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Home My WebLink AboutForm 460- Maribeth Bushey-Lang for City Council 2013 (2013-09-21)4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my k ge think.informatign under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed on -17 By D* By herein and in the attached schedules is true and complete. I certify H SF ing Officehokfer, Candidate, State Measure Proponent or Rovilla oftwofspry E on By 11 Date Signature of CwtmftV Offic&dder, Carddate, State Meastre Proponertt Executed on Date By Sigr*tre of Cotter Ofteholder, Car4date, State Meastoe Proponer*d FPPC Form 460 (Januaty/06) FPPC Toll -Free Helpflne.- 888 ASK -FP (8661276-3772) State of Callifomint CALIFORNIA 4 0 b' FORM Statement covers period Date of election if applicable: 7/1/13 (Month, D. Year) For Official Use Only from 9/21/13 11/5/13 through I - Type of Recipient Committee: All Committees - Complete Parts Is 20 3, and 4. 2. Type of Statement: Officeholder, Candidate Controlled Committee E:] Primarily Formed Ballot Measure Preelection Statement Quarterly Statement 0 State Candidate Election Committee Committee Semi-annual Statement Special Odd -Year Report 0 Recall 0 Controlled E] Termination Statement Supplemental Preelection (Also complete Pad 5) 0 Sponsored (Also file a Form 410 Termination) Statement - Attach Form 495 General Purpose Committee (Also Compete F*t 6) Amendment (Explain below) 0 Sponsored ® Primarily Formed Candidate/ 0 Small ContributorCommittee Officeholder Committee 0 Political Party/Central Committee (Also Complete Pait 7) W M_777777- 10M-111 sm Iva :417 M- • W-47-311• ii �_Al N A Q 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my k ge think.informatign under penalty of perjury under the laws of the State of California that the foregoing is true and correct Executed on -17 By D* By herein and in the attached schedules is true and complete. I certify H SF ing Officehokfer, Candidate, State Measure Proponent or Rovilla oftwofspry E on By 11 Date Signature of CwtmftV Offic&dder, Carddate, State Meastre Proponertt Executed on Date By Sigr*tre of Cotter Ofteholder, Car4date, State Meastoe Proponer*d FPPC Form 460 (Januaty/06) FPPC Toll -Free Helpflne.- 888 ASK -FP (8661276-3772) State of Callifomint Type or print in ink. EIE [OGW73 a R , 6. a NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey Lang OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of San Rafaeal RESIDENTIALJBUSI NESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94901 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. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [] YES Q NO COMMITTEE ADDRESS STREET ADDRESS (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 STREET ADDRESS (NO P.O. BOX) Page 2 Of 1 6. Primarily Formed Ballot Measure Committez 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 1 7. Primarily Formed Candidate/Officeholder COMMIttGO List names of officeholder(s) or candidate(s) for which this committee Is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E]SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT E]OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE CITY STATE ZIP CODE AR LA UUUt:/VHUNt Attach continuation sheets if necessary FPPC Forin 460 (January/06) FPPC Toll -Free Helpfine: 366/ASK-FPPC (866/276-3772) State of Callforrila Expenditures Made 6,230.53 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ................................... .......................... Schedule H, Line 3 0- 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 61230.53 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 81954.48 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 39579.26 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 18,764.27 Current Cash Statement 12. Beginning Cash Balance ................... ... Previous Summary Page, Line 16 $ 21650-00 13. Cash Receipts ................................................... Column A, Line 3 above 17,880.00 14. Miscellaneous Increases to Cash .......................... Schedule t, Line 4 0 15. Cash Payments .................................................. Column A, Line 8 above 61230.53 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 14,299.47 If this is a termination statement, Line 16 must be zero. Cash Equivalents and Outstanding Debts 0 18. Cash Equivalents ............. __ ................ .... See instwfions on reverse $ 19. Outstanding Debts ............ ....... Add Line 2 + Line 9 in Column B above $ 81954.48 $ 61280.53 0 $ 61280.53 81954.48 41579.26 $ 19,814.27 To calculate Column B, add amounts in Column A to th(.f. 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* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different tom amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline.- 86$/ASK-FPPC (8661275-3772) Statement covers period U"k 1 CALIFORNIA 4bA from 7/1/13 FORM 9/21/13 through NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 ��358370 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR TOTTO AL DATE Running In Both the State Primary and (FROM ATTACHED SCHEDULES) G enerall Elections 179880.00 $ 20,580.00 H 0 0 1/1 through 6/30Date 2. Loans Received ...................................................... Schedule B, Line 3 88000 $ 20,.00 580 1 20. Contributions Received $ $ 3l579.20 41579.20 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Adof 21,459.20 25,159.20 Made $ $ Expenditures Made 6,230.53 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ................................... .......................... Schedule H, Line 3 0- 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 61230.53 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 81954.48 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 39579.26 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 18,764.27 Current Cash Statement 12. Beginning Cash Balance ................... ... Previous Summary Page, Line 16 $ 21650-00 13. Cash Receipts ................................................... Column A, Line 3 above 17,880.00 14. Miscellaneous Increases to Cash .......................... Schedule t, Line 4 0 15. Cash Payments .................................................. Column A, Line 8 above 61230.53 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 14,299.47 If this is a termination statement, Line 16 must be zero. Cash Equivalents and Outstanding Debts 0 18. Cash Equivalents ............. __ ................ .... See instwfions on reverse $ 19. Outstanding Debts ............ ....... Add Line 2 + Line 9 in Column B above $ 81954.48 $ 61280.53 0 $ 61280.53 81954.48 41579.26 $ 19,814.27 To calculate Column B, add amounts in Column A to th(.f. 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* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different tom amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline.- 86$/ASK-FPPC (8661275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded Monetary to whole dollars.• Statement covers period ' from 7/1/13 . • through 9/21/13 Page tj of 2 - SEE INSTRUCTIONS ON REVERSE NAME OF FILER NAME I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE A FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR RE, CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (ET IT I.D. ALSO ENTER IDNUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND 7/13/13 Paula Kamena ❑COM Paula Kamena, 500.00 500.00 ❑OTH Former Marin Novato ❑ PTY County District Attorney ❑ SCC ®IND 7/15/13 Seaneen Wilson ❑coM Administrative Law 100.00 100.00 ❑ OTH Judge, CPUC Oakland, CA ❑ PTY ❑ SCC WIND 7/19/13 ❑COM retired 100.00 100.00 ❑ OTH San Rafael, CA ❑ PTY ❑ SCC ®IND G ys Gillian ❑coM retired 7/20/13 ❑ OTH 100.00 100.00 San Rafael, CA 94901 ❑ PTY ❑ SCC ® IND Maynard Willms ❑coM retired 7/21 /13 E] OTH 100.00 100.00 an a ae , 1 ❑ PTY ❑ SCC SUBTOTAL $ 900.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ............................................ $ 16,500.00 2. Amount received this period — unitemized 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 1.) ....................... TOTAL $ 1,380.00 17, 880.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period towholedollars. 