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HomeMy WebLinkAboutForm 460 - Samantha Sargent for City Council 2011 (2013-12-31)Recipient Committee Type or print in ink. Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Statement covers periodDate of election If applicable: from - -'-� / I I I Z_ I (Month, Day, Year) Date Stamp SEE INSTRUCTIONS ON REVERSE through _ti'_O_j�n_ dS� I ii 1. Type f Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 2. Type of Statement: Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure M "lection Statement 0 State Candidate Election Committee Committee Q'I'Semi-annual Statement 0 Recall 0 Controlled F1 Termination Statement (Also complete Part 5) 0 Sponsored (Also file a Form 410 Termination) F-1 General Purpose Committee (AJSO Complete ftrt 6) ❑ Amendment (Explain below) 0 Sponsored r Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) "16 C u o ( CITY STATE ZIP CODE C1 V -I -C 14— el MAILI NO. AND STREET CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER VI\,1 COVER PAGE , Page _L Of — For Official Use C F-1 Quarterly Statement M Special Odd -Year Report F-1 Supplemental Preelection Statement - Attach Form 495 \.J CITY ZIP CODE AREA CODE/PHONE Ct C, ct '76 , 0 ( STATE( 56 kA li�" MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification 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 laws of the State of California that the foregoing is true and correct. 11 Executed on 11-31 By 14 S Trp6turer6rAss�,stantlfeeKurer'l�� _�3 Executed on ZBye Zt Date Executed on Date Executed on Date BY Sq' -t— of ContalkV Officd-clder, Cardidate, State Mea"e Propawt By SW,at-eofC-*o&Ver, Canddate, State Measoxe Pmpawt FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (85612753772) State of California Recipient Committee Type or print in ink. COVER PAGE-PART2 Campaign Statement O'. t60 Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE �t0T' OFFICE SOUGHT OR HELD (INCLUDE LOCATION MD DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO_ AND TREM CITY STATE ZIP - ,)- 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. •'' 1, NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Pageof ` _ 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER( JURISDICTION (❑ SUPPORT ❑ 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 ohhcehohder(s) or candhdate(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/05) FPPC Toll -Free Helpline: 966/ASK-FPPC (8661275-3772) State of Callfomia Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 411 112- through 12-1-4,1 J/,�- NAME OF FILER C1 el 1�kict ai U Contributions Received ColumnA columna TOTALTHISPER100 (MOM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE 1. Monetary Contributions ......... ..................... .... Schedule A, Line 3 $ 5,2 -"c -- $ 'p- C;Z 4) — 2. Loans Received ............... ...... ...... ...... Schedule B, Line 3 17$—C 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 ....................................................... Schedule E, Line 4 $ $ 7. Loans Made ................. ............ .......................... Schedule H, Line 3 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 10. Nonmonetary Adjustment ........................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+ 10 $ $ Current Cash Statement '239 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... .... Add Lines 12 + 13 + 14, then subtract Line 15 $ ff this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents...... ..... ... - ....... See instructions on reverse $ 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). I SUMMARY PAGE Page 3 Of I.D. NUMBER / 3 '-/ ,, Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 7/1 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 (mm/dd/yy) "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) Schedule Type or print in ink. SCHEDLILE A Amounts may De rounaeo Monetary Contributions Received to whole dollars. Statement covers eriod p A F from ---4 / / / / i- - L 0 through / 2- /,3 Page SEE INSTRUCTIONS ON REVERSE _ of -7 NAME OF FILER '5 I.D. NUMBER DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER LD NUMBER) CONTRIBUTOR CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE (IF SELF-EMPLOYED, EWER NAME Or BUSINESS) PERIOD (JAN. I - DEC. 31) (IF REQUIRED) [,,I O'A IND 4COM -2CO DOTH (7 rv- Q PTY scC Zi EKD E]COM S,_C U 1 2 110TH rt Ila &,c�jmp El PTY r-1 SCC 11 C -0CLY f-49 VA IND K COM 2 !