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Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2011 (2014-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if applicable: 7/1/14 1 (Month, Day, Year) from through 12/31/14 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) E] General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee F Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) McCullough for City Council 2011 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE JAN 14 2015 Page 1 of 3 me, For Official Use Only ity Clerk's office itv of San Rafael 2. Type of Statement: E] Preelection Statement V Semi-annual Statement E] Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) [-] Quarterly Statement E] Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Andrew McCullough MAILING ADDRESS 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 OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the bestf 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 C;?Ct. Executed on 1/12/15 By Date 1/12/15 By Executed on Date of Treasurer or or Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. 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 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94901 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? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) COVER PAGE - PART 2 Page 2 of 3 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI 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 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 ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from 7/1/14 SUMMARY PAGE through 12/31/14 Page 3 of 3 SEE INSTRUCTIONS ON REVERSE - NAME OF FILER I.C. NUMBER Andrew McCullough 1339798 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROMATTACHED SCHEDULES) TOTALTO DATE General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received ......... ......... ....................... .... Schedule B, Line 3 $ 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I + 2 $ Received $ — $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 0 $ 0. Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... Schedule E, Line 4 $ $ Candidates 7. Loans Made ............................................................. Schedule H, Line 3 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 Date of Election Total to Date (mm/dd/yy) 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 0 $ 0 $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 10,346.12 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the 0 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last reported in Column B. 0 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 $ 10,346.12 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 $ 0 for this calendar year, only 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if any). 18. Cash Equivalents ........................................ See instructions on reverse $ 0 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column a above $ 0 FPPC form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)