460 Debt Semi-Annual 2nd
from
07/olo12003
COVER PAGE - LONG FORM
[E []a~tpW [E
Recipient Committee
Campaign Statement
(Government Code Sections 84200 - 84216.5)
FEB - 2 2004
6
Statement ........ period
through 12/31/2003
(Month, Day, Y..~
N/A
1. Type of Recipient Committee:
IJ!I Officeholder, Candidate Controlled Committee 0 Ballot Measure Committee
0 State Candidate Election Committee 0 Primarily Formed
0 Recall 0 Controlled
0 Sponsored
2. Type of Statement:
0 Pre-election Statement
~ Semi-annual Statement
0 Termination Statement
0 Amendment (Explain below)
0 Quarterly Statement
0 Special Odd-Year Report
0 Supplemental Pre-election
Statement - Attach Form 495
0 General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
0 Primarily Fomned Candidate
Otticeholder Committee
3. Committee Information
I.D. NUMBER
990787
Treasurer(s)
CITY STATE ZIP CODE
Cupertino CA 95014
STREET ADDRESS {IF DIFFERENT} NO. AND STREET OR PO BOX
AREA CODE/PHONE
(408) 725-8939
NAME OF TREASURER
Dolly Sandoval
STREET ADDRESS
10720 Alderbrook Lane
CITY
San Jose
STATE
ZIP CODE
AREA CODE/PHONE
(408) 725-8939
COMMITTEE NAME
Dolly Sandoval for Supervisor - Debt Retirement
Commi ttee
STREET ADDRESS {NO P.O. BOX}
10720 Alderbrook Lane
CA 95014
NAME OF ASSISTANTTREASURER, IF ANY
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
STATE
ZIP CODE
AREA CODE/PHONE
CITY
OPTIONAL FAXIE-MAIL ADDRESS
OPTIONAL FAXIE-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the infomnation contained herein and in the attached schedules
is true and complete, I certify under penalty of perjury under the laws of the Sta~lifornia tha~gOin9 is true and correct.
Exec"tedDO \a.....-. 70,2-004 ~
Exec"tedoo j~ ?,Õ~E1iV'-I-
By
URER OR ASSISTANT TREASURER
DAIT
By
DATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR
Exec"ted 00
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
Exewted 00
DATE
By
.,GNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, STATE MEASURE PROPONENT
State of California Fair Political Practices Commission,
S/CCW - PCAB05 01380 (Rev. 9/99)
Recipient Committee
Campaign Statement
Cover Page - Part 2
COVER PAGE - PART 2
2 of
5. Officeholder or Candidate Controlled Committee 6. Ballot Measure Committee
NAME OF BAllOT MEASURE
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
RESIDENTIAUBUSINESS 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
10. NUMBER
Friends of Dolores Sandoval
NAME OF TREASURER
851028
CONTROLLED COMMITTEE?
Ed Hoffman
COMMITTEE ADDRESS
STREET ADDRESS (NO PO BOXI
10720 Alderbrook Lane
CITY
STATE
ZIP CODE
AREA CODEIPHONE
Cupertino
CA 95014
(408)725-8939
COMMITTEE NAME
J.D. NUMBER
NAME OF TREASURER
CONTROLLED COMMITTEE?
COMMITTEE ADDRESS
STREET ADDRESS (NO P.O. BOX)
STATE
ZIP CODE
AREA CODEIPHONE
0 SUPPORT
0 OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any,
BALLOT NO. OR LETTER
JURISDICTION
NAME OF OFFICEHOLDER, CANDIDATE OR, PROPONENT
OFFICE SCUGHT OR HELD
DISTRICT NO. IF ANY
7. Primarily Formed Committee
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT DR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOlDER DR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER DR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
Campaign Disclosure Statement
Summary Page
SUMMARY PAGE
(\111.'011'" 460
FOR'.
from
Statement covers period
07 /01/2003
NAME OF FILER Ms, Dolores Sandoval,
Committee
through,12 / 31/2 003
Dolly Sandoval for Supervisor - Debt Retirement
Page 3 of
1.0, NUMBER
Contributions Received
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
1. Monetary Contributions.
2. Loans Received
"Schedule A. Line 3 $
Schedule B, LIne 7
Q..",QQ
0.00
3. SUBTOTAL CASH CONTRIBUTIONS"
'" Add Lines 1 + 2 $
"" Schedule C, LIne 3
Q..",QQ
0,00
4, Non-monetary Contributions"
5. TOTAL CONTRIBUTIONS RECEIVED"
Column B
CALENDAR YEAR
TOTAL TO DATE
Q..",QQ
110,000.00
1l0,000.00
0.00
110,000.00
990787
Calendar Year Summary for Candidates
Running in Both the Stale Primary and
General Elections
1/1 Ihmu9h 6130
711 to Date
20. Contributioos
Received"..'
