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Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2011 (2012-06-30)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 1/1/12 through 6/30/12 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee M Primarily Formed Ballot Measure (D State Candidate Election Committee Committee 0 Recall 0 Controlled (Al- C—Plele Part 5) 0 Sponsored ZIP CODE (Also C-49etL Patt 6) Ej General Purpose Committee CA Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee 0 PoliticalParty/Central Committee (Also Ccmpfete Part 7) 3. Committee Information I.D. NUMBER 4onn�nn NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) McCullough for City Council 2011 STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODE/PHONE CITY CA 94901 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the besto" 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 96*ct. Executed on 7119/12 Date Executed on 7/19112 Date Executed on Date Executed an Date BY BY By Serrature afCw*DWrV Officehokler, candidate. State Measure Propawd BY S-qutwa d Cantm" Officehokler. candidate, State Measkse Proporwvt FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 666/AST{-FPPC (8661275-3772) State of California Recipient Committee Type or print In Ink. COVERPAGE-PART2 r� i Campaign Statement �' „ Cover Page --Part 2 Page 2 of 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE 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. COMM17TEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMnTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE BALLOT NO. OR LETTERI JURISDICTION O 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 Listnamesof 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 Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275.3772) State of Cailfamla Campaign Disclosure Statement Type or print in ink. Schedule E, Line 4 $ SUMMARY PAGE Summary Page 8. SUBTOTAL CASH PAYMENTS .................................... Amounts may be rounded to whole dollars. 9. Accrued Expenses (Unpaid Bilis) ...............................schedule Statement covers period d I 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE................................Add Lines 8 + s + 10 $ from 111/12 through 6x'30112 Page 3 of SEE INSTRUCTIONS ON REVERSE I NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHIS PERIOD (FROMATTACHEDSCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 0 111 through 6130 7/1 to Date 2. Loans Received...................................................... schedule B. Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines/+2 $ 0 $ 0 Contributions 20. Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 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 ra Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add tines 6 + 7 $ 9. Accrued Expenses (Unpaid Bilis) ...............................schedule 1 < uns 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE................................Add Lines 8 + s + 10 $ 0 $ 0 U $ 0 0 0 $ 0 0 0 0 0 0 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 10,396.12 To calculate Column 8, add 13. Cash Receipts ................................................ ... Column A, tine 3 above 0 amounts in Column A to the corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0 from Column B of your last 15. Cash Payments .................................................. Column A, tine a above 0 report. Some amounts inColumn A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 10,396.12 figures that should be subtracted from previous ff this is a termination statement Litre 16 must be zero. period amounts. If this is 17. LOAN GUARANTEES RECEIVED ........................... schedule B. Part 2 S Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instruct/ons on reverse $ 19. Outstanding Debts ......................... Add Llne 2 + Ltne B fn Column B above $ 0q 0the first report being filed for this calendar year, only carry over the amounts I from tines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' OfSubject 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/OS) FPPC Toll -Free Helpllne: 8661ASK-FPPC (866/2763772)