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Home My WebLink AboutForm 460- Maribeth Bushey-Lang for City Council 2013 (2013-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statern t c vers period from through 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee Lj Primarily Formed Ballot Measure State Candidate Election Committee Committee Recall Controlled (Also Complete Part) Sponsored (Also Complete Part 6) General Purpose Committee Sponsored Small Contributor Committee Political Party/Central Committee 3. Committee Information Primarily Formed Candidate/ Officeholder Committee (Also Complete Patt 7) in NUMBER All COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) CITY STATE ZIP CODE AREA CODEIPHONE 40 of MAILING ADDRESS (IF DIFFER NT} NO. AND STREET OR P.O® BOX CITY ^ a STATE ZIP CODE AREA CODEIPHONE # , OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification I have used all reasonable diligence In preparing and reviewing this statement and to the best of M under penalty of perjury der the I s of the State of California that the foregoing is true and coir t. -1 T A4"*4k 'A 1 By Executed or, look— Exe-cuted or, By Date gnatulr of Date of election if applicable: (Month, Dayj Year) NIMEM Page t Of For Official Use Only 2. Type of Statement:, _e City 'R r "a - an a 1-1 Preelection Statement L QUarterly Statement Semi --annual Statement t Special Odd -Year Report Termination Statement Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Treasurer(s) AME OF TREASURER . MAILING ADDRESS 7 *" C7 CITY Nl� SIATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E-MAIL ADDRESS ntained herein and in the attached schedules is true and complete. I certify Executed on Date B, y Signature of Co;n(rorling i0fficeholder, Carididate, Proponent By Exe-1--i-ited on Date &Q -nature of C4artrolhng Officeholder. Car.,Ondate,'_State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline- 866/ASK-FPPC (866/275-3172) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 NAME OF OFFICEHOLDER OR CANDIDATE LC — I—at vt OFFICE SOUGHT OR HELD (INCLUDE LOICATION AND RIOT NUMBER IF APPLICABLE) C% 0 C" RESIDE 14TIALIBUSI NESS ADDRESS (NO. AND SfTREST) CITY STATE ZIP ' - 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? � YES NO t COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? I , YFS NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 BALLOT NO. OR LETTER JURISDICTION SUPPORT 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 7. Primarily Forrhed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE ft OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER -OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT ,j OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary NIM1101 .1 1 � I I I I 1 00 1 NNW IN 10"W1,11 IN .1. 1 iiiii'lli I FPPC Form 460 fJanuary/05) FPPC Toll -Free Helpline: 866 ASI (8661275-3772) State of California Campaign Disclosure Statement Summary Page NAME OF FILER Lot Type or print in ink. Amounts may be rounded to whole dollars. 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 Lines 3 + 4 Column A TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) $ $ $ 6. Payments Made ....................................................... Schedule E, Line 4 $ � C/ 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 G, Line 3 OT62 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + iGi $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 1101,11 13. Cash Receipts ................................................... Column A, Line 3 above lop^ 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 1115 $ �6 If this is a termination statement, Line 16 must be zero. 7. LOAN GUARANTEES RECEIVED ........................... Schedule B. Pa"I 2 its Cash Equivalents and Outstanaing Debts 118. Cash Equivalents .... __ ................ ___ ....... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line -9 in Column B above $ Staterne t covers period from 7 1 1 11x' through (01-7_>of rz.> _J Column B CALENDAR YEAR TOTALTO DATE $ $ -7 $ -7 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 arrounts from Lines 2, 7, and 9 (if 00*5&Page — of I.D. NUMBER -5tS 40o Calendar Year Summary for Candidates Running i the State Primary and General Elections 1/1 through 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 Limit) *Amounts in this section may be different from amounts reported in Column B. FPPC For 460 (Januar /05 FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) CALIFORNIA 460 from FORM through Page Of NAME OF FILEER I.D.'NUMBER t , Schedule A Summary . Amount received this period — itemized monetary contributions. (include all Schedule A subtotals.) ........................................................................................................ . Amount received this period -- unitemized monetary contributions of less than 1 ............................. 3. Total monetary contributions received this period. f dd I Inp nd 9. Fntiar here and n the Surnm ry Fees, Column , Lire 1.) ....................... TOTAL FP''C Feer " FP'PC Toll -Free Helpfine: 366/ASK-FPPC (866/275-3772) *Contributor Codes IND - Individual COM — Recipient Committee (other than PTY or SCC) OH — Other .., business entity) PTY — Fol€tical Party SCC — Sell Contributor Committee N Srhpdule C Type or print in ink. SCHEDULE C Amounts may be roundedStatement Nonni � rl�'tc'" ry Contributions Received to whole dollars. covers periodAmok CALIFORNIA 46U from FORM through Page of Cz> SEE INSTRUCTIONS ON REVERSE NAME OF FILEF ' yr+fw • I.D. NUMBER DATE FULL NAME, STREET ADDRESS ANC? QIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE* IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER �� SELF-EMPLOYED, ENTER DESCRIPTION OF GOODS OR SE,RVIC AMOUNT/ FAIR MARKET VALUE CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION fi0 DATE {1F REQUIRED) RECEIVE[) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) )BIND [—]COM44*4*.. �] OTh 1 0 PTY EiSCG ND Q COM ... DOTH � tIL _-- PTY Q SCC IND 1 COM OTh tt PTY SCG IND 1;57 k COM OTN 1 to t ,� PTY SCG � lJ BTC}iA� Attach additional information on appropriately labeled continuatibn sleets. ) wilt; Ili 1. Amount received this period —itemized nonmonetary contributions. I (Include all Schedule C subtotals.)..................................................................................................................... $ 2. Amount received this period — unitemized nonmonetary contributions of fess than $100 .................................... $ Total nonmonetary contributions received this period. and the Summary e, Column A, Lines 4 and I � .. TOTAL �A� L.I�eS �� . ��telµ der � F $ A t__V_0_ PPC Form 460 (January/05 FPPIC Toll -Free helpline, 8ASK-FPPC (866/275-3772) IND — Individual COM -- Recipient Committee (other than PTY or SCC) CT -- Other (e.g., business en ity PTY -- Political Party SCC -- Small Contributor Committee Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. NAME OF FILER V1 � �� J �: / fit+ C 4. �Vt Cr%V 47 Statement covers period from through r5 Page of I.D. NUMBER If of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CODES: one MBR member communications RAD radio airtime and production costs cK/p campaign paraphernalia/misc. IVITG meetings and appearances RFD returned contributions CNS CTB, campaign consultants contribution (explain nonmonetary, OFC office expenses SAL TEL campaign workers' salaries t.v. or cable airtime and production costs CVC civic; donations PET PHO petition circulating phone banks TRC candidate travel, lodging, and meals FIL candidate filing/ballot fees PCNL polling and survey research TRS staffispouse travel, lodging, and meals FND fundraising events independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor IND LEG legal defense PRO professional services (legal, accounting) VOT WEB voter registration information technology costs (internet, e-mail) LIT campaign literature and mailings PRT print ads 4k15 � 11-t'� 11, Payments that are contributions or independent expenditures must also be summarized on Schedule D. ScheduleE Summary E subtotals.) .................................................................. ...... .................................... $ 1. Itemized payments made this period. (Include all Schedule 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 he and on the Summary Page, Column A, 'Line 6.1 ................. ........... TOTAL $ FPPC Form 460 (January/O FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3771