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2nd 460 Super Semi-Annual Dals,amp Œ ~ py JL~i e4Wt eé21tÎ.s)2005 Recipienl Campaig JAN 3 1 2005 -ii:', C~/~f-;'/\ Ot:i?t.Jiy n"';"1I~r. r-,,_\,I......._ .- -·'AN -~S"f Yo DateofElec::tioftIl~IT" .. F:. co (IIonIb. Doy, v.., B" J_. tit. ...At CCJI¥WS pwiod ~ 07/01/2004 IhnIugh 12/31/2004 CUPERTINO CITY CLER (Government C, o Quarterly Statement o Special Odd-Year Report o Supplemental Pre-election Statement - Attach Form 495 2. Type of Statement: o Pre-election Statement œ Semi-annual Statement o Termination Statement o Amendment (Explain below) 1. Type of Recipient Committee: III Officehol~r, Candidate Cootrolkid Committee 0 Ballot Measure Committee o State Candidate Election Committee 0 Primarify FOT1'\1ed o Racall 0 Controllad o Sponsored o PrlmarUv Formed Candidate omceholder Committee o General Purpose Committee o Sponsored o Small Contributor Committee o PolitIcal Party/Central Committee AREA CODEJPHONe (408) 725-8939 ZlPcoœ 95014 STA.TE CA Treasurer(s} NAME OF TREASURER Dolly Sandoval STREET ADDRESS 10720 Alderbrook Lane COTY San Jose NAME OF ASSISTANT TREASURER, IF ANY I.D.NUM8ER 990787 Infonnation 3. Committee COMMITTEE NAME Retirement AREA COOEIPHONE (408) 725-8939 Dolly Sandoval for Supervisor Committee STREET AOORE5S(NO P.O. BOX) 10720 Alderbrook Lane CITY STATE ZIP coœ Cupertino CA 95014 STREET AOORESS(!F DIFFERENT) NO. AND STREET OR P.O. BOX Debt AREA COD~ONE ( ) ZIP CODE STATE STREET ADDRESS CITY AREA CODElPHONE ZIP CODE STATE OJTY OPTIONAL: FAXIE-MA1l ADDRESS the information contained herein and in the attached scheduk3s is true and correct. 4. Verification I have used all reasonable dnigence in preparing and reviewing this slalement and to the best 01 my kno' is true and complele, I certify under penalty 01 perjury under the laws te of California thet the I&;ag, 1!3¡ los- By em 3; oS- 8y DATE OPTIONAL: FAXIE.MA1l ADDRESS () / Executed on stATE MEASURE PROPONENT OR RESPONSIBlE OFFICER OF SPONSOR SIGNAT' on Executed MEASURE PROPONENT SIGNATURE Of CONTROLLING OFRCEHOlœR, CANDIDATE, STATE MEASURE PROPONENT Slato of california Fair Political Practicea Commission, SIGNATURE. Of CONTROLUNG OfFICEHOLDER, CANDIDATE, STATE By By CATE Executed on DATE PCAB05 01380 (Rev, 9/99) Executed on SlCCW COVER PAGE - PART 2 Recipient Committee \111{)','1\4 Campaign Statement Oln¡ . Cover Page - Part 2 ... 20f 5. Officeholder or Candidate Controlled Committee 6. Ballot Measure Committee NAME OF OfFICEHOLDER OF CANDIDATE NAME OF BALLOT MEASURE Ms_ Dolores Sandoval OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER I JUR'S01CTlON ] []~RT Board of Supervisors, District 5, Santa Clara County [] QlWSE RE$IOENTtAUBUSJNeSS AOORESS (NO. AND STREEn CITY STATE ZIP CODE Identify the controlUn; officeholder, candidate. or state measure proponent. if any. 10720 Alderbrook Lane Cupertino CA 95014 NAME OF OFFICEHOLDER, CANDIDATE OR, PROPONENT Related Commltt_ Not Included In this Statement: Ust any commlltees not included in this consolidatad statamant that ara controDad by you or which ara primarily OFFICE SOUGHT OR HELD DŒTRICT NO. IF ANY formed to receive contributions or to make expenditures on behalf of your candidacy. 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 AAME Of OFFICEHOUJER OR CANCIDATE OFFICE SOUGHT OR HEtD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE 7. Primarily Formed COMMITTEE NAME I.D. NUMæR NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS {NO P.O. BOX} C"Y STATE ZIP CODE AREA CODElPHONE COMMmEE NAME I.D. NUMBER NAME. OF TREASURER CONTROlLED COMMITTEE? COMMITTeE ADDRESS STREET ADDRESS {NO P.O. BOX} CITY STATE ZIP CODe AREA CODEJPHONE SUMMARY PAGE S_covers perfod 2004 Campaign Disdosure Statement Summary Page 6 01 throughJ2/31/2004 P8ge 3 of Retirement 1.0. NUMBER 990787 <:...........rV_Summary forCa_ Running in Bofb!he S_ Prim8Iy_ ~ CIeI:Iiod6 111 throug, 6130 07 from Debt Dolly Sandoval for Supervisor NAME OF FILER Me. Dolores Sandoval, Committee Contributions Received ioDate 71 Conbibulions Received .... , Expenditures M8de .......... $ 20. 2 Cofumn B CAlENDAR 'fEAR TOTAL TO DATE $ Column A TOTAl THIS ÆRrOD (FROM ATTA.CHED SCHEDVlES) 00 $ $ Schedule A, UI18 3 Schedule B, UI18 7 Monetary Contributions loans Received $ $ Add Unes 1 + 2 Schedul6 C, UI18 3 AddUnes 3 + 4 SUBTOTAL CASH CONTRIBUTIONS Non-monetary Contributions ............... TOTAL CONTRIBUTIONS RECEIVED 1, 2. 3, 4, 5, ~ UmIt Summary fDr_ Candk"" ~ I 22, 0.00 .LQQ 0.00 $ $ Cumulative Exoenditure Made' (ff Subject to VoItm\ar, Expenditure Umi Total to Date Oats of Election (mmlddJyy) $ 0.00 0,00 0,00 0.00 0,00 OJJ) $ Schedule E, Una 4 Schedule H, UI18 7 Expenditures Made 6. Cash Payments $ Add Unes 6 + 7 Schedule F, UI18 3 Schedule C, Une 3 AeJdUnes8+9+10 7, loans Made 8, SUBTOTAL CASH PAYMENTS 9, Accrued Expenses (Unpaid Bills) 10. Nonmonetary Adjustment ,......,.. 11, TOTAL EXPENDITURES MADE Current Cash Statement Balance $ 2 $ $ Previous Summary Page, Una 16 Column A, Une 3 above Schedul6 I, Una 4 12, Beginning Cash 13, Cash Receipts 2 $ 14, MlsceDaneous Increases to Cash 15. Cash Payments .........,....""",,,,,.. Cclumn A. Une 8 above 16, ENDING CASH BJUMlICJœs 12 + 13 + 14, then subtract Une 15 If this is a Termination Statement, Une 18 must be zero. 0.00 .LQQ UO,OOO~QQ $ """,,$. Cclumn C above $ 17. LOAN GUARANTEES RECEIVEDSchedule B, Part I, Column (b) Cash Equivalents and Outstanding Debts 18, Cash Equivalents ' 19. Outstanding Debts Add Line 2 + Una 9 in PCAB05 01380 (Rev, el9Ð) SlCCW SCHEDULE B . Part --period 2004 Schedule B - Part loans Received Page 4 of 6 1.0. NUMBER 01 Ihtough.12/31/2004 Debt Retirement 07 from (01 CUMULATIVE CONTI\I8UTIONS TO DATE CAlENDAR YEAR 990787 (~ ORIGINAl AMOUNT OF LOAN (01 !NTEREST PAID THIS PERIOD OUTSTANDING aAlANCE . T CLOSE OF THIS S 20.000 $ 20,000 PER ELECTION .% !L.9.QO AAlE (01 AMOUNT PAID OR FORGIVEN THIS PERIOD o PAID · 0 o FORGIVEN · º Dolly Sandoval for Supervisor Ibl AMOUNT RECEIVED THIS PERIOD OUTS1'~NG BALANCE BEGINNING THIS IF AN INDMDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF..eMPlO'tED, ENTER 1'WÆ000BUSINESS Councilmember NAME OF FILER Ms. Dolores Sandoval Committee FULL NAME. STREET AOIJRE$s AND ZIP CODE OF LENDER (IF COMMmEE, ALSO ENTER 1.0. NUMßER) Ms. Dolores Sandoval 10720 Alderbrook Lane Cupertino CA 95014 CUpertino City óf · CAlENDAR YEAR 09/30/1999 DATE INCURREO o 12/31/2005 DATE DUE OPA!D $ 0 Is 25,000 o FORGIVEN · º º . S 20.000 see Ii INO 0 COM 0 OTH 0 PTY 0 Me Dolores Sandoval Continued) · S 25.000 0.000 % AAlE · CALENDAR YEAR $ 0 I 02/29/2000 DATE INCURRED 12/31/2005 OATE DUE OPAJO '- o FORGIVEN · º . $ 25.000 0..0 o COM OOTH OPTY Osee Me. Dolores Sandoval (Continued) (Continued) · $ 40 000 0.000 % AAlE $ 40.000 o · 11/06/2000 DATE INCURREO o 12/31/2005 DATE DUE º º $ 40.000 o COM 0 OTH 0 PTY 0 see INO o 0.00 $ 85,000.00 0.00 0,00 $ $ $ 0.00 $ SUBTOTAL Schedule B Summary 1, Loans received this period (Total Column (b) plus initemized loans 0.00 $ less than $100,) 2. Loans paid Of forgiven this period (Total Column (c) plus loans under $100 paid orfOfgiven,) {Include loans paid by a third party that are also itemized on Schedule A. 00 o $ NET 3, Net change this period, (Subtract Line 2 from Line 1,) Enter the net here and on the Summary Page. Column A, Line 2 SCHEDULE B - Part I (cont) Schedule B - Part I (Continuation Sheet) --period Loans Received 07/01/2004 from through 12/31/2004 "- Sol 6 NAME OF FilER Ms. Dolores Sandoval, Dolly Sandoval for Supervisor Debt Retirement 1.0. NUMBER Committee 990787 FUll NAME, STREET AClJRESS AND ZIP CODE If AN INDMDUAl, ENTER . (b) (,) (.) (Q ., OUTS /lND1NG AMOUNT AMOUNT PAtO OUTS ANDI\IG INTEREST ORIG!NAL CUMUlATIVE OF lENDER OCCUPATION AND EMPlOYER BAlAACE SALANCEAT {If SELF.£MA.OYED, EN:TER BEGINNING THIS RECEIVED THIS OR FORGrveN CLOSE OF THIS PAID THIS ,+.MOUNT OF CONTRIBUTIONS (IF COMMITTEE, A1.SO ENTER 1.0. NUUSER) QF_ -II PERIOD THIS PERIOD PERIOD LOAN TO CA TE Ms. Dolores Sandoval o PAID CALENDAR YEAR (Continued) ( Continued) 0 10.000 0.000 % 10.000 (Continued) $ , , , o FORGIVEN RATE PER ELECTION , 10.QaO , -2. , 0 12/31/2005 , 0 11/13/2000 $ o INO 0 COM 0 OTH 0 PTY 0 see DATE DUE DATE INCURRED Ms, Dolores Sandoval o PAID CAlENDAR 'fEAR (Continued) (Continued) 0 15 000 0.000 ~ 15,000 (Continued) (Continued) , , , , D fORGIVEN RATE PER ELECTION , 15 000 , 0 , 0 12/31/2005 $ 0 11/18/2000 , OINO o COM OOTH Om Osoe - DATE DUE DATE INCURRED o PAID CALENDAR YEAR , , _% $ , o FORGIVEN RATE PER ELECTION o INO 0 COM 0 OTH 0 m 0 see , , - , , - , DATE DUE DATE INCURRED o PAm CAlENDAR YEAR , , _% , , o FORGIVEN RATE PER ELECTION OINO o COM OOTH OPTY Oscc , - , , - , DATE DUE DATE INCURRED o PAID CALENDAR YEAR , , _% , , o FORGNEN RATE PER ELECTION DINO o COM DOTH OPTY Oscc , , - , - - , IJATEOUE - - SUBTOTAL $ 0,00 $ 0,00 $ 25,000,00 $ 0.00 Schedule Miscellaneous Increases to Cash 07 from thnJugh 12/31/2004 ,,-. §..of 6 NAME OF FILER Ms. Dolores Sandoval, Dolly Sandoval for Supervisor Debt Retirement i1îÑÜMBER Conunittee 990787 - FULL NAME AND AODRESS OF SOURCE DATE (IF COMMITIeE, !N AOOITION TO COMMITTEE'S NAME AND ADDRESS. ENTER I.D. NlIMBER DESCRIPTION OF RECEIPT AMOUNT OF RECEIVED OR, IF NO 1.0. NUMBER HAS BEEN ASSIGNED. eNTER 'TREASURER'S NoVÆ '" ADOR;ESS) INCREASE TO CASH - 12/31/2004 santa Clara County Firefighters Check Lost & Void 504,07 Local 1165 3071 Driftwood Drive san Jose. CA 95128 - - - - - - - - = - SUBTOTAL $ 504.07 = - Miscellaneous Inc_ to Cash Summary L Increases to cash of $100 or more this period, """"""""'''''''''''''''''''''''' .............. $ 04.07 2, Increases to cash under $100 this period. (Do not itemize,) ".",,,,,,,,,,,,,...,,,,,,'..,,,,,,,,,.,,,,"',,,,"',,,,....,,,,,,,,, ".. ,"...,,'" .............. $ 1;¡'.Q;ì, 3, Total of all interest received this period on loans made to others. (Schedule H, Part II (b).) ""..".."..".."''''".."""..'''........"..,,,.............,..''' .............. $ !L º 4, T ota! miscellaneous increases to cash this period, (Add Lines I, 2, and 3. Enterhere and on the Sununary Page, Line 15,) TOTAL S