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Semi-annual debt retirement Statement covers period COVER PAGE Recipient Committee Campaign Statement Cover Page (Govemment Code Sections 84200 - 84216.5) U-~D1t~ s~m~\i1 r~: lor 6 , u!~, from 07/01/2006 through 12/31/2006 (Month, OIly, Year) L IPER1 !NO CITY CLE For Official Use Only N'/n 1. Type of Recipient Committee: IJJ Officeholder, Candidate Controlled Committee 0 Ballot Measure Committee o State Candidate Election Committee 0 Primarily Formed o Recall 0 Controlled o Sponsored 2. Type of Statement: o Pre-election Statement ~ Semi-annual Statement o Termination Statement o Amendment (Explain below) o Quarterly Statement o Special Odd-Year Report o Supplemental Pre-election Statement - Attach Form 495 o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee o Primarily Formed Candidate Officeholder Committee 3. Committee Information 1.0. NUMBER 990787 Treasurer(s) (408) 725-8939 NAME OF TREASURER Dolly Sandoval MAILING ADDRESS 10720 Alderbrook Lane CITY San Jose NAME OF ASSISTANT TREASURER, IF ANY STATE ZIP CODE CA 95014 AREA CODElPHONE (408) 725-8939 COMMITTEE NAME Dolly Sandoval for Supervisor - Debt Retirement Committee STREET ADDRESS (NO P.O. BOX) 10720 Alderbrook Lane CITY STATE ZIP CODE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX AREA CODElPHONE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODElPHONE OPTIONAL: FAXIE-MAIL ADDRESS / OPTIONAL: FAXlE-MAIL ADDRESS 4. 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 schedules is true and comPlete.. I certify under penalty of perjury under the laws OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT State of California Fair Political Practices Commission. S/CCW - PCAB05 01380 (Rev. January/OS) Recipient Committee Campaign Statement Cover Page - Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OF CANDIDATE Ms. Dolores Sandoval OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Board of Supervisors, District 5, Santa Clara County RESIDENTIALJBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP CODE 10720 Alderbrook Lane Cupertino CA 95014 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. COMMITTEE NAME I.D. NUMBER Friends of Dolly Sandoval NAME OF TREASURER 1277455 CONTROLLED COMMITTEE? Sarah Hathaway-Felt COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) 10720 Alderbrook Lane CITY STATE ZIP CODE AREA CODElPHONE Cupertino CA 95014 (408) 725-8939 COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODElPHONE COVER PAGE - PART 2 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION o SUPPORT o OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE Campaign Disclosure Statement Summary Page SUMMARY PAGE Statement covers period ( \111 (lR'\1 \ 460 H>R\J ham 07/01/2006 through 12/31/2006 Dolly Sandoval for Supervisor - Debt Retirement NAME OF FILER Ms. Dolores Sandoval, Committee Contributions Received 1. Monetary Contributions ..............................,...... Schedule A, Line 3 $ 2. Loans Received ................................................ Schedule B, Line 7 3. SUBTOTAL CASH CONTRIBUTIONS .................. Add Lines 1 +2 $ 4. Nonmonetary Contributions .............................. Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........,........ Add Lines 3 + 4 $ Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDUUES) Column B CALENDAR YEAR TOTAL TO DATE Page 3 or 1.0. NUMBER 6 990787 Calendar Yeer Summary for Candidates Running In Both the State Primary and General ElecUons 1/1 through 6/30 7/1 to Date 20. Contributions Received .... $ 21. Expenditures Made .......... $ o o 0.00 0.00 0.00 0.00 0.00 $ 0.00 110,000.00 110.000.00 0.00 110,000.00 o o $ $ ExpendUure Umlt Summary for State Candidates Expenditures Made 6. Cash Payments ................................................ Schedule E, Line 4 $ 7. Loans Made ...................................................... Schedule H, Line 7 8. SUBTOTAL CASH PAYMENTS .........................,.. Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) ...................... Schedule F, Line 3 10. Nonmonetary Adjustment ................................ Schedule C, Line 3 11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance .......... Previous Summary Page, Line 16 $ 13. Cash Receipts ....,.................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 15. Cash Payments ....................................... Column A, Line 8 above 16. ENDING CASH BALANCE ............ Lines 12+13+14, less Line 15 $ If this is a Termination Statement, Line 16 must be zero. 0.00 0.00 0.00 0.00 0.00 0.00 $ 0.00 0.00 0.00 0.00 0.00 0.00 $ $ 25,916.88 0.00 25.85 0.00 25,942.73 17. LOAN GUARANTEES RECEIVED Schedule B, Part 1, Column (b) $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................................................$. 19. Outstanding Debts .......... Add Line 2 + Line 9 in Column C above $ S/CCW - PCAB05 01380 (Rev. January/OS) 0.00 0.00 110,000.00 22. Cumulative Expenditure Made* (If Subject to Voluntary Expenditure Umit) Date of Election (mmlddJyy) Total to Date . Amounts in this section may be different from amounts reported in Column B. Schedule B - Part I Loans Received Statement covers period ham 07/01/2006 through 12/31/2006 Dolly Sandoval for Supervisor - Debt Retirement NAME OF FILER Ms. Dolores Sandoval, Committee FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Ms. Dolores Sandoval (c) AMOUNT PAID OR FORGIVEN THIS PERIOD (b) AMOUNT RECEIVED THIS PERIOD IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF ~%E~~~~\WE~;ITER Councilmember o PAID $ 0 o FORGIVEN City of Cupertino IiIIND 0 COM 0 OTH 0 PTY 0 scc Ms. Dolores Sandoval (Continued) $ 20,000 $ OUTS ANDING BALANCE AT CLOSE OF THIS $ 20,000 0 $ 0 12/31/2006 $ DATE DUE o PAID $ 0 $ 25,000 o FORGIVEN $ 25,000 $ 0 $ 0 12/31/2006 $ DATE DUE o PAID $ 0 $ 40,000 o FORGIVEN $ 40,000 $ 0 $ 0 12/31/2006 $ DATE DUE SUBTOTAL $ 0.00 $ 0.00 $ 85,000.00 $ o IND 0 COM 0 OTH 0 PTY 0 scc Ms. Dolores Sandoval (Continued) (Continued) o IND 0 COM 0 OTH 0 PTY 0 SCC Schedule B Summary 1. Loans received this period ...................................... ...... ................................................................ $ (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period ................................................................................................. $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ................................................... Enter the net here and on the Summary Page, Column A, Line 2 NET $ 0.00 0.00 0.00 (e) INTEREST PAID THIS PERIOD 0.000 % $ RATE 0.000 % $ RATE 0.000 % $ RATE SCHEDULE B - Part I ( \I II (H{\I \ 460 JOJ{\J Page 4 or I.D. NUMBER 990787 (I) ORIGINAL AMOUNT OF LOAN 20,000 o 09/30/1999 $ DATE INCURRED 6 (g) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR 000 $ PER ELECTION o 02/29/2000 $ DATE INCURRED 40,000 $ o 0.00 CALENDAR YEAR PER ELECTION $ Schedule B - Part I (Continuation Sheet) Loans Received SCHEDULE B - Part I (cont.) Statement covers period ftom 07/01/2006 through 12/31/2006 Dolly Sandoval for Supervisor - Debt Retirement NAME OF FILER Ms. Dolores Sandoval, Committee FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Ms. Dolores Sandoval (Continued) (Continued) (Continued) IF AN INDIVIDUAl, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS a OUT ANDING BALANCE BEGINNING THIS OUTS ANDING BALANCE AT CLOSE OF THIS (b) AMOUNT RECEIVED THIS PERIOD (e) AMOUNT PAID OR FORGIVEN THIS PERIOD o PAID $ 0 $ o FORGIVEN 10,000 o IND 0 COM 0 OTH 0 PTY 0 scc Ms. Dolores Sandoval (Continued) (Continued) (Continued) (Continued) $ 10,000 $ o IND 0 COM 0 OTH 0 PTY 0 scc $ $ 0 $ 0 12/31/2006 $ DATE DUE o PAID $ 0 $ 15,000 o FORGIVEN 0 $ 0 12/31/2006 $ DATE DUE o PAID $ $ o FORGIVEN $ $ DATE DUE o PAID $ $ o FORGIVEN $ $ DATE DUE o PAID $ $ o FORGIVEN $ $ DATE DUE 0.00 $ 0.00 $ 25,000.00 $ o IND 0 COM 0 OTH 0 PTY 0 SCC $ 15.000 $ o IND 0 COM 0 OTH 0 PTY 0 SCC $ $ o IND 0 COM 0 OTH 0 PTY 0 SCC $ $ SUBTOTAL $ 0.000 % $ 10,000 $ RATE PER ELECTION 0 11/13/2000 $ DATE INCURRED CALENDAR YEAR 0.000 % $ 15,000 $ RATE PER ELECTION 0 11118/2000 $ DATE INCURRED CALENDAR YEAR (e) INTEREST PAID THIS PERIOD RATE RATE RATE ( \III liH\1 \ 460 I () I{ " Page 5 or 6 1.0. NUMBER 990787 (I) ORIGINAL AMOUNT OF LOAN (g) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR % $ $ PER ELECTION $ DATE INCURRED CALENDAR YEAR % $ $ PER ELECTION $ DATE INCURRED CALENDAR YEAR % $ $ PER ELECTION $ PATE INCURRED 0.00_ SCHEDULEr Schedule I Miscellaneous Increases to Cash Slalement covers period ( \I "PW\I \ 460 lOR\! NAME OF FILER Ms. Dolores Sandoval, Committee fiom 07/01/2006 through 12/31/2006 Dolly Sandoval for Supervisor - Debt Retirement Page 6 or 1.0. NUMBER 6 990787 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS, ENTER 1.0. NUMBER OR, IF NO I.D. NUMBER HAS BEEN ASSIGNED, ENTER TREASURER'S NAME & ADDRESS) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH SUBTOTAL $ 0.00 Schedule I Summary 1. Itemized increases to cash this period. ............................................................................................... 2. Unitemized increases to cash under $100 this period. 0.00 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ...... ...................... ................. ..... ................. ..............., .... ......... ... ... ..... ...... 4. Total miscellaneous increases to cash this period. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Line 14.) ........................... TOTAL $ $ $ $ 25.85 0.00 25.85