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Home My WebLink AboutForm 460 - Greg Brockbank for Mayor 2011 (2012-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Statement covers period Date of election if applicable: from 7 / t / 1-4, (Month, Day, Year) through I21 ZI 1. Type of Recipient Committee: An Committees - complete Parts 1, 2, 3, and 4. ( Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall Q Controlled (Also Complete Part 5) Q Sponsored STATE (Also Complete Part 6) ❑ General Purpose Committee ( O Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER t D x 36 NO COMMITTEE) v,C,Q k0"k. F^r_ "° OR' 2. 11 STREET ADDRESS (NO P.O. BOXI CITY STATE ZIP CODE AREA CODE/PHONE ( ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE Date Stamp 2. Type of Statement: ❑ Preelection Statement CR Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER c.rCkrra MAILING ADDRESS COVER PAGE Page of _ For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 CITY q STATE ZIP CODE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE 4. Verification 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. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on �j ' I� 3 Dat Executed on Zi -3 Date Executed on DOW Executed on Data By By By Signature ofContro" Otricahoider, Can6date, Staff Measm Pmponent BY SWatumOfCantroang OftelvIder,O ,StateMeasureProponent FPPC Form 460 (Januaryl06) FPPC Toll -Free Heipllne: 866lASK-FPPC (8661276-3772) State of California Recipient Committee Type or print In ink. COVER PAGE - PART 2 Campaign Statement CALIFORNIA Cover Page — Part 2 FORM 6 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY - STATE ZIP 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 ❑ 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 CODEIPHONE Page 2, of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION f-1SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT SOUGHT OR 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 ❑ 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 (Januaryt05) FPPC Toil -Free Helpline: 8661ASK-FPPC (8661276-3772) State of Camfornla Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE iNAME OF FILER Contributions Received Type or print In ink. Amounts may be rounded to whole dollars. Column TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) ri k-\ A rl 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 1 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 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 If this is a termination statement, Line 16 must be zero. El 19 $ $ Cl n 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents........................................ See instrucHons on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ Statement covers period CALIFORNIA from FORM C through page 3 of I.D. NUMBER 7, 9 'A' 3 Column 8 Calendar Year Summary for Candidates CALENDAR YEAR TOTALTODATE Running in Both the State Primary and I General Elections 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). I 1/1 through 6130 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subject to Voluntary Expenditure Unitt) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule Type or print In Ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to wholle'dollars. Statement covers period from through Page Of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMrFTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) F-JIND F-JCOM 00 BOTH6011 [-] PTY Q_f EISCC FJIND FICOM nOTH r-1 PTY [:]SCC nIND EICOM E]OTH E] PTY EISCC nIND ncom [:]OTH F1 PTY F_1SCC MIND EICOM MOTH E] PTY 0 SCC SUBTOTAL$ 100, 00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ............... ....... ............................ ......... .............................. ......... $ 2. Amount received this period — unitemized monetary contributions of less than $100 ............................. $ M 3. Total monetary contributions received this period. I tyo' 00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .............. ........ TOTAL $ *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: 8661ASK-FPPC (8661276-3772)