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Home My WebLink AboutForm 460 - Samantha Sargent for City Council 2011 (2013-06-30) AmendmentRecipient Committee Campaign Statement CoverPage Code 84200-84216.5) coversStatement period from 01/01/2013 Date of •• .• (Month, Day, Year) 1. Type A RecliplentParts # 4. JZ Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure State aate Election Committee Committee RecallControlled Sponsored(Also Comp/ete Part 5) 0 Purpose(Also Complete Pat 6) E] General t _ .e Committee0 Sponsored 0 Small Contributor Political Party/Central l Committee Primarily FormedCandidate/ Officeholder (Also Complete Part 7) 3. y i * Information COMMITTEE1341306 DATE'S NAME IF NO COMMITTEE) .. Samantha Sargent for San Rafael City Council 2011 STREET ADDRESS rBOX) CITY STATE ZIP . EA CODE/PHONE San Rafael Ca 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Executed on 01/17/2014 Date Executed on 01/17/2014 Date Executed on Date 91 Date Stamp For Official Use Only 0 «reelection Statement EJ :... arterly Statement / Semi-annual Statement 0 _ Reportal Termination rt PreelectionEl supplemental (Also file . Form 410 Termination) E Amendment (Explain•- • Missed expenditures and payments are listed NAME OF TREASURER Darren Sergent MAILING ADDRESS CITE` STATE ZIP CODE AREACODE/PHONE Sen Rafael Ca 94901 NAME E OF ASSISTANT TREA URER, IF ANY OPTIONAL:STATE ZIP CODE AREA CODE/PHONE ADDRESS By Sgnature of Controffing, SWe Measure Executed on Date By SiMature of Controffingmer, Canddate, State Measum Propment FPPC Form 460 (January/05) FPPC; Toll -Free Helpline: /ASIC -FP 75-3772) State of California Type or print In Ink. 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Samantha Sargent OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael Ca 94901 Related Committees Not Included In this Staterneft. List any committees not included in this statement that are controlled by you or are primarily formed to receiv4 contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER U0WR01L-EE1V-WW-,MTTTEE! YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER Page ------2 of . SUPPORT OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. pig OFi� FICE SOUGHT OR HELD DISTRICT NO, IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names offliceholder(s) or candidate(s) for which this committee is primarily formed. 7: COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD I M I M- NAWEUF�7ko`917 CONTROLLED GOMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE FFICE SOUGHT OR HELD [] YES C] NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA COD PHONE 1. jlliiiili�111�1;11, [] SUPPORT E] OPPOSE SUPPORT OPPOSE FPPC Form 460 (January/05) State of Califomia 16ft 0 WW& a Type or print in ink. t;ampaign ulisclosure Statement Amounts may be rounded Summary Page to whole dollars. NAME OF FILER Samantha Sargent for San Rafael City Counc I Contributions Receleved Schedule E, Line 4 $ 1075.75 ColumnA Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 1075.75 TOTALTHIS PERIOD 10. Nonmonetary Adjustment . ......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE .............add Lines 8 + 9 + 10 $ 1075.75 (FROM ATTACHED SCHEDULES) 1. Monetary Contributions ........................................... Schedule 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 $ 1075.75 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 1075.75 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 $ 1075.75 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 4398.25 13. Cash Receipts ................................................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 10775 15. Cash Payments .................................................. Column A, Line 8 above 5. 16. ENDING CASH BALANCE ........ Add Lines 12 + 13 + 14, then subtract Line 15 $ 3322.50 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED... ................ ....... Schedule B, Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents . ............. --.— ................. See instructions on reverse $ 0 19. Outstanding Debts .......... ......... Add Line 2 + Line 9 in Column B above $ 0 Statement covers period CALIFORNIA from 01/01/2013 1 FORM 4 through 06/30/2013 I.D.NUMBER 11341306 Column B Calendar Year Summary for Candidates CALENDAR YEAR Runni TOTAL TO DATE nq-•s_ the State Primary aflu GeneralElections 0 i $ 1/1 through 6/30 7/1 to Date 1075.75 $ 1075.75 $ 1075.75 20. Contributions Received $ $ 21 . Expenditures Made $ Expenditure Limit Summary for State Candidates 22, Cumulative Expenditures Made* If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mmlddlyy) J— To calculate Column B, add amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts from Column B of your last reported in Column B. 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), FPPC Form 460 (January/05) FPPC Toll - Free Helpfine: 866tK-FPPC (866/275-3772) oft Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, r ar' and Committees INSTRUCTIONSSEE +r • or print Amounts be e -M to whole NAME OF FILER Samantha Sargent for San Rafael City Council DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMrrrEE Gavin Newsome Monetary 6/23/13 Contribution Nonmonetary Contribution Independent Support Oppose Expenditure Katie Rice for Marin BOS 0€ n t ry 3 Contribution [3 Nonmonetary Contribution Independent Support Oppose Expenditure Monetary Contribution No mo r Contribution Independent Support Oppose Expenditure Mi coversStatement _ o 01/01/2013 CALIFORNIA 4 b44C from `CRM 06/3012013 4 through�► # Of NUMBER 1341306 Ong N,it;, CUMULATIVE TO DATE PER ELECTION O . - CALENDAR PERIOD YEAR TO DATE EMS i .Oft bchedule E avium ;191011 NAME OF FILER ,i Samantha Sargent for San Rafael City Council Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from 01/01/2013 through 06/30/2013 I Illiq I I I 111 r 11; 1! M�� I l!"!14111011H 1111111111 111111111 k"OUTT-W4 IT MET M., I.D. NUMBER 1341306 CMP campaign paraphemalia/misc. KI 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 CVC civic donations PET petition circulating TEL t.va 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 TIRS staff/spouse travel, lodging, and meals M independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRIr print ads VVEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Gavin Newsome for Lt. Govn event sponsorship 300 Katie Rice For Marin BOS event sponsorship IND 150.00 San Rafael Police Association ongoing support CVC 100 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 550 FPPC Form 460 (January/05) IJI Lij Schedule E Type or print In ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. NAME OF FILER Samantha Sargent for San Rafael City Council 6*4vslgalvj�� from 01/01/2013 through 06/30/2013 Page of I. D. NUMBER 1341306 1 ro ji I I 1 1 11111