HomeMy WebLinkAboutForm 460 - Firefighters' Association PAC (2016-12-31)Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from ____ 7_1_1_/2_0_1_6 __
12/31/2016 through ________ _
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
o Officeholder, Candidate Controlled Committee o Primarily Formed Ballot Measure
Committee o State Candidate Election Committee o Recall
(Also Complela Parl 5)
10 General Purpose Committee
® Sponsored o Small Contributor Committee o Political Party!Central Committee
3. Committee Information
o Controlled o Sponsored
(Also Complala Part G)
o Primarily Formed Candidate!
Officeholder Committee
(Alsa Compla :. Parl 7)
I.D. NUMBER
891308
NAME IF NO COMMI
STREET ADDRESS (NO P.O. BOX)
CITY
san Rafael
STAT E ZIP CODE
Ca 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE
San Rafael Ca 94912
OPTIONAL: FAX / E·MAIL ADDRESS
4. Verification
AREA CODE/PHONE
AREA CODE/PHONE
Date of election if applic:at,IcU
(Month, Day, Year)
iiilMP.!IMII
COVER PAGE
CITY CLERK'S 0
2. Type of Statement:
o Preelection Statement
fi2I Semi-annual Statement o Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
ANDREW ROGERSON
MAILING ADDRESS
CITY
ROHNERT PARK
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY
OPTIONAL: FAX / E·MAIL ADDRESS
o Quarterly Statement o Special Odd-Year Report
STATE ZIP CODE
CA 94928
STATE ZIP CODE
AREA CODE/PHONE
AREA CODE/PHONE
I have used all reasonable d iligence 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.
certify under penalty of perjury under the laws of the State of California that the foregoing is and correct.
Executed on //7 "Z-/2-0 ;y-BY.":::==~=~;;::=-='"-o=,<,::;~..J~ .... ~~;. ~~o('~~====:--______ _ r /DatC
Executed on ------:O::-a.,-Io------
Execuled on ------:O~a.,-le------
Execuled on ------:O~a.,-Ie------
By_=-~~~~~~~~~=;~~~~ __ ~~~~=-~~ __ _ Signalure of Coni rolling Officeholder. Candida Ie. Siale Measure Proponenl or Responsible Officer of Sponsor
By _________ ~~~~~~~~~~~~~~~~~~----------Signalure of Conlrolling Officeholder, Candidate. Siale Measure Proponenl
By----------~S~lg~na~IU~re~o~f~Co~n~lrO~lfi~ng~O~m~lce~h~otd~e~~~Ca~n~di~da~lo~,S~la~le~M~e~as~ur~e~P~ro~po~ne~n~l----------
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
ColumnA Contributions Received TOTAL THIS PERIOD
(FRO~I ATTACHEO SCHEDULES)
1. Monetary Contributions ................................................... Scl19dule A. Lme 3 $ o
2. Loans Received................................................................ Schedule B. Lme 3 o
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ o
4. Nonmonetary Contributions............................................ Schedule C, Lin e 3 o
5 . TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ o
Expenditures Made
6. Payments Made................................................................ Schedule E, Line 4 $ o
7. Loans Made................... ...... ...... ....... .... ............................. Schedule H, Lino 3 o
8. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 $ o
9. Accrued Expenses (Unpaid Bills) .......................................... Sclledule F. Lme 3 o
10. Nonmonetary Adjustment... ...................................................... Schedule C, Line 3 o
11. TOTAL EXPENDITURES MADE. ....................................... Add Lines 8 + 9 + 10 $ o
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 87,094
13. Cash Receipts ........................................................... Column A. Line 3 above o
14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4 9
15. Cash Payments ......................................................... Column A. Line 8 above o
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15 $ 87,103
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule B. Part 2 $ o
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ See instructions on reverse $ o
19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ o
SUMMARY PAGE
Statement covers period CALIFORNIA -4' 6' 0--'
7/1/2016 from _________ _ FORM ,
12/31/2016 through ________ _ Page __ 2 __ of 6"
$
$
$
$
$
$
Column B
CALENDAR YEAR
TOTAL TO DATE
o
o
o
o
o
500
o
500
o
o
500
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).
