
(Add Lines I, 2, and 3. Enter here and on the Summary Page,
3.
4.