The URL can be used to link to this page

Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2011 (2012-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Statement covers period from 7/1/12 through 12/31/12 1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. LZ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure C) State Candidate Election Committee Committee 0 Recall 0 Controlled (A/ -Complete Part 5) 0 Sponsored E] General Purpose Committee (At -Complete Part 6) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Pad 7) 3. Committee Information I.D.NUMBER 1 1339798 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) McCullough for City Council 2011 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Date Stamp Date of election if applicable: (Month, Day, Year) 2. Type of Statement: E] Preelection Statement Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) E] Amendment (Explain below) Treasurer(s) NAME OF TREASURER Andrew McCullough MAILING ADDRESS COVER PAGE I Page 1 of 3 1 FFor Official Use Only ❑ Quarterly Statement r-1 Special Odd -Year Report F-1 Supplemental Preelection Statement - Attach Form 495 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 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 M(y 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 Wect. 1/31/13 Executed on By Date Signature of TreasurerorAssistard Treasurer 1/31/13 Executed on By. Date SFgn&-ofCor*oWNOffiWh*W Candidate. State Measure Proponent or ResponstUleOffloarofSponsor Executed on By Dam SOVVe Of C0ntrokV Officaholder, Cartodate, State Measure Proponent Executed on By Date Signature of g Officeholder. Candidate, State Me"" Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612754772) State of Calffomia Recipient Committee Type or print in ink. COVER PAGE - PART 2 Campaign Statement CALIFORNIA 4• 1 Cover Page — Part 2 FORM S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Andrew McCullough OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 Related Committees Not Included in this Statement: Listany 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? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (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 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 3 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER( JURISDICTION I ❑ 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 List names of officeholder(s) or candidates) 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 ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Foran 460 (January/06) FPPC Toll -Free HelpfRne: 8661ASK-FPPC (8661276-37T2) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/12 SUMIMARYPAGE SEE INSTRUCTIONS ON REVERSE 6. Payments Made....................................................... Schedule E, Line 4 $ through 12/31/12 Page 3 Of 3 NAME OF FILER 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 I.D. NUMBER Andrew McCullough 1339798 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHISPEWD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 2. Loans Received ...................................................... schedule B, Line 3 0 0 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ 0$ 0 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 0 $ 0 Made $ $ Expenditures Made 6. Payments Made....................................................... Schedule E, Line 4 $ 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS.................................... Add Lines 6 + 7 $ 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 $ 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 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... add cine 2 +Line sin Column B above $ 0 $ 0 0 $ 0 0 0 $ 0- 0 0 10,396.12 0 0 0 0 0 0 0 0 0 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (it Subject to Voluntary Expenditure Unwit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/06) FPPC TDII-Free Helpline: 8661ASK-FPPC (8661276-3772)