460 termination ecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Statement covers pertod
from
,h,ough
Date of election if eppllcebl
(Month, Day. Year)
DEC - 9 2003
)ERTINO
COVERPAGE
of
Olllcia[ Use Only
1. Type of Recipient Committee: All Committees - Comlplet* pm~lm 1, 2. 3. and 4.
vC~ Officeholder, Candidate Controlled Co?nmittee O State Candidale Election Committee
O Recall
[] Gene ral Purpose Committee
{~ Sponsored
O Small Contdbutor Commillee
(~ Political Party/Central Cof'n~niilee
[] BallotMeasure Committee C) Primarily Formed
C) Controlled
C) Sponsored
[] primarily Formed Candidate/
Otticeholder Committee
Type of Statement:
[] Preeleciion Statement
[] Semi-annual Slatement
~.. Te r m/nation Statement
[] Amendrm~nt (Explain below)
[] Ouadedy Slalement
[] Special Odd-Year Repod
[] Supplemenlal Preelection
Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
STATE ZIP CODE REA CODE/PHONE
NAME OF ASSISTANT TREASUReR, IF ANY ~
ZIP CODE
MAILING ADDRESS (IF DIFFERENTI NO. AND STREET OR P.O[ BOX MAILING ADORESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS OP¥1ONAL: FAX I E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to Ihe best
certify under penalty of perjury under the laws of the State of California that the foregoing~J~. _
ecipient Committee
Campaign Statement
Cover Page-- Part 2
Type or print in ink.
COVER PAGE - PART 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER tF APPLICABLE)
RESIDENTIAL'BUSINESS ADDRESS (NO. AND STREET) ~ITY STATE ZIP
Related Committees Not Included in this Statement: Liatenycommlttees
not included In this statement that are controlled by you or ere primarily formed to receive
COMMIT[EE NAME I.D. NUMBER
NAME OE TREASURER CONTROLLED COMMII~rEE?
[] YES [] NO
COMMIT3~E ADORESS STREET ADDRESS (NO P.O. BO>
CITY STA31~. ZIP CODE AREA COD~JPHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
[] ~ES [] NO
STREET ADDRESS (NO P,O. BO~
COMMIIq'EE ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
6. Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER
JUR'SD'CT'ON [ ~OPPosESUPPORT
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER. CANDIDATE. OR PROPONENT
OFFICE SOUGHT OR HELD~r DISTRICT NO. IF ANY
7. Primarily Forn~d Committee List names of officeholder(s) or candidate(s) for
which this committee I, primarily formed.
NAME OF OFFICEHOLDER OR CANDIOATE
NAME OF OFFICEHOLDER OR CANDIDATE
[] SUPPORT
[] OPPOSE
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
[]SUPPORT
[]OPPOSE
NAME OF OFFICEHOLDER OR CAN01DATE r~SUPPORT
OPPOSE
NAME OF OFFICEHOLDER OR CANOIDATE [~SUPPORT
[~OPPOSE
Attach continuation sheets if necessary
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
Type or print In
Amounts may be rounded
to whole dollars.
thro.ghl /O?
NAME OF FILER
Contributions Received
1. Monetary Contributions ........................................... Schedule A, £ ~ne 3
2. Loans Received ...................................................... Schedule B. Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ........................ Add Lines I + 2
4. Nonmonetary Contributions .................................... Schedul, C. Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .,-: ....................... AddUnes 3 * 4
Column A
Column B
Expenditures Made
6. Payments Made ....................................................... Schedule E, Line
7. Loans Made ............................................................. Schedule H, Line
8. SUBTOTAL CASH PAYMENTS .................................... Add~.i~s 6 *
9. Accrued Expenses (Unpaid Bi[is) ............................... ScheduleF. Line
10. Nonmonetary Adjustment .......................................... Schedule C. Line
11. TOTAL EXPENDITURES MADE ................................ AddLines8+9* lO
Current Cash Statement
12. Beginning Cash Balance ....................... pre~ou$Sunlrnaq/Page, LinelS
13. Cash Receipts ................................................... CotumnA, Llne3above
14. Miscellaneous Increases to Cash ........................... Schedule I. Line 4
15. Cash Payments .................................................. ColumnA. LineSabove
16. ENDING CASH BALANCE .......... Add Lines 12+ 13+ t4. Ihen subtract Line ~ 5
If this is a terrnina~on statement, Line 16 must be zero.
