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HomeMy WebLinkAboutForm 460- Maribeth Bushey-Lang for City Council 2013 (2013-10-19)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. I eDate Sta t.,- , e7A Statement covers period from 9/22/13 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Maribeth Bushey Lang for San Rafael City Council 2013 STREET ADDRESS (NO P.O. BOX) [60-194agm n T �7-1 Page 1 of 16 Date of election if applicable: (Month, Day, Year) For Official Use Only rf;v S 11/5/13 2. Type of Statement: Preelection Statement F-1 Quarterly Statement Semi-annual Statement F-1 Special Odd -Year Report Q Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kn A e the * formatim"i co ed herein 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. X Executed on 10/24/13 By Date Signature of Treas r Assistant Treas Executed on 10/24/13 By Date Signakr&ef Cortrofting Officeholder, Candidate, State Measure Proporient or R ro"Sible oKer of spon Executed on Cate By Signature of Controlling Offnehdder, Candidate, State Measure Rmponent Executed on Date By Sign re of Controlling Offrce�Candidate, State Measure ProponeM FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) State of California Treasurer(s) NAME OF TREASURER Mark Kyle, Esq. MAILING ADDRESS CITY San Rafael STATE CA ZIP CODE 94901 AREA CODE/PHONE ( NAME OF ASSISTANT TREASURER, IF ANY James Waite, CPA MAILING ADDRESS CITY San Rafael STATE CA ZIP CODE 94901 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 my kn A e the * formatim"i co ed herein 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. X Executed on 10/24/13 By Date Signature of Treas r Assistant Treas Executed on 10/24/13 By Date Signakr&ef Cortrofting Officeholder, Candidate, State Measure Proporient or R ro"Sible oKer of spon Executed on Cate By Signature of Controlling Offnehdder, Candidate, State Measure Rmponent Executed on Date By Sign re of Controlling Offrce�Candidate, State Measure ProponeM FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) State of California # i # Ir " MAW CALIFORNIA'U 10 e . s . - FORS 4o r E t � IV Page � » # 2 of 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey Lang OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City Of San Rafael RESIDENTIALBUSINESS 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? F-] YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES F-1 NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 5. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION Q 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 Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [� SUPPORT Q OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E] SUPPORT OPPOSE Attach continuation sheets if necessary FPPC Form 460 (January 06 I=PICC Toll -Free Helpline. ASK-FP'PC (866/276-3772) State of Califo is Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/22/13 W11TI Expenditures Made To calculate Column B, add amounts in Column A to the corresponding amounts I I from Column B of your last 6. Payments Made ....................................................... Schedule E, Line 4 $ through 10/19/13 Page 3 of 16 SEE INSTRUCTIONS ON REVERSE Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 NAME OF FILER Add Lines 8 + 9 + 10 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if I.D.NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 any). 358370 I Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and (FROM ATTACHED SCHEDULES) General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 16 239 $ ,$ 36,819 0 0 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 16,239 $ 36,819 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 913 5,492 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 17,152 $ 42,311 Made $ $ Expenditures Made To calculate Column B, add amounts in Column A to the corresponding amounts I I from Column B of your last 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 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 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. Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents.. .................. ............ � . see instructions on reverse $ 19. Outstanding Debts ...................... � Add Line 2 + Line 9 in Column B above $ 18,958 $ 0 189958 $ 1,503_ 913 21,434 $ 25,238 0 25,238 10,517 5492 41,247 14,299 To calculate Column B, add amounts in Column A to the corresponding amounts I I from Column B of your last 16,239 0 18,958 report. Some amounts in Column A may be negative 1 figures that should i® subtracted from previous 11,580 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). 10,517 Expenditure Limit Summary for State 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/06) FPPC Toll -Free Helpline: 866/ASE -FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA from 9/22/13 ,, FORM 4 16 10/19/13 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * ( IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND 9/22/13 ❑Com Banker 250 250 E] OTH Union Bank San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND 9125/13 Mark Nelson ❑COM Entrepreneur/Partner 500 500 F-1 OTH Sonoma State San Rafael, CA 94903 ❑ PTY University/Altus Equity ❑ SCC ® IND 9/25/13 Skip Berg ❑COM Principal 500 500 E] OTH Berg Holdings Corp. Sausalito, CA 94965 ❑ PTY ❑ SCC ZIND 9/25/13 Arthur Latno, Jr. ❑COM retired 200 200 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND Joan Thayer y El COM retired 125 125 9/22/13 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC SUBTOTAL$ 1575 Schedule A Summary Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.)