HomeMy WebLinkAboutForm 460 - Paramedic Services PAC (2016-06-30)Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from ___ J_a_n_ . .....;1._2_0_1_6 __
June 30.2016 through ________ _
1. Type of Recipient Committee: All Committees -Complete Parts 1. 2. 3. and 4.
3.
o Officeholder, Candidate Controlled Committee o State Candidate Election Committee
fi2l Primarily Formed Ballot Measure
Committee o Recall
(Also Complele P.~ 5)
o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee
IS> Controlled o Sponsored
(Also CompI.,. P.~ 6)
o Primarily Formed CandIdate/
Officeholder Committee
(AJso Complate PM 7)
Committee for San rafael Paramedic Services
STREET ADDRESS (NO P.O. BOX)
CITY
San Rafael
STATE ZIP CODE
CA 94903
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE
OPTIONAL: FAX I E-MAIL ADDRESS
AREA CODE/PHONE
415-235-2859
AREA CODE/PHONE
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of
certify under penalty of pe~ury under the laws of the State of California that the foregoing is true n
NA
2. Type of Statement:
o Preelection Statement
Ii2I Semi-annual Statement o Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Greg Knell
MAILING ADDRESS
Same as Committee
CITY
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY
OPTIONAL: FAX I E-MAIL ADDRESS
o Quarterly Statement o Special Odd-Year Report
STATE ZIP CODE AREA CODEJPHONE
STATE ZIP CODE AREA CODE/PHONE
con rned herein and in the attached schedules is true and complete.
::::::::: ~~1:~:/:~3::~:~ /:/:V;=~:/=6==~~ -I-r oat · By -';;'lSlg==n:::ature:-:::":o:;-;f :i:n::::i:I~lng~O:;::fl1co=ha:;::ld==or.-rc::::8n:::;dld::::.::::-\ •• -:;s-::::ta\:::-e M:::.:::a.:::-:uro=Pro::::pa::::n:::en:O:\ o;:;r;;:Re::::spa:::n::;.';;:;:bl.::-;O"'fnc;;::o~r 0;;;' ;;;sp::::on~sor:--
Executed on -----""O"'a'.,,------
Executed on --------=0""'8Ie--------
By--------~S~l g~na~lu~ro~O~fc~o~nlro~I~lIn~g~Offi~IC~~~OI~d.~~""C~an:::;dl~da:;::lo~.S~m:::-:lo~M'-e::::as~ur~O~Pro~pa~n~e=nl-----------
By----------~5~lg~n.~lu~~-O~fC~on~~~I~lin~g~Offi~I C~.h~o~~e~~""c~an:::;dl~da:;::te~.5~w:::-:le~M'-e~as~ur-o~Pro~pa~n~e"'nl-----------
FPPC Form 460 (Jan/20i6)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Contributions Received
1. Monetary Contributions ................................................... Schedule A, LIne 3
2. Loans Received................................................................ Schedule B, Line 3
3 . SUBTOTAL CASH CONTRIBUTIONS .............................. Add LInes 1 + 2
4 . Nonmonetary Contributions............................................ Schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Unes 3 + 4
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 B + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summery Pege, 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 B above
16 . ENDING CASH BALANCE .................. Add LInes 12 + 13 + 14, then subtrect Line 15 $
If thIs is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEiVED ................................ ScheduleB, Part 2 $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ Sea instructions on reverse $
19. Outstanding Debts .............................. Add LIne 2 + Une 91n Column B above $
Amounts may be rounded
to whole dollars.
ColumnA
TOTAL THIS PERIOD
(FROM ATIACHED SCHEDULES)
0
0
0
0
0
50.00
o
50.00
o
o
50.00
5,295.12
o
2.49
50.00
5247.61
o
o
o
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM Jan. 1,2016 from _________ _
June 30, 2016 through _______ _ Page ___ of __ _
Column B
CALENDAR YEAR
TOTAL TO DATE
$ 0
0
$ 0
0
$ 0
$ 50.00
o
$ 50.00
o
o
$ 50.00
To calculate Column B,
add amounts In Column
A to the corresponding
amounts from Column B
of your last report. Some
amounts in Column A may
be negative figures that
should be subtracted from
previous period amounts. If
this is the first report being
filed for this calendar year,
only carry over the amounts
from Lines 2,7, and 9 (if
any).
1.0. NUMBER
983147
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/1 to Date
20 . Contributions 0 Received $ $
21 . Expenditures
Made $ 0 $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made·
(If SubJact to Voluntary Expandltur. Limit)
Date of Election
(mm/dd/yy)
~~--
Total to Date
$-----
$-----
* Amounts In this section may be different from amounts
reported in Column B .
FPPC Form 460 (Jan/20i6)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEDULE E
Schedule E
Payments Made
Amounts may be rounded
to whole dollars. Statement covers period
from __ J_a_n._1--,,_2_0_1_6 __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
through _J_u_n_e_3_0--,,_2_0_1_6_ Page ___ of __ _
NAME OF FILER I.D. NUMBER
983147
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP 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 fund raising 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 WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITIEE. ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
California Secretary of State Annual Political Committee Registration Fee
Sacramento, 50.00
CA
* 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. 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 $ _____ _
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov