HomeMy WebLinkAboutForm 460 - Samantha Sargent for City Council 2011 (2012-12-31)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
(NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
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)