��V �6 'Z e--, FJOTH '1>4 V -t C A- [] PTY nscc 941e-11-11\ 4C (e L; &.-Ce [:] IND MCOM ❑OTH n PTY 11 scc ❑IIND ❑Com ❑OTIH Q PTY El SCC SUBTOTAL$ 57--dOe Schedule A Summary 1. Amount received this period — itemized monetary contributions. (include all Schedule A subtotals.) ... — ............. - ........ ---- ....... — ........ ....... — ......... $ 2. Amount received this period — uniternized monetary contributions of less than $100 .............. ..... — $ 3. Total monetary contributions received this period. {Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line ..... TOTAL $ *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY— Political Party SCC — Small Contributor Committee FIPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) SCHEDULE B - PART 1 bcneauie tj - Pan 1Arno"Unts may be' rounded Statement covers period CALIFORNIA A Loans Received to whole dollars. F 60 from FORM SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER IF AN INDIWDUAL, ENTER OCCUPATION AND EMPLOYER (a) OUTSTANDING BALANCE (b) AMOUNT (C) AMOUNT OUTSTANDING DING INTEREST (f) ORIGINAL W CUMULATIVE (IF COMMITTEE, ALSO ENTER lo, NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS ERIOD RECEIVED THISBALANCEAT PERIOD OR FORGIVEN THIS PERIOD* CLOSE OF THIS PERIOD PAID THIS PERIOD AMOUNTOF LOAN CONTRIBUTIONS TO DATE V3 ❑PAIDA/ CALENDARYEAR beFORGIVEN PERELECTION— RATE $ $ tk IND 0 COM El OTH E] PTY 0 SCC s $ DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR f -I FORGIVEN PER ELECTION— RATE f (:] IND [3 COMEl OTH ❑PTY C] SCC DATE DUE DATE INCURRED E] PAID CALENDAR YEAR ❑ FORGIVEN PERELECTION— RATE t[] IND [I COM [I OTH❑PTY [] SCC I DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period.................................................................................................................... (Total Column (b) plus uniternized loans of less than $100.) 2. Loans paid or forgiven this period . . .......................... ....... ...... .............. .......... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) __ .... ...... ........... ....... NET $ Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. (tnter (e) on SdvdLde E, Lire 3) fContributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) N Schedule D .qrHFr)i 11 F 0 U111111dry ut CXpenuilLure5 type or print in ink. Amounts may be rounded Supporting/Opposing Otherilii to whole dollars. Statement covers period CALIFORNIA 460 Candidates, Measures and Committees from FORM through I Z13111 2- 4-- SEE INSTRUCTIONS ON REVERSE Page. of NAME OF FILER I.D. NUMBER -3 ly DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNTTHIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE OR COMMITTEE PERIOD (JAN. I -DEC. 31) (IF REQUIRED) lJ cl r -a' 4vgm Monetary 5C 12- Contribution Nonmonetary Contribution ❑ Independent Support ❑ Oppose Expenditure rl WtA-, Monetary Contribution CoA'� CA— ❑ Nonmonetary Contribution ❑ Independent Support El Oppose Expenditure 0 Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent 0 Support 0 Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ................... -- ... ... --- $ 2. Uniternized contributions and independent expenditures made this period of under $100 .... -- .... ........ -- ... ........ .... _ .... _- 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ....... A ;IL2 0 1-I co TOTAL $ FIPPC Form 460 (January/05) FPIPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 2— through Page -)I of I.D. NUMBER W] c" CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia/misc. MBR member communications RAD radio 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 CVG civic donations PEr petition circulating TEL t.v. or cable airtime and production costs FL 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 W independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger'services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER} CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Cv C PC, VA 4,J GY-I, -50 CA Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) .... .......... ...... ......... ........ $ J 2. Uniternized payments made this period of under $100 ....... ...... ....... ........ ....... _ ....... ........... 3. Total interest paid this period on loans, (Enter amount from Schedule 13, Part 1, Column ................. ............ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) . ............ _ ... ... TOTAL $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-3772)