1.0 . NUMBER
891308
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 Ihrough 6/30 7/1 to Dale
20. Contributions
Received $ _____ _ $-----
21. Expenditures
Made $ _____ _ $-----
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made·
(II SubJoct to Voluntary Expondlturo LImit)
Date of Election
(mm/dd/yy)
Total to Date
$-----
$-----
'Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Firefighters Political Awarness Committee
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FU L L NAME , STREET ADD RESS AND Z IP CODE OF CO NTRIBUTOR CONT R IB UTOR
(IF COMMITTEE. A LSO ENTER 1.0. NUMBER) CODE *
IF AN INDIVIDUAL. ENT ER
OCCUPATI ON AND EMPLOYER
(IF SELF.EMPLOYED. ENTER NAME
OF BUSINESS)
= Schedule A Summary
DINO
DCOM
DOTH
DpTY
Dsce
DIND
DeOM
DOTH
DpTY
Osee
DIND
DeOM
DOTH
DpTY
Osee
DINO
DCOM
DOTH
DpTY
Osee
DINO
DCOM
DOTH
DpTY
Dsce
SUBTOTAL $
SCHEDULE A
Statement covers period
from ___ 7_'_1 '_2_0_1_6 __ _
'. CALIF~RN'iA 460
FORM . , . .
through __ 1_2_'3_1_'2_0_1_6 __ Page _3 __ of i
AMOUNT
RECEIVED THIS
PERIOD
1.0 . NUMBER
891308
CU M ULATIVE TO DATE
CALENDAR YEAR
(J AN . 1 -DEC . 3 1)
PER ELECTION
TO DATE
(IF REQUIRED)
·Contributor Codes
INO -Individual 1. Amount received this period -itemized monetary contributions.
(Include all Schedule A subtotals.) ......................................................................................................... $ ______ 0 COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ _______ 0
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ______ 0
sec -Small Contributor Committee
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule D
Summary of Expenditures
Supporting/Opposing Other
Candidates, Measures and Committees
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Firefighters Political Awarness Committee
DATE NAME OF CANDIDATE . OFFICE . AND DISTRICT, OR
MEASURE NUMBER OR LETTER AND JURISDICTION .
OR COMMITTEE
o Support D Oppose
o Support D Oppose
o Support o Oppose
Schedule D Summary
Amounts may be rounded
to whole dollars.
TYPE OF PAYMENT
0 Monetary
Contribution
0 Nonmonetary
Contribution
0 Independent
Expend iture
D Monetary
Contribution
0 Nonmonetary
Contri bution
D Independent
Expenditure
0 Monetary
Contribution
D Nonmonetary
Contribution
D Independent
Expenditure
DESCRIPTION
(I F REQUIRED)
SUBTOTAL
SCHEDULE D
Statement covers period
--;-.. --....-
from ___ 7;..;,'...:.;1 'c::;2;..;,0...:.;1.::...6 __
CALIFORNIA 460
FORM
through __ 1.:..::2=:..'.::...3..c;.1 ',;::2.::...0 1,;...6:....-_ page ___ 4_ of ~
$
AMOUNT THIS
PERIOD
I.D . NUMBER
891308
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1-DEC . 31)
PER ELECTION
TO DATE
(IF REQUIRED)
1. Itemized contributions and independent expenditures made this period. (Include all Schedule 0 subtotals.) ....................................................... $ ____ ....::0,-
2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................... $ ____ --"0'-
3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL .. $ ____ -'0 .....
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc,ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule I
Miscellaneous Increases to Cash
SE:E INSTRUCTIONS ON REVERSE
NAME OF FILER
San Rafael Firefighters Political Awarness Committee
DATE FULL NAME AND ADDRESS OF SOURCE
RECEIVED (IF COMMITIEE . ALSO ENTER 1.0 . NUMBER)
Bank Of America
12/31/2016 1000 4th St San Rafael Ca . 94901
Amounts may be rounded
to whole dollars. Statement covers period
from ___ 7_/1_/2_0_1_6 __ _
through __ 1_2_/3_1_/2_0_1_6 __
DESCRIPTION OF RECEIPT
Intrest Earned
SCHEDULE I
CALIFORNIA 460
FORM
Page _5 __ of _5 __
1.0. NUMBER
891308
AMOUNT OF
INCREASE TO CASH
9
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Itemized increases to cash this period ............................................................................................................................ $ _______ 9
2. Unitemized increases to cash of under $100 this period ................................................................................................. $ ______ 0
3. Total of all interest received this period on loans made to others. (Schedule H. Column (e).) ....................................... $ ______ 0
4. Total miscellaneous increases to cash this period. (Add Lines 1. 2. and 3. Enter here and on the
Summary Page. Line 14.) ............................................................................................................................. TOTAL $ _____ 9_
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov