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460 Recipient Committee 07-01-13 thru 12-31-13Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) ON from Type or print in ink. - COVER PA( D D t pIA '• Statement covers period Date of election if applic FEB - 3 2014 1 of 22 (Month, Day, Year) F r Official Use Only 7/1/2013 through 12/31/2013 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 2. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) O Sponsored ® General Purpose Committee (Also Complete Part 5) O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) I.D. NUMBER 3. Committee Information 1340395 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX ERTINO CITY CLERK Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ® Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Andrae Macapinlac MAILING ADDRESS 456 OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS Treasurer: senatormac9@aol.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. i•��! A / Executed on 1 / 31 / 2 013 By Data Signature of Treasurer or Assistant Treasurer Executed on By Data Signature of Controlling Olticaholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By FPPC Form 460 (January105) Date Signature of Controlling officeholder, Candidate, State Measure Proponent FPPC Toll -Free Helplina: 868lASK-FPPC (88812753772) State of California 1819513-0 Recipient Committee Campaign Statement Cover Page - Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTUUJBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: /_istenycommittees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf, of your candidacy. COMMITTEE NAME I.D. NUMBER I NAME OF TREASURER CONTROLLED COMMITTEE? ❑;YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER Type or print in ink. 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 Page 2 of 22 El SUPPORT ❑ OPPOSE 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 Candidate/Officeholder Committee Us( names or officeholder(s) or candidate(s) for which this committee Is primarity formed. OR HELD NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary SUPPORT FPPC Form 460 (January/05) FPPC Ton -Free HelDlim: 8861ASK-FPPC (8661275-3772) State of Cellfomla 1819513-0 Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2013 SUMMARY PAGE throu h 12/31/2013 Page 3 of 22 SEE INSTRUCTIONS ON REVERSE 9 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 134039S Contributions Received 1. Monetary Contributions ................................................ schedule A, Line 3 2. Loans Received ................................. 7........................ schedule 8, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ................................ Add Lines 1+2 4. Nonmonetary Contributions ........................................... Schedule e, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ............................... Add Lines 3 + 4 Expenditures Made 6. Payments Made ......................................................... schedule E. Line 4 7. Loans Made............................................................... schedule r1, Line 3 o. SUBTOTAL L,nan PAYMENTS ........................................ Add Lines ii + 7 9. Accrued Expenses (Unpaid Bills) .................................... schedule F, Line 3 10. Nonmonetary Adjustment ............................................ schedule c, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 819+1p Current Cash Statement 12. Beginning Cash Balance .............................. Previous summary Page, Line 16 13. Cash Receipts ..................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 15. Cash Payments ................................................... Column A, Line 8 above 16. ENDING CASH BALANCE ............... Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ schedule B, Part Cash Equivalents and Outstanding Debts Column A Column B TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE $17,950.00 $17,950.00 $0.00 $0.00 $17,950.00. $17,950.00 $0.00 $0.00 $17,95.0.00 $17,950.60 $5,426.00 $0-.00 $5,426.00 $7,428.00 $0.00 $7,428.00 $0.00 $0.00 $0.00 $0.00 $5,426.00 $7,428.00 $4, 246 . 00 To calculate Column B, add $17,950.00 amounts in Column A to the corresponding amount $0.00 from Column B of your last report. Some amounts in $5 , 426 .00 Column A may be negative $16, 770.00 figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only $0.00 carry over the amounts from Lines 2, 7, and 9 (if any). 18. Cash Equivalents .............................................. see instructions on reverse $0.00 19. Outstanding Debts ........... . Add Line 2 + Line 8 in Column Babove $0.00 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 8f30 711 to Date 20. Contributions Received 21. Expenditures Made Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (if Subjeci to Voiuniary Expenditure Limit) Date of Election Total to Date (mmiddlyy) Amounts in this section may be different from amounts reported in Column B. FPPC Form 460(Januaryl05) FPPC TO -Free Helplire: 86WASK-FPPC (866275-3772) 1819513-0 SCHF_Dtll F A Schedule A I YF 1 F.". ,,,,. Amounts may be rounded Statement covers period - Monetary Contributions Received to Whole dollars. / 7/1/2013 from 1p.g, 12/31/2013_ through of 22 SEE INSTRUCTIONS ON REVERSE NAME OFFILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE A CALENDAR YEAR CA CAN. PER ELECTION TO DATE RECEIVED EE. ALSO ENTER I.D. NUMBER) (IF COMMIT -TEE. CODE' (IF SELF-EMPLOYED, ENTER NAME PERIOD 1 - DEC. (IF REQUIRED) OF BUSINESS) 7/24/2013 Ro Khanna ® IND OCCUPATION: Atorney $100.00 $100.00 46727 Crawford Street ❑ COM EMPLOYER: Wilson Fremont, CA 94539 ❑ OTH Soneini Goodrich & ❑ PTY Rosati Cl SCC 8/4/2013 Jerry Hill ®'IND OCCUPATION: Senator $100.00 $100.00 23 Edwards Ct_ ❑ COM CO EMPLOYER: CA State Burlingame, CA 94010 ❑ OTH Sentae ❑ PTY ❑ SCC 8/4/2013 Kansen Chu ® IND OCCUPATION: 1124 Sabal Ct. ❑ COM Councilmember 1$200.00 1$200.00 Jose, CA 95132 ❑ OTH EMPLOYER: City of San (San I tJ PTY ❑:SCC 9/2/2013 Jim Davis ® IND OCCUPATION: $100.00 $100.00 424 Southwood Ave ❑ COM Councilmember Sunnyvale, CA 94086 ❑ OTH EMPLOYER: City of ❑ PTY Sunnyvale ❑ SCC 9/8/2013 Erik Fong ® IND OCCUPATION: Manager $100.00 $100.00 1310 Saddle Rack St., #440 ❑ COM 'EMPLOYER: Apple, Inc. San Jose, CA 95126 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ Schedule A Summary 1. Amount received . Amount received this period - unitemized monetary contributions of less than $100 3. Total monetary Page, Column A, Line 1.) ... $17,950.00 $0.00 ...................................... TOTAL $17, 950.00 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee .FPPC Form 460 (Januaryl05) FPPC Toll -Free Helptine: 8661ASK-FPPC (8601275-3772) 1819513-0 SCHEDULE A (CONT.) Schedule A Continuation Sheet ounts P.may o'� Amounts may be rounded Statement covers period • - Monetary Contributions Received to whole dollars. 7/1/2013 • - , � from 12/31/2013 through 5 22 Page of NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 IF AN INDIVIDUAL,. ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/8/2013 Kalen Gallagher ® IND OCCUPATION: $100'.00 $100.00 2422 Neville Avenue ❑ COM Entrepreneur San Jose, CA 95130 ❑ OTH EMPLOYER: Class Dojo ❑ PTY ❑ SCd 9/15/2013 Paul Fong ® IND OCCUPATION: Member $500.00 $500.00 465 North Wolfe Road ❑ COM EMPLOYER: CA State Sunnyvale, CA 94085 ❑ OTH Assembly ❑ PTY O SCC 9/15/2013 Jim Griffith ® IND OCCUPATION: Manager $1,000.00 $1,000.00 540 Saco Terrace Cl COM EMPLOYER: Apple, Inc. Sunnyvale, CA 94089 (� OTH U PTY ❑ SCC 9/22/2013 Joyce Iwasaki ® IND OCCUPATION: retired $100,00 $100.00 124 Second Street #5 ❑ EMPLOYER: none Los Altos, CA 94022 COM ❑ OTH ❑ PTY ❑ SCC 9/30/2013 ® IND OCCUPATION: Member $100.00 $100.00 839 Clearview Drive ❑ COM EMPLOYER: Berryessa San Jose, CA 95133 ❑ OTH Union School Board ❑ PTY ❑ SCC "Contributor (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC -Small FPPC Form 460(January105) FPPC To8-Free H.Iplire 8661ASK-FPPC (8661275-3772) 1819513-0 SCHEDULE A (CONT.) Schedule A Continuation Sheet ''P� Amounts may be rounded - Statement covers period a Monetary Contributions Received to whole dollars. 7/1/2013 0 • d from through 12/31/2013 �_ _ Page of � NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME Of BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/30/2013 Danillo Boac ® IND OCCUPATION: retired $100.00 $100.00 839 Clearview Drive ❑ EMPLOYER: none San Jose, CA 95133 COM ❑ OTH ❑ PTY ❑ SCC 9/30/2013 Anjali Kausar ® IND OCCUPATION: Executive $100.00 $100.00 19731 Yuba Ct ❑ COM Director Saratoga, ca 95070 ❑ OTH EMPLOYER: Cupertino ❑ PTY Chamber of Commerce Cl SCC 9/30/2013 Leon Kimura ® IND OCCUPATION: not $100.00 $100.00 848 E. TAYLOR ST ❑ employed San Jose, CA 95112 COM ❑ OTH EMPLOYER: no I . r-i PTY LJ Pi Y I I 1 ❑:SCC 9/30/2013 D. Tily Chang ® IND OCCUPATION: Planner $100.00 $100.00 759 26th Ave ❑ COM EMPLOYER: SF San Mateo, CA 94403 ❑ OTH Transportation Authority ❑ PTY ❑ SCC 9/30/2013 Melton Wong ® IND OCCUPATION: PAC $1,100.00 $1,100.00 229 N Whisman Rd ❑ COM Director Mountain View, CA 94043 ❑ OTH EMPLOYER; MVPFF 1965 ❑ PTY ❑ SCC SUBTOTAL $'. 'Contributor IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small FPPC Form 460 (January105) FPPC Toll -Free Helplim: 666/ASK-FPPC (B66/275-3772) 1819513-0 SCHEDULE A (CONT.) 5Chedule A Continuation Sheet 'rP.., P..."„,,, Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. • I B 1 7/1/2013 from • through 12/31/2013 page 7 of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED OP COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' ER NAME (IF SELF-EMPLOYED, BUSINESS) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/30/2013 Marc Berman ® IND OCCUPATION: Attorney $100.00 $100.00 640 Forest Ave., #C ❑ COM EMPLOYER: Self Palo Alto, CA 94301 ❑ OTH ❑ PTY ❑ SCC 10/6/2013 John Linder ® IND OCCUPATION: Teacher $100.00 $100.00 320 Mill Pond Drive ❑ EMPLOYER: Oak Grove San Jose, CA 95125 COM ❑ OTH School District ❑ PTY ❑ scc 10/6/2013 Andy Wong ® IND OCCUPATION: Dep $100.00 $100.00 43344 Mission Boulevard ❑ Campaign Manager . Fremont, CA 94539 COM n nTu EMPLOYER: Ro Khanna for ,—,--... ICongress I Li PTY ❑ SCC 10/6/2013 Craig Steckler ® IND OCCUPATION: retired $100.00 $100.00 1225 Wisteria Drive ❑ COM EMPLOYER: retired Fremont, CA 94539 ❑ OTH ❑ PTY ❑ SCC 10/6/2013 Emy Thurber ® IND OCCUPATION: retired $100.00 $100.00 694 Benvenue Avenue ❑ EMPLOYER: none Los Altos, CA 94024 COM ❑ OTH ❑ PTY ❑ SCC *Contributor Codes IND - Individual COM - (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small SUBTOTAL$ L-11-# y' FPPC Form 460(January/05) FPPC Toq-Free H.Ipine: 866/ASK-FPPC (866/275-3772) 1819513-0 Type or print in ink. SpeheduieA+ (Continuation Sheet) Type SCHEDULE A CONT. Statement covers period7NUMBER Amounts may be rounded Monetary Contributions Received to whole dollars. , afrom 7/1/2013 � 12/31/2013 through of 22NAME OF FILERASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) IF AN INDIVIDUAL, ENTER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME RECEIVED THIS PERIOD CALENDAR YEAR (JAN. 1 . DEC. 31) TO DATE (IF REQUIRED) OF BUSINESS) 10/6/2013 Jill Chesler ® IND OCCUPATION: retired $100.00 $100.00 1454 Carnot Dr Cl EMPLOYER: none San Jose, CA 95126 COM ❑ OTH ❑ PTY ❑ SCC 10/6/2013 Brandon Li ® IND OCCUPATION: Policy Aide $100.00 $100.00 3018 Balmoral Dr ❑ EMPLOYER: City of San San Jose, CA 95132 COM ❑ OTH Jose ❑ PTY ❑ ScC 10/6/2013 Sunshine Borelli ® IND OCCUPATION: -Legislative $100.00 $100.00 282 N. Creek Drive ❑ COM Aide San Jose, CA 95139 ❑ EMPLOYER: State ( ) NTH (Legislature I I 1 t_ 1 PTY ❑ ScC 10/6/2013 Ajay Bhutoria ® IND OCCUPATION: IT $100.00 $100.00 38853 Bluegill Drive ❑ COM Consultant Fremont, CA 94539 El OTH EMPLOYER: Self ❑ PTY ❑ SCC 10/6/2013 Anna Eshoo ® IND OCCUPATION: Member $300.00 $300.00 555 Capitol Mall,Suite 1425 ❑ EMPLOYER: U.S. House of Sacramento, CA 95814 COM ❑ CO OTH Representatives ❑ PTY ❑ SCC SUBTOTAL$ *Contributor Codes IND - Individual COM - (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small FPPC Form 460 (January/05) FPPC T.H-Fr H.Ipfl a 86&ASK-FPPC (8661275-3772) 1819513-0 ,. ,.. 'T e ; , ; ; L. SCHEDULE A (CONT.) acneauile A Conianuation aneet) ir� �' r,,..". ". Amounts may be rounded Statement covers period ® - Monetary Contributions Received to whole dollars. 7/1/2013 from 12/31/2013 through Page -9-- of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD RECEIVED THIS CALENDAR YEAR R CALCAL 1 -DEC. A TO DATE (IF REQUIRED) OF BUSINESS) 10/6/2013 Dennis Raj ® IND OCCUPATION: Political $100.00 $100.00 1070 Danbury Dr ❑ COM Director San Jose, CA 95126 ❑ OTH EMPLOYER: South Bay ❑ PTY Labor Council ❑ SCC 10/14/2013 Amanda Montez IND OCCUPATION: Community $250.00 $250.00 311 North 2nd Street, #1 ❑ COM Outreach Specialist San Jose, CA 95112 ❑ OTH EMPLOYER: Midpeninsula ❑ PTY Open space authority ❑ SCC 10/14/2013 Christine Pham ® IND OCCUPATION: Attorney $100.00 $100.00 4624 Holycon Circle ❑ COM EMPLOYER: Jaurigue Law San Jose, CA 95136 El OTH Group u rlr ❑ SCC 10/6/2013 Buu Thai ® IND OCCUPATION: Trustee $350.00 $350.00 1634 Roberts Ave. ❑ COM EMPLOYER: Franklin San Jose, ca 95122 ❑ OTH McKinley School ❑ PTY District ❑ SCC 10/14/2013 Joshua Barousse ® IND OCCUPATION: Field $150.00 $150.00 4148 Snowbank Ct El COM Representative San Jose, CA 95135 ❑ OTH EMPLOYER: CA State ❑ PTY Sentae Cl SCC *Contributor Codes IND - Individual COM - Recipient Committee ( than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor $ FPPC Form 460 (January/05) FPPC Tall -Free Helpline: 863/ASK-FPPC (8661275-3772) 1819513-0 n_ff-_-2__e_ w i9%___.e�._ .I T.,.e ...;+;;11 SCHEDULE A (CONT.) %21.11CUUIC Fi k%0 1111111. dLIVII 01MM) a....-.... Amounts may be rounded Statement covers period - Monetary Contributions Received to whole dollars. � 7/1/2013 0' from 12/31/2013 through Page 1D of z2 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) 11/19/2013 PG&E Corporation ❑ IND $5,000.00 $5,000.00 77 Beale St. ❑ COM San Francisco, CA 94105 ® OTH ❑ PTY ❑ SCC 10/14/2013 Law Offices of Jimmy Nguyen ❑ IND $100.00 $100.00 4848 San Felipe Rd, st 150 ❑ COM San Jose, CA 95125 ® OTH ❑ PTY ❑ SCC 10/15/2013 South Bay Labor Council COPE ❑ IND $100.00 $100.00 2125 Almaden Rd, st 107 ®COM San Jose, ca 95125 ❑ ICOMIMI,TEE ID: 744711 ( OTH I I 1 U PTY ❑ SCC 10/24/2013 UFCW Local 5 ❑ IND $100.00 $100.00 240 S Market St ®COM San Jose, CA 95113 ❑ COMMITTEE ID: 1394035 OTH ❑ PTY ❑ SCC 10/15/2013 CORE Affordable Housing, LLC ❑ IND $150.00 $150.00 470 South Market St ❑ COM SanJose, CA 95113 ® OTH ❑ PTY ❑ SCC 'Contributor (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small SUBTOTAL$ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) 1819513-0 Schar%i da Tvne or mint in ink SCHEDIIt F A !( (']NT 1 Amounts may be rounded Monetary Contributions Received to Statement covers period o - whole dollars. 7/1/2013 e from 12/31/2013 through Page 11 of 22 NAME OF FILER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) I.D. NUMBER1340395 IF AN INDIVIDUAL, ENTER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' IF SELF-EMPLOYED, ENTER NAME RECEIVED THIS CALENDAR YEAR TO DATE OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 10/7/2013 Intellectual Property Law Group, LLC ❑ IND IND $1,000.00 $1,000.00 12 S First St, 12th Floor ❑ COM San Jose, CA 95113 ® OTH ❑ PTY SCC 9/16/2013 PLUMBERS & STEAMFITTERS LOCAL 393, POLITICAL ❑ IND $1,000.00 $1,000.00 ACTION FUND ® COM 555 Capitol Mall,Suite 1425 Sacramento, ca 95814 ❑ OTH COMMITTEE ID: 851452 ❑ PTY ❑ SCC 9/27/2013 San Jose Police Officers Association PAC ❑ IND $400.00 $400.00 1161 N First St ® COM San Jose, CA 95112 ID: 951339 ❑ iCOMMITTEE ( OTH t_I PTY ❑ SCC 10/4/2013 San Jose Branch -NAACP Banquet Fund ❑ IND $350.00 $350.00 304 North 6th Street ❑ COM San Jose, Ca 95112 ® OTH ❑ PTY ❑ SCC 9/27/2013 Kansen Chu for Assembly 2014 ❑ IND $250.00 $250.00 1387 Tribute Rd ® COM Sacramento, CA 95315 COMMITTEE ID: ❑ 1356097 OTH ❑ PTY ❑ SCC SUBTOTAL$ 'Contributor Codes IND - Individual COM - Recipient (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small FPPC Forth 460 (January/05) FPPC Toll -Free HelPline: 866/ASK-FPPC (866/275-3772) 1819513-0 Q..4.w.J..1.. A Tvna nr nrint in inle SCHEDULE A (CONT_) vve.�wu.` r-� wve can er,eeaaove e V e eCCe� Amounts may be rounded Statement covers period - Monetary Contributions Received to whole dollars. 0 7/1/2013 e' from 12/31/2013 through Page 12 of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 IF AN INDIVIDUAL, ENTER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) REQUIRED) OF BUSINESS) (IF 9/20/2013 Cortese for Supervisor 2012 ❑ IND $200.00 $200.00 4221 Littleworth Way ® COM San Jose, CA 95125 COMMI-TTEE ID: ❑ OTH 1344275 ❑ PTY ❑ SCC 10/4/2013 Gilbert Wong ® IND IND OCCUPATION: $200.00 $200.00 10785 Penninsular Ave ❑ Councilmember Cupertino, CA 95014 COM ❑ OTH EMPLOYER: City of ❑ PTY Cupertino ❑ SCC 10/4/2013 Clarence Madrilejos ® IND OCCUPATION: Realtor $100.00 $100.00 1831 Pine Hollow 3 ❑ EMPLOYER: Century 21 I San Jose, CA 9513 COM �-1 I^ OTH I I I I Li PTY ❑ SCC 10/4/2013 Peter Lerce-Munoz ® IND OCCUPATION: $100.00 $100.00 8200 Kern Ave Apt 202 ❑ COM Councilmember Gilroy, CA 95020 ❑ OTH EMPLOYER: City of ❑ PTY Gilroy ❑ SCC 8/4/2013 Gustav Larson ® IND OCCUPATION: Software $200.00 $200.00 305 Bishop Ave ❑ COM Engineer Sunnyvale, CA 94086 ❑ OTH EMPLOYER: Cienga Corp ❑ PTY ❑ SCC 'Contributor Codes IND - Individual COM - Recipient (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small SUBTOTAL $ FPPC Form 460 (January/05) FPPC TOII-Free Helpline: 866/ASK-FPPC (8661275-3772) 1819513-0 c..L...,1..�_ w -r,,, — rinf h Ir4 SCHEDULE A (CONT.) Amounts may be rounded Statement covers period - Monetary Contributions Received to whole dollars. e � 1 7/1/2013 • - 9 from 12/31/2013 through Page 13 of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 IF AN INDIVIDUAL, ENTER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE* (IF SELF- RECEIVED THIS CALENDAR YEAR TO DATE ER NAME PERIOD (JAN. 1 - DEC. 31) REQUIRED) OF BUSINESS) (IF 10/4/2013 Dennis Chiu IND ®IND OCCUPATION: Field $100.00 $100.00 1046 Jena Ter El Representative Sunnyvale, CA 94089 ❑ OTH EMPLOYER: CA State ❑ PTY Assembly ❑ SCC 10/4/2013 Peter Chiu ® IND OCCUPATION: Physician $100.00 $100.00 58 Morton Way ❑ EMPLOYER: Kaiser Palo Alto, CA 94303 COM ❑ OTH Permanente ❑ PTY ❑ SCC 8/27/2013 Rich Gordon for State Assembly 2012 ❑ IND $1,000.00 $1,000.00 405 El Camino Real, suite 507 �COMMITTEE ®COM Menlo Park, CA 94025 I� 1D: 125592 I 1 1 OTH LJ PTY ❑ SCC 8/21/2013 Democratic Activists for Women Now ❑ IND $500.00 $500.00 PO Box 6614 ®COM San Jose, CA 95150 COMMITTEE ❑ OTH ID: 950169 ❑ PTY ❑ SCC 7/24/2013 Trustee 2012 ❑ IND $500.00 $500.00 6628 Catamaran St ®COM San Jose, CA 95119 ❑ OTH COMMITTEE ID: 1348221 ❑ PTY ❑ SCC `Contributor Codes IND - Individual COM - Recipient (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small SUBTOTAL$ FPPC Form 460 (Januaryl05) FPPC Totl-Free Helpline: 8661ASK-FPPC (8661275-3772) 1819513-0 _qr-hg% iu iin B Tvne or nrint in ink SCHEDULE A (CONT.1 — _• ------ - - ,,--• •�.......�..+.. v. e`�a/ Amounts may be rounded Monetary Contributions Received to dollars. Statement covers period - whole 7/1/2013 -0. , from 1 12/31/2013 through Page 14 of 22 NAME OF FILER I.D. ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) NUMBER 1340395 DATE FULL NAME; STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED THIS PERIOD CALENDAR YEAR (JAN. 1 • DEC. 31) TO DATE (IF REQUIRED) 7/22/2013 Simitian for County Central Committee 2016 ❑ IND $450.00 $450.00 725 Greer Rd ®COM Palo Alto, CA 94903 COMMITTEE ❑ ID: 1360584 OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH U PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January105) FPPC To1W," Helplim 866/ASK-FPPC (866/275-3772) 1819513-0 R('HFlll If P R - PAPT 1 Amounts may be rounded Loans Received to whole dollars. Statement covers period 7/1/2013 from 0 - 0' SEE INSTRUCTIONS ON REVERSE 12/31/2013 through Page 15 of 22 NAME OF FILER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) I.D. NUMBER 1340395 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IFSELF-EMPLOYED, ENTER NAME OF BUSINESS) OUTSTANDING BALANCE BEGAq%S THIS ERR O AMObUNT RECEIVED THIS PERIOD AMOUNT PAID OR FORGIVEN THIS PERIOD* OUTSTANDING BALANCE AT CLODS&% THIS INTEREST PAID THIS PERIOD ORIGINAL AMOUNT OF LOAN CUMULATIVE CONTRIBUTIONS TO DATE ❑ PAID CALENDAR YEAR o� RATE FORGIVEN PER ELECTION' t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION* t❑ INC) ❑ COM ❑ OTH ❑ PTY ❑ SCC I I I I ( DATEDUE ) )DATE INCURRED I ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION' t❑ IND ❑ COM ❑ OTH ❑PTY ❑SCC DATE DUE DATE INCURRED SUBTOTAL$ $ $ $ Schedule B Summary 1. Loans received this period................................................................................. (Total Column (b) plus unitemized loans of less than $100.) 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. *Amounts forgiven or paid by another party also must be reported on Schedule A. '* If required. $0.00 $0.00 .... NET $0.00 (May be a negative number) (Enter (e) on Schedule E, Line 3) *Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPPC TWI-Free Helpline: 666/ASK-FPPC 1866/275-3772) 1819513-0 SCHEDULE C Amounts may be rounded Statement covers period s - Nonmonetary Contributions Received to whole dollars. 7/1/2013 • • from 12/31/2013 through Page 16 Of 22 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER.I.D. NUMBER) CODE' (IF SELF-EMPLOYED, ENTER NAME GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE REQUIRED IF ( ) OF BUSINESS) (JAN. 1 -DEC. 31) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC El IND El a OTH I l LJ 1'IY I I 1 I I ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period - itemized nonmonetary contributions. (Include all Schedule C subtotals.).......................................................................... 2. Amount received this period - unitemized nonmonetary contributions of less than $100 ..... 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ... $0.00 $0..00 TOTAL $0.00 "Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) 1819513-0 SCHFntJI_F n acneoule 1i I — - Amounts ............... Amounts may be rounded Summary of Expenditures to whole dollars. Supporting/Opposing Other Statement covers period 7/1/2013 from ® - d •' ` � Candidates, Measures and Committees through 12/31/2013 page 17 of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 DATE NAME OF CANDIDATE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent Expenditure ❑ Support ElOppose ❑ Monetary Contribution ❑ Nonmonetary Contribution l l�i Inrinnnndent 1 I i l u Expenditure ❑ Support ❑ Oppose ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent Expenditure El Support ElOppose SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotafs.) 2. Unitemized contributions and independent expenditures made this period of under $100.................................................................... 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ................ $0.00 $0.00 $0.00 FPPC Form 460(January105) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) 1819513-0 Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2013 SCHEDULE E 12/31/2013 SEE INSTRUCTIONS ON REVERSE through Page 18 of 22 NAME OF FILER I.D. NUMBER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) 1340395 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND PAYEE (IF COMMITTEE, ALSO TERER I.D. NUMBER) ALSO ENTER CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Silicon valley Democratic Club Holiday Party $150.00 2401 Moore Park Ave suite 110 I I 1 San Jose, CA 95128 Carolyn Shin FND $40.00 1620 Waxing Ave Sunnyvale, CA 94087 Pacific Printing FND $380.00 1002 S. 2nd Street San Jose, CA 95112 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary this period of under $100.................................................................................. 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) .............................. period. (Add lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) $5,426.00 $0.00 $0.00 $5,426.00 FPPC Form 460 (January105) FPPC Toll -Free Helpline: 86&ASK-FPPC (866275-3772) 1819513- Schedule E Type or print in ink. Continuation Sheet) Amounts may be rounded ayments Made to whole dollars. ON REVERSE NAME OF FILER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) CODES: If one of the following codes accurately describes the payment, you may enter the code CMP campaign paraphemalia/misc. MBR member communications CNS campaign consultants MTG meetings -and appearances CTB contribution (explain nonmonetary)" OFC office expenses CVC civic donations PET petition circulating FIL candidate filing/ballot fees PHO phone banks FND fundraising events POL polling and survey research IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads Statement covers period from 7/l/2013 through 12/31/2013 SCHEDULE E Page 19 of 22 I.D. NUMBER 1340395 Otherwise, describe the payment. RAID radio airtime and production RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS PAYEE (IF COMMITTEE, ALSO ENTERR I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Olympic Recognition Products FND $413.00 1358 E. San Fernando St San Jose, CA 95116 t I I Dynasty Seafood Restaurant FND $4,403.00 10123 N Wolfe Rd Cupertino, CA 95014 Andrae Macapinlac Dinner Mtg Reimbursement $30.00 456 Lomer Way Milpitas, CA 95035 Anna Ko FND $10.00 754 The Alameda Apt 3211 San Jose, CA 95126 or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ FPPC Forth 460(January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3T/2) 1819513-0 Schedule f= Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2013 through 12/31/2013 SCHEDULEF Page 20 of 22 I.D. NUMBER 1340395 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSING OF THIS PERIOD I 1 I I I SUBTOTAL$ $ $ $ Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)....................... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100..)..... 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)..................................................................................... .INCURREDTOTALS $0.00 ....................................................................PAID TOTALS $0.00 ....NET $0.00 (May be a negaWe number) FPPC Farm 460 (January/05) FPPC TdI1 Free Helplin 866/ASK-FPPC (866/275-3772) 1819513-0 Schedule H Loans Made to Others* Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2013 12/31/2013 SCHEDULE SEE INSTRUCTIONS ON REVERSE through Page 21 of 22 NAME OF FILER ASIAN PACIFIC -ISLANDER EMPOWERMENT PAC (API EMPOWERMENT PAC) I.D. NUMBER 1340395 FULL NAME, STREET ADDRESS AND ZIP CODE OF RECIPIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) IF AN INDIVIDUAL, ENTER OCCUPATION AND. EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) (a) OUTSTANDING BALANCE BEGINNING THIS PERIOD (b) AMOUNT LOANED THIS PERIOD (c) REPAYMENT OR FORGIVENESS THIS PERIOD' (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD (a) INTEREST RECEIVED (0 ORIGINAL AMOUNT OF LOAN (9) CUMULATIVE LOANS TO DATE ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION" 'Loans that are contributions to another candidate or committee must also be summarized on ScheduleD. Loans forgiven must also be reported on Schedule E. DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN ( I I PER ELECTION•• I DATE DUE I I DATE INCURRED SUBTOTAL j $ 1 $ Is Schedule H Summary 1. Loans made this period............................................................. ............................................................. ............ $0.00 (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans....................................................................... (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.)..................................... Enter the net here and on the Summary Page, Column A, Line 7. $0.00 .....................NET $0.00 (May be a negative number) $ (Enter (e) on Schedule I, Line 3) " If required. FPPC Form 460 (January/05) FPPC ToB--Free Helpiine: 866/ASK-FPPC (8661175-3772) 1819513-0