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Home My WebLink AboutForm 460 - Maribeth Bushey for City Council 2017 (2018-06-30)Campaign Statement Cover Page Statement covers period from January 1, 2018 [E0R0 W Date of election if app licableP I I of —3— - a (Month, Day, Year) I J U L 3 1 2'Q 18 1 1 Llyo( Official Use Only Jul 1, 2018 November 7, 2017 CI-P� CLERKS OF , - SEE INSTRUCTIONS ON REVERSE through y f r- i 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement: 0 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement O State Candidate Election Committee Committee Semi-annual Statement ❑ Spec al Odd -Year Report O Recall O Controlled ❑ Termination Statement (Also Complete Part 5) O Sponsored (Also file a Form 410 Termination) (Also Complete Pad 6) ❑ General Purpose Committee ❑ Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (RsoComplete Pad7) 3. Committee Information l I -D. NAME (OR CANDIDATE'S NAME IF NO Maribeth Bushey for San Rafael City Council 2017 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL- FAX / E-MAIL ADDRESS 4. Verification Treasurer(s) NAME OF TREASURER MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE NAME OFASSISTANT TREASURER, IF ANY MAI LING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL- FAX / E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of periury under the laws of the State of California that the foregoing is true and correct Executed on61 ate D B,I - e - glyyatureoflp,a urerorAsslstantiT'aaaver n . Ai Its, i/ Executed on Date Executed on Date Executed on Date By Signature of Controlling Officeholder, Candidate Stale Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council RE SIDENTIALIBUSINESS ADDRESS (NO_ANDSTREET) 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 TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME LD NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO P. CITY STATE ZIP CODE AREA CODE/PHONE ...vv "1% r^ " -rni%i a Page 2— of 3 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE 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 Formed Candidate/Officeholder Committee Listnames of officeholder(s) or candidates) 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 ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov t,ampaign ulsciosure statement �� w •�� to whole dollars. Statement covers periodCALIFORNIA Summary Page January 1, 2018 FORM • from SEE INSTRUCTIONS ON REVERSE through July 1, 2018 Page !� of ? NAME OF FILER I.D. NUMBER Maribeth Bushey %?J 15�— .J ?� Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ S 111 through 6130 7/1 to Date 2. Loans Received................................................................ schedule B, Line 3 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 S $ Received $ $ 4. Nonmonetary Contributions ............................... ......... _.. Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED .................. ............... —Add Lines 3+4 $ 0 $ 0 Made $ $ Expenditures Made 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 S If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 S Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... _..................................... See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ $ 0 $ TO 11 ❑• 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 amounts from Lines 2, 7, and 9 (if any). 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) — J $ 'Amounts In this section may be different from amounts ,eported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov