The URL can be used to link to this page

Home My WebLink AboutForm 460 - Maribeth Bushey for City Council 2017 (2018-06-30) AmendmentRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from January 1, 2018 through June 30, 2018 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. 91 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Pert 5) 0 Sponsored (Also Complete Pert 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Mo Complete Pert 7) 3. Committee InformationI I.D. NUMBER 1358370 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Maribeth Bushey for San Rafael City Council 2017 STREETADDRESS (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 CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification Date of election if appli (Month, Day, Year) c� T TV [E ' i11 AUG 6 2018 November 7,2011 CIV CLERK'S OFFIC COVER PAGE of— For f—For Official Use Only 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement 2 Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) m Amendment (Explain below) Treasurer signature / Date Executed added Treasurer(s) NAME OF TREASURER Maribeth Bushey 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 AREACODE/PHONE 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. , D ^�r �/� Executed on Dale B gnature of Ileasurer or As t Treasurer Executed on Date By Signa urs of Controlling Officeholder, Candidate, State Measure Pr&6nant or Responsible Officer of Sponsor Executed on Date Executed on Dale By Signature of Controlling Officeholder, Candidate, Stale Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPCAdvice: 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 RES IDENTIAL/BUS] NESS 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? [:1 YES E] 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 ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 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 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 ❑ 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 Campaign Disclosure Statement Amounts may be rounded to whole dollars. Summary Page Statement covers period from January 1, 2018 SUMMARY PAGE Expenditures Made 6. Payments Made................................................................ through June 30, 2018 Page 3 of 3 SEE INSTRUCTIONS ON REVERSE 0 0 B. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 0 $ 0 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 NAME OF FILER 10. Nonmonetary Adjustment......................................................... Schedule c, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ I.D. NUMBER Maribeth Bushey 1358370 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary (FROM ATTACHED SCHEDULES) TOTAL TO DATE and General Elections 0 0 1. Monetary Contributions................................................... Schedule A, Line $ $ 0 0 �/� through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule B, Line 3 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 0 0 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 21. Expenditures 0 0 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 0 $ 0 7. Loans Made....................................................................... Schedule H, Line 3 0 0 B. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 0 $ 0 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 0 10. Nonmonetary Adjustment......................................................... Schedule c, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ AddLines 8+9 + 10 $ 0 $ 0 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 tines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 1 1 1 17. LOAN GUARANTEES RECEIVED ................................ Schedule A Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 19. Outstanding Debts .............................. Add Line 2 + Line s in Column B above $ 0 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— 1 $ 1 1 $ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov