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Home My WebLink AboutForm 460 - Samantha Sargent for City Council 2011 (2012-06-30) AmendmentRecipientCommiftee Campaign Statement. CoverPage (Govemment Code Sections 84200-84216.1-. UZ Statement covers period 12/31/2011 from through 06/30/2012 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2,3, and 4. Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Alw Complete Part 5) 0 Sponsored General Purpose Committee (Also Complete Part 6) 0 Sponsored Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I 11.D.NUMBER 1341306 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Samantha Sargent for San Rafael City Council 2011 STREET ADDRESS (NO Pb CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Executed on 01/17/2014 [we Executed on 01/17/2014 C�ate Executed on DaW 0 M IJ Date of election If applicable: Page of on (Mth, Day, Year) For Official Use Only I 11/08/2011 2. Type of Statement: Preelection Statement Ej Quarterly Statement Semi-annual Statement E] Special Odd -Year Report E3 Termination Statement Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Missed expenses and contribution are listed NAME OF TREASURER Darren Sargent MAILING ADDRESS CITY STATE ZIP CODE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE '6P'_T_1_0__NAL: FAX / E-MAIL ADDRESS By Signature of Controffing OfficWrNder, Camfidate, State Measure Pry Executed on Date By Signature of Cot*offing Offia4x)4der, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866JASK-FPPC (866/275-3772) State of California W 4 JFORNIA FORM 4 5. Officeholder or ! Controlled NAME OF OFFICEHOLDER CANDIDATE Samantha a " APPLICABLE)OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF San RESIDENTIALJBUSINESS ADDRESS ., San a Related Committees Notnot included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMI'TTEENAME T.D. NUMBER Included STREET ADDRESS (NO ROBOX)CONTROLLED COMM177EI YES NO CITY STATE ZIP CODE AREA CODE/PHONE 6. Pr1imarlilyBallotMeasure Committee NAME OF BALLOT MEASURE Page Of & . SUPPORT OPPOSE Identify _ controlling officeholder, candidate, s ffi. - proponent,, .; y. OFFICE SOUGHT !*" HE DISTRICT NO. IF ANY 7. PrImarily Formed Candlidate/Offilceholder Committee List names officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF TREASURER CONTROI~LED COMMITTEE?NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD YES NO COMMITTEE DRESS STREET ADDRESS , ) CITE' STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets FPPC Form 460 (January/05) State of California e or fit. at Statement Amounts may be rounded �.. rint in ink. * Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Samantha Sargent for San Rafael City Council Contributions i Column TOTALTHIS PERIOD ACHEDSCHEDULES) 1. Monetary Contributions ........................................... Schedule A, Eras a 2. Loans Received ...................................................... Schedule a Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines . Nonmon tart' Contributions .................................... schedule C, Line . TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lire + 4 Expenditures • . Payments Made ........................................................ Schedule l E, Lite 298 . Loans Made ............................................................. Schedule H, Line 3. SUBTOTAL CASH PAYMENTS T° .................................... Add Lines 6 + 7 298 . Accrued Expenses Unpaid ills) ............................... schedule F, Lire 10. Nonmonetary Adjustment .......................................... Schedule C, Line 11. T T ITU ................................ Add Lines + 9 + 298 12. Beginning Cash Balance Previous Summary , Lias . 24 13. Cash Receipts lump A, Lias 3 above 50 . Miscellaneous Increases to Cash ........................... schedule , Line 4 A Cash Payments .................................................... Column A, Line 8 above 298 . Add Lines 12 + 13 + 14, thea subtract Line 5 <9.76> ff this is a tetTninatidn statement, Lire 16 mast be zero. . LOAN GUARANTEES RECEIVED...... . .................... Schedule , Part Cash Equivalents and Outstanding Debts Equi valents .........................—............ See instructions on reverse . Outstanding Debts.................. a....... Add Line Lias 9 in Column B above Columnumn Calendar .f Summary Candidates CALENDAR YEAR TOTAL TO DATE Runningin 1Moth the .rte Primary and $ 50 General Elections III through 6/30 7/1 to Date 4 298 ' 2. Contributions Received 21. Expenditures Made 1 Expenditure L11ml Summary it for State Candidates 22. Cumulative ExpendituresMade* different(If Subjeet to Voluntary Expenditure Limit) late of Election Total to Date (mm/dd/yy) *Amounts in this section may be FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) covers` Aft Aft " - r I CALIFORNIA wa 12/31/2011 a 4bu from I FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Samantha ,-Coulnc DATE L NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, FLYER RECEIVED IF COMMITTEE,ENTER I.D. NUMBER) 7E OCCUPATION AND EMPLOYER IF SELF-EMPLOYED, , ENTER NAME F BUSINESS) through 06/30/201 Page 4 I.D. NUMBER 1341306 CALENDARAMOUNT CUMULATIVE TO DATE PER ELECTIO RECEIVED THIS YEAR TO DATE PERIOD (JAN. I - DEC. 31) (IF REQUIRE] FPPC Form 460 (January/05) FIPIPC Toll -Free l (866/275-3772) Summary ofExpenditures Amounts+�-d Candidates,Supporting/Opposing Other to whole dollars. Measures and Committees REVERSESEE INSTRUCTIONS ON NAME OF FILER Samantha Sargent for San Rafael DATE SAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT MEASURE NUMBER OR LETTER AND JURISDICTION, ORCOMMITTEE Monetary Contribution onmonetary Contribution Independent Support Oppose Expenditure Monetary Contribution Nonmonetary Contribution Independent Support Oppose Expenditure Monetary Contribution onrnonetery Contribution independent uppert Oppose Expenditure SUBTOTAL $ Statement covers period CALIFORNIA 12/31/2011 FORM 46C from 06/30/2012 5 through .. ., CALENDAR1341306 CUMULATIVE TO DATE PER ELECTION AMOUNTTHIS YEAR TO DATE PERIOD . Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)......................................................... 2. Unitemized contributions and independent expenditures madethis period of under 5 ,W ,,. C Form 460 (January/05) ., Schedule E Payments Made �ji� l�, 1:1Apt 1 11111 1111111 ir;��111111�11111 I Type or print tin ink. Amounts may be rounded to whole dollars. Statement covers period from 12/31/2011 through 06/30/2012 Page 6 Of I.D. NUMBER CODES.- If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the paymenl, CMP campaign paraphernalia/misc. MBR member communications RAD radici 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.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 M independent expenditure supporting/opposing others (explain) POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads MB information technology costs (internet, e-mail) tilt L4Uaa#: Lail Kaj U:j ir# 11011 T_X7TWW7TtTTXTT1k K#TtWV1 t7T# M 177111 1. Itemized payments made this period. (include all Schedule E subtotals.) .............................................................................................................. $ 125 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 173 4. Total payments made this period. (Add Lines 1. 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 298 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)