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Home My WebLink AboutForm 460 - Samantha Ramirez for Board of Education Trustee 2020 (12-31-2022)Recipient Committee Campaign Statement Cover Page If, Statement covers period Date of election if app E4i I Q N 3 0 2023 from July 1,2022 (Month, Day, Year — _ . SEE INSTRUCTIONS ON REVERSE through December 31, 2022 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Pad 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee O Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Pad 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Pad 7) I.D. NUMBER 1430980 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Samantha Ramirez For San Rafael City Schools 2020 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94901 OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification have used all reasonable diligence in preparing and reviewing this statement and to the best of my certify under penalty of perjury under the laws of the State of California that the foregoing is true and Executed on 1/29/2023 By Date Executed on 1/29/2023 Date Executed on Date Executed on Date By COVER PAGE I of For Oficial Use Only Cl CLERK'S OFFICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement m Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Samantha Ramirez 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 AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS By Signature of Controlling Officeholder, Candidate, State 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 Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Samantha Ramirez Amounts may be rounded to whole dollars. CODES: If one of the following codes accurately describes the payment, you may enter the code CMP campaign paraphernalia/misc. MBR member communications CNS campaign consultants MTG meetings and appearances CTB contribution (explain nonmonetary)* OFC office expenses CVC civic donations PET petition circulating FIL candidate filing/ballot fees PHO phone banks FND fundraising events POL polling and survey research IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Secretary of State 150011th Street, Room 495, Sacramento, CA 95814 Statement covers period from July 1, 2022 through December 31, 2022 Page d of I.D. NUMBER 1430980 Otherwise, describe the payment. ULE E RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (intemet, e-mail) CODE OR DESCRIPTION OF PAYMENT FIL Annual Fee & Penalty * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) ................................. 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).). AMOUNT PAID 200.00 SUBTOTAL $ 200.00 $ 200.00 ............................................................ $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 200.00 FPPC Form 460 ()an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from July 1, 2022 SUMMARY PAGE Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 41653 13. Cash Receipts........:...:.............................................. Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments..........................................::............. Column A, Line 6 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 216.53 If this is a termination statement Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule e, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ 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). $ *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 December 31, 2022 Page — of SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER Samantha Ramirez 1430980 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received .......................... ........... ................ ........... Schedule s, Line 3 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS............. ................. Add cines 1 +2 $ $ Received $ _ $ 4. Nonmonetary Contributions. ...... Schedule C, Line 3 21. Expenditures Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E, Line 4 $ 200.00 $ Candidates 7. Loans Made....................................................................... Schedule H, Line 3 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS................. ...................... Add Lines 6+7 $ $ (If subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 Date of Election Total to Date 10. Nonmonetary Adjustment..................................................... Schedule C, Line 3 — (mm/dd/yy) 11. TOTAL EXPENDITURES MADE....................................Add Lines 6+9+10 $ $ _— 1 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 41653 13. Cash Receipts........:...:.............................................. Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments..........................................::............. Column A, Line 6 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 216.53 If this is a termination statement Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule e, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ 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). $ *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