HomeMy WebLinkAboutForm 460 - Andrew McCullough for City Council 2015 (2016-12-31)Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from _____ 7_/1_'_16 __ _
12/31/16 through ________ _
1. Type of Recipient Committee: All Committees-Complete Parts 1, 2, 3, and 4.
3.
I!ll Officeholder, Candidate Controlled Committee o State Candidate Election Committee o Recall
(Abo Complel. Petl SJ
o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee
McCullough for City Council 2015
STREET ADDRESS (NO P.O. BOX)
CITY
San Rafael
STATE
CA
o Primarily Formed Ballot Measure
Committee o Controlled o Sponsored
(A"" C<lmpkl. Petl6)
o Primarily Formed Candidatel
Officeholder Committee
(Abo Complol. Petl7)
AREA CODEIPHONE ZIP CODE
94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX I E-MAIL ADDRESS
4. Verification
Date of election if ap
(Month, Day, Year)
2. Type of Statement:
o Preelection Statement
~ Semi-annual Statement o Termination Statement
DateSlamp
JAN 3 0 20 17
CLERK'S OFFI E
o Quarterly Statement o Special Odd-Year Report
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Andrew McCullough
MAILING ADDRESS
CITY
San Rafael
NAME OF ASSISTANT TREASURER. IF ANY
MAILING ADDRESS
CITY
OPTIONAL: FAX I E-MAIL ADDRESS
STATE ZIP CODE
CA 94901
STATE ZIP CODE
AREA CODE/PHONE
AREA CODE/PHONE
I have used all reasonable diligence in preparing and reviewing this statement and to the best of knowledge the information contained herein and in the attached schedules is true and complete.
certify under penalty of perjury under the laws of the State of California that Ihe foregoing is e nd correct.
,?£,t:~
Executed on 1/29/17
Date
Executed on
Date
Executed on
Dale
Executed on
Dale
By
By
By
By
Signature of Treasurer or Assistant Treasurer
Signature of ConlrcUlng Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Signa lure of Controlling Officeholder, Candidate, Stale Measure Proponent
Signaturo of Controlling Officeholder, Candidate, State Measure Proponenl
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Recipient Committee
Campaign Statement
Cover Page -Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Andrew McCullough
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
San Rafael City Councilmember
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREED CITY STATE ZIP
San Rafael CA 94901
Related Committees Not Included in this Statement: Listanycommlttees
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.
COMMITIEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
DYES ONO
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITIEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
DYES o NO
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE -PART 2 .... ~""
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETIER JURISDICTION o SUPPORT o 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
offlceholder(s) or candidate(s) for which thIs committee ;s prlmarffy formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Andrew McCullough
Contributions Received
1. Monetary Contributions ................................................... Schedule A, Line 3
2. Loans Rece ived ................................................................ Schedule B, Line 3
$
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 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 S
7. Loans Made ....................................................................... Schedule H, Line 3
8. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 $
9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3
10. Nonmonetary AdjustmenL ...................................................... Schedule C, Line 3
11. TOTAL EXPENDITURES MADE. ....................................... Add Lines 8 + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summary Page, Lme 16 $
13 . Cash Receipts ................................................. .... ...... Column A, Lme 3 above
14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4
15. Cash Payments ......................................................... Column A, Line 8 above
16 . ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtracl Line 15 S
If this is a termination statement, Une 16 must be zero .
17. LOAN GUARANTEES RECEiVED ................................ ScheduleB. Part 2 S
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ See inslructlons on reverse $
19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $
Amounts may be rounded
to whole dollars.
ColumnA
TOTAl THIS PERIOD
(FROM ATIACHEO SCHEDULES)
o
o
o
o
a
50
a
o
o
o
50
3002.84
a
o
50
2952.84
a
o
o
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM from ____ 7_'_1'_1_6 __ _
h h 12'31/16 t roug ___________ _ Page __ 3 __ of __ 4_
$
$
$
$
$
s
Column B
CALENDAR YEAR
TOTAL TO DATE
o
o
o
a
o
2600
a
2600
o
o
2600
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
previou's 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).
1.0. NUMBER
1339798
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/1 to Date
20. Contributions
Received $ _____ _ $-----
21 . Expenditures
Made $ ____ _ $-----
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
(II Subject 10 Voluntary Expenditure limit)
Date of Election
(mm/dd/yy)
Total to Date
$_----
$-----
"Amounts in th is section may be different from amounts
reported in Column B.
FPPC Form 460 (Jan/20I6)
FPPC Advice: advice@fppc.ca,gov (866/275-3772)
www.fppc.cil.gov
SCHEDULE E Schedule E
Payments Made
Amounts may be rounded
to whole dollars. Statement covers period
from __ ---.:..7.:..../1:.:./~16=__ __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE through __ 1..::;2--,/3--,1--,/1--,6~_ Page_4 __ of _4 __
NAME OF FILER I.D. NUMBER
Andrew McCullough 1339798
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production cos Is
CNS campaign consultants MTG meetings and appearances RFD returned contributions
CTB contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries
CVC civic donations PET petition circulating TEL t. v. or cable airtime and production costs
FIL 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
IND 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
LIT campaign literature and mailings PRT print ads WEB Information technology costs (Internet. e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMtnEE. ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAlD
Secretary of State
FIL 50
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS 50
Schedule E Summary
50 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _
o 2. Un itemized payments made this period of under $1 00 .................................................................................................................. " ...................... $ _____ _
o 3. Total interest paid this period on loans. (Enter amount from Schedule B. Part 1. Column (e}.} ............................................................................. $ _____ _
50 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 (Jao/2016)
FPPC Advice: advice@fppc.ca.gov (866/27S-3772)
www.fppc.ca.gov