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Home My WebLink AboutForm 460 - Maribeth Bushey-Lang for City Council 2013 (2014-06-30)Recipient Committee Campaign Statement CoverPage (Government Code Sections 84200-84216.6) Type or print in ink. Statement covers periodTDate of e0ection 'if applicablel-A r from January 1, 2014 (Month, Day, Year) SEE INSTRUCTIONS ON REVERSE through June 30, 2014 L=�: _=M�11 MIMI I I IN I � I I 111 11 11 1 , I 1. Type of Recipient COMMIfte'. All Committees - Complete Parts 1, 2$ 3, and 4. Officeholder, Candidate Controlled Committee E] Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part) 0 Sponsored (Also Complete Part 6) General Purpose Committee 0 Sponsored Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Pad 7) 3. Commiftee Information I.D.NUMBER 1 1358370 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MAILING ADDRESS (IF DIFFERE NT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL.- FAX / E-MAIL ADDRESS N/A Date Stamp Ti'me: city clerk's Offl 0 Preelection Statement [Z Semi-annual Statement El Termination Statement (Also file a Form 410 Termination) Amendment (Explain below) Page - 1 of 6 For Official Use Only Quarterly Statement Special Odd -Year Report Supplemental Preelection Statement - Attach Form 495 MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL.' FAX / E-MAIL ADDRESS Executed on Date BY Signature of Controlling Ofteholder, Candidate, State Measure Proponent Executed Date Signature of ConWfing Officeholder, Candidate, State Measur,6 Proponent FPIPC Fonn 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) State, of California NAME OF TREASURER CONTROLLED COMMITTEE? YES NO COMMITTEE ADDRESS STREETA DDRESS CITY STATE ZIP CODE AREA CODE/PHONE 9. Primarily Formed Ballot Measure Commiftee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER AFORNIA"' 460:�111"'� "OR ZMW� Page Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO, IF ANY 7. Primarily Formed Candidate/Officeholder COMMiftft List names of officeholder(s) or di date(mmittee s) for which this cois primaril cany formed. mAui= ar)p T1= NAME OF OFFICEHOLDER OR CANDIDATE I OFFICE SOUGHT OR HELD COMMITTEE NAME I.D. NUMBER I I NAME OF OFFICEHOLDER OR CANDIDATE I OFFICE SOUGHT OR HELD NAMij E OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E] YES E] NO COMMITTEE ADDRESS STREETADDRESS CITY STATE ZIP CODE AREA CODEIPHONE Attach con6nuation sheets if necessary ORT E] OPPOSE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) State of California Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 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 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 1, 2014 through June 30, 2014 Page 3 Of -- 6 J.D. NUMBER 1358370 C��I� IIII! l�I� �I��I��II II�� IIID: lumnoB If this is a termination statement, Line 16 must be zerl 17. LOAN GUARANTEES RECEIVED ........................... Schedule 8, Part 2 $ N Cash Equivalents and Outstanding Debts 19. Outstanding Debts 0 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111t 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Umft) Date of Election Total to Date (mm/dd/yy) $ *Amounts in this section may be different from amounts reported in Column B. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Marlbeth Bushey Lang for San Rafael City Council 201 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER (IFCOMMITTEE, ALSO ENTER 1. D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Statement covers period AU from January Schedule A Summary 1. Amount received this period - itemized monetary contributions. 500.00 (include all Schedule A subtotals.) ........................................................................................................ $ 2. Amount received this period - uniternized monetary contributions of less than $100 ............................. 3. Total monetary contributions received this period. 500.00 (Add Lines I and 2. Enter here and on the Summary *Contributor Codes IND - Individual Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) Political Patty SCC - Small Contributor Commiftee Schedule C Nonmonetary Contributions Received Maribeth Bushey Lang for San Rafael City Council 2013 Z' Z -71M DATE FULL NAME, STREET ADDRESS AND RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 1, 2014 through June 30, 2014 IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET (IF SELF-EMPLOYED, ENTER VALUE NAME OF BUSINESS) Page 5 Of 6 I.D. NUMBER CUMULATIVE TO PER ELECTION DATE TO DATE CALENDAR YEAR (IF REQUIRED) (JAN 1 -DEC 31) *Contdbutor Codes IND — Individual Recipient Commiftee (other than PTY or SCC) OTH — Other (e.g., business entity) Political Party Small Contributor Commiffee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) ScheduleE ".4 SEE INSTRUCTIONS ON REVERSE ;qqiqM;qiilip my" �011 11 1 , I q I 11111p 'T W -W41 a WTI M11 Type or print in ink. Amounts may be rounde, to whole dollars. Statement covers period from January 1 2014 through June 308 2014 Page 6 Of — 6 I.D. NUMBER I CW campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nor monetary)* 0FC office expenses SAL campaign workers' salaries CVC civic donations PEr petition circulating TEL tm. or cable airtime and production costs FI L candidate lin /ballot fees PHO phone banks TRIC 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 V\EB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Mark Kyle San Rafael, CA 94901 DESCRIPTION OF PAYMENT Eel MISSION 1. Itemized payments made this period. (include all Schedule E subtotals.) .............................................................................................................. $ 11000.00 2. ized Unitempayments made this period of under $100 ................................................................... ......... .................... ..................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1 , Column (e).) .............................. ................................................ $ 0 FPPC Form 460 (January/06) FPPC Toll -Free Helpline.- 866/ASK-FPPC (8661275-3772)