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Home My WebLink AboutForm 460 - Samantha Ramirez for Board of Education Trustee 2020 (12-31-2021)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/21 through 12/31/21 1. Type of Recipient Committee: All committees — complete Parts 1, 2, 3, and 4. W1 Officeholder, Candidate Controlled Committee O State Candidate Election Committee ❑ Primarily Formed Ballot Measure O Recall Committee O Controlled (Also CompleNPal 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political PartylCentral Committee (Also Complele Part 7) 3. Committee Information I.D. NUMBER 1430980 _ COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Samantha Ramirez for San Rafael City Schools 2020 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX Cl FY STATE ZIP CODE AREACODE/PHONE San Rafaek CA 94903 OPTIONAL: FAX / E-MAIL ADDRESS COVER PAGE Date of election If applicabl F — �n22I ill P of 4 (Month, Day, Year) �` r Official Use only 1 ICITY CLERK'S OF ICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Semi-annual Statement ❑ Special Odd -Year Report LJ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Samantha Ramirez MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94903 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent 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 Samantha Ramirez OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City School Board, Trustee Area 1 RESIDENTIAL/BUS INESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP San Rafael CA 94903 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. NAME OF TREASURER I.D. NUMBER ❑ YES ❑ NO STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME NAME OF TREASURER ADDRESS STREET I.D. NUMBER CONTROLLED COMMITTEE? ❑ YES ❑ NO C}Ty STATE Z(P CODE AREA CODEIPHONE COVER PAGE - PART 2 Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION j I1{ ❑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 Listnames 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 7/1/21 SUMMARY PAGE Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 524.53 13. Cash Receipts ..... Column A, Line 3 above 12/31/21 Page 3 of 4 SEE INSTRUCTIONS ON REVERSE 15. Cash Payments......................................................... Column A, Line 8 above 108 16. ENDING CASH BALANCE ...............Add Lines 12 + 13 + 14, then subtract Line 15 $ 416.53 through NAME OF FILER I.D. NUMBER Samantha Ramirez 1430980 A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary (FROM ATTACHED SCHEDULES) TOTAL TO DATE and General Elections 1. Monetary Contributions................................................... Schedule A, Line $ $ 1/1 through 6/30 711 to Date 2. Loans Received................................................................ Schedule B, Line 3 20. Contributions 3, SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED...............................Add Lines 3+4 $ $ Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E Line 4 $ 108 $ 108 Candidates 7. Loans Made....................................................................... Schedule H, Line 3 108 108 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS...................... ................. Add Lines6+7 $ $ (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 Date of Election Total to Date (mm/dd/yy) 10. Nonmonetary Adjustment .............. :............................... .......... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 108 $ 108J $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 524.53 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 108 16. ENDING CASH BALANCE ...............Add Lines 12 + 13 + 14, then subtract Line 15 $ 416.53 If 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). "Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Samantha Ramirez Amounts may be rounded to whole dollars. Statement covers period from 7/1/21 through 12/31/21 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SC Page 4 of 4 .D. NUMBER 1430980 CMP campaign paraphernalia/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 WEB Google Domain for Website * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary AMOUNT PAID 108 108 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 108 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov