1st Semi-Annual 460 Supervisor
COVERPAGE-LONGFORM
Statement cove.. period
Date of Election W -;
JUL 2 2 2004
Recipient Committee
Campaign Statement
(Government Code Sections 84200 - 84216.5)
from
01/01/2004
(-. Day. Year
through 06/30/2004
N/JI
1. Type of Recipient Committee:
III Officeholder, Candidate Controlled Committee 0 Ballot Measure Committee
0 State Candidate Election Committee 0 Primarily Formed
0 Recall 0 Controlled
0 Sponsored
0 General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
2. Type of Statement:
0 Pre-election Statement
[!I Semi-annual Statement
0 Termination Statement
0 Amendment (Explain below)
0 Quarteriy Statement
0 Special Odd-Year Report
0 Supplemental Pre-election
Statement - Attach Form 495
0 Primarily Formed Candidate
Officeholder Committee
3. Committee Information
990787
Treasurer(s)
COMMITTEE NAME
NAME OF TREASURER
Dolly Sandoval
Dolly Sandoval for Supervisor - Debt Retirement
Committee
STREET ADDRESS (NO P.o. BOX)
10720 Alderbrook Lane
STREET ADDRESS
10720 Alderbrook Lane
CITV STATE ZIP CODE
Cupertino CA 95014
STREET ADDRESS (IF DIFFERENT) ND. AND STREET OR P.o. BOX
AREA CODEIPHONE
(408) 725-8939
CITV
San Jose
STATE
CA 95014
AREA CODEIPHONE
(408) 725-8939
NAME OF ASSISTANT TREASURER,IF ANV
STREET ADDRESS
CITV
STATE
ZIP CODE
AREA CODEIPHONE
CITV
STATE
ZIP CODE
AREA CODElPHDNE
OPTIONAL FAXÆ.MAIL ADDRESS
/
OPTIONAL FAXIE-MAILADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kn~ge the information contained herein and in the attached schedules
is true and complete. I certify under penalty of perjury under the laws of the S~ California.)Þat th«foregðipg is true and correct.
Executed on1 12..2../200'+ By (I-
Executed on -¡ 12-2-r~(y..¡ By
ASSISTANTTREASURER
Exeouted on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLlDER, CANOIDATE, STATE MEASURE PROPONENT
Exeouted on
By
SIGNATURE 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
NAME OF OFFICEHOLDER OF CANDIDATE
5. Officeholder or Candidate Controlled Committee 6. Ballot Measure Committee
NAME OF BALLOT MEASURE
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) CITV 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
'D NUMBER
Friends of Dolores Sandoval
NAME OF TREASURER
851028
CONTROLLED COMMITTEE?
Ed Hoffman
COMMITTEE ADDRESS
STREET ADDRESS (NO P.O. BOX)
10720 Alderbrook Lane
CITV
STATE
ZIP CODE
AREA CODE/PHONE
Cupertino
CA 95014
(408) 725-8939
COMMITTEE NAME
'D. NUMBER
NAME OF TREASURER
CONTROLLED COMMITTEE?
COMMITTEE ADDRESS
STREET ADDRESS (NO P.O. BOX)
STATE
AREA CODEIPHONE
ZIP CODE
BALLOT NO OR LETTER
0 SUPPORT
0 OPPOSE
JURISOICTION
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 Committee
NAME OF OFFICEHOLDER OR 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 OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
Campaign Disclosure Statement
Summary Page
SUMMARY PAGE
C \LtF. OR".\ 460
FOR'I
from
Statement covers peñod
01/01/2004
NAME OF FILER Ms. Dolores Sandoval,
Committee
through.06/30/2004
Dolly Sandoval for Supervisor - Debt Retirement
Page 3 of
1.0. NUMBER
Contributions Received
1. Monetary Contributions ......
.... Schedule A, Line 3 $
Schedule B, Line 7
2. Loans Received
3. SUBTOTAL CASH CONTRIBUTIONS.
.. Add Lines 1 + 2 $
.. Schedule C, Line 3
4. Non-monetary Contributions.
5. TOTAL CONTRIBUTIONS RECEIVED.
.. Add Lines 3 + 4 $
Expenditure Limit Summary for State
Candidates
Expenditures Made
6. Cash Payments
7. Loans Made
Schedule E, Line 4 $
Schedule H, Line 7
8. SUBTOTAL CASH PAYMENTS
Add Lines 6 + 7 $
9. Accrued Expenses (Unpaid Bills) ..
10. Nonmonetary Adjustment
.. Schedule F, Line 3
Schedule C, Line 3
11. TOTAL EXPENDITURES MADE ..
Current Cash Statement
..AddLines8+9+10 $
12. Beginning Cash Balance ..... .... Previous Summary Page, Line 16 $
13. Cash Receipts
14. Miscellaneous Increases to Cash
Column A, Line 3 above
Schedule I, Line 4
15. Cash Payments
Column A, Line 8 above
16. ENDING CASH BA~Cl1les 12 + 13 + 14, then subtract Line 15 $
II this is a Termination Statement, Line 16 must be zero.
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
Q..."QQ
0.00
Q..."QQ
0.00
0.00
Q..."QQ
0.00
0.00
0.00
Q..."QQ
0.00
23,336.31
0.00
1 L..ê.Q
0.00
23,348.21
0.00
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 $
SfCCW - PCAB05 01380 (Rev. 9/99)
..$.
0.00
110,000.00
Column B
CALENDAR YEAR
TOTAL TO DATE
~
110,000.00
110,000.00
0.00
110,000.00
Q..."QQ
0.00
Q.."QQ
0.00
Q.."QQ
0.00
990787
Calendar Year Summary for Candidates
Running in Both the Slate Primary and
General Elections
1/1 Ihmugh 6/30
71110 Dale
20. CoolribullDns
Received.. . $.
-
21. Expeodlluces
Made .......... $
-
22. Cumulative Expenditure Made'
(It Subject 10 VDluota'Y Expeodllure Llm')
Dale of Election
(mm/dd/yy)
Tol,lIo Dale
SCHEDULE B - Part I
Schedule B - Part I
Loans Received
Statement covers period
from
01/01/2004
C \LtFOR'I \ 460
FOIÜI
NAME OF FILER Ms. Dolores Sandoval,
Committee
through. 0 6 / 3 0 / 2 0 04
Dolly Sandoval for Supervisor - Debt Retirement
Page~ of
1.0. NUMBER
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
I" COMMITT". Al'O '""R I D. NUM"R)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF.EMPLOYED. ENTER
NAM' OF B",IN'"
Councilmember
OUTS&NDING
BALANCE
BEGINNING THIS
(b)
AMOUNT
RECEIVED THIS
PERIOD
(0)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD
OUTSTANDING
BALANCE AT
CLDSE OF THIS
!'EB!
(,)
INTEREST
PAID THIS
PERIOD
990787
(ij
ORIGINAL
AMOUNT OF
LOAN
(9)
CUMULATIVE
CONTRIBUTIONS
~
CALENDAR YEAR
Ms. Dolores Sandoval
10720 Alderbrook Lane
Cupertino, CA 95014
0 PAID
,~
[jJ IND 0 COM 0 OTH 0 PTV 0 SCC
Ms. Dolores Sandoval
(Continued)
0 PAID
I ---1.Q....QQQ. I ~ % I I --1Q....QQQ. I-
RATE PER ELECTION
12/31/2004 09/30/1999 ,-
DATE DUE DATE INCURRED
CALENDAR YEAR
,~I ~%I'~ I-
RATE PER ELECTION
City of Cupertino
0 FORGIVEN
I ---1.Q....QQQ. I, ~ I I ~
0 IND 0 COM 0 OTH 0 PTV 0 SCC
Ms. Dolores Sandoval
(Continued) (Continued)
,~
0 FORGIVEN
,~I,~I,~
12/31/20D4 ,~ D2/29/20DD ,-
DATE DUE DATE INCURREO
0 PAID I CALENDAR YEAR
,~,~ ~% I~l'-
0 FORGIVEN RATE PER ELECTION
0 IND 0 COM 0 OTH 0 PTV 0 scc
SUBTOTAL $ D.DD $ O.OD $ B5,000.OD $
Schedule B Summary
1, Loans received this period .........................,.,....,.............