...................................................... 2. Amount received this period — unitemized monetary contributions of less than $100 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... 15,025 1,214 *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 TOTAL $ 16,239 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tvpe or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM , from 10/19/13 5 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Terrell Anderson ❑COM Executive 9/25/13 ❑OTH Donor Concierge 100 100 San Rafael, CA 94901 ❑ PTY ❑ SCC North Ba Leadership Council PAC []IND9/25/13 ®coM 750 750 ❑ OTH San Rafael 94901 ❑ PTY ❑ SCC IND ❑COM F ' evine for Assembly � 250 250 9/26/13 [:]OTH San Rafael, CA 94915 El ❑ SCC ®IND ❑COM retired 100 100 9/25/13 Movo, ❑ OTH ❑ PTY ❑ SCC ❑IND Building Trades Council Let's Build Responsibly ®coM 9/30/13 400 400 ❑ OTH 4174 Redwood Hwy, San Rafael, CA94903 ❑ PTY ❑ SCC SUBTOTAL$ 1600 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 9/22/13 • from • 6 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Brian Sobel El COM Communications 9/30/13 E] OTH Consultant, 100 100 e a uma, ❑ PTY self-employed ❑ SCC Fiona Ma for SBOE 2014 - FPPC#1343107 ❑IND z coM 10/1 /13 250 250 ❑ OTH Sacramento, CA 95864 ❑ PTY ❑ SCC Albert Boro IND ICOM retired 10/1/13 250 450 DOTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND retired 10/1/13 ❑ COM 75 575 ❑ OTH Novato, CA 94947 ❑ PTY ❑ SCC ®IND retired 10/1/13 ❑COM 75 175 ❑ OTH ❑ PTY [:]SCC SUBTOTAL$ 750 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 9/22/13• •RNIA ' from 7 r 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR A ZIP ADDRESS CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED IT I.D. NUMBER) (IF COMMITTEE, CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND Marin Builders Association PAC, #1358370 ®COM 10/4/ 13 E] OTH 1000 1000 San Rafael, CA 94903 ❑ PTY ❑ SCC San Rafael Police Association PAC ❑IND zCOM 10/4/13 3000 3000 ❑ OTH PO Box 151557, San Rafael CA 94915-1557 ❑ PTY ❑ SCC John Burton ®IND Chairman, 10/5/13 ❑OTH California Democratic 100 100 an ranclsco, ❑ PTY Party ❑ SCC ®IND 10/5/13 David Bernardi ❑COM 100 100 ❑ OTH Novato, CA 94947 ❑ PTY ❑ SCC ®IND 10/5/13 Jack Krystal J ❑ COM 200 200 ❑ OTH San Rafael, CA 94912 ❑ PTY ❑ SCC SUBTOTAL$ 4400 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 • ' RM from 8 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®ICOM Stephen Schmidt retired 9/22/13 DOTH 125 125 San Rafael, CA 94901 ❑ PTY ❑ SCC Josh Adler IND ICOM Doctor 100 100 9/22/13 DOTH UCSF San Rafael, CA 94901 ❑ PTY ❑ SCC BIND COM Risk Manager 100 100 9/22/13 ❑ oTH San Rafael, CA 94901 ❑ PTY ❑ SCC Norman Davis OCOM IND CPA 100 100 9/22/13 1 DOTH self-employed San Rafael, CA 94901 D PTY I SCC Joe Shekou ® IND ❑COM Property manager 9/22/13 DOTH Ba Park Real Estate Y 1000 1000 San Rafael, CA 94901 I PTY ❑ SCC SUBTOTAL$ 1425 *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) Schedule A (Continuation Sheet) Tvve or Print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM t from 9 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE ZIP 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 (E COMMITTEE, ALSOAND I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Roy Howell OCOM retired 1000 1000 9/22/13 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ ScC Maynard Willms IND ICOM retired 50 150 10/5/13 [:]OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Dorothy Breiner ®❑COM IND retired 50 150 10/8/13 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ Scc No. Calif. Carpenters Regional Council IND ❑COM � 10/8/13 ❑ OTH 250 250 Oakland CA 94621 ❑ PTY ❑ SCC E] IND California Real Estate PAC, FPPC #890106 O COM 10/5/13 1000 1000 ❑ OTH Los Angeles, CA 90020 ❑ PTY ❑ SCC SUBTOTAL$ 2350 *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) Schedule (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM t from 10 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE A FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR RE,ALSAND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED IT O ENTER I.D. NUMBER) (IF COMMITTEE, CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND Michael Ghilotti ❑COM 250 250 10/8/ 13 E] OTH an a ae , 94901 ❑ PTY ❑ SCC ®IND ❑ COM 100 100 10/8/13 0"901 ❑ OTH ❑ PTY ❑ SCC ZIND 10/8/ 13 Rosalie Weigle ❑ COM 500 500 ❑ OTH 901 ❑ PTY ❑ SCC Marin Women's PAC, FPPC #1332045 E] IND ICOM 10/8/13 200 200 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC ®IND 10/8/ 13 ❑ COM 100 100 Oan*ae, ❑ OTH A 94901 ❑ PTY ❑ SCC SUBTOTAL$ 1150 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT) Y Monetary Contributions Received Amounts may be rounded -- Statement covers period •. to whole dollars. 9/22/13 FORM , from 11 10/19/13 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 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 (IFCOMMITTEE,ALSO ENTER I.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®❑COM Thomas Loucks Sales 100 100 10/10/13 ❑OTH Frank Howard Allen ❑ PTY Realtors ❑ SCC Patricia Kendall ®IND El COM Administrator 10/11/13 Kaiser Permanente 250 250 San Rafael, CA 94903 ❑ PTY ❑ SCC ❑IND 10/11/13 S, Inc. ❑ COM 100 100 Z OTH San Ra ae , 901 El PTY ❑ SCC Jeanne Leocini ®[:]COM IND retired 100 175 10/11/13 E] OTH an a ae , ❑ PTY ❑ SCC Gary Giacomini ®IND ❑COM Partner 10/18/13 E] OTH Hanson Bridgett LLP 250 250 Larkspur, CA 94939 ❑ PTY ❑ SCC SUBTOTAL$ 800 *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) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded statement covers period �. to whole dollars. 