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Home My WebLink AboutForm 460 - Paramedic Services PAC (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 Date of election if applicable: 1 /1 /112 1 (Month, Day, Year) from through 6/30/12 Date Stamp COVER PAGE I Page 1 of 3 1 Official Use Only 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. 2. Type of Statement: ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure CITY ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Carl Tregner MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 ( 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 my knowledge the information contained herein and in the attached schedules Is true and complete. I certify under penalty of perjury under the la s of to State of California that the foregoing Is true and correct. c., Executed on By otTroawrerorAsar/antTruswsr Executed on By of r Canddft, Stale M saPmW*MarR Of 8rofSW'W Executed on r By S , Slate Executed on Date By SWaihm ofCon#o" 015whokler, CNWKkb,Std FPPC Form 460 (January/08) FPPC To"ree Helpline: 6661ASK-FPPC (666(275.3772) State of California Campaign Disclosure Statement Summary Page Type or print In Ink. Amounts may be rounded Statement covers period to whole dollars. from 1/1/12 SEE INSTRUCTIONS ON REVERSE through 6/30/12 Pago 2 of 3 NAME OF FILER I.D,NUMBER Committee for San Rafael Paramedic Services 983147 ColummA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHMPM100 CALENDAR YEAR Running Both the State Primary and (:ROMATTACHWSQH�$) TOTALTODATE In General Elections 1. Monetary Contributions ........................................... schedule A, Line 3 $ 19.29 $ 19.29 0 0 1/1 through WO 7/1 to Date 2. Loans Received ...................................................... Schedule 8, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lined +2 + 2 19.29 $ $ 19.29 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 19.29 $ 19.29 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 18 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... SdWV9 1, Lino 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. $ 0 $ 0 $ 0 $ 0 $ 5328.04 19.29 0 0 $ 5347.33 17. LOAN GUARANTEES RECEIVED ........................... Schedule 8, Port 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19, Outstanding Debts ......................... Add Line 2 +Line 9 i Column Babove $ ■ U, 0 0 $ 0 To calculate Column 8, add amounts In Column A to the corresponding amounts from Column B of your lost report. Some amounts In Coiumn A may be negative figures that should be subtracted from previous period amounts. If this is the first report being led 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* IN Subject to voknory Upndh— Lhnin Date of Election Total to Date (mm/dd/yy) *Amounts In this section may be different from amounts reported in Column S. FPPC Form 460 (January/05) FPPC Tolt-Free Helpline: 8661ASK-FPPC (8661275-3772) .Qr-hadi da A Type or print In Ink. SCHEDULE A —"'--'"'— Amounts may be rounded y Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 460 1/1/12 from a through 6/30/12 of Page 3 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Committee for San Rafael Paramedic Services 983147 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR S ANDO AIF CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (EET n TEE, I.D. NUMBER) CODE * (IF SELF-EMPLOYED, EMR NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFB MINESE) ❑ IND ❑ COM ❑ OTH PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SGC ❑ IND ❑ COM [30TH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH PTY ❑ SCC SUBTOTAL$ Schedule A Summary 1. Amount received this period — itemized monetary contributions. 0 (Include all Schedule A subtotals.)............ ..................................................................... ....................... $ 2. Amount received this period — unitemized monetary contributions of less than $100 ........................ $ 19.29 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ 19.29 *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 TolFFree Helpllns: 8SWASK FPPC (866/275.3772)