The URL can be used to link to this page

Home My WebLink AboutForm 460 - Paramedic Services PAC (2011-12-31)Recipient CommftWe Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Statement covers period ' Date of election if appal from 7/1/11 (Month, Day, Year) through 12/31/11 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) O Sponsored ® General Purpose Committee (AW Complete Part 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information IlDuPP�? Committee for San Rafael Paramedic Services STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE • •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. i certify under penalty of perjury under the taws of tf a State of California that the foregoing is true and correct. Executed on j / wBy otTressufor orAssistantTrassiger Executed on By Si 4reofC-er,C .Staff Messure ProponentorResponsbie OffioerofSpomr Executed on By Date SWwhre ofCorftlftori , State Messuv Proponent Executed on By Date SofComrofffv Oftehokler, Carddate, state Measure Proponent FPPC Fort 460 (January/05) FPPC Toil -Free Helpline: 866/ASK-FPPC (5881278-3772) State of California Type or print In Ink. COVER PAGE - PART c Recipient Committee CALIFORNIA Campaign Statement.. ' • 1 Cover Page — Part 2 Page of 3 6. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER ' JURISDICTION RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement; L/sranycommittees 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 NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO CITY STATE ZIP CODE AREA CODE/PHONE • NAME OF TREASURER COMMITTEE•D- •r- • P.O. c• CITY STATE ZIP CODE •• • - Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460(January/06) FPPC Toil -Free Helpline. 6661ASK-FPPC (6661276-3772) State of California Campaign Disclosure Statement Summary Page Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/11 SUMMARY Expenditures Made $ 6. Payments Made ....................................................... Schedule E, Line 4 $ through 12/31/11 Page. 3 of 3 SEE INSTRUCTIONS ON REVERSE 9. Accrued Expenses (Unpaid Bills) ..................... — ....... Schedule F Une 3 10, Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ NAME OF FILER 0 $ 0 I.D.NUMBER Committee for San Rafael Paramedic Services 983147 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPER100 CALENDAR YEAR TOTALTO DOWE Running in Both the State Primary and (FROMATTACHEDSCHMULES) General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ — 102.00 0 0 1/1 through 6130 7/1 to Date 2, Loans Received...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 0$ 102.00 20, Contributions Received $ $ — 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21, Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED .......................... • Add Lines 3 + 4 $ 0 $ 102.00, Made $ $ Expenditures Made $ 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Unes 8 + 7 $ 9. Accrued Expenses (Unpaid Bills) ..................... — ....... Schedule F Une 3 10, Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 0 $ 0 0 0 0 $ 0 0 0 0 0 0 $ 0 Current Cash Statement 12. Beginning Cash Balance.............. ........ Previous Summary Page, Line 16 $ 5,328.04 13. Cash Receipts ... ....... ...................... .... --- .... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0 15. Cash Payments ..... .............. — ................... ....... Column A, Line 8 above — 0 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 5,328.04 If this Is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ..... .......... -- ..... Schedule 8, Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0 19. Outstanding Debts ......................... Add Line 2 +Line gin Column B above $ 0 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subject to voluntary Expenditure Lin*) Date of Election Total to Date (mm/dd/yy) Anel $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline* 866/ASK-FPPC (866/275-3772)