$
To calculate Column B. add
amounts in Column A ~o the
corresponding amounts
trom Column B ol your last
report. Some amounls in
Column A may be negative
figures that should be
subtracted from previous
period amounts. Il Ihis is
the first report being Iliad
for this calendar year. only
carq/ over the amounts
Irom Lines 2. 7. and 9 (il
any).
20. Conlributions
Received
21. Expenditures
Made
Expenditure Limit Summary for State
Candidates
$ $
$ $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ........................................ Seek]s¢ructtonsoc3£eve~e $
19. Outstanding Debts ......................... AddUne2+LineginC~u~Tebove $
17. LOAN GUARANTEES RECEIVED ........................... SchedUle I~, Part 2 $
General Elections
22. Cumulative Expenditures Made'
Date ol Election
(mm/dd/yy)
__/
Tolallo Date
$
$
$
'Since January t. 2001. Amounts in this seclion may be
dilferenl trom amounts repoded in Column B
FPPC Form 460 (Jur~e/01)
FPPC Toll-Free Helpl[ne: 866/ASK-FPPC
SUMMARY PAGE
Calendar Year Summary for Candidates
Running in Both the State Primary and
chedule A Type or print In ink. SCHEDU{.E A
Monetary Contributions Received'i ,o whole dollar., from
Oscc
~COM
~OT~
~SCC
~OTH
~ PTY
~scc
~OTH
~ PTY
~scc
~cou
~OTH
~PTY
~scc
SUBTOTAL $ , ~,~t~ .,:
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 monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $
[ 'Contribulor Codes
IND - Individual
COM - Redpient Commi~ee
(olher than PTY o¢ SCC)
OTH - Olhet
PTY- Political Parly
SCC- Small Contributor Con~nille o
FPPC Form 460 (June/Ol)
FPPC Toll-Free Helpllne: 8661ASK-FPPC
chedule B - Part 1
Loans Received
SEEINSTRUCTIONS ON REVERSE
NAME OF FILER
Type or print In ink.
Amo~nts may be rounded
to whole dollars.
SCHEDULEB-P^RT1
Page ~ of ~
FULL NAME. STREET ADDRESS AND ZIP CODE
OF LENDER
IF AN INDIVIDUAL, ENTER
(.)
OUTSTANOING
AMOUNT
{c) (d)
OUTSTANDING
AMOUNT PAiD BALANCE AT
INTEREST
PAID THIS
I.D. NUMBER
t~.IND [] COM [] OTH E] pTY [] SCC
t~.IND [] COM [] O33"1 [] PTY [] SCC
OCCUPATION AND EMPLOYER
BALANCE
BEGINNING THIS
PERIOD
RECEIVED THIS
PERIOD
s ~
OR FORGIVEN CLOSE OF THIS
THIS PERIOD ' PF..RIOD
,?'2-~,/~
PERIOD
RATE
$. $
t[] IND [] COM [] OTC [] PTY [] SCC
SUBTOTALS $ $ /~Z~,)/' $ --~ $
Schedule B Summary so.~E.~.3)
1. Loans received this pedod .................................................................................................................... $ ~'
(Total Column (b) plus unitemized loans less than $100.)
2. Loans paid or forgiven this period - .............................. $ /~ ~
(Total Column (c) plus leans under $100 paid or forgiven.)
(Include leans paid by a third pa~ that are also itemized on Schedule A.)
3. Net change this peri~. (Subtract Line 2 from Line 1.) ............................................................... N~ $ ~/~ ~
Enter the net here and on the Summa~ Page, Column A, Line 2.
[ IfND~:~I~e~oM- .edplenl ~mml.ee (other Ih.n P~ o, SCC} OTH - Other p~- Polific., Pa~ SCC- Small Conlnbuto, ~i.ee~
LOAN TO DATE
FPPC Form 460 (June/D1)
FPPC TolI-Eree Helpllne: 866/ASK-FPPC