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Home My WebLink AboutForm 460- Greg Brockbank for City Council 2013 (2013-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 1/1/13 SEE INSTRUCTIONS ON REVERSE I through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored r-1 Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1 1355049 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) BROCKBANK FOR CITY COUNCIL 2013 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ( Date of election if applicable: (Month, Day, Year) 1/5/13 COVERPAGE Date Stamp CALIFORNIA 460 r ceivea FORM Page 1 of JUIM13 1 For Official Use Only S 2. Type of Statement: El Preelection Statement F-1 Quarterly Statement [Z Semi-annual Statement F1 Special Odd -Year Report ❑ Termination Statement F-1 Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Brockbank MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ( 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. Executed on 7/31/13 By Date Signature of Treasurer or Assistant Treasurer 7/31/13 Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Type or print in ink. S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE GREG BROCKBANK OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Councilmember, City of San Rafael RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94903 Related Committees Not Included in this Statement: List any committees 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 NAME OF TREASURER CONTROLLED COMMITTEE? F-1 YES ❑ NO COMMITTEE ADDRESS' STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [:] YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) COVER PAGE - PART 2 Page Of _J 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE I BALLOT NO. OR LETTER JURISDICTION [-]SUPPORT F] OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD I DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E]SUPPORT OPPOSE W I y ti [At t: LIF uuutl- AKtA k..,UUt/t-'r1UNt: Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Statement covers period CALIFO . RNIA 460 1/1/13 FORM fron, I Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 through 6/30/13 Page of 0 SEE INSTRUCTIONS ON REVERSE 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 11,899.76 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 NAME OF FILER 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 11899.76 I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 12. Beginning Cash Balance ....................... Previous Summary Page; Line 16 $ 0.00 To calculate Column B, add 1355049 18,207.00 amounts in Column A to the Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR Running in Both the State Primary and report. Some amounts in 15. Cash Payments ................................................. Column A, Line 8 above (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1. Monetary Contributions ............................................ Schedule A, Line 3 $ 14Y207.00 $ subtracted from previous If this is a termination statement, Line 16 must be zero. 4YO00.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 18,207.00 $ $ 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 547.80 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 18,754.80 $ Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 19899.76 $ 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 11,899.76 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 11899.76 $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page; Line 16 $ 0.00 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 18,207.00 amounts in Column A to the corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 from Column B of your last 11 899.76 report. Some amounts in 15. Cash Payments ................................................. Column A, Line 8 above Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 61307.24 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) $ J $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPLC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Cnknr41 do A TvPe or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA t 1/1/13 from • through 6/30/13 Page 7 of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) V]IND 2/28 Jeff Kroot E] COM Architect (self) $100 ❑ OTH San Anselmo, CA 94960 ❑ PTY ❑ SCC ®IND Francis W. Parnell & Diana D. Parnell ❑COM Physicians (self) $100 2/28 - ❑ OTH Ross, CA 94957 ❑ PTY ❑ SCC ®IND Deb Hubsmith ❑COM Manager $35 2/28 ❑OTH Marin Co. Bicycle Fairfax, CA 94978 ❑ PTY Coalition ❑ SCC WIND Shahla Davoudi ❑COM Property investor/mgr. $100 3/1 ❑OTH (self) San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND Clark Hinderleider ❑COM surgeon/scientist $100 3/2 (self) Mill Valley, CA 94941 ❑ PTY ❑ SCC SUBTOTAL$ 435 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.)...................................................... .............................. $ 2. Amount received this period — unitemized monetary contributions of less than $100 ... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .......... TOTAL $ 12,954 1,353 14,207 `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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded to dollars. Statement covers period CALIFORNIA A60 whole 1/1/13 FOR from through 6/30/13 Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR AND ZIP CODE CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (E COMMITTEE, ALSO CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®❑COM Ed Boyce retired $200 3/1 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Ellen Obstler W] IND Dretired EICOM $250 3/2 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Helen Bacon ®IND ❑ COM retired $250 3/2 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Frank Solomon ®IND real estate investor $100 3/3❑COM ❑ OTH (self) San Rafael, CA 94903 ❑ PTY ❑ SCC Ed Vorous OcoM IND Dustbusterz (self) $300 3/5 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ ScC SUBTOTAL$ 1100 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period• . to whole dollars. 1/1/13 FORM , from 6/30/13 (? through page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) IND ®❑COM Keith & Gail Lester retired 3/5 ❑ OTH $100 San Rafael, CA 94901 ❑ PTY ❑ SCC Linda Remy ®❑IoM researcher $100 3/5 ❑OTH UCSF Mill Valley, CA 94941 ❑ PTY ❑ SCC Ken Hobbs ® IND ❑ COM retired $100 3/5 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Faye & Lou Hinze OCOM IND retired $100 3/6 ❑ OTH Corte Madera, CA 94925 ❑ PTY ❑ SCC Katherine Crecelius ® []COM COM housing consultant (self) 3/8 $200 ❑ OTH Novato, CA 94948 ❑ PTY ❑ SCC SUBTOTAL$ 600 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers periode . towholedollars. 1/1/13 e ' ' from 6/30/13 through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE A 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 (ET IT E,ALSENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND Douglas Kerr ❑COM retired 3/8 E]OTH $99' Larkspur, CA 94939 ❑ PTY ❑ SCC Raymond Katz ® IND El COM dentist (self) 3/9 $50 ❑ OTH Larkspur, CA 94939 ❑ PTY ❑ SCC 3/9 David Cou EI IND retired $250 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Bill Carney & Tamra Peters ®IND ❑ COM consultants (self) 3/12 $250 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Vicki Sievers ®❑CaM retired 3/13 $100 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 749 "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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period • . to whole dollars. 1/1/13 ' from • 6/30/13 through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (E COMMITTEE, ALSENTERI.D.NUMBER) CODE * (IFSELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Jeff Brusati E]COM sports store owner 3/15 E] OTH (self -- T&B Sports) $100 San Rafael, CA 94903 ❑ PTY ❑ SCC Stan Gold ®IND ❑COM retired 3/16 $100 ❑ OTH Petaluma, CA 94952 ❑ PTY ❑ SCC Denise Luc ®IND ❑COM Professor 3/18 ❑OTH Dominican University of $100 San Rafael, CA 94901 ❑ PTY Calif. ❑ SCC Judy Schriebman V❑COM IND homeopath (self) 3/13 $50 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Roger E. Roberts ® IND ❑ COM retired 3/20 $150 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 500 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period. to whole dollars. 1/1/13 ,from FPage of through 6/30/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITfEE,ALSO ENTER ID.NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND E] Com Executive Director 3/21 E] OTH Community Action Marin $100 Novato, CA 94949 ❑ PTY ❑ SCC ®IND retired 3/25 E] Com $75 OTH Mill Valley, CA 94941 El PTY ❑ SCC ® El COM COM ind. investor (self) 3/26 $250 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Lee Domanico ®IND ❑IoM CEO 3/27 E] OTH Marin General Hospital $100 Mill Valley, CA 94941 ❑ PTY ❑ SCC Elaine Brockbank ®IND ❑IoM retired 3/31 $100 ❑ OTH Kentfield, CA 94904 ❑ PTY ❑ sCC SUBTOTAL$ 625 `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 (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 FORM ' from through 6/30/13 page t of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (E COMMITTEE, ALSO I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Carol Misseldine ZIND consultant (self) 4/23 WovatoW,94949 E]OTH $100 ❑ PTY ❑ SCC Peter G. Joseph ®IND ❑ COM retired $100 5/9 ❑ OTH San Anselmo, CA 94960 ❑ PTY ❑ SCC John Reynolds ®IND El COM retired 1 $ 00 5/9 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Jonathan Frieman IND ICOM football coach $250 5/9 E] OTH an a ae , 01 ❑ PTY ❑ SCC Belle Cole ®IND ❑ COM retired $300 5!9 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 850 XA '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period I CALIFORNIA to whole dollars. 1/1/13 - ' from • page of through 6/30/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (E COMMITTEE, ALSENTERI.D.NUMBER) CODE * (IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Roberta Goldberg g]coM retired 5/9 ❑ OTH $125 San Rafael, CA 94901 ❑ PTY ❑ SCC Janet Wiscombe & Ed Lai ®IND El COM retired 5/9 $100 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 5/9 Keith & Gail Lester ®IND ❑ COM retired $100 �0o" CIO E] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 5/15 Raymond Katz ® IND ❑ COM dentist (self) $50 f0. 0 Q ❑ OTH Larkspur, CA 94939 ❑ PTY ❑ SCC Steve Shaiken ®IND ❑ COM attorney (self) 5/16 $100 ❑ OTH Fairfax, CA 94930 ❑ PTY ❑ SCC SUBTOTAL$ 475 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period . to whole dollars. 1/1/13 • ' from • page of through 6/30/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Robert Spofford [:]COM retired 5/19 E] OTH $250 San Rafael, CA 94901 ❑ PTY ❑ SCC S ®IND retired 5/20 E-1COM $250 F1OTH Be ve ere, ❑ PTY ❑ SCC Diana Conti ®IND E] COM Ex. Dir. 5/20 E] OTH PARCA $150 Mill Valley, CA 94941 ❑ PTY ❑ SCC Kevin Gladstone ®IND ❑ COM Usher 5/21 E] OTH Century Theaters $100 San Rafael, CA 94901 ❑ PTY ❑ SCC Mary Gidley ® IND El COM retired 5/21 $50 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 800 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 • ' from through 6/30/13 Page (- of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE ND 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 (IF COMMITTEE, ALSO I.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Wade Holland ICOM retired $100 5/21 ❑ OTH Inverness, CA 94937 ❑ PTY ❑ SCC es Council (#900667) ❑IND (] COM 5/21 $150 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC ert Kingsley ®IND COM ❑ COM retired $100 5/21"957 E] ❑ PTY ❑ SCC Roger E. Roberts ®IND El COM retired $100 $250 5/21 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND retired 5/23WMAW" ❑ COM $50 $250 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 500 *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) Schedule (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 1/1/13 fromthrough FPage € of 6/30/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IFCOMMITEE,ALSO ENTER I.D.NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®❑IoM Deborah Hubsmith Manager 5/23�� ❑OTH Marin Co. Bicycle $100 $135 Fairfax, CA 94978 ❑ PTY Coalition ❑ SCC Gumbiner & Eskridge [:]IND El COM 5/23 $100 W1 OTH ❑ PTY ❑ SCC Dave Coury W]IND COM retired 5/23 $250 $500 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Ellen S. Karel ®IND ❑ COM retired 5/25 $100 ❑ OTH Corte Madera, CA 94925 ❑ PTY ❑ SCC Clark Hinderleider ®IND ❑ COM scientist/surgeon 5/25$100 E] OTH (Self) $200 ❑ PTY ❑ SCC SUBTOTAL$ 650 '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) Schedule (Continuation Sheet) Type or print in ink. SCHEDULE (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 FORM ' from through 6/30/13 Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (E COMMITTEE, ALSENTERI.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Don Miller EIcoM retired $ 150 5/27 ❑ OTH Tiburon, CA 94920 ❑ PTY ❑ SCC Dietrich Stroeh ®IND ❑CO Engineer $100 5/30 E] OTH (self - Stueber/Stroeh) Novato, CA 94949 ❑ PTY ❑ SCC Angelo Douvos ElCOM IND retired $50 $100 6/1 ❑ OTH San Rafael, CA ❑ PTY ❑ SCC Mark Leno for Senate 2012 (#1293202) ❑IND V coM $250 6/6 - ❑ OTH Encenitas, CA 92024 ❑ PTY ❑ SCC George John OCOM IND Attorney (self) $250 6/7 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ ScC SUBTOTAL$ 800 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period . to whole dollars. 