7/1/13 ' - from • through 9/21/13 Page S of 2 NAME OF FI LER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CIF COMMITTEE, ALSO ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Robert Barnett ❑COM retired 7/22/13 ❑ OTH 500.00 500.00 San Rafael, CA ❑ PTY ❑ SCC Denise R an IND ®❑COM homemaker; 7/22/13 ❑OTH none 150.00 150.00 San Rafael, CA ❑ PTY ❑ SCC Resource Conservation PAC ❑IND VCOM 7/24/13 (FPPC # 1347886) ❑OTH 500.00 500.00 San Rafael, CA ❑ PTY ❑ SCC Resource Conservation PAC ❑IND 7/24/13 (FPPC # 1347886) ❑OTH 500.00 1000.00 San Rafael, CA ❑ PTY ❑ SCC All Boro ®IND ❑COM retired 7/25/13 200.00 200.00 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 1,850.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 7/1/13 ' from FORM through 9/21/13 Page to of 2 NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR A RE,ALSAND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED IT I.D. NUMBER) (IF COMMITTEE, CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND J. Dietrich Stroeh ICOM Civil Engineer, 7/26!13 ❑OTH CSW/Stuber-Stroeh 100.00 100.00 Novato, ❑ PTY Engineering Group ❑ ScC Meg Gottstein ®IND ❑COM Consultant, Regulatory 7/27/13 E] OTH Assistance Project 1 100.00 100.00 ❑ PTY ❑ SCC Kate Collin ® IND ❑COM Councilmember, 7/28/13 ❑OTH San Rafael City Council 500.00 500.00 San Rafael, CA ❑ PTY ❑ SCC Robert Ter Huffman MIND ❑ COM Scientist, 7/29/13 F] OTH Huffman -Broadway 1000.00 1000.00 San Rafael, CA ❑ PTY Group ❑ SCC Philip Weismehl ®IND ❑ COM 7/29/13 100.00 100.00 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 1,800.00 '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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period RNIA to whole dollars. 7/1/13 , 460 from a• 9/21/13 7 2 through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE ADDRESSZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND Dorothy Breiner E]COM retired 7/30/13 E] OTH 100.00 100.00 ❑ PTY ❑ SCC Janet Econome ®❑IoM IND retired 7/30/13 100.00 100.00 ❑OTH an ranclsco, ❑ PTY ❑ ScC Cyr Miller ®COM IND EJ retired 7/30/13 100.00 100.00 E] OTH San Rafael, CA ❑ PTY ❑ SCC Neil Moran mIND ❑COM Attorney, 8/2/13 ❑OTH Fretias McCarthy 100.00 100.00 San Rafael, CA ❑ PTY MacMahon & Keating LL ❑ SCC Roger A. Smith ®IND ❑COM Real Estate Sales 7/30/13 ❑ OTH CCNKF 300.00 300.00 San Rafael, CA ❑ PTY ❑ SCC SUBTOTAL$ 700.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period _ to whole dollars. 7/1/13 - ' from 21 9/21/13 through page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND ®❑COM Dan Burcham Administrative Law Judge 7/31/13 ❑OTH CPUC 100.00 100.00 a an ❑ PTY ❑ SCC ®IND ❑coM City Treasurer 8/1/13 , San Carlos, CA ❑OTH Cit of San Carlos Y 100.00 100.00 ❑ PTY ❑ SCC ®IND ❑Steamship COM Shipping 8/1/13 ❑ OTH Geeral 1,000.00 1,000.00 San Rafael, CA 94901 ❑ PTY ❑ SCC Richard Kalish WJINDAttorney EICOM 8/2/13 ❑OTH Kalish Nexon LLP 250.00 250.00 San Rafael, CA ❑ PTY ❑ ScC Linda Rochester WIND FICOM Judge 8/5/13 E] OTH CPUC 100.00 100.00 San Francisco, CA ❑ PTY ❑ SCC SUBTOTAL$ 1,550.00 "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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 7/1/13 , lof_�z from •• � 9/21/13 through Page NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND 8/6/13 Glenn Walker ❑COM 300.00 300.00 ❑ OTH ❑ PTY ❑ SCC ❑IND 8/7/13 120 Buckley Apartments ❑COM 500.00 500.00 ® OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Leo P. Isotalo PCOM IND retired 8/7/13 500.00 500.00 ❑OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ❑ IND 8/13/13 Beale Street Parking, LLC ❑COM 500.00 500.00 ®OTH ❑ PTY ❑ SCC ❑IND 8/13/13 Cal -Pox Inc. El COM 750.00 750.00 LZ OTH Novato, CA ❑ PTY ❑ SCC SUBTOTAL$ 2,250.00 '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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) ScheduleA (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 7/1/13 FORM , from through 9/21/13 Page 10 of NAME OF FI LER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE ADDRESSZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR A CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ITTEE .D. NUMBER) (IF