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Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2011 (2011-09-24)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 7/1/2011 through 9/24/2011 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee F -I Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete PattS) 0 Sponsored (Also Complete Pelt 6) M General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information (DATE'S NAME IF NO McCullough for City Council 2011 0 Primarily Formed Candidate/ Officeholder Committee (Also Complete Pad 7) STREET ADDRESS (NO P.Q. 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 CODEIPHONE OPTIONAL: FAX ' E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) 11/8/2011 2. Type of Statement: Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE Page _I of For Official Use Only El Quarterly Statement F-1 Special Odd -Year Report El Supplemental Preelection Statement - Attach Form 495 NAME OF TREASURER Randy Coleman MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94901 NAME OF ASSISTANT TREASURER, IF ANY Andrew McCullough MAILING ADDRESS CITY STATE ZIP CODE AREA COD&PHONE San Rafael Ca 94901 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 correo, Executed or By Date f Signature of Treasurer or Assistant Treasurer Executed on .2- 4 [( if By Date Signature of Controihnq Off-mricider. Candrdate, State Measure Proponent or Posponsbe Officer of Sponsor Executed or, Date By Signature of Controlling Otficeroo1w, Candidate, State Measure Proponent Executed or By Date SgratLre of Cortroil rig Cffic&-spfer, Canddate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866(ASK-FPPC (866/275-3772) State of California Type or print in ink. COVER PAGE - PART 2 Recipient Committee CALIFORNIA Campaign Statement FORM 460 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) City Of San Rafael Council RESIDENTIAUBUSINESS 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME LD, NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page __.1, of 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 OR HELD 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 Attach continuation sheets If necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) State of California Campaign Disclosure Statement Type or print In ink. - SUMMARYPAGE Statement covers period-, CALIFONIA 6 Amounts may be rounded Summary Page to whole dollars. from0 7/1/2011 FORM Page ,3 of through 9/24/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 Contributions Received Column A TOTALTHISPERIOD Column B CALENDAR YEAR Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) TOTALTO DATE Running In Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 17,211.99 $ 17,211.99 2. Loans Received ...................................................... Schedule B, Line 3 15,000.00 15,000.00 1/1 through 6/30 7/1 to Date 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 32,211.99 $ 32,211,99 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ..................... ..... Add Lines 3 + 4 $ 32,211.99 $ 32,211.99 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... Schedule E, Line 4 $ 8,712.83 $ 8,712.83 Candidates 7. Loans Made ............................................................. Schedule H, Line 3 0 0 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 8,712.83 $ 8,712.83 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 8,712.83 $ 8,712.83 $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 0 To calculate Column B, add 13. Cash Receipts ........................... ....................... Column A, Line 3 above 32,211-99 amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule I, Line 4 .27 from Column B of your last reported in Column B. 15. Cash Payments ..................... ............. .............. Column A, Line 8 above 8,712.83 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 23,499,43 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, ands (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ... _ ....... ... See instructions on reverse S 19. Outstanding Debts .. ....... _ ............ _ Add Line 2 + Line 9 in Coiumn B above S 15,000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Gr_hPdu11f± A Type or print in ink. SCHEDULE A Amounts may be rounaea Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 4 7/1/2011 from l • ! FORM Page - of through 9/24/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER LD, NUMBER Andrew McCullough 1339798 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 FcoMMIrrEE,ALSND Lp, NUMBER) CODE * (IFSELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND 9/3 Richard Kalish ❑COM Attorney $250.00 $250.00 MOTH Kalish, Nexon and San Rafael, CA 94901 r7 PTY Birnbaum, LLP 7 Scc ®IND 915 Jeanne Leonclni e ❑COM 70TH retired $100.00 $100.00 San Rafael, CA 94901 7 PTY 7 SCC 71ND s/5 Leoncinl's Garden Service - �--� � �, S ICOM $100.00 $100.00 ®OTH San Rafael, CA 94901 ❑ P-ry 7 SGC ®IND 9/6 Lls Lisa Turbis is ❑COM Attorney $100.00 $100.00 MOTH Autodesk San RoanfaleT,11TW61 7 PTY 7SCC ®IND 9/12 Roy Howell ❑COM Chemist $2,000.00 $2,000.00 MOTH Red Line Synthetic Oil 10 ❑ PTY Corp. 7scc SUBTOTAL$ 2,550.00 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.} ...... $ H .... TOTAL $ 15, 600.00 1,611.99 17, 211.99 '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 Tall -Free Helpline: 866/ASK-FPPC (866!275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts maybe rounded Statement covers period I CALIFORNIA to whole dollars. 7/1/2011 FO • RM 460 from Page of_L_ through 9/24/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIPO 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, ALSO ENTER I.D. NUMBER) CODE * (IF SELF•EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) ®IND 9/13 Peter Martin ❑COM Retired $100.00 $100.00 ❑ OTH San afae , ❑ PTY ❑ SCC San Rafael Firefighters Assn IND ®COM PAC # 891308 9/17 $1,000.00 $1,000$1,000.00San 1. a ae , 01 p POTH TY ❑ SCC Marin Professional Firefighters [] IND COM ® PAC # 930791 9/17 , $1,000.00 $1,000.00 ❑ OTH Sacramento, CA 95 ❑ PTY ❑ SCC 9/18 Dennis Fisco , ''", PCOM IND Investor $250.00 $250.00 (❑OTH Seagate Properties, Inc. I alley, CA 41 ❑ PTY ❑ SCC 9/18 Paula Kamena OINDRetired C]COM1:1 $500.00 $500.00 WW OTH Novato, CA ❑ PTY ❑ SCC SUBTOTAL$ $2,850.00 'Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SGC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (666/275-3772) Schedule A (Continuation Sheet) Tvpe or print In ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period e • to whole dollars. 7/1/2011 / from Page ___ of z through 912412011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR A RE, CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (EETIF IT ALSO ENTER LD. NUMBER) CODE * (IFSELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Michael J. Smith pcOM Real Estate Developer 9/18 GOTH Waterford Assoc. $200.00 $200.00 ITM 949 5 ❑ PTY ❑ SCC 9(18 Robe000, ®IND ❑COM Realtor $250.00 $250.00 ❑ OTH Realty House SanW49 ❑ PTY ❑ SCC Rand t and Glena Coleman ®IND F] COM Retired 9/20 $100.00 $100.00 ❑ OTH San Rafael, CA 94 1 pPTY ❑ sCC Dirck and Ph, s Brinckerhott ®coM IND 0 Real Estate Broker/self 9120 "'`4t V nOTH employed $250.00 $250.00 a ae ,'` P . 4901 PTY CFO/H&L Real Estate ❑ SCC 9120 Dottie Breiner®p COM Retired $100.00 $100.00 l ❑ OTH an Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 900.00 `Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party BCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline; 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Tvpe or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIAORM to whole dollars. 7/1/20 • i from Paged of /.1 through 9!24/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIPDEO FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR STREETADDRESS CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED LD.N CODE * (IFSELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND 9/20 Maki Daijogo pcoM BOTH Attorney Daijogo & Pedersen, LLf}7 $100.00 $100.00 i ❑ PTY p sCC Bob and Mary Ellen Irwin ®pcoM IND Retired 9/22 $100.00 $100.00 pOTH CA 944901 p PTY p SCC Morrow Cater IND pcoM CEO 9122 poTH Cable Communications $250.00 $250.00 a7f' OAW 01 p PTY p SCC San Rafael Chamber of Commerce RIND pcoM PAC# 1281286 9/22 $2,000.00 $2,000,00 p OTH San Rafael, CA 9 01 p PTY p sCC Leo Isotalo MIND pcoM Retired 9/22 $300.00 $300.00 WIC p OTH San ape A 01 p PTY ❑ SCC SUBTOTAL$ 2,750.00 'Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCG - 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. 7!112011 FORM i from Paged of through 9/24/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIPD.N DEO FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR E(IF CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED COMMITTEE,ALSAND CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) IND 9/22 Leonard Rifkind m W3COD MOTH Attorney The Rifkind Law Group $100.00 $100.00 Larkspur, CA 94939 M PTY M SCC 9123 Teke Kelley qs JZ INDAttorney ncom self employed $1,000.00 $1,000.00 MOTH elvedere, CA 94920 ❑ PTY M SCC 9(23 ff ert ®IND ❑COM Attorney Keegin, $250.00 $250.00 iiina MOTH Harrison, Schoppert, el, CA 949063 ❑PTY Smith & Karmer LLP ❑ SCC Stephanie Plant IND DLand Developer $250.00 $250.00 9/23 Tla MOTH Cal Pox, Inc. I lley, CA 94941 M PTY M SGC 9/23 Ed and Michelle Sarti IND OCOM Attorneys $500.00 $500.00 MOTH Self-employed en Ie d,fts M PTY p SCC SUBTOTAL_ $ 2,100.00 '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 A (CONT.) Monetary Contributions Received Amounts maybe rounded Statement covers period CALIFORNIA to whole dollars. 7/1/2011 eRM 460 1 from Page — of through 9/24/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE DEO FULL NAME, STREET ADDRESS AND 21P CODE OF CONTRIBUTOR STREETA RE,ALSAND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED II .D.N CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) JZ 9/23 Kate Colin Homemaker $500.00 $500.00 "C9 M OTH a ael, M PTY M SCC 9(23 Matthew Davis I.` ®IND ❑COM Attorney $250.00 $250.00 MOTH Walkup Melodic Sari Francisco, CA 94117 M PTY []SCC Perry Litchfield ®COM Businessman 9/23 Th Mae MOTH Self-employed $1,000.00 $1,000.00 afl, CA 94901 M PTY M sCC 9123 Paul Sloan IND PCOM Attorney $250.00 $250.00 MOTH Self-employed afadf 94901 M PTY M SCG 9/23 Kon F1COM Executive $100.00 $100.00 *Gail MOTH Asian Pacific Fund and, A 9 611 El PTY M SCC SUBTOTAL $ 2,100.00 "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: 8661ASK-FPPC (8661275-3772) 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. 7/1/2011 FO R M 4 6 0 from page of through 9/24/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 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 IIF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. I - DEC, 31) (IF REQUIRED) OFBUSINESS) Patricia Skidmore IND OF-1 COM Retired $200.00 $200.00 9/23n OTH San Rafael, CA 94901 r-1 PTY [] SCC 9/23 Raymond Syufy 1 a gaillifilimamillre OIND F-1 COM CEO Syufy Enterprises $500.00 $500,00 I MOTH Mph'�Rafael,�CA901 n PTY 1771 SCC 9/23 Castillo ICOMVictor r_1 COM Executive Syufy Enterprises $300.00 $300.00 []OTH CUi1b Madera, 794925 []PTY E]SCC Robert Gibson OIND R COM Project Manager $600.00 $600.00 9/23 WCA rOTH Stanford Properties an Rafael, 94901 M PTY MSCC Joe and Sally Garbarino lZ IND PCOM Executive $300.00 $300.00 9/23 F OTH Marin Sanitary 01 _] [:] PTY []SCC SUBTOTAL$ 1,900.00 `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) Tvpe or print in Ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 7/1/2011 FORM ,60 from Page. of through 9/24/2011 NAME OF FILERI.D. NUMBER Andrew McCullough 1339798 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 D.N CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFSUSINESS) 9/23 Kim P a,rikh_ pIND Homemaker $100.00 $100.00 FiOTH 49 ❑ PTY ❑ SCC RajiW Parikh ®IND COMConsultant $100.00 $100.00 9123 pOTH Self-employed 4949 ❑ PTY ❑ SCC 9/24 Paul Finkle ®IND ❑COM President $250.00 $250.00 OTH Shared HR S a ae , X ❑ PTY ❑ scC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ scC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SGC SUBTOTAL$ 450.00 `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 B - PART 1 Schedule B - Part 1 punt - ay b Amounts may be rounded Statement covers period pCALIFORNIA i Loans Received to whole dollars. 7/112011 FORM • from page of through 0/24/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Andrew McCullough 133979$ FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE (b) AMOUNT (c) AMOUNT PAID OUTSTANDING BALANCEAT INTEREST ORIGINAL 6 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 LD. NUMBER) NAMEOFBUSINESS) PERIOD THIS PERIOD" P RIOD PERIOD LOAN TO DATE Andrew McCullough Attorney r-1 PAID CALENDAR YEAR 21 Biscayne Ct $ $ 15,000 e� � 15,000 S 15,000 ❑FORGIVEN PERELECTION" San Rafael, Ca 94901 SYLIFY RATE 0 $ 15,000 q $ $ DATE DUE DATE INCURRED to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR $ $ a $ $ ❑ FORGIVEN PER ELECTION`* RATE $ $ $ $ S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION** S $ $ S $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 15,000$ 0 $ 15,000 $ 0 Schedule B Summary Loans received this period.............................................................................. (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.) ........................................ Enter the net here and on the Summary Page, Column A. Line 2. Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. (Enter (e) on Schedule E, Line 3) $ 15.000 I NET $ 15.000 i Ma+ be a necatrae tContributor Codes IND - individual COM - Recipient Committee (other than PTY or SCG) 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 (6661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2011 through 9/24/2011 Page _i '� of _ NAME OF FILER I.U. NUMt$tH Andrew McCullough 1339798 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PFJ professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IFCOMMiTTEE,ALSO ENTER i.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Muelrath Public Affairs Inc Voter Data 3 2,122.50 Santa Rosa Ca 95404 City Of San Rafael 1400 5th Ave FIL 764.00 San Rafael, Ca 94901 Belaire Displays Signs 2,061.50 Richmond, Ca 94804 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 4,948.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).............................................................................................................. $ 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 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 $ 8,537.04 .175.79 N 8,712,83 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (666/275-3772) Schedule E (Continuation Sheet) Payments Made INSTRUCTIONS Andrew McCullough Type or print In ink. Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers periodCALIF• . NIA from 7/1/2011 FORM through 9/24/2011 Pae of "® I.D. NUMBER 1339798 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CM' 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 PEr 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' CODE OR DESCRIPTION OF PAYMENT I AMOUNT PAID (!F COMMITTEE, ALSO ENTER I.D. NUMBER) Innerworkins San Rafael, Ca 94901 Capital Mailing Services San Rafael, Ca 94901 11118 ELIVaUT .i i- • American Ex ress/ Dr Don's Buttons Glendale, Arizona 85308 rai MIA E BE Signs 312.04 300.52 247.35 1,729.13 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3589,04 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 666/ASK-FPPC (6661275-3772) 0^111%,ftelsaLm I ,qrHFntjt F I Miscellaneous Increases to Cash Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period 7/1/2011 from60 through 9/24/2011 CALIFORNIA FORM 4 Page - / ��" Of NAME OF FILER Andrew McCullough I.D. NUMBER 1339798 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule I Summary 0 1. Itemized increases to cash this period. ......... ........................ ................. ......................... ........................ $ — 2. Unitemized increases to cash of under $100 this period .............................. ...... ................ .............. ............ $ 27 3. Total of all interest received this period on loans made to others, (Schedule H, Column (e).) ...... _ ......... ......... $ 4. Total miscellaneous increases to cash this period. (Add Lines 1; 2, and 3. Enter here and on the SummaryPage, Line 14.)...... ..... __ ..... ....... _ ......... _ ....... ....... ....... .... __ ........... .......... __ ....... ... TOTAL $ FPPC Form 460 (January/05) FPPIC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) I W