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460 Debt Retire Semi-Annual COVER PAGE - LONG FORM lE @te~1 WI Recipient Committee Campaign Statement 6 !:..of Official Use Only 2005 JUL 2 8 84216.5) (Government Code Sections 84200 A Date of Election if 81 Statement covers period UPERTINO CITY CUERK (IIonth, Day, Year) 01/01/2005 from o Quarterly Statement o Special Odd-Year Report o Supplemental Pre-election Statement - Attach Form 495 2. Type of Statement: o Pre-election Statement ~ Semi-annual Statement o Termination Statement o Amendment (Explain below) 06130/2005 1. Type of Recipient Committee III Officeholder, Candidate Controlled Committee D Ballot Measure Committee o State Candidate Election Committee 0 Primarily Formed o Recal 0 Controlled o Sponsored through o Primarily Formed Candidate Officeholder Committee D General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee Treasurer(s) NAME OF TREASURER Dolly Sandoval 1.0. NUMBER 990787 Information COMMITTEE NAME Dolly Sandoval for Supervisor Committee Committee 3. Retirement Debt STREET ADDRESS 10720 Alderbrook Lane AREA CODE/PHONE 408) 725-8939 ZIP CODE 95014 STATE CA CITY c(/P f.6Z:ï1 N':> NAME OF ASSISTANT TREASURER. IF ANY AREA CODElPHQNE (408)725-8939 ZIP CODe 95014 STREET ADDRESS (NO P.O. BOX) 10720 Alderbrook Lane CITY STATE Cupertino CA STREET ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX AREA CODElPHONE ( ZIP CODe STATE STREET ADDRESS CITY OPTIONAL: FAXlE-MAIL ADDRESS AREA CODE/PHONE ZIP CODe STATE CITY OPTIONAL: FAXIE-MAIL ADDRESS () / knowledge the information contained herein and in the attached schedules rer' is true and correct Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my is true and complete. I certify under penalty of perjury under the laws te of Car ia that tl By ~ 7 ì Executed on 4. SIGNATURE OF CONTROLUNG OFFICEHOlDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR ey Executed on SIGNATURE OF CONTROLLING OFFICEHOlDER, CANDIDATE, STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT State of California Fair Political Practices Commission. By By DATE Executed on DATE PCAB05 01380 (Rev. 9/99) Executed on SlCCW COVER PAGE - PART 2 Recipient Committee \LIFOR:-;I \ 4 t ~ Campaign Statement OK\l Cover Page - Part 2 Page 2 of 6 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 (INClUOE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTEA JURISDICTION D SUPPORT Board of Supervisors, District 5, Santa Clara County o OPPOSE RESIDENTIALJBUSINESS ADDRESS {NO. AND STREET} CITY STATE ZIP CODE Identify the controlling offiçeholder, candidate. or state measure proponent. if any. 10720 Alderbrook Lane Cupertino CA 95014 NAME OF OFFICEHOlDER, CANDIDATE OR, PROPONENT DISTRICT NO. IF ANY OFFICE SOUGHT OR HELD 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. 7. Primarily Formed Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPf'ORT o OPPOSE 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE COMMITTEE NAME .D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODElPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) - CITY STATE ZIP CODE AREA CODElPHONE SUMMARY PAGE Campaign Disclosure Statement Statement covers period lOt] Summary Page from 01/01/2005 throughO 613 0 /2 0 0 5 Page 30f 6 NAME OF FILER Ms. Dolores Sandoval Dolly Sandoval for Supervisor - Debt Retirement LD. NUMBER Committee 990787 Contributions Received Column A Column B Calendar Year Summary to< Candidates TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE 1. Monetary Contributions .........................._.......... Schedule A, Line 3 0.00 0.00 General Elections $ L 2. Loans Received ................................................ Schedule B, Line 7 0.00 110.000.00 1/1 through 6/30 7/1 to Date 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ........... ...... Add Lines 1 + 2 $ 0.00 $ - 110.000.00 Received.... f; 4. Non-monetary Contributions.. ....................... .. Schedule C, Line 3 0.00 0.00 21. Expenditures Made .......... $ 5. TOTAL CONTRIBUTIONS RECEIVED ......... ....... Add Lines 3 + 4 $ 0.00 L 110,000.00 - - Expenditures Made Expenditure limit Summary for State 6. Cash Payments ............................................. .. Schedule E. Line 4 $ 0.00 $ 0.00 Candidates 7. Loans Made .....h... .... ...................................... Schedule H, Line 7 0.00 0.00 22. Cumulative Expenditure Made* (If Subject to Voluntary Expenditure Limit) 8. SUBTOTAL CASH PAYMENTS ............................ Add Lines 6 + 7 $ 0.00 $ 0.00 Date of Election Total to Date 9. Accrued Expenses (Unpaid Bills) .................. ... Schedule F, Line 3 0.00 0.00 (mmlddlyy) 10. Nonmonetary Adjustment ... ............................ Schedule C, Line 3 0.00 0.00 11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ 0.00 $. 0.00 Current Cash Statement 12. Beginning Cash Balance .......... Prewous Summary Page, Line 16 $ 23.864.31 13. Cash Receipts ...... .................................. Column A, Line 3 above 0.00 14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 11.84 15. Cash Payments ....................................... Column A. Line 8 above 0.00 16. ENDING CASH BA.-(tI!¡es 12 + 13 + 14. then subtract Line 15 $ 23.876.15 If this is a Termination Statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule B, Part 1. Column (b) $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........ .............. ..................... ............. ....................$, 0.00 19. Outstanding Debts ... ...... Add Line 2 + Line 9in Column C above $ 110,000.00 S/CCW - PCAB05 01380 (Rev. 9/99) SCHEDULE B - Part S1a1ement covers period Schedule B - Part Loans Received 6 4 of Page .D. NUMBER 01/01/2005 througlL 06/3 0 /2005 Retirement from {gJ CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR 990787 {n ORIGINAL AMOUNT OF LOAN {.J INTEREST PAID THIS PERIOD OUTSTANDING BALANCE AT CLOSE OF THIS " Debt {o¡ AMOUNT PAID OR FORGIVEN THIS PERIOD for Supervisor (b) AMOUNT RECEIVED THIS PERIOD oUTsriNDING BAlANCE BEGINNING THIS " Dolly Sandoval IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED, ENTER NAME OF BUSINESSI Councilmember Dolores Sandoval Committee NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER Ms NAME OF FILER FULL $ $ 20,000 0.000 RATE $ 20,000 Q PAID o .0. NUMBER) Ms Dolores Sandoval 10720 A1derbrook Lane Cupertino CA 95014 PER ELECTION % $ o FORGIVEN Cupertino City of $ CALENDAR YEAR 09130/1999 DATE INCURRED Q $ 12131/2005 DATE DUE o $ o $ $ 20.000 o PTY 0 sec Sandoval o COM 0 OTH IiIND PAID o Dolores Continued Ms PER ELECTION $ $ 25.000 % Q....QQQ RATE $ 25.000 o FORGIVEN $ o $ CALENDAR YEAR 02/29/2000 DATE INCURRED Q $ 12/31/2005 DATE DUE o PAID $ o o $ $ 25.000 OpTY Osee Dolores Sandoval Continued Continued COM 0 OTH o IND o Ms PER ELECTION $ $ $ 40.000 0.000 % RATE o $ $ 40.000 12/31/2005 DATE DUE o o FORGIVEN $ o $ o $ $ 40.000 o PTY 0 SCC D COM 0 OTH o IND 0.00 $ 00 85,000 $ 0.00 $ 0.00 SUBTOTAL $ Schedule B Summary 1. Loans 00 o $ received (b) plus in itemized loans this period less than $100. (Total Column 00 o $ 2. Loans paid or forgiven this period loans under $100 paid or forgiven that are also plus (c) (Total Column 00 o $ NET itemized on Schedule A. Line 2 (Subtract Line 2 from Line Enter the net here and on Column A, ) 1 third party the Summary Page, (Include loans paid by a this period. Net change 3. SCHEDULE B - Part Statement covers period (Continuation Sheet) Schedule B - Part Loans Received 01/01/2005 from 6 page----2 of .D. NUMBER through_ 0613 0 /2 005 (,) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR 990787 (I) ORIGINAL AMOUNT OF LOAN (.) INTEREST PAID THIS PERIOD Debt Retirement OUTS1ANDING BALANCE AT CLOSE OF THIS (0) AMOUNT PAID OR FORGIVEN THIS PERIOD for Supervisor (b) AMOUNT RECEIVED THIS PERIOD ., OUTSTANDING BAlANCE BEGINNING THIS Dolly Sandoval IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPlOYED, ENTER NAME_Qf BUSINESS: Dolores Sandoval Committee FUll NAME, STREET ADDRESS AND ZIP CODE OF LENDER F COMMITTEE, ALSO ENTER Ms NAME OF FILER o .0. NUMBER) Sandoval Continued Dolores Continued Continued Ms PAID PER ELECTION , 10,000 0.000 % RATE 10,000 , o FORGIVEN o , 11/13/2000 DATE INCURRED o , 12131/2005 DATE DUE o , o , $ 10.000 SCC DpTY 0 o COM D OTH D INO CALENDAR YEAR PAID o Dolores Sandoval Continued Continued Continued Continued Ms PER ELECTION , , $ 15,000 11/18/2000 DATE INCURRED 0.000 % RATE o , 15,000 12/31/2005 DATE DUE , o o FORGIVEN o , o , $ 15,000 SCC DpTY 0 o COM 0 OTH IND o CALENDAR YEAR , , o PAID % RATE $ PER ELECTION FORGIVEN o , DATE INCURRED , DATE DUE , , , o PTY 0 see o CCM 0 DTH IND o CALENDAR YEAR , $ PAID o % RATE , PER ELECTION FORGIVEN o , DATE INCURRED , DATE DUE , , , DpTY 0 OOTH OeOM o CALENDAR YEAR , , % PAID o SCC IND PER ELECTION RATE , , o FORGIVEN , 0.00 , $ DATE DUE 000.00 25 $ 0.00 , $ 0.00 , , SUBTOTAL $ SCC DpTY 0 o COM 0 OTH o INO SCHEDULE Statement cover.; period Schedule Miscellaneous Increases to Cash 6 Page~ of 1.0. NUMBER 01/01/2005 through. 0613 0 /2005 Retirement from NAME OF FILER 990787 AMOUNT OF INCREASE TO CASH Debt DESCRIPTION OF RECEIPT for Supervisor FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS. ENTER I,D. NUMBER OR, IF NO !.D. NUMBER HAS BEEN ASSIGNED, ENTER TREASURER'S NAME & ADDRESS) Sandoval Dolly Dolores Sandoval Committee Ms DATE RECEIVED 00 o SUBTOTAL $ 0.00 11.84 $ $ 0.00 11.84 $ $ TOTAL 15. Line Miscellaneous Increases to Cash Summary 1. Increases to cash of $100 or more this period. .. 2. Increases to cash under $100 this period. (Do not itemize.) ............................................... Total of all interest received this period on loan (Schedule H, Part II (b).) ................................... Total miscellaneous increases to cash this period. (Add Lines I, 2, and 3. Enter here and on the Summary Page, 3. 4.