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HomeMy WebLinkAboutForm 460 - Eric Holm for City Council 2009 (2011-12-31) TerminationReciplerd Committee Campaign Statement Cover Page (Govemment Coda Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE 'type or print in Into. Statement Covera plariod Date of election if applicable: 711111 (Month, Day, Year) from through 12/31111 Data Stamp Paye t1QV tK eAiJt O For Of clai Use Only 1. Type of Recipient Committee: All Committees— Complete Parte 1, 2, 3, and 4. 2. TYpe of Statement: Offlceholder, Candidate Controlled Commlttea ❑ PrlmarllyFormed Bellot Measure ❑ Preelection Statement [-1 Quarterly Statement 0 State Candidate Election Committee Committee MAILIN13 ADDRESS (IF DIFFERENT) NO, AND STREET OR RO, BOX CITY STATE CITY STATE Z(P CODE OPTIONAL: FAX I S -MAIL. ADDRESS Treasurer(s) NAME OF TREASURER MICHAEL WHIPPLE WAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE SARI RAFAEL CA 94915-1626 ( NAME OF ASSISTANT TREASURER, IP ANY MICHELLE WHIPPLE TANNER MAILING ADDRESS CITY STATE ZIP CODE OPTIONAL, FAX r E-MAIL ADDRESS 4. Verification I have used all reasonable diligence In preparing and reviewing this statement Bad to the best of my Rnowledge the Informatlon conlalned heraln and in the attached schedules Is true and complete, i certify under penaltyof perjury under the laws ofthe Slate of Galffomla that the foregoing Is true and correct. Exacuted oar By 3 Exacuied on -- By Dal Executed an Comte By s�nalureNcayrei'rVo lesnolder.Caoikfata,StaleAlegreProG rtf Fxecateclfln B Cale y S"lLreoittmiJUOftaha#ar,cem1dem,StaratAeasuraFrarcnen? FI"PG Form 4617 (January/05) FPPC Tot -Free HeipNns: 8+661AS*F4'PC (688 275.3772) State of Catilomla Type or print in Ink, Recipient Committee Campaign Statement Cover Page —'part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE ERIC HOLM OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) SAN RAFAEL CITY COUNCIL. RES IDENTIALIBUSI NESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP SAN. RAFAEL, CA 94915 Related Committees Not Included in this Statement: t.rst any commlttees not Included /n this statement that are controlled by you or arse primarily Conned to receive contributions or make expend/tures on behalf of your eandfdaey. DOMmTTEE NAME I.D. NUMBER NAME OF TREASURER OONTROLLED COMMITTEE? © YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O.6oX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OFTREASURER OONTROLLEDCOMMITTEE? ❑ YES F1 NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PI-ONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION COVER PAGE.- PART 2 Page 2 of 6 ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CAND(DATE, OR PROPONENT OFFICE SOUGHT OR DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnamesof afflceholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER ORGANDIDATE OFFICE SOUGHT OR HELD ❑ SVPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAVE OF OMCEHOLDER OR CANDIDATE OFFICE SDUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuatlon sheets If necessary FPPC Farm 460 (Januaryl%) FPPC Tdi-Free Rdpirrte: 8e61ASK-FPPC (86WZ7f-3772) State of CaTiforn[a Campaign Disclosure Statement Type or print In Ink. be - SUMMARYPAGE Summary Page Amounts may rounded to whole dollars. Statement covers period from 711/11 1 through 12/31/11 Page 3 6 of 6 - SEE tNSTRUGMONS ON REVERSE NAME OF FILER LD, NUMBER ERIC HOLM FOR SAN RAFAEL CITY COU NIGI L 2009 1320372 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAILTM PMOD CALENDARYEAR Running in Both the State Primary and �FROMA17ACHEDSCWCAJLFS) TOTALTO DATE General Elections 1. Monetary Contributions ........................................... schedule A Lirte 3 3 0.00 $ 0.00 Ill th"h W30 7f1 to Data 0.00, 0.00 2. Loans Received... ................. .............. .................. schedule a Line 3 3, SUETOTALCASH CONTRIBUTIONS.- ..................... Add Lines 142 $ 0.00 $ O.OD 20. Contributions Received $ $ 0.00 0.00 4. Nonmonetary Contributions .................... ...... ........ schedule C, we a 21. Expenditures 6. TOTAL CONTRIBUTIONS RECEN/20 - ...... ................. Add Linn 3 + 4 $ 0.00 $ 0.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... schedule E-, Line 4 3 1604.59 $ 2254.59 Candidates 7. Loans Made.., ..............,,. ............ .................... -- 3ChadfffaHL)n&3 O.DC OM 22. Cumulative Expenditures Made' 8, SUBTOTALCASH PAYMENTS .................................... Add Lines 6 4� 7 $ 1504.59 2254.59 Ws*9cjtcVo4unfzryEKp&9ftreLfimft) 9. Accrued Expenses (Unpaid Bills) .......... .................... Scheduie F Line J Ho .00 Date of Election Wall to Date 10. Nonmo netary Adjustm ant. ......... ...... --- ................... Schedui& C, L ", -3 0.00 0.00 (mmtdcVyy) 11, TOTAL EXPENDITURES MADE .................... ........... AVd Lines 8 + 9 + 10 $ 1504,59. $ 2254.59 $ $ Current Cash Statement 12, Beginning Cash Balance .. ....... ............. Prevtous Summary Pago, Line 16 $ 1504.59 To calculate, Column S, add 13. Cash Receipts .... .................. ....... ................ - C0)umnAL1rr,93above 0.00. amounts in Column A to line 0,00 corresponding amounts *Amounts, in this section may be dirrerent from a rnounts, 14. Miscellaneous I ncreases to Cash........................... Schedtrie)JIna4 from Golumn B of your last reported in Column B. 1504,59 raped. Some amounts In 15. Cash Payments..... ....................... - ................... Column A, Line 8 a�om Column A may be negative 16. ENDING CASH BALANCE Add Lines 12 -f 13 f 14, then SM51raof Lim 16 $ 0,00 figures that should be subtracted from previous if this is Ej termination statement, Line 16 mud be zero, period amounts. If this is the first report being filed 8, Pvt 2 $ 0.00 for this cale rkdar year, only 17, LOAN GUARANTEES RECEIVEDSzch edare carry over the amounts from 1 -hies 2, 7, and 9 (if any). Cash Equivalents and Outstanding Debts 18. 'Cash Equivalents ..................................... see fr?sftua6=s onrevame $ 0�00 - 19. Outstanding AddLfrre2+Un&9lnCdumr?Baba" $ 0,00 FPPC Form 460 (January/05) FPK Toll -Free Helpllne: 866fASK-FPPC (6661275.3772) Schedule E Payments Made c=F RKPZTPI Ir-11ON9 ON REVERSE NAME OF FILER ERIC HOLM FOR SAN RAFAEL CITY COUNCIL 2009 Type or print In Ink. Statement covers period Amounts may be rounded to whole dollars. from 7/1/11 through 1.,26 12(31/11 Page 4 of --6 1320372 CODES-. If one of the following codes accurately describes the payment, you May enter the code. Otherwise, describe the payment. CryP campaign paraphernalia/mise. MR member ocramunications RAU RFD radio airtime and production costs returned contibutloins CNS campaign consuAfants (explain nonmonetary)k MTG OFC meetings and appearances office expenses SAL campaign workers' salaries CTB contribijiton PF petition circulating TEL t.v. or cable airtime and production costs CVC civic donations PI -0 phone banks TRC candidate, travel, todging, and meals FIL candidate filingfballot fees POL polling and survey research TRS staft/spovse travel, lodging, and. mals FND IND fundralsing events independent expenditure supporfing/opposIng others (explain)4 POS postage, delivery and messenger services TSF transfer between committees of the same candidatefsponsor PRO PRO professional services (legal, acoountlng) VOT voter registration LEG legal defense PRT print ads information technollogy costs (Interne(, e -mall) LIT campaign libeFalure and mailings NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMEMT AMOUNT PAID (FCOW.111 1EE.&SO ENTER MNUMBER) The Rater Centerl"O Box 3517 CTB Charitable contribution 114.46 San Rafael, CA 94901 1 Marlin R.E.D.S. Rugby Sausalito, CA 94965 Michael W. Whipple, CPA accounting 667.00 PRO San Rafael, CA 94915-1626 Payments that are contributions or independent expenditures must also be summarized on Schedule 0. SUBTOTAL$ 1181.46 Schedule E Summary1454.59 1. Itemized payments made this period, (include all Schedule E subtotals.). ........................................................................... ................................. $ 50.00 2. Unkernized payments rnade this period of under $100 ........ — ................... ...................................... ... — .............................................................. $ 0.00 3. Total interest paid this period on loans, (Enter amount from Schedule 6, part 1, Column ....... .......... ................... ......... .......................... $ 1504.59 4, Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6®) ......... ........ ......... TOTAL $ F PPC Form 460 (JanuaryJ05) FPPC Tbl!Wrae Helpline: 866fASK-FPPC (866(275-3772) Schedule E Type or print In Ink. SCHEDULE E (CONT.) Amounts may be rounded Statement covers period (6ontinuation Sheet) to whole dollars. 