1/1/13 , from •' / Page of 6/30/13 through NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR OF COMMITTEE, ALSO AND I.D.NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND William Sims ❑IoM retired 6/8 ❑ OTH $100 Sausalito, CA 94965 ❑ PTY ❑ SCC Bill Daniels E] IND ❑ COM 6/10 $500 W] OTH Novato, CA 94949 ❑ PTY ❑ SCC Ed Boyce OCOM IND retired 6/11 $50 $250 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Jeff Levin ® IND El COM therapist (self) 6/11 $100 ❑ OTH Marin City, CA 94960 ❑ PTY ❑ SCC ®IND retired 6/11 El COM $100 ❑ OTH O 1 ❑ PTY ❑ SCC SUBTOTAL$ 850 `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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 1/1/13CALIFORNIA 460 from through 6/30/13 Page of ` NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (E COMMITTEE, ALSENTERI.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND ❑COM realtor (self) 6/12 ❑ OTH $100 Ova O, 47 ❑ PTY ❑ SCC ®IND ❑ therapist pist (self) 6/12 $100 ❑ OTH ❑ PTY ❑ SCC ®IND ❑coM supervisorial aide 6/13 ❑OTH County of Marin $100 Novato, CA 94947 ❑ PTY ❑ scC ®IND El COM Director 6/15 010aeOF41 E] OTH American Sports Institute $100 ❑ PTY ❑ SCC Keith Meloney IND EICOM retired 6/17 ad ❑ OTH $100 94903 ❑ PTY ❑ SCC SUBTOTAL$ 500 `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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 O - 460 from 6/30/13 through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT r RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®ICOM Jack Gibson Attorney (self) $100 6/18 ❑ OTH San Anselmo, CA 94960 ❑ PTY ❑ scC ®IND retired 5/20 ❑COM $100 ❑ OTH San Rafael, CA 94901 I PTY ❑ SCC ®IND video director (self) 6/19 ❑ COM $100 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND Attorney (self) 6/19 ❑COM 1 $ 00 ❑ OTH Fairfax, CA 94930 ❑ PTY ❑ scc Doug Kerr ®❑IND COMretired $100 $199 6/21 E]OTH Larkspur, CA 94939 ❑ PTY ❑ SCC SUBTOTAL$ 500 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 FORM t from through 6/30/13 page i of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®❑COM Lawrence Baskin Attorney (self) 6/21 ❑ OTH $150 San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND retired 6/21 El COM $100 ❑ OTH Lagunitas, CA 94938 ❑ PTY ❑ SCC Ral h McLeran ® IND El COM realtor (self) $250 6/21 ❑ OTH Kentfield, CA 94904 ❑ PTY ❑ SCC David Glick ®IND El COM therapist (self) $125 6/22 ❑ OTH Fairfax, CA 94930 ❑ PTY ❑ scC Esther Wanning VIEItherapist (self) $500 6/23 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 1125 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period • . to whole dollars. 1/1/13 • ' from • 6/30/13 through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED _ CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND John & Berneice Moore ❑ coM retired 6/23 ❑ OTH $100 an a ae , 01 ❑ PTY ❑ SCC John Reynolds ®IND retired 6/23ElCOM $35 $135 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ sCC Jud Schriebman OCOM IND homeopath (self) 6/23 $50 $100 E]CO San Rafael, CA 94903 ❑ PTY ❑ SCC Steve Burdo ®IND El COM consultant 6/23 E] OTH Kathleen Russell & $100 San Anselmo, CA 94960 ❑ PTY Associates ❑ SCC ®IND retired 6/23 0" ❑COM $35 $135 "125 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 320 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary/ Contributions Received Amounts may be rounded Statement covers period ICALIFORNIA to whole dollars. 1/1/13 , from FORM 6/30/13 through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 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 (E COMMITTEE, ALSENTERI.D.NUMBER) CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Elaine Brockbank []COM retired 6/23 E] OTH $230 $330 Kentfield, CA 94904 ❑ PTY ❑ SCC ®IND retired 6/23 ❑ COM $25 $100 ❑ OTH Mill Valley, CA 94941 ❑ PTY ❑ SCC Jack Be S ®IND ❑ COM retired 6/23 $20 $110 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Hugh/Delehanty/ & Barbara Graham ®❑ IND COM author (self) 6/23 $100 ❑ OTH Mill Valley, CA 94941 ❑ PTY ❑ SCC Richard Benson ®IND ❑ COM Assessor/Recorder/Clerk 6/23 E] OTH County of Marin $100 Novato, CA 94947 ❑ PTY ❑ SCC SUBTOTAL$ 475 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 1/1/13 FORM ' from 6/30/13 "" through Page of `~ NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (E COMMITTEE, ALSO I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) WIND 6/23 Ken Hobbs ❑COM retired $50 $100 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Aref Ahmadia dba West End Cafe ICOM IND owner $150 6/23 ❑OTH West End Cafe and San Rafael, CA 94901 ❑ PTY Catering ❑ SCC ®IND ❑COM real estate investor $400 $500 6/25 F-1OTH (self) San Rafael, CA 94903 ❑ PTY ❑ SCC Dolores Heeb ®IND ❑ COM retired 100 $ 6/26 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Woody Rowland WIND ❑COM attorney (self) $100 6/26 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 800 '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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA '460 to whole dollars. 1/1/13 from FORM 6/30/13 through Page '` - of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE A ZIPDEO FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR RES CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED SAND (IF COMMITTEE, I.D.N IT CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND rjorie Goodman ICOM Leg. liaison 6/26 E] OTH Hanson Bridgett $100 Novato, CA 94949 ❑ PTY ❑ SCC Carolyn Lenert ®IND El COM realtor (self) 6/28 $100 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Mary Gidley ® IND ❑ COM retired $100 6/28 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 300 `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) t5Z IND n COM n OTH n PTY ❑ SCC DATE DUE DATE INCURRED F] PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION IND Ej COM 0 OTH [:1 PTY [:1 SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION** IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS 41000$ 4,000 Schedule B Summary 1. Loans received this period ..................................................................................................................... $ 4,000 (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.) ............................................................... NET $ 4,000 Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. If required. (Enter (e) o Schedule E, TContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Type or print in ink. SCHEDULE B - PART I Schedule B - Pad 1 Amounts may be rounded Statement covers period ]=, Loans Received to whole dollars. 1/1/13' CALIFORNIA 460 from FORM f I �` 6/30/13 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (a) OUTSTANDING BALANCE (b) AMOUNT W AMOUNT PAID (d) OUTSTANDING BALANCEAT (e) INTEREST M ORIGINAL M CUMULATIVE OF LENDER (IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TMJ DATE Greg Brockbank attorney (self - Marin ❑PAID CALENDAR YEAR Law Center) $ $ 47000 41000 $ — $ San Rafael, CA 94901 E:] FORGIVEN RATE PER ELECTION" 4,000 t5Z IND n COM n OTH n PTY ❑ SCC DATE DUE DATE INCURRED F] PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION IND Ej COM 0 OTH [:1 PTY [:1 SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION** IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS 41000$ 4,000 Schedule B Summary 1. Loans received this period ..................................................................................................................... $ 4,000 (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.) ............................................................... NET $ 4,000 Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. If required. (Enter (e) o Schedule E, TContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule C t"Nr" ftxl T • NP I Type or print in ink. I -A Amounts may be rounded to whole dollars. Statement covers period from 1/1/13 SCHEDULEC Schedule C SummanA 1. Amount received this period — itemized nonmonetary contributions. 547.80 (include all Schedule C subtotals.) ..................................................................................................................... $ 2. Amount received this period — uniternized nonmonetary contributions of less than $100 .................................... $ 3. Total nonmonetary contributions received this period. 547.80 (Add Lines I and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... I UTA L $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) 6/30/13 through Page Of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES CALENDAR YEAR (IF REQUIRED) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) E]IND Bill Daniels -- United Markets [:]Com food for $547.80 6/23 VOTH campaign kickoff San Rafael, CA 94901 F-1 PTY E1SCC F-1INC} FICOM F -10TH OPTY E1SCC F-11ND F-1COM F -10TH E-1 PTY FISCC [�IND F-1COM [:]OTH El PTY EISCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ $547.80 Schedule C SummanA 1. Amount received this period — itemized nonmonetary contributions. 547.80 (include all Schedule C subtotals.) ..................................................................................................................... $ 2. Amount received this period — uniternized nonmonetary contributions of less than $100 .................................... $ 3. Total nonmonetary contributions received this period. 547.80 (Add Lines I and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... I UTA L $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule D Summary of Expenditures Type or print in ink. SCHEDULED Statement covers period Supporting/Opposingtither Amounts may be roundedCALIFORNIA. 460 to whole dollars. 1 /1 /13 from Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE through 6/30/13 Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE. CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE (IF REQUIRED) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) DCCM (Democratic Central Committee of Monetary sponsorship of fundraiser 1/26 Marin) Contribution $125 [� Nonmonetary Contribution [] Independent ❑ Support ❑ oppose Expenditure 317 MWPAC (Marin Women's Political action �lJ Monetary Contribution sponsorship of fundraiser Committee) $125 171 Nonmonetary Contribution Independent ❑ Support ❑ oppose Expenditure 6/4 Cardmember Service (for Friends of Judy [,Zj Monetary sponsorship of fundraiser Arnold) Contribution $250 Nonmonetary Contribution Independent Support C] oppose Expenditure SUBTOTAL. $ $500 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) 500 2. Unitemized contributions and independent expenditures made this period of under $100 ............ $ 200 . Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 700 1=PPC Form 460 (January/06) 1=PPC Toll -Free Helpline: 866/AS1 -I PPC (866/276-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. NAME OF FILER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 Statement covers period from 1/1/13 through 6/30/13 Page 2 `1 of I.D. NUMBER 1355049 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalialmisc. MBR member communications RAD radio airtime and production costs 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 M 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 PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Green Dog Campaigns CNS $31000.00 DCCM sponsorship of fundraiser $125-00 Strahm Communications remits and stationery envelopes $638.32 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3763.32 Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) .............................................................................................................. $ 11,550.12 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 349.64 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 11,899.76 FPPC For 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule E Type or print in ink. SCHEDULE E (CONT.) Statement covers period (Continuation Sheet) Amounts may be rounded CALIFORNIA 4 Payments Made to whole dollars. from 1/1/13 FORM .60 6/30/13 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants IVITG 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 PFK) phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals M 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 IIT' camnaian literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) MWPAC sponsorship of fundraiser $125-00 Indie Politics CNS $2,400.00 Cardmember Service postage, campaign meeting meals, sponsorship of POS fundraiser $488.38 Cherie Maria Alvarez SAL $1,000.00 Timodesigns PRO $150.00 PHU FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E (Continuation Sheet) Payments Made I Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period frnm 1/1/13 SCHEDULE (CONT) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID through WOW -1 15 Page �1�7( 0 f SEE INSTRUCTIONS ON REVERSE $3623.42 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVIP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs 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 PFIO 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 PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Indie Politics POL and kickoff invites $3623.42 #171 U410h - & W111:1111011r.-Im IM I I- XMI FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule'in Type or print in ink. Statement covers period Paymp tints Made by an Agent or Independent Amounts may be rounded A A Fkq vi 0 1 Contractor (on Behalf of This Committee) to whole dollars. from 1/1/13 115 1 10M 6/30/13 SEE INSTRUCTIONS ON REVERSE through Page Of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 1355049 NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD I radio airtime and production costs CNS campaign consultants K4TG 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Indie Politics POL (and kickoff invites) $3623.42 Attach additional information on appropriately labeled continuation sheets. TOTAL* $ $3623.42 Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or it contractor as reported on Schedule E. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-1=PPC (866/275-3772)