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Home My WebLink AboutForm 460 - Maribeth Bushey for Council D3 2022; 06-30-23Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 01.01 /2023 through W302023 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 21 Officeholder, Candidate Controiled Committee El Primarily Formed Ballot Measure State Candidate Election Committee Committee Recall Controlled Also campLi'Pait, 5" 1 LJ, Sponsored (Aio Conqp.We Part 6) General Purpose Committee Sponsored 7 Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Centrai Committee 44l4o Corip We Pad 7) KIM I'M 1"M1110-TWWW"IM =-* - LID. NUMBER 1452093 Re -Elect Maribeth Bushey San Rafael City Council District 3 STREET ADDRESS NO P.G. BOX) 396 STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 415- ADDRESS (IF DIFFERENT) NO- AND STREET Z5770. BOX CITY-- — STATE E ZIP CODE AREA CODE1PHONE OPTIONAL: FAX / E-MAI L ADDRESS COVER PAGE attf "1.r-+Deoelecion ie.L U (Month, Day,# 3 2. Type of Statement, MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAY/ E-MAiLADDRESS markkyleBaw@gmaii.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of ;sty to Executed on 07j23/2023 - - 15it-e— Executed on Date Executed on --cwt—e a a By Signature of Controlling tceholder, Candidate, State M.easure proponent BY Signature of Controlling Officeholder, Candidate,, State Measure Propment FPPC Form 460 (Jan/2016)) A COVER PAGE - PART 2 Related Committees Not Included in this Statement: List any commiffees not included in this stabament that are controlled by you or are primarily formed to receive contHbutions or rake expenditures on behalf'ofyour candidacy. COMMITTEE NAME NAME OF TREASUF COMMI TTEE ADDR I.D. NUMBER [I YES C3 NO (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE[PHONE COMMITTEE NAME OF COMMFT-TEE I.D. NUMBER CONTROLLED COS MI: C] YES NO (NO P-0. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER 1 JURISDICTION Page 2 of 4 f—I SUPPORT OPPOSE identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE. OR PROPONENT OFFICE SOUGHT OR DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List narnes of officeholder(s) or candldatefs) for which this committee is p4marfly 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 El OPPOSE Attach'condnuadon sheets ff necessary FPPC Form 460 (Jan/2016) Campaign Disclosure Statement Amounts may be rounded to whole dollars. Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Re -Elect Maribeth Bushey San Rafael City Council District 3 Column A TOTAL THIS PERIOD (FROM . OM ATTACHED SCHEDULES) 1. Monetary Contributions................................................... Sche&1e A, Line 3 $ 0 2, Loans Received.,...... ................... ...... � � schedule B, Line 3 0 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines I + 2 $ 0 4. Nonmonetary Contributions............................................ schedule c, Line 3 0 5� TOTAL CONTRIBUTIONS RECEIVED............................... Add Lines 3+4 $ 0 Expenditures Made 6. Payments Made.. ............... - ................ ........ ........ Schedule, E, Line 4 $ 50-00 7. Loans Made. ................................. - ........... ...... ............ schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENT ......... ......... .... - AdULIeS6+7 $ 50.00 9. Accrued Expenses (Unpaid Bills) ..........................................schedule I=, Linea 0 10. Nonmonetary Adjustment........ .......... _ ........... ........................ Schedule C, Lifie 3 0 111. TOTAL EXPENDITURES MADE ........................ ......... - Add Lines 6 + 9 + 10 $ 50.00 Current Cash Statement 12. Beginning Cash Balance............................ Previous Summary Page, Line 1S $ 1705.0 13. Cash Receipts .................................... ......... ____ ..... Column A, Line 3 above 0 14. Miscellaneous increases to Cash .................................. schedup- 1, Line 4 0 15. Cash Payments .................... ....... ....... ............ Column A Lire 6 above 50.00 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 655.01 If this is a terminafion statement, Line 16 must be zero. 17. LOAN GI-L)ARANTEES RECEWED................................ scheduleB,Part2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ see inst"Waons on reverse $ 0 19. Outstanding Debts.............................. Add Line 2 + Line 5 in Column B above $ 0 SUMMARY PAGE Statement covers period from 01.101/2023 through 06)30/2023 1 Page 3 of 4 Column B CALENDAR YEAR TOTAL TO DATE 0 0 $ 0 0 $ 0 $ 50.00 0 20. Contributions Received $ $ 21. Expenditures Made $ Candidates 50.00 22. Cumulative Expenditures ures Mad $ (if Subject to Vaiuntary Expenditure Lirmt) 0 Date of Election Total to Date 0 (mmi'ddlyy) $ 50.00 $ 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 W 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. SCHEDULE E Schedule E Arnounts may be rounded to whole dollars. Payments Made SEE 1NSTRUCT!ONS ON REVERSE Re -Elect Maribeth Bushey San Rafael City Council District 3 Statement covers period from 01/0112023 through 06tSo/2023 CODE& If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. l.D. NUMBER 1452093 CMP campaign paraphernalialmisc. PASR 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 "VC 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 supportinglopposing others (explain)* POS postage, delivery and messenger services T F transfer between committees of the same c-andidatelsponsor 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 3 I CODE OR DESCRIPTION OF PAYMENT I AMOUNT PAID ,F 1 1 i I COMINMITTEE, ALSO ENTER I.D. NUMBER' Califfornia Secretary of State FIL 50-00 Sacramento, CA 95814 Payments that are contributions or independent expenditures must also be summarized on Schedule 0. SUBTOTAL 50.00 $ Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) ................................... ........ ....... ......... _ ......... ... __ 2. nitemized payments made this period of under $1 00.__ ......... ....... ........ ........... ......... ............ ............... _ ....... $ 50.00 ............. $ 0 3. Total interest paid this petiod on loans. k"nter amount cue U ' I Q I . .............. 1. . ................. ....... _ . . ......... 4. Total payments made this period. (Add Lines I , 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .................... ... $ 0 TOTAL$ 50.00 FPPC Form 460 (Jan/2016))