460 Pre-election 2nd ecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Type of Recipient Commi~ee: Au CommIR~ - Comple[e Pa~ 1, 2, 3, end 4.
COVEI:t PAGE
For Ollicial Use Only
Officohotdec Candidate Controlled Committee
State Candidate Election Committee
Recall
[] Gone ral Purpose Committee O Sponsored
O Srnall Contributor Committee
O Politica~ Party/Central Committee
0 Primarily Formed
0 Controlled
O Sponsored
[] Pdmadly Formed Candidate/
Officeholder Committee
2. Type of Statement: ~ Proelection Statement
[] Semi-annual Statement
[] Terminalion Statement
[] Amendment (Explain below)
[] Quarterly Slalement
[] Special Odd-Year Repod
[] Supplemental Preelection
Stalement - Attach Form 495
Treasurer(s)
MAILING ADDRESS
CITY STATE ZIP COOE AREA CODE/PHONE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E MAIL AOORESS
CITY
STATE ZIP CODE AREA COOE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS
4. Verification
I have used a reasonable diligence in preparing and reviewing this slatement and ~o the be.s~y ,/~ge the inlormation contained herein and in the ettached schedules is true and complete
certily under penalty of pedury under the taws of the State el Calilornia that the foregoin~~t.
chedule El - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
FULL NAME. STREET ADDRESS AND ZIP CODE.
OF LENDER
IF AN INDIVIDUAL. ENTER
OCCUPAT)ON AND EMPLOYER
Type or print In Ink.
Amourtt$ may be rounded
to whole dollars.
OUTSTANDING AMOLINT
BALANCE IECEIVED THIS
~IND [] COM [] OTH [] PTY [] SCC
t[~ IND [] COM 0 Om [] PTY [] SCC
to INO [] COM [] OTH [] pTY [] SCC
(c)
AMOUNT PAID
iR FORGIVEN
THIS PERIOD °
SCHEDULE B - PART 1
(d)
DATE O~3E
$
$
INTEREST CUkAULAlqIVI~
PAID TH~S CONT F~IeUTIONS
PERIOD LOAN TO DATE
Schedule B Summary
1. Loans received this period .................................................................................................................... $
(Total Column (b) plus unitemized loans less than $100.)
2. Loans paid or forgiven this period ......................................................................................................... $
(Tolal Column (c) p us loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Netchangethisperiod. (Subtract Line 2 from Line l.) ............................................................... NET $ ~
Enler tho net here and on tho Summary Page. Column A. Line 2.
It Co~tdbb, tor Codes
IND - Indl'dduaJ COM - Redplenl Committee (other than FTY or SCC)
OTH - Olher
PTY - Political Party
SCC - Small Conlribulor Commitle~
FPPC Form 460 (Jur~e/O1)
FPPC Toll-Free Helpllne: 86GIASK-F~PPC
· . Sqhedule A Type or print I. Ink. SC3-1EDU~E A
Monetary Contributions., Received to who,. doi,.r., from
SEE INSTRUCTIONS ON REVERSE
?
[] coa
I~OTH
[] PTY
E]~NO
[~OTH
[~ PTY
[~SCC
,. [] OTH
[] PTY
~SCC
~NO
~o~
~ PTY
~SCC
~OTH
~SCC
SUBTOTALS " :~ 7--~.~'~.~' .,',
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 rnonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) ....................... TOTAL
'Conlribulo~ Codes
IND - Individual
(other than PTY or SCC)
PTY - Pcflitical Parly
FPPC Form 460 (Jur~e/01}
FPPC Toll-Free Helpllne: 8S6~ASK-IcPPC