COMMITTEE, CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) E] IND 8/13/13 GSG Partners [-I COM 500.00 500.00 ® OTH 94901 ❑ PTY ❑ SCC 8/13/13 Bramante Martin ®IND ❑COM 500.00 500.00 ❑ OTH San Rafael, CA ❑ PTY ❑ SCC ®IND Partner, 8/13/13 E] OTH Cal -Pox, Inc. 500.00 500.00 San Rafael, CA ❑ PTY ❑ SCC 8/9/13 Lynn Carew LZIND El COM 250.00 250.00 ❑ OTH ❑ PTY ❑ SCC ®IND El COM Investment advisor, 8/11/13 ❑ OTH self 500.00 500.00 ❑ PTY ❑ SCC SUBTOTAL$ 2,250.00 `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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 7/1/13 , from FORM through 9/21/13 Paged ' of 2-l_ NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND ❑COM CFO, 8/14/13 E] OTH Seagate Properties 500.00 500.00 San Rafael, CA 94901 ❑ PTY ❑ SCC Mark Polite ® IND ❑ COM 8/21/13 500.00 500.00 ❑ OTH Mill Valley, CA 94941 ❑ PTY ❑ SCC ® IND El COM businessman, 8/27/13 F1 OTH self 750.00 750.00 San Rafael, CA 94901 ❑ PTY ❑ SCC Leo P. Isotalo WCOM IND retired 9/1/13 0 OTH 500.00 1,000.00 an a ae , ❑ PTY ❑ SCC Larry A. Paul OCOM IND architect, 9/3/13 00TH self-employed 100.00 100.00 an a ae , ❑ PTY ❑ SCC SUBTOTAL$ 2,350.00 "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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 7/1113 � 6 from FORM through 9/21/13 Page 12, of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OFBUSINESS) ®IND ❑COM Attorney, 9/11/13 E] OTH CPUC 100.00 100.00 1 ❑ PTY ❑ SCC San Rafael Firefighters PAC/ #891308 ❑IND ®COM 9/11/13 1,500.00 1,500.00 ❑ OTH an a ae , 4912 ❑ PTY ❑ SCC Mary Gratiot ®IND []COM 9/17/13 250.00 250.00 ❑ OTH Novato, CA 94945 ❑ PTY ❑ Scc Phil Abe ICOM IND Member, 9/19/13 ❑OTH San Rafael Citizen 150.00 150.00 San Rafael, CA 94901 ❑ PTY Advisory Committee ❑ ScC Ph His Brinckerhoff ZIND E]COM CFO, 9/19/13 ❑OTH H & L Commercial Real 150.00 150.00 1 ❑ PTY Estate ❑ SCC SUBTOTAL $ 2,150.00 `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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period _ to whole dollars. 7/1/13 -F—Z-L fromthrough e 9/21/13 Page! o NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE A RES ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED SAND (IF COMMITTEE, I.D. NUMBER) IT CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND Democratic Central Committee of Marin ®COM 9/19/ 13 D OTH 100.00 100.00 acramen o, ❑ PTY ❑ SCC Ga Ra hianti ®IND ❑COM Attorney, 9/19/13 self 500.00 500.00 ❑ OTH San Rafael, CA 94901 D PTY D SCC Richard Kalish ZINDAttorney, EICOM 9/20/13 DOTH Kalish Nexon LLP 100.00 350.00 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 700.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule C ^ ` Type or print in ink. SCHEDULE C wmouncs may oe rounuou Nonmonetary Contributions Received to whole dollars. Statement covers period . - from 7/1/13 • ' - Ivi through 9/21/13 2 7,PDagNUM'BER SEE INSTRUCTIONS ON REVERSE _N_ of NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 1 358370 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 -DEC 31) (IF REQUIRED) ®IND 7/20/13 Ben Strumwasser ❑COM Principal, printing for event $25.00 $25.00 00TH Circle Point Inc. Lafayette, CA 94549 ❑ PTY ❑ SCC ®IND 7/22/13 Mark K le ❑COM Attorney/Gov't Affairs,Leg Legal $375.00 $1,375.00 ❑OTH Operating Engineers San Rafael, CA 94901 0 PTY Local Union #3 [-]SCC 7/29/13 Mark K le ®❑COM same as above Legal $500.00 $1,875.00 [10TH ❑ PTY ❑ SCC 7/30/13 tz IND IZCOM Manager, running shoes $36.00 $36.00 *an*aae 00TH Management Group , 4901 0 PT. ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 936.00 Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.) .................................................. 2. Amount received this period — unitemized nonmonetary contributions of less than $100 .. 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) . ........ $ 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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule C — �Z_ Type or print in ink. SCHEDULE C Amounts may be rounded Nonmonetary Contributions Received to whole dollars.CALIFORNIA Statement covers period , 60, from 7/1/13 • - through 9/21/13 Page PS �_ SEE INSTRUCTIONS ON REVERSE of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IFAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) (IF REQUIRED) Mark K le ®IND ❑COM Attorney/Gov't Affairs, Legal $250.00 $2,125.00 8/3/13 ❑OTH Operating Engineers ❑PTY Local Union #3 [:]SCC ®IND 8/6/13 n ❑COM Human Resource Two cases of $246.50 $246.50 Generalist, wine San Rafael, CA 94901 ElpTy TTH rinchero Winery ❑ SCC 8/14/13 ullou hZIND ❑COM Attorney, bumper stickers $103.00 $603.00 ❑ OTH Syufy Enterprises San Ra ael, ❑ PTY ❑ SCC 9/17/13 Sandra Knell - Mailing Services ❑❑IND data $90.19 $90.19 ®OTH management, Novato, CA 94949 F-1 PTY printing, mailing ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 689.69 Schedule C Summary Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.) .................................................. 2. Amount received this period — unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) 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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule C - Type or print in ink. SCHEDULE C - - - - - -- amounts may no rounaea Contributions Received to whole dollars. ---MNonmonetary Statement covers period • - from 7/1/13 A • ' - through 9/21/13 Page �' of 2J— SEE INSTRUCTIONS ON REVERSE VAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * (IFSELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 -DEC 31) Tom Jereb ®IND [-]COM Engineer, sign hardware, $200.00 $200.00 9/17/13 ❑ OTH PG&E posts an a ae , ❑ PTY ❑ SCC ❑IND 9/19/13 Strahm Communications ❑COM printing $1,753.57 $1,753.57 ®OTH an a ae , F1 PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ Pte' ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ $1,953.57 Schedule C Summary 1. Amount received this period - itemized nonmonetary contributions. (Include all Schedule C subtotals.)................................................................................... 2. Amount received this period - unitemized nonmonetary contributions of less than $100 .. 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) . 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 3,579.26 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E 12 W L4A; a, SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Amounts may be rounded to whole dollars. NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 jpiq[ Statement covers period from 7/1/13 through 9/21/13 :F.Ti r: I.D. Nqui ■u UMBER 358370 CIVP 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 CVC civic donations PET petition circulating TB_ t.v. or cable airtime and production costs FIL candidate filing/ballot fees PFK) 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 MB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Elizabeth Johnson reimburse for Fed Ex delivery 855 Broadmoor Court POS $27.00 Lafayette, CA 94549 PayPal, Inc. fees for website contribution collection www.paypal.com/1 -888-221-1161 $17.15 [no physical address] * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. Schedule E Summary USH -W1 11 1. Itemized payments made this period. (Include all Schedule E subtotals.) .............................................................................................................. $ 2. Uniternized payments made this period of under $100 ........................................................................................................................................... $ 2= N 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) .... ............... ............ .............. ........ .... $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 61230.53 Schedule E " y Type or print in ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Statement covers period from 7/1/13 through 9/21/13 SCHEDULE E (CONT) Page % g of I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP 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 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 COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Marin Women's PC dinner meeting MTG $35.00 Mill Valley, CA 94941 Elizabeth Swanson reimburse for wine for event $60.00 San Rafael, CA 94901 Margot Duane photography for campaign materials $350.00 San Rafael, CA 94912 four waters media, Inc. ! graphic design, messaging consultation, printing $3607.37 West Sacramento, CA 95605 I II Davide Restaurant FND $725.97 ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 4778.34 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) I Schedule E - $ (Continuation Sheet) Payments Made SEE INSTRUCTI, NAME OF FILER REVERSE Maribeth Bushey Lang for San Rafael City Council 2013 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/13 through 9/21/13 SCHEDULE E (CONT.) Page ( � of , I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CUP 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 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 UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) City of San Rafael, c/o City Clerk's Office 1400 Fifth Avenue FIL $840.00 San Rafael, CA 94915-1560 Democratic Central Committee of Marin Dining with Democrats dinner meeting , 94903-0411 MTG $65.00 SRHS Athletic Boosters advertisement and sponsorship at local high school 1, San Rafael CA 94901 I annual fundraising golf tournament � $200.00 Mark Kyle reimbursement for copying and UPS delivery POS $41.88 San Rafael, CA 94901 --- r_ [VI VVI Fuli rULJIIU /nI IC111J San Rafael, CA 4915-0268 LIT $261.16 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1408.04 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTI NAME OF FILER ON REVERSE Maribeth Bushey Lang for San Rafael City Council 2013 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/13 through 9/21/13 SCHEDULE F Page 2' o of 2 I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphemalia/mist. 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 CVC civic donations PEr 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 I IT rimnaian literature and mailinos PRT print ads WEB information technology costs (Internet, e-mail) * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)...... 0 $ 4,215.64 $ 261.16 $ 3,954.48 2. Total accrued expenses paid this period. (Include all Schedule F. Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) . 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.).............................................................. ......... INCURRED TOTALS $ ............. PAID TOTALS $ 9,215.64 261.16 8,954.48 ........................................... I........ NET $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD PM Cohen Public Affairs LIT + OFC 0 775.46 261.16 514.30 San Rafael, CA 94915-0268 Belaire Displays lawn + road signs 0 2,582.00 0 2,582.00 production Richmond, CA 94804 Peter Rieks/Dedita Design WEB NJEJWvato CA 94947 0 858.18 0 858.18 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)...... 0 $ 4,215.64 $ 261.16 $ 3,954.48 2. Total accrued expenses paid this period. (Include all Schedule F. Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) . 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.).............................................................. ......... INCURRED TOTALS $ ............. PAID TOTALS $ 9,215.64 261.16 8,954.48 ........................................... I........ NET $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule F Type or print in ink. Amounts may be rounded (Continuation Sheet) to whole dollars. Accrued Expenses (Unpaid Bills) zl� 11i01:4:1 Maribeth Bushey Lang for San Rafael City Council 2013 Statement covers period from 7/1/13 through 9/21 /13 1 Page 1-k Of 21 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia/misc. MW 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 CVC civic donations PET 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 ND 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 (intemet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR(a) DESCRIPTION OF PAYMENT OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD M AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD PINI Cohen Public Affairs CNS r%,r% 14 CAIIMO 0 51000.00 0 51000.00 San Rafael, CA 94915-0268 SUBTOTALS $ 0 $ 51000.00 $ 0 $ 51000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)