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HomeMy WebLinkAboutForm 460 - Samantha Sargent for City Council 2011 (2012-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from / 1 1 '� C I i through Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. - 'FOOfficeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also CornpAete Part 5) 0 Sponsored F] General Purpose Committee (Aiso Cornpkle Pwl 6) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also CarnrWe Part 7) 3. Committee Information COMMITTEE NAME 'OR CANDIDATES NAME $F NO CCMMITTEE) "I J, 4L_ S�CL-rx Ve, ce'I�m C_ I I LC M ST RIEET ADDRESS (NO P 0 BOX) CA '79qo) '_ - CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR PO BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL FAX / E-MAIL ADDRESS 4. Verification COVER PAGE 'ved Date of election if applicable: Page of (Month, Day, Year) For Official Use Only 2. Type of Statement: F-1 P eelection Statement ❑ Quarterly Statement Se 'i -annual Statement L] Special Odd -Year Report F] Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 EJ Amendment (Explain below) Treasurer(s) NAME OF TREASURER "r r -'e v AILING ADDRESS CITY NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS ZIP CODE AREA CODEiPHONE CITY STATE ZIP CODE AREA CODEIPHOINE OPTIONAL FAX ' E-MAIL ADDRESS 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 under penalty of perjury under the laws ofthe State of California that the foregoing is true and ec�_, Executed on By Date uree€TreeT AssisarYTreasurer Executed on By 7" Date qaA­f' — � 1 4 a_ _4 Executed on Date BY &gnatare eControlling Offilcehoder, Candidate, Stave Measure Proponent I certify Executed on Date BY Signature or Contrdling Officeholder, Canddate, &ate Measure Prcponeft FPPC Form 460 (January/05) FPPC Toll -Free Helpline', 8MASK-FPPC (866II27537721 State of California Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Type or print in ink. OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 0 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? I ❑ YES [:] NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 14IW & 18, 111 I.D. NUMBER NAME OF TREASURERCONTROLLED COMMITTEE? I F-1 YES ❑ NO 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page a of -3 BALLOT NO. OR LETTER JURISDICTION SUPPORT I I Fj f --j OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD 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. COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Ej SUPPORT [I OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT n OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT F1 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE FPPC Form 460 (January/06) FPPC Toll -Free Helpline: BW/ASK-FPPC (866/276-3772) State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Wl Contributions Received Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions ................... ..... Schedule A, Linea $ f� 2. Loans Received ............. .............................. Schedule B. Line 3 C4 3. SUBTOTAL CASH CONTRIBUTIONS ....... Add Lines I + 2 $ 4. Nonmonetary Contributions........._._........._.._....... schedule c, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ......... .... ..... ... Add Lines 3 + 4 $ Expenditures Made 6. Payments Made .............................. 7. Loans Made .... _ ................. ..... __ 8. SUBTOTAL CASH PAYMENTS ....... 9. Accrued Expenses (Unpaid Bills).. 10. Nonmonetary Adjustment .............. 11. TOTAL EXPENDITURES MADE. ..... Schedule E, Line 4 Schedule H, Line 3 ................... Add Lines 6 + 7 Schedule F, Line 3 ............ ___ ... Schedule C, Line 3 � .... .... ...... AW Lines 6 + 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 ... ... _ AoV Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero, SUMMARY PAGE Statement covers -period CALIFORNIA A ; FORM 46' from _12-1,51 1,20 d through Page 3 of 3 I.D. NUMBER Column B CALENDAR YEAR TOTALTODATE $ $ 17. LOAN GUARANTEES RECEIVED .... Schedule 8, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents,..... . .................. ____ See instructions on reverse $ jo 19. Outstanding Debts ..,. ......... __ ... Add Line 2 + Line 9 in Column B above $ ; 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), Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 711 to Date 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 (mmldd/yy) 1 1 $ "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 (866/275-3772)