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Home My WebLink AboutForm 460 - COST (2011-12-31) TerminationRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 7/1/11 through 12/31/11 Date of election if applicable: (Month, Day, Year) Date Stamp 'v= COVER PAGE Page — of — For Official Use Only 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 1/31/12 2. Type of Statement: (L�� =_A�' LLA ❑ Officeholder, Candidate Controlled Committee Ballot Measure Committee By M Preelection Statement- 7Quarterly Statement 0 State Candidate Election Committee (g) Primarily Formed Signature of Controling Offic"der, Candidate, State Measure Proponent or Responsible Offer of Sponsor Semi-annual Statement ❑ Special Odd -Year Report 0 Recall 0 Controlled Executed on Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) 0 Sponsored ❑ Amendment (Explain below) Statement - Attach Form 495 (Also Complete Part 6) State of California F-1 General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee M Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D.NUMBER 1 1339114 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Citizens Opposing San Rafael Target STREET ADDRESS (NO P.O- BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Same CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Tamara Hull, CPA MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 NAME OF ASSISTANT TREASURER, IF ANY N/A MAILING ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE AREA CODEIPHONE 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 correct. 1/31/12 (L�� =_A�' LLA Executed on Date By Signature of Treasurer or Assistant Tredsurer Executed on Date By Signature of Controling Offic"der, Candidate, State Measure Proponent or Responsible Offer of Sponsor Executed on Date By Signature of Controlling Ofteriolder, Candidate, State Measure Proponent Executed on Date By Sgiature of Controlling Offcet�oldsr, Canddate, State Measure Proponent FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC 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 N/A OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 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 None NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER None NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary COVER PAGE - PART 2 Page of 6. Ballot Measure Committee NAME OF BALLOT MEASURE No onTarget Referendum BALLOT NO. OR LETTER JURISDICTION ® SUPPORT didn't occur San Rafael ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT N/A OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed 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 N/A ❑ 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 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC State of Califomia Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from 7/1/11 SUMMARY PAGE Expenditures Made through 12/31/11 Page of SEE INSTRUCTIONS ON REVERSE 7. Loans Made............................................................. Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ NAME OF FILER $ 6993 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 I.D. NUMBER Citizens Opposing San Rafael Target -937 -937 11. TOTAL EXPENDITURES MADE ................................Add Lines a + 9 + to 1339114 0 $ 7056 Column A Column B Calendar Year Summary for Candidates Contributions Received 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 TOTALTHISPERIOD CALENDARYEAR Running in Both the State Primary and 13. Cash Receipts ................................................... Column A, Line 3 above (FROM ATTACHED SCHEDULES) TOTALTODATE 0 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 General Elections from Column B of your last 0 0 63 1. Monetary Contributions ........................................... Schedule A, Line 3 $ $ Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 7056 1/1 through 6130 7/1 to Date 2. Loans Received...................................................... Schedule s, Line 3 subtracted from previous if this is a termination statement, Line 16 must be zero. 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 0 $ 7056 20. Contributions Received $ $ the first report being filed 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 0 $ 7056 Made $ $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 63 $ 6993 7. Loans Made............................................................. Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 0 $ 6993 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 1000 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 -937 -937 11. TOTAL EXPENDITURES MADE ................................Add Lines a + 9 + to $ 0 $ 7056 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 63 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the 0 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 63 report. Some amounts in 15. Cash Payments ........................................ Column A, tine &above Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 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 s, Part 2 $ 0 for this calendar year, only carry over the amounts any) Lines 2, 7, and 9 (if. Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 0 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) $ $ �_J $ Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded Monetary to whole dollars. Statement covers period CALIFORNIA• from 7(1111 FORM through 12/31111 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 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 I.D.NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) RIND None ❑COM ❑ OTH ❑ PTY ❑ SCC RIND ❑ COM ❑ OTH ❑ PTY ❑ SCC RIND ❑ COM ❑ OTH ❑ PTY ❑ SCC RIND ❑ COM ❑ OTH ❑ PTY ❑ SCG RIND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ Schedule A Summary *Contributor Codes 1. Amount received this period — contributions of $100 or more. IND- Individual (Include all Schedule A subtotals.) .............. .................... ........ ........ ......... ..................... $ 0 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period — unitemized contributions of less than $100 ............................................. $ 0 OTH - other PTY — Political Party 3. Total monetary contributions received this period. SCC -Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summa Page, ColA, Line 1. TOTAL $ 0 � g Column } ....................... FPPC Foran 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC GCHEDULEB-FAJ{T1 .,~~ ~ ~-..— ''_ ts ded Statement covers period dollars. CALIFORNIA 460 Loans Received to whole 7/1/11 FORM from 12/31/11 SEE INSTRUCTIONS ON REVERSE through Page — of NAME OF FILER I.D.NUMBER Citizens Opposing San Rafael Target 1339114 FULL NAME, STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT AMOUNTPAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE Jonathan Frieman Philanthropist f -I PAID CALENDAR YEAR 10 FORGIVEN PER ELECTION— San afael, California 94901 RATE DATE DUE DATE INCURRED tEg IND Ej COM [:] OTH 0 PTY [_1 SCC Bill Daniels Owner E] PAID CALENDAR YEAR 10 FORGIVEN PER ELECTION — San Ra 1, California 94901 RATE DATE DUE DATE INCURRED tER IND [I COM El OTH [:1 PTY El SCC E] PAID CALENDARYEAR FORGIVEN PER ELECTION RATE DATE DUE DATE INCURRED tE]IND El COM [I OTH El PTY [:1 SCC SUBTOTALS $ $ $ $ ME= Schedule B Summary 1. Loans received this period ..................... ...... .......... ----.................... ---.............. —............. $ (Total Column (b)plus unitennizedloans less than G1OO) 2. Loans paid orforgiven this period ........................ ......... .......... ...... —................ ................... ....... $ ObtmCoumn(c)plus loans under $10Dpaid orfonnivenj (Include loans paid byathird party that are also itemized onSchedule A.) 3. Net change this period. (Subtract Line 2 from Line 1] ............................... ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. (Enter won Schedule E, Line 3) *Amounts forgiven or paid by ' another party also must be reported on Schedule A. If required. fCnntributn Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY —Political Party SCC — Small Contributor Committee FppC Form 460 (June/01) SCHEDULE B - PART 2 Schedule B —Part 2 Type or print in ink. Statement covers period. Amounts may be rounded ' Loan Guarantors to whole dollars. 711/11 i-. - • from 12/31/11 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 FULL NAME, STREET ADDRESS AND IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE BALANCE ZIP CODE OF GUARANTOR CONTRIBUTOR OCCUPATION AND EMPLOYER LOAN GUARANTEED OUTSTANDING (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED. ENTER THIS PERIOD TO DATE TO DATE NAME OF BUSINESS) LENDER CALENDARYEAR None ❑ IND ❑ COM $ DATE ❑ OTH PER ELECTION (IF REQUIRED) ❑ PTY ❑ SCC $ CALENDARYEAR ❑ IND LENDER ❑ COM $ [_1 OTH PER ELECTION DATE (IF REQUIRED) ❑ PTY ❑ SCC $ CALENDARYEAR ❑ IND LENDER ❑ COM $ PER ELECTION ❑ OTH (IF REQUIRED) DATE ❑ PTY ❑ SCC $ CALENDARYEAR ❑ IND LENDER ❑ COM $ DATE OTH PER ELECTION (IF REQUIRED) ❑ PTY ❑ SGC $ rater on SUBTOTAL $ Summary Page, MW Lr* 17 only, FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule C Type or print in ink. SrHFnl II F r amounis may oe rounaeu Nonmonetary Contributions Received to whole dollars.CALIFORNIA Statement covers period 7/1/11 from , , FORM • 12/31/11 SEE INSTRUCTIONS ON REVERSE through page of NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION DATE RECEIVED ZIP CODE OF CONTRIBUTOR ENTER I.D. NUMBER) CODE OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES FAIRMARKET VALUE CALENDAR YEAR TO DATE (IF REQUIRED} (IF COMMITTEE, ALSO NAME OF BUSINESS) (JAN 1 -DEC 31) ❑IND None N ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ MEEMEORRM Schedule C Summary 1. Amount received this period — nonmonetary contributions of $100 or more. (Include all Schedule C subtotals.).................................................................. ................................ $ 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ................. 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ................ $ TOTAL $ I V I *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCG) OTH — Other PTY — Political Party SCG — Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC .� Schedule D SCHEDULED Summary of Expenditures Type or print in ink. Statement covers period X Supporting/Opposing Other Amounts may be rounded to dollars. 7/1/11 M Candidates, Measures and Committees whole from 7ftg�e_ 12131/11 through of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Citizens Opposing San Rafael Target 1339114 CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN, 1 -DEC. 31) (IF REQUIRED) ORCOMMITTEE None rl Monetary Contribution Contribution Independent E] Support f-1 Oppose Expenditure F1 Monetary Contribution Nonmonetary Contribution E] Independent 0 Support Oppose Expenditure Monetary Contribution Nonmonetary Contribution Independent Support Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Conthbudonsand independent expend�unasn�odethis per�dof$1OOorn�ora.(|ndudoaUSchedule Daubtoto�j---------------. $ " 2.Unhenizedcontributions and independent expendituresnnade this period ofunder $1UO—..... ..... ...... ............ --...... --------.......... '$ " 3.Total contributions and independent expenditures made this period. (Add Lines 1and 2. Do not enter on the Summary PaDej... --'TOTAL $ " FPpc Form ^sn(Junem1) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Citizens Opposing San Rafael Target Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/11 through 12/31/11 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment Page of I.D. NUMBER 1339114 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 W 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 UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER i.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT Bill Daniels Loan repayment (balance of funds) 522 - 3rd Street San Rafael, California 94901 AMOUNT PAID 63 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 63 Schedule E Summary 1. Payments made this period of $100 or more. Include all Schedule E subtotals. $ 0 2. Unitemized payments made this period of under $100 .................................... 63 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................... $ 0 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 63 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule F Type or print in ink. Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. SEE INSTRUCTIONS ON REVERSE SCHEDULE F Statement covers period from 7/1/11 through 12/31/11 ( Page of NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. NSR 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 PEf 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 W 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 CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTANDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNTINCURRED THIS PERIOD ( AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD None * Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ....................... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) . 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................................................ � • j I ................... PAID TOTALS $ 0 0 ....... NET $ ......................... s May be a ne atsve number FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) Type or print in ink. Amounts may be rounded to whole dollars. statement covers p from 7/1/11 SCHEDULE through 12/31/11 Pa SEE INSTRUCTIONS ON REVERSE ge of NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 NAME OF AGENT OR INDEPENDENT CONTRACTOR N/A 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 F D fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals ND 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 Lrr campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID None Attach additional information on appropriately labeled continuation sheets. TOTAL* $ d * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule H Type or print in ink. Amounts may be of rounded Loans Made to Others* to whole dollars. Statement covers period frnm 7/1/11 12/31/11 SCHEDULE H ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION— DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ also be reported on Schedule E. —IMM (Enter (e) cn Schedule I, Line 3) Schedule H Summary 1. Loans made this period .............................. 0 If Required (Total Column (b) plus unitemized loans less than $100.) 0 2. Payments received on loans........................................................................................................................................... $ (Total Column (c) plus unitemized payments less than $100.) 3. Net change this period. Subtract Line 2 from Line 1. NET $_ 0 9 P ( )..................................................................... May be a negat;,e Tuber) (Enter the net here and on the Summary Page, Column A, Line 7.) FPPC Form 460 (June/01) FPPC Tall -Free Helpline: 866/ASK-FPPC through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Citizens Opposing San Rafael Target 1339114 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER (a) OUTSTANDING (b) AMOUNT (c) REPAYMENT OR A OUTSTA DING (e) INTEREST (fl ORIGINAL (9) CUMULATIVE OF RECIPIENT OCCUPATION AND EMPLOYER BALANCE LOANED THIS FORGIVENESS BALANCE AT RECEIVED AMOUNT OF LOANS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD PERIOD THIS PERIOD" CLOSE OF THIS PERIOD LOAN TO DATE ❑ PAID CALENDAR YEAR None ❑ FORGIVEN RATE PER ELECTION— DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION— DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ also be reported on Schedule E. —IMM (Enter (e) cn Schedule I, Line 3) Schedule H Summary 1. Loans made this period .............................. 0 If Required (Total Column (b) plus unitemized loans less than $100.) 0 2. Payments received on loans........................................................................................................................................... $ (Total Column (c) plus unitemized payments less than $100.) 3. Net change this period. Subtract Line 2 from Line 1. NET $_ 0 9 P ( )..................................................................... May be a negat;,e Tuber) (Enter the net here and on the Summary Page, Column A, Line 7.) FPPC Form 460 (June/01) FPPC Tall -Free Helpline: 866/ASK-FPPC ncuFnop/ .... ..... ... ..Miscellaneous Increases to Cash Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/11 through 12/31/11 CALIFORNIA FORM 460 Page - of NAME OF FILER Citizens Opposing San Rafael Target I.D. NUMBER 1339114 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNTOF INCREASE TO CASH Attach additional infonnationunappropriately labeled continuation sheets. Schedule I Summary 1.Increases tocash of$1ODormore this period ................................................................................... 2.Uniternizedincreases tocash under S1OOthis period ......... .......... --......... .... --..... ... ............ 3. Total of all interest received this period on loans made to others. (Schedule H. Column (e)j ... .... 4. Total miscellaneous increases tocash this period. (Add Unaa 1. 2, and 3. Enter here and on the --� --$ ------'$ SUBTOTAL * 0 O U rppc Form 4*o(Jvne/o1) FPpcToll-Free Helpline: oVsw.mm-Fppo