21, Expendit",es
Made .."...... $
"AddLines3+4 $
0.00
Expenditure Limit Summary for Stale
Candidates
Expenditures Made
6. Cash Payments
7, Loans Made
Q..",QQ
0,00
Schedule E, Line 4 $
Schedule H, LIne 7
8. SUBTOTAL CASH PAYMENTS
AddLlnes6+7 $
"Schedule F, Line 3
Q..",QQ
0.00
g, Accrued Expenses (Unpaid Bills) "
10. Nonmonetary Adjustment
Schedule C, LIne 3
"AddLines8+9+10 $
Q..",QQ
0.00
11, TOTAL EXPENDITURES MADE
Current Cash Statement
12, Beginning Cash Balance" ' Previous Summary Page, LIne 16 $
23,324,30
13. Cash Receipts
14. Miscellaneous Increases to Cash
Cotumn A. Line 3 above
, Schedule I, Line 4
Q..",QQ
12.01
15. Cash Payments
Column A, Line 8 above
Q..",QQ
23,336,31
16, ENDING CASH BAlllllllCl:Eles 12 + 13 + 14, fhen sublract LIne 15 $
If/his is a Tenmination Statement, Line 16 must be zero,
17. LOAN GUARANTEES RECEIVED Schedule B, Part 1, Column (b) $
Cash Equivalents and Outstanding Debts
0.00
18, Cash Equivalents
19, Outstanding Debts"
110,000.00
. Add Line 2 + Line 9 in Column C above $
S/CCW - PCAB05 01380 (Rev. 9/99)
Q..",QQ
O. QO
Q..",QQ
0.00
Q..",QQ
0,00,
22, Cumulative Expenditure Made"
(If S"bject to Volunta'Y Expenditu,e Limit)
Date of Election
(mmlddfyy)
Totalto Date
Schedule B - Part I
Loans Received
SCHEDULE B - Part I
Statement çovers period
c.\LlHJI<~IA 460
FOR'.
from
07/01L2003
NAME OF FILER Ms. Dolores Sandoval,
Committee
through,12/31/2003
Dolly Sandoval for Supervisor - Debt Retirement
Page 4 of
1.0. NUMBER
FULL NAME, STREET ADDRESS AND ZIP CODE
OFlENOER
'" COMMITTEE, ALSO ENTER (D. NUMBER)
Ms. Dolores Sandoval
10720 Alderbrook Lane
Cupertino, CA 95014
IF AN INDIVIDUAL ENTER
OCCUPATION AND EMPLOYER
'" SELF-EMPLOYED, ENTER
NAME OF BU5'NESS
OUTs1},.DING
BAlANCE
BEGINNING THIS
(b)
AMOUNT
RECEIVED THIS
PERIOD
Councilmember
City of Cupertino
(o)
AMOUNT PND
DR FORGIVEN
THIS PERIOD
0 PAID
.~
0 FORGIVEN
.~I.~I.~
IiIIND 0 COM 0 OTH 0 PTY 0 SCC
Ms. Dolores Sandoval
(Continued)
DpND
.~
0 FORGIVEN
.~I.~I.~
0 FORGIVEN
0 INO 0 COM 0 OTH 0 PTY 0 scc
SUBTOTAL $ D.DD $ D,DO $ BS.ODO.OD $
Schedule B Summary
1. Loansreceivedthisperiod. ".""""" .""."" "".""
(Total Column (b) plus initemized loans less than $100.)
0 INO 0 COM 0 OTH 0 PTY 0 scc
Ms. Dolores Sandoval
(Continued) (Continued)
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
DpND
.~
NET $
OUTSTANDING
BALANCE AT
CLOSE OFTHIS
(0)
INTEREST
PAID THIS
PERIOD
990787
(Q
ORIGINAL
AMOUNT OF
LOAN
(g)
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
.~I -2..,.QQQ...%I'~ ,-
RATE PER ELECTION
12/31/2°04I,~ .Q1LlQLill9 ,-
DATE DUE DATE INCURRED
CALENDAR YEAR
,~I -2..,.QQQ...%I'~ ,-
RATE PER ELECTION
12/31/20041'~ D2/29/2000 ,-
DATE DUE DATE INCURRED
CALENDAR YEAR
,~I -2..,.QQQ...%I'~ ,-
RATE PER ELECTION
O. OD
$
O. OD
O. DD
SCHEDULE B - Part I (conI.)
Schedule B - Part I (Continuation Sheet)
Loans Received
S_nt covers peñod
from
07101/2003
C\l.It.,'OR:\L\ 460
FOR"
NAME OF FILER Ms. Dolores Sandoval,
Committee
through.12/31/2003
Dolly Sandoval for Supervisor - Debt Retirement
p- 50f
1.0. NUMBER
FULL NAME. STREET ADDRESS AND ZIP CODE
OFLENDER
(IF COMMITTEE, ALSO ENTER LD NUMBER)
Ms. Dolores Sandoval
(Continued) (Continued)
(Continued)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SElF-EMPLOYED, ENTER
NAME OF BUSINESS
OUTS¡~NDING
BAlANCE
BEGINNING THIS
(b)
AMOUNT
RECEIVED THIS
PERIOD
(e'
AMOUNT PAID
OR FORGIVEN
THIS PERIOD
OUTStANDING
BALANCE AT
CLOSE OFTHIS
f'EBl
(-,
INTEREST
PAJOTHIS
PERIOD
990787
'0
ORIGINAL
AMOUNT OF
LOAN
(g)
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
0 PAID
0 ---9- 10 --1Q...QQQ.
~%IO~IO-
RATE PER ELECTION
0 FORGIVEN
0 INO 0 COM 0 OTH 0 PTY 0 SCC
Ms. Dolores Sandoval
(Continued) (Continued)
(Continued) (Continued)
0--1Q...QQQ. 10------!2- 10---9- 112/31/2D041°---9-I"/13/2DDD Io-
DATE DUE DATE INCURRED
0 PAJD
0---9-10~
CALENDAR YEAR
0 FORGIVEN
~%IO~IO-
RATE PER ELECTION
0 INO 0 COM 0 OTH 0 PTY 0 SCC
$~ 1$------!2- 10---9-112/31/20041$---9-1"/18/20001$-
DATE DUE DATE INCURRED
DpAJD
CALENDAR YEAR
$-1$-
0 FORGIVEN
~%I$-I$PERELECTION
DIND 0 COM 0 DTH 0 PTY 0 SCC
$-1$-1$-
$-
$-
DATE DUE
DATE INCURRED
0 PAID
CALENDAR YEAR
$-1$-
0 FORGIVEN
~%I$-I$~
0 INO 0 COM 0 OTH 0 PTY 0 SCC
$-1$-1$-
$-
$-
DATE DUE
DATE INCURRED
0 PAID
0_1$-
CALENDAR YEAR
0 FORGIVEN
~%IO-I$~
$-
0 INO 0 COM 0 OTH 0 PTY 0 scc
SUBTOTAL $ 0.00 $ 0,00 $ 25,000.00 $
SCHEDULE I
Schedule I
Miscellaneous Increases to Cash
Statement COYefS peñod
from
07LQU2003
CALlt."OR'I.\ 460
FOR'!
NAME OF FILER Ms. Dolores Sandoval,
Committee
Ihrough12/31/2003
Dolly Sandoval for Supervisor - Debt Retirement
Page 6 of
I.D. NUMBER
990787
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMM'TTEE, 'N ADDmON TO COMMITTEE'S NAME AND ADDRESS, ENTER LD. NUMBER
OR. IF NO '.D NUMBER HAS BEEN AS5'GNED. ENTER TREASURER'S NAME & ADDRESS)
DESCRIPTION OF RECEIPT
AMOUNT OF
INCREASE TO CASH
SUBTOTAL $
0.00
Miscellaneous Increases to Cash Summary
1. Increases to cash of$1O0 or more this period.
2. Increases to cash under $tOO this period.
(Do not itemize.) .............................................
3, Total of all interest received this period on loans made to others.
(Schedule H, Part II (b),) .......................................
4. Total miscellaneous increases to cash this period.
(Add Lines t, 2, and 3. Enter here and on the Summary Page, Line 15.)
0,00
$
$
12.01
0.00
TOTAL
$
12 - 01