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)