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Home My WebLink AboutForm 460 - Paramedic Services PAC (2013-12-31)CQVERPAGE Recipient Committee Campaign Statement Cover Page Type or print 1n ink. CALIFORNIA 460 FORM (Government Code Sections 84200-84216.5) rs_;;;;';;;;P~Io;;-;;~;;-;r;;;~;t =5.E~P.19 2tli~ I Statementr co~V'" rS"lLerlOd Dale of election if ( Page / / / '1 (Month. O.y. Ye •• ) 'rom I i Clerk's Office of San Rafael For Official Use Onty SEE tNSTRUCTIONS ON REVERSE through -L/.<..,?;<-=h:..clL.t:...cI.J,-- 1. Type of ReCipient Committee: All CommfttHa -Campleta Parts 1, 2, 3. and 4. o Officehokier, Candidate Controlled CommiHee ~ Primarily Fanned Ballot Measure Committee o State Candidate Election Convnittee o Recall (Nso~IePilll5) ~General Purpose Committee o Sponsored o Small Contributor Committee o Political PartyICenbal Committee 3. CommiUee Infonnation IF NO ® Controlled o Sponsored (Also CO'np/!IIe PBI1 dl o Pnmanly Fonned Candidate! OffICeholder Committee [Also Ccmpete PaIr 7) Committee for San Rafael Paramedic Services STREET ADDRESS (NO POBOX) San Rafael STAlE ZIP CODE CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. ANO STREET OR P.D BOX CITY OPnONAL" FAX I E·MAtl ADDRESS Exea.Jted on Exealled on ExeClJled on Executed on STATE ZIP CODe .,.. - AREA CODE/PHONE AREA CODE/PHONE By By By By 2. Type of Statement: f:reelection Statement Semt-aMual Statement Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Knell MAILING ADDRESS Same as committee CITY NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL FAX J E·MAll ADDRESS STATE o Quarte.1y Stafement o Speaat Odd· Y.a. Report o Supplemental Preeledion Stafement • Allach Foan 495 ZIP CODE AREA CODE/PHONE STATE ZIP CODE AREA CODE/PHONE herein and in the attached schedoles is true and comp&ete . I certify SignalU1lClf~OII'aI1c.kW Candidal:e.StateMNstnl~ FPPC Form 480 (JanU4llry/05) FPPC ToU·Free Helpline: 8661ASK.fPPC (86lin75-Jn2t State of CalifOmia li'po or print in in!<. SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts mlly b. rounded to whofe doM.rs. Statomont ?v ... period from ?[!/t 3 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FilER fi. ,,~lfee Contributions Received ColumnA TOTAl. THIS PERIOO fFROMATTACHED SOi£DULESI 1. Monetary Contributions ........................................... S_ A. Un. 3 $ ;J. t;. 34- 2. Loans Received ...................................................... S_ B. Uno 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... A .. Un""2 $ ,?C(. ~-q:. 4 . Nonmonetary Contributions .................................... Sehe_ C. Uno 3 5. TOTAL CONTRIBUTIONS RECEIVED ........................... A .. u... 3' < $ 'J 9· 'P'1 Expenditures Made 6. Payments Made ....................................................... S<hoduIo Eo liM < $ -:e- 7 . Loans Made ............................................................. S<hoduIo H. Uno l 8. SUBTOTAL CASH PAYMENTS .................................... _Uno ... 7 S 4}- 9 . Accrued Expenses (Unpaid Bills) ............................... Schedu .. F,Uno3 10. Nonmonetary Adjusbnent .......................................... S"''''''''' C. /io. 3 11. TOTAL EXPENDITURES MADE ................................ A .. tm •••••• '0 S Current Cash Statement 12. Beginning Cash Balance ....................... Preyfous SummaryP.ge. Un. 16 5 13. Cash Receipts ................................................... Colli,"" A. Untt 3 .bo .... 14. Miscellaneous Increases to Cash ........................... SchadM I, IJne 4 15 . Cash Payments .................................................. CoIunvIA.UMS.bow 16. ENDING CASH BALANCE .......... AddUnu f2+ 13'1<, __ LIne 15 $ " fills t. • fotminaflon _'"""'. line 16 must be ZOID . 17. LOAN GUARANTEES RECEIVED ........................... S_ B. P." 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ....... ~ ... _ .......................... Se.I~.on,.w,.. S ---.... 'V"7r-- 19. Outstanding Oebts ......................... Add Un. 2 + Un.' in Column B.bove $ _____ ""-__ through 1;1J~!t3 Page $ s s $ $ ColumnB CAt..!HOAR yEAlt TOlALTOOOE To calculate Column B, add amOl.J1ts in Cok.mn A to the corresponding amounts from cotlml'l B of your last report . Some amounts in Column A may be negative fig ..... thai should be lubtnu::ted from previous por1od amounIs. ~ this Is the fiBi report belng filed for this calendar year. only cany over the amounls from Lines 2 . 7 , and 9 (if .ny). I.D. NU MBER QP3 1 ti- Calendar Vear Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 711 to Dale 20. Conlributions Received $ ____ _ $ ___ _ 21 . Expenditures M~ $ ____ _ $_--- Expenditure limit Summary for State Candidates 22. Cumulltlve Expenditures Mad.- rr~I.VIllunl:Mr~NlJrNe' Date of Election (mmlddlyv) Total '0 Dale $_--- ·Amounls In this section may be different from amounts repo~ed in Column B. FPPC Form 460 (JlnulrylOsl FPPC TolI..fr .. Helpline: 8181ASK.FPPC (8661276-3772, • Schedule A Monetary Contributions Received seE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print In Ink. Amounts may be rounded to whole dollars, DATE RECEIVED FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (lFCOMMmEE.AI..SOENTERLO.NUUBER) CODe * IF AN INDMDUAL, ENTER OCCUPATION AND EMPLOYER pfSElF-EUPlOYED, EHlER NAME or BUSINESS) Schedule A Summary 1. Amount received this period -itemized monetary contributions. olNO oeOM DOTH o PlY osee OINO oeOM DOTH o PlY osee olNO oeOM DOTH o PlY osee olNO oeOM DOTH o PlY osee olNO oeOM DOTH o PlY osee SUBTOTALS Statemanl c:,. period from 7 d lY through /y/J/(IJ SeHEOULEA CALIFORNIA 460 FORM Page 1,0 . NUMBER ?}f>3 /¥7 AMOUNT RECEIVED THIS PERIOD CUMULATJVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TOCATE (IF REOUIRED) ·Contrlbutor Codes INO-Individual (Include all Schedule A subtotals.) ...........................•...............•.•••..............••........•...................••..•.•.••.. $ _____ ..,- 2. Amount received this period -unitemized monetary contributions of less than $1 00 .....•..•.................... $ _--=?_Cf._. ,_3--'.1_ COM -Recipient ConwniHee (other than PTY or seC) OTH -Olher (e.g •• business entity) PTY -Political Party 3. Total monetary contributions received this period. I L (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ........•...•.......... TOTAL $ _--.:"7~q~. ::.3~'C,--SCC -Small Contributor Committee FPPC Form 460 (January/OS) FPPC Tol~F"", Helpline: 8661ASK-FPPC (8661275-37721