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Home My WebLink AboutForm 460 - Paramedic Services PAC (2013-06-30)Wkipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) (a Type or print in ink. COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee for San Rafael Paramedic Services STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS CO IPAGE slum Date of election if applicable: JUL 2 4 20 113 Page 1 . of 4 (Month, Day, Year) I I For Official Use Only Time'. CI i , WS Office L. -i C *�� r r1tw nf Rafae..'01, 2. Type of Statement: Preelection Statement M Quarterly Statement Semi-annual Statement 0 Special Odd -Year Report E] Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Treasurer(s) NAME OF TREASURER Carl Tregner MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHnNE 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 preparin 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 I ws of the ate of California that the foregoing is true and correct. d Executed on 3,7,14 13 By f Date Signature of Treas4&r or Assistant Treasurer Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosu-re Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from 1/1/13 41 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE To calculate Column B, add 29.11 through 6/30/13 Page 2 of 4 NAME OF FILER 50.00 report. Some amounts in Column A may be negative I.D. NUMBER Committee for San Rafael Paramedic Services period amounts. If this is the first report being filed 9831 A. 1 47 Contributions Received Column A Column B Calendar Year Summary for Candidates any). TOTALTHIS PERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Linea $ 29.11 $ 29.11 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I + 2 $ 29.11 $ 29.11 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 29.11 $ 29.11 Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 50.00 $ 50.00 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 50.00 $ 50.00 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 1© $ 50.00 $ 50.00 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule I, Line 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. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 5376.63 To calculate Column B, add 29.11 amounts in Column A to the corresponding amounts from Column B of your last 50.00 report. Some amounts in Column A may be negative 5355.74 figures that should be subtracted from previous period amounts. If this is the first report being filed 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if JM any). I 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) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) es Schedule A Monetary Contributions Received 0 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 1/1/13 0 SCHEDULE A SEE INSTRUCTIONS ON REVERSE through 6/30/13 Page 3 of 4 NAME OF FILER I.D.NUMBER Committee for San Rafael Paramedic Services 983147 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 — DEC. 31) (IF REQUIRED) OF BUSINESS) F1 IND ncom r] OTH n PTY El SCC r] IND ncom nOTH F1 PTY n SCC n IND FICOM nOTH F] PTY n SCC F] IND ncom E] OTH [:] PTY n SCC n IND EICOM [:] OTH Ej PTY ❑SCC SUBTOTAL $ Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (include all Schedule A subtotals.) ........................................................................................................ $ 0 COM --Recipient Committee (other than PTY or SCC) 2. Amount received this period - uniternized monetary contributions of less than $100 ............................. $ 29.11 OTH - Other (e.g., business entity) PTY - Political Party 3. Total monetary contributions received this period. 99 11 L SCC - Small Contributor Committee {Add Lines I and 2. Eater here and on the Summary Page, Column R, Line -I.) ....................... lUUAL FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E 0 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 1/1/13 0 SCHEDULEE SEE INSTRUCTIONS ON REVERSE through 6/30/13 Page 4 of 4 NAME OF FILER I.D. NUMBER Committee for San Rafael Paramedic Services 983147 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW 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 PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads MB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) .............................................................................................................. $ 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 50.00 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 $ 50.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)