9/22/13 from through 10/19/13 page 12 of 16 NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®❑COM Maureen Boro Pharmacist 10/18/13lIll ❑OTH SFVAMC 250 250 San CA 94901 ❑ PTY ❑ SCC Operating Engineers Local Union District 10 ❑IND M 10/18/13 500 500 MOTH TH 1620 S. Loop Rd., Alameda CA 94502 ❑ PTY ❑ ScC ❑ IND 10/18/13 otti, Inc. ❑COM 225 225 W] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 975 *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) .-hpclulp C Type or print in ink. SCHEDULE C Amounts may be rounded Nonmonetary Contributions Received to whole dollars. Statement covers period -1111 i • - , from 9/22/13 • ' • - Page 13 of 16 through 10/19/13 SEE INSTRUCTIONS ON REVERSE VAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IFAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED) (IF COMMITTEE. ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) ®IND 9/22/13 Mark Kyle ❑COM Attorney Legal 250 2375 ❑OTH Operating Engineers San Rafael, CA 94901 ❑ PTY Local Union #3 ❑ SCC WIND 9/26/13 Mark Kyle ❑COM same as above Legal 500 2875 -same as above ❑OTH ❑ PTY ❑ SCC WIND ❑COM Mayor food and drink at 146 146 10/20/13 010aOW901 ❑ OTH City of San Rafael event ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 896 Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)..................................................................................................................... $ 2. Amount received this period — unitemized nonmonetary contributions of less than $100 .................................... $ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ..................... TOTAL $ *Contributor Codes IND—Individual 896 COM — Recipient Committee 17 (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party 913 SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made 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. SCHEDULE E Statement covers period from 9/22/13 through 10/19/13 Page 14 of 16 I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP 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 fundraising 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 COMMITTEE, ALSO ENTER I. D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID PM Cohen Public Affairs reimburse for data, web design, web ad, office supplies, mail supplies 514.20 San Rafael, CA 94915-0268 Pa Pal Inc. transactional fees for web -based campaign contributions 25.55 [no physical address] lawn and road signs 2,582.00 Richmond, CA 94804 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3121.75 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ........................ $ 18,957.90 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ NA 3. Total interest pard this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ..................................................... .......................... $ 0 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 18,957.90 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Type or print in ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Statement covers period from 9/22/13 through 10/19/13 SCHEDULE E (CONT.) Page 15 of 16 I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP 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 fundraising 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 I IT namnninn literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) eter Rieks WEB 858.18 Novato, CA 94947 United States Postal Service RAFAEL POS 3,171.02 San Rafael CA 94901-9991 LIT 2,491.00 an a four waters media, inc. flyer, sign, campaign literature, and social media LIT design and production 1,815.95 West Sacramento, CA 95605 Affairs CNS 7,500.00 San Rafael, CA 94915-0268 j * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 15,836.15 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) SCHEDULE F Schedule F Type or print in ink. Amounts may be rounded Statement covers periodCALIFORNIA , ' Accrued Expenses (Unpaid Bills) to whole dollars. from 9/22/13 • - through SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 10/19/13 Page 16 of 16 I.D. NUMBER 358370 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 fundraising 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) * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 2,330.25 $ 3893.41 $ 2,330.25 $ 1,563.16 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 3893.41 accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 2,330.25 accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)...................................................................................... NET $ 1,563.16 May be a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD PM Cohen Public Affairs OFC, POS, WEB, 514.30 1192.46 514.30 678.16 political data San Rafael, CA 94915-0268 four waters media, inc. literature/social media 1,815.95 2700.95 1,815.95 885.00 design, writing West Sacramento, CA 95605 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 2,330.25 $ 3893.41 $ 2,330.25 $ 1,563.16 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 3893.41 accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 2,330.25 accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)...................................................................................... NET $ 1,563.16 May be a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)