(Total Column (b) plus initemized loans less than $100.)
O. DO
2. Loans paid or forgiven this period
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include ioans paid by a third party that are also itemized on Schedule A.)
$
D.DD
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
Schedule B - Part I (Continuation Sheet)
Loans Received
SCHEDULE B - Part I (con!.)
from
01/01/2004
C\LtFOR:\I\ 460
FOR'I
Statement covers period
NAME OF FILER Ms, Dolores Sandoval,
Committee
Dolly Sandoval for Supervisor
Page~ of
1.0. NUMBER
990787
AMOU~~ PAID °B~,y~~~::'TG INTJ~EST
OR FORGIVEN CLOSEOFTHIS PAID THIS
THIS PERIOD P Rii", PERIOD
0- I~--
,---.JL,~ ~"~ ,-
0 FORGIVEN RATE PER ELECTION
,---.JL 12/31/20D4 '------!L 11/13/2DDD ,-
DATE DUE DATEINCURRED
0 PAID CALENDAR YEAR
,---.JL,~ ~"~ ,-
0 FORGIVEN RATE PER ELECTION
,~ I'------!L I,---.JL 12/31/2004 ,------!L 11/lB/2DDD ,-
DATE DUE DATE INCURRED
0 PAID CALENOAR YEAR
,-,--,,-,-
0 FORGIVEN RATE PER ELECTION
,-1,-1,- ,- ,-
DATE DUE DATE INCURRED
0 PAID CALENDAR YEAR
,-,- -"-,-
0 FORGIVEN RATE PER ELECTION
,-1,-1,- ,- ,-
DATE DUE DATE INCURRED
0 PAID CALENDAR YEAR
'-1'-1 -'1'-1'-
0 FORGIVEN RATE PER ELECTION
through.06/30/2004
Debt Retirement
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTeR 1.0. NUMBER)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF"MPLOYED. ENTER
NAME OF BUSINESS
,
OUTSTANDING
BALANCE
BEGINNING THIS
ß!QQ.
(b)
AMOUNT
RECEIVED THIS
PERIOD
INTÈREST
PAID THIS
PERIOD
Ms, Dolores Sandoval
(Continued) (Continued)
( Continued)
0 IND 0 COM 0 OTH 0 PTV 0 scc
Ms, Dolores Sandoval
(Continued) (Continued)
(Continued) (Continued)
,---1.Q....QQJL I'------!L
0 IND 0 COM 0 OTH 0 PTV 0 SCC
0 IND 0 COM 0 OTH 0 PTV 0 SCC
0 IND 0 COM 0 OTH 0 PTV 0 SCC
,-
0 IND 0 COM 0 OTH 0 PTV 0 scc
SUBTOTAL $ D.DD $ O.DD $ 25,000.00 $
SCHEDULE I
Schedule I
Miscellaneous Increases to Cash
Statement coven; period
!rom
01101/2004
C\LtFOR'-I.\ 460
rUlnl
NAME OF FILER Ms. Dolores Sandoval,
Committee
through.06/30/2004
Dolly Sandoval for Supervisor - Debt Retirement
Page~ of
I.D. NUMBER
990787
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
I" COMM'TTEE. IN ADDmON TD CDMM'TTEFS NAME AND ADDRESS, ENTER 'D. NUMBER
OR. " NO 'D. NUMBER HAS BEEN '""GNED. ENTER TREASURER'S NAME & ADDRESS}
DESCR)PTION OF RECE(PT
AMOUNT OF
INCREASE TO CASH
Miscellaneous Increases to Cash Summary
I. Increases to cash of$IOO or more this period,
2. Increases to cash under $100 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 1,2, and 3. Enter here and on the Summary Page, Line 15.)
SUBTOTAL $
$ 0.00
$ 11.90
$ 0.00
TOTAL $ ll.90
0.00