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Home My WebLink AboutForm 460 - Paramedic Services PAC (2012-12-31)ecipientCommiftee ampaign Statement over Page overnment Code Sections 84200-84216.5) E INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period 7/1/12 from through 12/31/12 Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee E] Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 51 0 Sponsored (Also Complete Patmt General Purpose Committee 0 Sponsored M Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) Committee Information I'D NUMBER 983147 COMMITTEE NAME (OR CANDIDATES NAME IF NO COMMITTEE) Committee for San Rafael Paramedic Services STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Date Stamp Date of election if applicable: (Month, Day, Year) 2. Type of Statement: ❑ Preelection Statement W Semi-annual Statement F71 Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Carl Tregner MAILING ADDRESS COVER PP Page of — For Official Use Only 7 Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 CITY STATE ZIP CODE AREA CODE/PHO San Rafael CA 94903 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHO OPTIONAL: FAX i E-MAIL ADDRESS 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. I certify under penalty of perjury under the la of the State of California that the foregoing is true and correct. Executed on -3 By Data Signature of Trea"r or Assistant Treasurer Executed on Date By Signature of Contra -Hing Officeholder Candidate. State Measure Propment or Responsibe Officer Of 977 Executed on Date By SgrmtLxe of Con.trcAng OffcehoKler Gar4idate, State Measure Proponent Executed or, Da�e By SigratLie at Cortrok?ng Cffi:cehokier Candidate, State Measude Propwent FPPC Form 460 (January FPPC Tot( -Free He(plitte: 866/ASK-FPPC (866r275-3* State of Callfo ampaign Disclosure Statement Type or print in ink SUMMARYPP Statement covers period CALIFORNIA 460 Amounts may be rounded immary Page to whole dollars. 7/1/12 from FORM 12/31/12 2 3 INSTRUCTIONS ON REVERSE through Page - of AE OF FILER I.D. NUMBER I ,ommiftee for San Rafael Paramedic Services 983147 )intributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHISPER100 CALENDARYEAR in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATERunning 29.30 48.590 General Elections Monetary Contributions .... .................. _ ........ ......... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date Loans Received .. ........... ........... ....... ....... . Schedule B, Line 3 SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 29.30 $ 48.59 $ 20. Contributions 0 0 Received $ $ Nonmonetary Contributions .......... Schedule CLine 3 21. Expenditures TOTAL CONTRIBUTIONS RECEIVED ............. ...... Add Lines 3 + 4 $ 29.30 $ 48.59 Made $ $ (penditures Made Expenditure Limit Summary for State Payments Made.. ........ __ .... __ ...... ...... , Schedule E. Line 4 $ 0 0 $ Candidates Loans Made......... ..... __ ......... ............... .. Schedule H, Line 3 0 0 0 0 22. Cumulative Expenditures Made' SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ $ (If Subject to Voluntary Fxpendture Limit) Accrued Expenses (Unpaid Bills) ........ _ .... ....... .... Schedule F Line 3 0 0 Date of Election Total to Date Nonmonetary Adjustment ................. ....... Schedule C, Line 3 0 0 (mm/dd/yy) TOTAL EXPENDITURES MADE ........ ...... ..... Add Lines s+ 9 + 10 $ 0 $ 0 $ $ irrent Cash Statement 5347.33 Beginning Cash Balance ..... ..... _ ......... Previous Summary Page, Line 16 $ To calculate Column B, add Cash Receipts ... ........ ......... _ ......... ....... __ ...... Column A, Line 3 above 29.30 amounts in Column A to the Miscellaneous Increases to Cash ........................... Schedule i, Line 4 0 — corresponding amounts from Column B of your last *Amounts in this section maybe different from amounts 0 reported in Column B. Cash Payments.. ............. ......... ....... Column A, Line 8 above — report. Some amounts in Column A may be negative ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 5376.63 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed LOAN GUARANTEES RECEIVED____ ... ........ ... Schedule 13, Part 2 $ 0 for this calendar year, only, carry over the amounts m Lines 2, 7, ands (if from ash Equivalents and Outstanding Debts 0 any, Cash Equivalents .......... __ ...... _ ............. _.. See instructions on reverse $ — 0 Outstanding Debts ... ...... ...... _ ..... Add Line 2 + Line 9 in Column 8 above $ FPPC Form 460 (January, FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-37 :hedule A Type or print in ink. SCHEDUI )Hata Contributions Received Amounts may be rounded ry Statement covers period to whole dollars. 7/1/12CALIFORNIA i from FORM 3 3 12/31/12 INSTRUCTIONS ON REVERSE through Page of IE OF FILER I.D. NUMBER ommittee for San Rafael Paramedic Services 983147 DATE STREETA ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR O RE, CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED it a�SAND I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS} ❑ 1ND F]CDM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH Q PTY ❑ SGC IND [:]Com ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH PTY ❑ SCC 171 IND ❑ coM ❑ OTH ❑ PTY scC SUBTOTAL$ hedule A Summary amount received this period — itemized monetary contributions. ;Include all Schedule A subtotals.} ....................................... kmount received this period — unitemized monetary contributions of less than $100 ............................. $ Total monetary contributions received this period. ;Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.} ....................... TOTAL $ 0 29.30 i #1 '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 464 (January, FPPC Toil -Free Helpline: 866/ASK-FPPC (666/275-37