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HomeMy WebLinkAboutForm 460- Maribeth Bushey-Lang for City Council 2013 (2013-10-19) AmendmentRecipient Committee Campaign Statement CoverPage (Government Code Sections 84200-84216.5) Type or print in ink. Date Stam 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) CITY STATE ZIP CODE San Rafael CA 94901 AREA CODE/PHONE ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Treasurer(s) CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS NAME OF TREASURER Mark Kyle, Esq. 6 Page of Date of election if applicable: (Month, Day, Year) For Official Use Only 11/5/13 2. Type of Statement: F� Preelection Statement F-1 Quarterly Statement F� Semi-annual Statement F-1 Special Odd -Year Report Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Provide additional/corrected information on 9 contributors; correct arithmetical & carry-over errors on pp. 3 + 13 (of original filing) 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 CODE/PHONE ( OPTIONAL: FAX / E-MAIL ADDRESS FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASI -FPPC (866/276-3772) State of California i• i � i i a E l s CALIFORNIA M-1 FORM 4 b4% 0 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 RESIDENTIALIBUSINESS 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? YES F� NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 0 6. Primarily Formed Ballot NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION F� SUPPORT Q 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 SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E] SUPPORT Q OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [:] SUPPORT OPPOSE Attach continuation sheets if necessary FPPC Form 60 (January/06) FPPC Toll-FreeHelpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE _Z2 Summary P age Amounts may be rounded Statement covers period to whole dollars. A 0 3101 from 9/22/13►W through 10/19/13 Page 3 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 Contributions Received Column A TOTALTHIS PERIOD Column B Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 16 $ 36,819 0 0 1/1 through 6/30 7/1 t© 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 1042 5,521 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 17,281 $ 42,440 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... Schedule E, Line 4 $ 18,958 $ 25,238 Candidates 7. Loans Made ............................................................. Schedule H. Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 18958 , $ 25,238 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 1,503 10,517 Date of Election Total to Date 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 1042 5,621 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 21,563 $ 41,376 $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 14,849 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 16,239 amounts in Column A to the 0 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 from Column B of your last, reported in Column B. 15. Cash Payments .................................................. Column A, Line 8 above 18,958 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 12130- 1 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if 0 any). 18. Cash Equivalents ........................................ see instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 10,517 FPPC For 460 (January/05) FPPC Toll -Free Helpline.- 866/ASK-FPPC (8661275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may of rounded Monetary to whole dollars. Statement covers period _ A• from 9/22/13 ' FORM 4 6 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 A DEO 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 (IF COMMITTEE, IT .D.N CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND 9/25/13 MirhaPl Smith El COM Retired 100 100 corrected address 0OTH San Rafael, CA 94901 ❑ PTY ❑ SCC WIND 10/5/13 David Bernardi ❑COM Engineer, 100 100 added occupation ❑OTH Project Management and employer Novato, CA 94947 ❑ PTY Services, LLC ❑ SCC WIND 10/5/13 Jack Krvstal E] COM President, Diversified 200 200 added occupation DOTH Capital Investments, Inc. and employer San Rafael, CA 94912 El PTY ❑ SCC BIND 9/22/13 Thomas Allen ❑COM Vice President, 100 100 corrected I ❑OTH Wells Fargo misspelled name, ban matael, CA 94901 ❑ PTY ❑SCC employer ®IND 10/8/13 Michael Ghilotti ❑COM President, 250 250 added occupation ❑OTH Ghilotti Bros., Inc. and employer San Rafael, CA 94901 El PTY ❑ SCC SUBTOTAL$ NA 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.) ...... $ no change TOTAL $ from original `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 3'F fromthrough • 10/19/13 5 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 CUMULATIVETO 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 Frank Noonan El Retired 10/8/13 E] OTH 100 100 added occupation San Rafael, CA 94901 ❑ PTY ❑ ScC 10/8/13 Rosalie Weigle ®IND FICO Realtor, 500 500 added occupation Frank Howard Allen and employer San Rafael, CA 94901 El PTY ❑ ScC Tracy Price ®IND COM ❑San Teacher, 10/8/13 F-1 OTH Rafael School 100 100 added occupation San Rafael, CA 94901 ❑PTY District and employer ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC []IND ❑ COM ❑ OTH ❑ PTY [:]SCC SUBTOTAL $ NA "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 Type or print Amounts may be rounded Nonmonetary Contributions Received to wholedollars. Statement covers period from 0/22/13 SEE INSTRUCTIONS ON REVERSE through 10/10/13 .Page 6 of 6 NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION DATE ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET CALENDAR YEAR TO DATE RECEIVED {IF COMMITTEE, ALSO ENTER I.Q. NUMBER} {IF SELF-EMPLOYED, ENTER NAME 4F BUSINESS) VALUE {JAN 1 - DEC 31 } {IF REQUIRED} ScheduleJ 1. Amount received this period -- itemized nonmonetary contributions. 908 IND -individual (include all Schedule C subtotals.) ..................................................................................................................... COM - Recipient Committee $0 {other than P or SCC} 2. Amount received this period -- unitemized nonmonetary contributions of less than $100 .................................... OTIC _ Other e.g., business entity PTY - Political Pam 3. Total nonmonetary contributions received this period. 1042 SCC - Spall Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Colum A, Lines 4 and 10.) ...................... TOTAL FPPC Form 460 (January/05 FPPC Toll -Free Helpline: e: 866/A i -FPP (866/275-3772) 2)