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Home My WebLink AboutForm 460 - Maribeth Bushey-Lang for City Council 2013 (2014-12-31)Type or print in ink. Statement covers period July 1, 2014 SEE INSTRUCTIONS ON REVERSE through December 31, 2014 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 0 Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Part 5) E] General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee E] Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Part 6) E] Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) —1: I.D. NUMBER C Committee Information 135837a COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE Date of election iIMM pif applicable::1 (Month, Day, Year) man NW.WM Page — 1 1 Of 4 For Official Use Only Time'. N/A City Clerk's Office nitv of San Rafael 2. Type of Statement: Preelection Statement E] Quarterly Statement Semi-annual Statement El Special Odd -Year Report F_Termination Statement [:1 Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 El Amendment (Explain below) Treasurer(s) NAME OF TREASURER Mark Kyle, Esq. MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL� FAX / E-MAIL ADDRESS mark.kyle@yahoo.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and tothe best of my knowl4h_ e infmation r,+i-,d /?trein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. il I I Y February 1, 2015 Executed on By Date February 1, 2015 Executed on By Date Signature of Controlling Officeholder Candidate, State Measure Proponent or Resp q6Ve11fficer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature ofConlrolling Officeholder Candidate. State Measure Proponent FPPC Form 460 (January185) FPPC Toll -Free Helpline: 866/ASK-FPPC (866(275-3772) State of California RE-31311321211113MM 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, San Rafael RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94901 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? I E] YES E] NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 0 YES 0 NO 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER Page 2 of 4 E] SUPPORT E] OPPOSE 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [j SUPPORT [:] OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] SUPPORT Ej OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT E] OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) I CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) State of California Campaign Disclosure Statement Type or print in Amounts may be round Summary Page to whole dollars. J SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 1. Monetary Contributions ...................... Schedule A,Line 51 $ 2. Loans Received Schedule B,Line 3 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 4, Nonmonetary Contributions ..... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ... ................. ..... � Add Lines 3 + 4 $ Expenditures Made 6, Payments Made ... _ ... ..... ...... 7, Loans Made..... ............... __._ ......... 8. SUBTOTALCASH PAYMENTS ....................... 9. Accrued Expenses (Unpaid Bills) ......... _ ...... 10. Nonmonetary Adjustment ... ........ .... _ .... 11. TOTAL EXPENDITURES MADE ...................... Column A TOTAL rHIS PERIOD (FROM ATTACHED SCHEDULES) 0 0 0 0- 0 0 Statement covers period from — July 1, 2014 through December 31, 2014 Page 3 of 4 I.D. NUMBER 1358370 Column B Calendar Year Summary for Candidates CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and 500 General Elections 1/1 through 6/30 7/1 to Date $ 500 1,000 $ 1,500 .... Schedule E, Line 4 $ 200 $ 1,200 ... Schedule H, Line 3 0 0 Add Lines 6+7 $ 200 $ 1,200 Schedule F Line 3 0 0 Schedule C, Line 3 0 1,000 ..... Add Lines 8 + 9 + 10 $ 200 $ 2,200 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 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. 395.08 0 0 200.00 195.08 17� LOAN GUARANTEES RECEIVED .... ...... .......... .... Schedule Cash Equivalents and Outstanding Debts 18. Cash Equivalents... ....... See instructions on reverse $ 0 19. Outstanding Debts .. ..... ..... ........ Add Line 2 + Line 9 in Column B above $ 0 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B: your last report. Some amounts in J 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). 20. Contributions Received $ 21. Expenditures Made $ $ 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: 666/ASK-FPPC (866/275-3772) r. " W i SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from July 1, 2014 through December I' ILII _ NUMBER 1358370 I Bii CMP campaign paraphernalia/misc. WOR 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 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 LrT campaign literature and mailings PRT print ads WEB information technology costs (internal, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMMEE, ALSO ENTER 1,13. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID California Secretary of Sate 1500 11th Street FIL 200.00 Sacramento, CA 95814 Payments that are contributions or Independent expenditures must also be Summarized on Schedule D. SUBTOTAL$ 2. -r Myrrients madeperiod of r. $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.) 200 0 ........ TOTAL $ 200 FPPC Form 460 (January1511%I �,. x :$ .«