7/1/11 Payments Made from Pae 5 of SEE INSTRUCTIONS ON REVERSE Through 12f31/11 F NAME OF FILER I.D. NUMBER ERIC HOLM FOR SAN RAFAEL CITY COUNCIL 2009 1320372 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNF campaign paraphernalia/mise, IVER member communications RAD radio a! itime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain ncnmonelaryr UFC office expenses SAL campaign workers' salaries CVG civic donations FET petfflon circulating TEL tv. or cable airtime, and production costs FIL candidate flificilballol fees PHO phone banks TRC candidate travel, lodging, and meals RAID fundraising events POL polling and survey research TRS staff/spouse travel, lodging, arml m8als ND Independent expenditure supporting/opposing Others (explainr 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 I FT onmnnIan literature and mallinas PRT print ads WEB Information tKhriok)W costs (InIernel, e-mail) NAME AND ADDRESS OF PAYEE IIF cofAMIrTEE, ALSO EWER 1D. NUMBERI CODE OR DESCRIPTION OF PAYMEIVT AMOUNT PAID Eric Holm San Rafael, CA 94916 WEB 119.26 Greg Bilke San Rafael, CA 94901 WEB 1 15187 Payments that are contributions or Independent expenditures must also be summarized on Schedule 0. SUBTOTAL $ 273.13 FPPC Form 460 (Jan uary105) FPPC Toll -Free Halpl Ino; 86&ASK.FPPC {866/275.3772) Type or print In I W Schedule F Amounts may be rounded Accrued Expenses (Unpaid Bills) towboledollars. NAME OF FILER ERIC HOLM FOR SAN RAFAEL CITY COUNCIL 2009 CODES: If one of the following CMP CNS CTB CVC FIL FND IND LEG k rr campaign parapherrWWrnisc. carnpaign consultants contribution (explain nonmonetar-W civic donations candidate fillingVballot fees fundraising events independent expenditure supporting legal defense .,,.,awn Iltornfijrp and mallinas codes accurately describes the payment, you may enter the code. MBR member communications mTG rneetings, and appearances OFC office expenses, PEr petition circulating PHO phone banks POL poling and survey research /opposing others (axp[aln)` POS postage, delivery and messenger servioes PRO professional services (legal, accounting) PRT print ads Statement covers period ftom 7/1/11 12/31/11 Page 6 Of 6 1.4. NUMBER 1320372 Otherwise, describe the payment. RAD radio airtime and production costs M returned oontrbull[cIns SAL campaign workers'salarias TEL U. or cable airilme and production costs TIRG candidate tf avel, lodging, and meals TRS staff/spouse travel, lodging, and meals 7'SF transfer between committees of the same ca n didaWs ponsor V07 voter registration WEB information technology costs (Internet, e-mail) A powenja ttiat are contributions or Independent expen(MUM rnM also tit SUBTOTALS $ 270.00 297.00 567,00 0.0 summarlud an schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (include all Schedule F, Column (b) subtotals for 297.00 accrued expenses of $1 DO or more, plus total unitemized accrued expenses under $100.) ...... .................. .................. INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (0) subtotals for payments on 567.00 accrued expenses of $100 or more, plus total uniternized payments on accrued expenses under $100.) ,....................... ...... PAID TOTALS $ 3, Net change this period, (Subtrkt Line 2 from Line 1. Enter the difference here and (270.00) on the Summary Page, Column A, Lire 9.) ........... ............................................ . ....................... .......................... ...... _.. N1ET $ may to a naw7%-a rmrrber FPPC Form 460 (January/06) FPPC Toll -Free Halpline: 0661ASK-FPPC (8661275.3772) NAME AND ADDRESS OF CREDITOR LIF CORMMEF�, ALSO ENTER 1,13. NUkASER) CODE CRING DESCRIF71ON OF RAYMENT OUTSTANDING BALANCE BEGINNING AIVIOUNTINCURRED TH[SPERIOD AMOUNT PAID THIS PERIOD OUTSTAND LOSE BALANCE AT C OF THIS PERIOD 1ALSOREPORTONE.) OF THIS PERIOD Michael W, Whipple, GPA Clerical, AccountingPO 0.00 270.00 297.00 567-00 San Rafael, CA 949115-1626 A powenja ttiat are contributions or Independent expen(MUM rnM also tit SUBTOTALS $ 270.00 297.00 567,00 0.0 summarlud an schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (include all Schedule F, Column (b) subtotals for 297.00 accrued expenses of $1 DO or more, plus total unitemized accrued expenses under $100.) ...... .................. .................. INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (0) subtotals for payments on 567.00 accrued expenses of $100 or more, plus total uniternized payments on accrued expenses under $100.) ,....................... ...... PAID TOTALS $ 3, Net change this period, (Subtrkt Line 2 from Line 1. Enter the difference here and (270.00) on the Summary Page, Column A, Lire 9.) ........... ............................................ . ....................... .......................... ...... _.. N1ET $ may to a naw7%-a rmrrber FPPC Form 460 (January/06) FPPC Toll -Free Halpline: 0661ASK-FPPC (8661275.3772)