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HomeMy WebLinkAboutForm 460- Greg Brockbank for Mayor 2011 (2011-09-24) AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Date Stamp Statement covers period Date of election if applicable: 'i (Month, Day, Year) from q through ... Committee: All Committees —ComPlete Parts 1, 2, 3, and 4. Type of Recipient officeholder, Candidate Controlled Committee n Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also complete Part 5) 0 Sponsored (Also Complete Part 6) General Purpose Committee ❑ Primarily Formed Candidate/ 0 Sponsored Officeholder Committee 0 Small Contributor Committee (Also Complete Part 7) 0 political Party/Central Committee I.D. NUMBER C 3, Committee Information COMMITTEE NAME (UK CANDIDATE 5 NAME IF NO COMMITTEE) Nk, IV -f t" r- )-C- ik )i qi It 3 I AKIn qTPFFT OR P.O. BOX 2. Type of Statement: COVER PAGE Page I .. of I For Official Use Only 0 Preelection Statement [:] Quarterly Statement E] Semi-annual Statement [J Special Odd -Year Report E] Termination Statement ❑ supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) J _[ JtXc,_1 sk''kk' 5 J _9 r! ljfv� X9 41f, ry - � WA, Treasurer(s) NAME OF TREASURER iMAILING ADDRESS CITY STATE h ZIP CODE r, NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS STATE ZIP CODE AREA _CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE CITY 4. ;7e ification statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify I have used all reasonable diligence in preparing and reviewing this under penalty of perjury under the laws of the State of California that the foregoing is true and corrqct. J, Executed on By Signature afTreasurer or Ass itant Tressurer Use, Executed on LOW By S,,jR-atureofControlhngumoenolder car6date, State Meastre prepo;jnt _orRe;pZn_wible Offioar of Sponsor Executed on By Signature 0T'_ommWgCff1Ceh01def, COrldriater State Measure Proponent Executed on ByS gnature of Con MeasLeeproponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Summary Page —1 Old PrX/V-PqF - NAME OF FILER 5 t le % Contributions Received 1. Monetary Contributions ........................................... Schedule A, Line 3 2. Loans Received ........... ....... - .................... Schedule B, Line 3 3, SUBTOTAL CASH CONTRIBUTIONS ..... ... __ ........... Add Lines I +2 4. Nonmonetary Contributions ....... ..................... . - . - . - - Schedule C, Line 3 5, TOTAL CONTRIBUTIONS RECEIVED - - . ................... .... Add Lines 3 + 4 Expenditures Made 6. Payments Made ....... ............ .................................. Schedule E, Line 4 7, Loans Made ............. ...... ........... .... - .... ........... Schedule H,cine 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 16 13. Cash Receipts .... .................................. ..... - ..... Column A, Line 3 above 14. Miscellaneous Increases to Cash ...... ........ ....... . . - . Schedule 1, Line 4 15. Cash Payments ..... -- ............... - ... ... --- .......... Column A, Line 6 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. Type or print in ink. Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $ 0 20 $ $ Statement covers period CALIFORNIA • FORM 4 from through Page of I.D-NUMBER J Column B Calendar Year Summary for Candidates CALENDAR YEAR Running in Both the State Primary and TOTALTO DATE 10 General Elections 1 li "'D %-'K; $ 315 $ $ , r"I Li $ o i :L , , -- $ $ �t'r $ $ 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 sin Column above 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). ill through 6/30 711 to Date 20. Contributions Received $ 21. Expenditures Made $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Urn t) Date of Election Total to Date (mm/dd/yy) I —J ---J I*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 (8661275-3772) P?A ry C Pe ry Contributions Received SEE INSTRUCTIONS ON REVERSE NAMEOF FILER Type or print In ink. Amounts may be rounded to whole dollars. DATE I FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR RECEIVED OF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR I CODE * Schedule A Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) 1 Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) .......... ...... ............................ ............. $ -1� 2. Amount received this period — unitemized monetary contributionsof less than $ $ 3. Total monetary contributions received this period. kAdd Lines I and 2. Enter here and on the Summary Page, Column A, Line TOTAL $ T Statement coversSCHEDULE A period CALIFORNIA' from. "Zi /1,; - I FORM 4601 through.. 1k, Pages of paga� of I,D.NUMBER AMOUNT CUMULATIVE TO DATE PER ELECTION �r YEAR RECEIVED THIS, CALENDAR YEAR TO DATE REQUIRED) PERIOD (JAN. I - DEC. 31) (IF TO t C 1,31 , �11 C/ 10 0, jo *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) cl, FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) OIND C2COjM E10TH El PTY EISCC EICOM [IOTH El PTY EISCC r7 IN [RIND C 0 Elcom El TM 0 H EIOTH E] PD TY El PTY E] EJSCC'g E❑SCC te'_k + BIND F JE01 EICOM M� CIOTH f PTY ]❑PTY E1SCc r IND HCOM [:10TH E] PTY EISCC Schedule A Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) 1 Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) .......... ...... ............................ ............. $ -1� 2. Amount received this period — unitemized monetary contributionsof less than $ $ 3. Total monetary contributions received this period. kAdd Lines I and 2. Enter here and on the Summary Page, Column A, Line TOTAL $ T Statement coversSCHEDULE A period CALIFORNIA' from. "Zi /1,; - I FORM 4601 through.. 1k, Pages of paga� of I,D.NUMBER AMOUNT CUMULATIVE TO DATE PER ELECTION �r YEAR RECEIVED THIS, CALENDAR YEAR TO DATE REQUIRED) PERIOD (JAN. I - DEC. 31) (IF TO t C 1,31 , �11 C/ 10 0, jo *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) cl, FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) ,ledule A (Continuation Sheet) Tvi3e or Drint In ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period I CALIFORNIA to whole dollars. 460 from tit FORM throughA Page — of NAME OF FILER 161&�j I.D. NUMBER 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 (W COMMrrTEE. ALSO ENTER I.D. MNSER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. I - DEC. 31) (IF REQUIRED) OF KiStNESS) EgIND E]COM /610,00 nOTH PTY OSCC -ve N21ND r1com Oki E]OTH 7r-177-5 —i-1170 [:] PTY 0SCC ©IND f -icom Si4t- E]OTH 4� i E3 PTY FISCC []IND ncom E30TH El PTY nSCC E]IND E]COOM DTH n PTY 0SCC SUBTOTALS *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/06) FPPC Toll -Free Helpline; 8661ASK-FPPC (8661275-3772) ,chedule A (Continuation Sheet) Type or print In ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. from hthrough– A-1 page. of ME OF FILER I.D. NUMBER 13 3 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (W COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE (IF SEU-EMPLOYFD, ENTER NAME PERIOD (JAN. I - DEC. 31) (IF REQUIRED) OF BUSINESS) SND nCOM EJOTH iCJ 7,07=7 7 El PTY ❑ SCC IND E]COM mr, W77 w2c nOTH 10, 71, El PTY ❑ SCC F]IND ncom irk- c1 DOTH Cit El PTY EISCC p L, DIND PAK- 54COM orc) I❑ DOTH PTY -r"41 EISCC RC'0M E]OTH [] PTY []SCC SUBTO $ 4- *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/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print in Ink. SCHEDULE A (CONT.) Monetary Contributions ReceivedWwholedollars. Amounts may be rounded Statement covers period CALIFORNIA 4•0 FORM from !T i through Page of I.D. NUMBER ME OF FILER A 'r FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE DATE (IF COMMITTEE, ALSO ENTER 10. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN, I - DEC. 31) (IF REQUIRED) RECEIVED OF BUSINESS) A 0 KIND ncom iGf f -I OTH og' A, El PTY E] SCC [�IND EICOM CITH EIPTY EISCC glIND EICOM (E. rs.r tea, E]OTH P�' 4, rc FIPTY El SCC []IND EICOM [:jOTH El PTY EISCC E]IIND [-]Com E]OTH [I PTY El SCC SUBTOTALS 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 Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) F pp c edule B — Par u —P S C LoansReceived V..-- -- --I-♦ a- t -G SCHEDULE R - PART I rt I Amounts may be rounded Statement covers period to whole dollars. , CIFORNIA ALi 460 from FORM through p SEE INSTRUCTIONS ON REVERSE go of NAME OF FILERI.D.NUMBER FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE (b) AMOUNT (cl AMOUNT PAID d AID 'AD C1 C 10) INTEREST V) ORIGINAL is) CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMER) (IF SELF-EMPLOYED ENTER NAME OF BUSINEW BEGINNING THIS BEGI —JDERIOD RECEIVED THIS PERIOD OR FORGIVEN THIS PERIOD ';0BU:ATLSA�TNAT, TH .. ��r T44-' PERIOD T� PAID THIS PERIOD AMOUNTOF LOAN CONTRIBUTIONS TO DATE Q�V(J 0 PAI I CALENDAR YEAR $ $ C] FORGIVENj.T PER ELECTION- TA 7-76 rN i 6�, RATE t[A IND [:] COM El OTH ❑ PTY El SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR E] FORGIVEN PER ELECTION RATE tEl IND El COM El OTH El PTY C3 SCC $ $ — $— S — DATE DUE — DATE INCURRED 0 PAID CALENDAR YEAR $— It $ $- 0 FORGIVEN PER ELECTION" RATE tC3 IND El COM D OTH El PTY El SCC $ DATE DUE DATE INCURRED SUBTOTALS $ Or) $ S $ Schedule B Summary 1. Loans received this period ................................................................................................................... $ (Total Column (b) plus uniternized loans of less than $100.) 2. Loans paid or forgiven this period ................... ........................... - ........................ ............................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule 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. arm a nnat" *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. (Enter (a) on SdnedLft I- Une 3) tContributor 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 Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) - 'chedule E Y Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. % FSR -, (( P)� �t Statement covers period from rY / " (%"4 (` through ( I Page of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemaha/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants WG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)` OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL Lv. 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 M Independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidateisponsor 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 (wcommnTEE.nusoENTER ID. MANOR) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID cOF 7 - wee, . T��`.�' aj+' . R Wit: --«...., � 1 (�' -�j ` j • � z,,; 4 9 3. Payments that are contributionsorindependent expenditures must also be summarized on Schedule D. SUBTOTALS 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 464 (January/05) FPPC Tall -Free Helpline: 866/ASK-FPPC (866/275-3772) ppp- ule E ontinuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Amounts may be rounded to whole dollars. statement covers period from through SCHEDULE E (CONT.) Page of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphematia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MfG meetings and appearances RFU returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL Lv. or cable airtime and production costs FIL candidate fi8ng/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 M 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 1 IT ramnaian literature and mailinas PRT print ads VWB information technology costs (Internet, a -mail} NAME AND ADDRESS OF PAYEE (W COMMITTEE, ALSO ENTER I.D. MAISER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID C - i 7 i!ii?t> F1 Sa s� {, e 12 Payments that are contributions or Independent expenditures must also be summarized on schedule 0. ct SUBTOTAL $1 FPPC Form 460 (January/tis) FPPC Toll -Free Helpline: 8661ASK-FPPC ($661275-3772) Schedule G Type or print in Ink.—11- • SCHEDULE G Payments Made by an Agent or Independent Amounts may be rounded Statement covers period CALIFORNIAAA Contractor (on Behalf of This Committee) to whole dollars. from I% 1) FORM _r%R0 SEE INSTRUCTIONS ON REVERSE through- Page of t NAME OF FILER I.D. NUMBER C, t3 3 9 2 NAME OF AGENT OR INDEPENDENT CONTRACTOR 0 �� u tu_ N1 (-, fj � CC, CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. NER 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 Lv. 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) * 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 f.o- ,C-N r' V1 P vA. ki VQ1 Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 17`5_ * Do not transfer to any other schedule or to the Summary Page, This total may ret equai the amount paid to the agent or iraeperdent contractor as reported or Schedule E, FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)