HomeMy WebLinkAboutForm 460 - Eli Hill for San Rafael City Council D2; 06-30-22Recipient Committee S m COVER PAGE
Campaign Statement �' • 1
Cover Page Mn
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 1/1/22
through 6/30/22
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
0 Officeholder, Candidate Controlled Committee
* State Candidate Election Committee
O Recall
(Also Complete Part 5)
❑ General Purpose Committee
O Sponsored
O Small Contributor Committee
O Political Party/Central Committee
3. Committee Information
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMM
Eli Hill for San Rafael City Council D2
STREET ADDRESS (NO P.O. BOX)
CITY
❑ Primarily Formed Ballot Measure
Committee
O Controlled
O Sponsored
(Also Complete Part 6)
❑ Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
I.D. NUMBER
1439056
STATE ZIP CODE AREACODE/PHONE
San Rafael, CA 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREACODE/PHONE
OPTIONAL: FAX/ E-MAIL ADDRESS
Date of election if appli1 J U I 20022
(Month, Day, Year)flli 11
11/8/22
2. Type of Statement:
❑ Preelection Statement
® Semi-annual Statement
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
1 of 9
For Official Use Only
❑ Quarterly Statement
❑ Special Odd -Year Report
Treasurer(s)
NAME OF TREASURER
Eli Hill
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
San Rafael, CA 94901
NAME OF ASSISTANT TREASURER, IF ANY
Dyana Delfin Polk
MAILING ADDRESS
STATE ZIP CODE AREA CODE/PHONE
Berkeley CA 94709
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.
Executed on % 2 S t / Z U'LZ By
Date
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of 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)
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Eli Hill
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
San Rafael City Council, District 2
RESIDENTIAL/BUSINESS 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 behaif of your candidacy.
COMMITTEE NAME
I.D. NUMBER
NAME OF TREASURER� CONTROLLED COMMITTEE?
❑ YES ❑ 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
COMM iTTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE - PART 2
Page 2
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
Of 9
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 N0. IF ANY
7. Primarily Formed Candidate/Officeholder Committee Listnamesof
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 (1an/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement Amounts may be rounded
to whole dollars.
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Eli Hill
SUMMARY PAGE
Statement covers peri
from 1/1%22
through 6/30/22 Page 3 of 9
Contributions Received
Column A
TOTAL THIS PERIOD
Column B
CALENDARYEAR
6. Payments Made................................................................
(FROM ATTACHED SCHEDULES)
TOTAL TO DATE
1. Monetary Contributions...................................................
Schedule A, Line 3
$ 4615
$ 4615
2. Loans Received................................................................
Schedule B, Line 3
0
8. SUBTOTAL CASH PAYMENTS .......................................
3. SUBTOTAL CASH CONTRIBUTIONS ..............................
Add Lines 1 +2
$ 4615
$ 4615
4. Nonmonetary Contributions ............................................
Schedule C, Line 3
0
0
5. TOTAL CONTRIBUTIONS RECEIVED ........................
........ Add Lines 3+4
$ 4615
$ 4615
Expenditures Made
6. Payments Made................................................................
Schedule E, Line 4
$
2368.95
$ 2368.95
7. Loans Made.......................................................................
Schedule H, Line 3
0
0
8. SUBTOTAL CASH PAYMENTS .......................................
Add Lines 6+7
$
2118.95
$ 2118.95
9. Accrued Expenses (Unpaid Bills
Schedule F, Line 3
0
0
10. Nonmonetary Adjustment.........................................................
Schedule C, Line 3
0
0
11. TOTAL EXPENDITURES MADE....................................Add
Lines 8+9+10
$
2118.95
$ 2118.95
Current Cash Statement
12. Beginning Cash Balance ............................
Previous Summary Page, Line 16
$
10,872.37
To calculate Column B,
13. Cash Receipts ...........................................................
Column A, Line 3 above
4615
add amounts in Column
0
Ato the corresponding
14. Miscellaneous Increases to Cash ..................................
Schedule 1, Line 4
amounts from Column B
15. Cash Payments.........................................................
Column A, Line 8 above
2368.95
of your last report. Some
amounts in Column A may
16. ENDING CASH BALANCE ..................Add
Lines 12 + 13 + 14, then subtract Line 15
$
13,118.42
be negative figures that
should be subtracted from
If this is a termination statement, Line 16
must be zero.
previous period amounts. If
this is the first report being
17. LOAN GUARANTEES RECEIVED ......................
Schedule 8, Part 2
$
filed for this calendar year,
only carry over the amounts
from Lines 2, 7, and 9 (if
Cash Equivalents and Outstanding Debts
any).
18. Cash Equivalents ................................................
See instructions on reverse
$
0
19. Outstanding Debts ..............................
Add Line 2 + Line 9 in Column 8 above
$
V
I.D. NUMBER
1439056
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
I 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 (Jan/2016)1
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A Amounts may be rounded SCHEDULE A
Monetary Contributions Received w W"Ole u011ara.
Statement covers period
CALIFORNIA ,
from 1/1/22FORM,
INSTRUCTIONS
through 6/30/22
Page 4 of 9
SEE ON REVERSE
NAME OF FILER
I.D. NUMBER
Eli Hill
1439056
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF
[FAN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
CONTRIBUTOR
CONTRIBUTOR
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
RECEIVED
CODE *
(IF SELF-EMPLOYED, ENTER NAME
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
OF BUSINESS)
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
2-19-22
Stephen Mizroch
0 IND
Unemployed
500
500
❑ COM
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
2-25-22
Linda Lieberman
Z IND
Unemployed
250
250
❑ COM
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
2-27-22
Damon Connolly
Z IND
Supervisor, Marin County
250
250
❑ coM
❑ OTH
San Rafael, CA 94903
❑ PTY
❑ ScC
3-20-22
Phyllis Lam
i7J IND
Self- employed, Small
100
100
❑ CoM
❑ OTH
Business Owner
San Jose, CA 95125
❑ PTY
❑ SCC
3-22-22
Mary Liz DeJong
Z IND
Unemployed
100
100
❑ COM
❑ OTH
San Francisco, CA 94112
❑ PTY
❑ ScC
SUBTOTAL $ 1200
Schedule A Summary
1. Amount received this period - itemized monetary contributions.
(Include all Schedule A subtotals.)....................................................................................
2. Amount received this period - unitemized monetary contributions of less than $100 ..
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.).
4250
..............$ 365
*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
TOTAL $ 4615 FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation ,Sh.e@t) Amounts may be rounded SCHEDULE A (CONT.)
Monetary Contributions Received to whole dollars.
Statement covers Period
• .
from 1/1/22
• -
Page 5 of 9
through 6/30/22
NAME OF FILER
I.D. NUMBER
Eli Hill
1439056
FULL NAME, STREET ADDRESS AND ZIP CODE OF
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
DATE
CONTRIBUTOR
CONTRIBUTOR
*
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE
(IF SELF-EMPLOYED, ENTER NAME)
OF BUSINESS)
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
3-22-22
Jeremiah Zins
Z IND
Grocery Manager, Trader
100
100
❑ CCM
❑ OTH
Joe's
San Rafael, CA 94903
❑ PTY
❑ SCC
3-22-22
Kim Chang
® iND
Freelance Consultant
too
100
0 OTH
i
NY, New York 10128
❑ PTY
❑ ScC
3-24-22
Ryne Scott
❑d IND
Consultant, Slalom
100
100
❑ COM
San Pablo, CA 94806
❑ OTH
❑ PTY
❑ SCC
4-9-22
Miles Lasater
I Z IND
Investor, Self -Employed
100
100
❑ COM
El OTH
New Haven, CT 6511
❑ PTY
❑ SCC
6-25-22
George Machun
IND
Unemployed
100
100
El COM
❑ OTH
San Rafael, CA 94901
❑ PTY
I ❑ SCC
SUBTOTAL $ 500
*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
Schedule A Amounts may be rounded SCHEDULE A
"' WIlVic ""IId"'
Monetary Contributions Received
Statement covers period
CALIFORNIA ,
60
from 1/1/22
-
SEE INSTRUCTIONS ON REVERSE
through 6/30/22
Page 6 of 9
NAME OF FILER
I.D. NUMBER
Eli Hill
1439056
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
CONTRIBUTOR
CONTRIBUTOR
*
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
RECEIVED
CODE
(IF SELF-EMPLOYED, ENTER NAME
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
OF BUSINESS)
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
0 IND
6-29-22
Marguerite Roemer
El COM
Unemployed
200
200
❑ OTH
San Mateo, CA 94402
❑ PTY
❑ SCC
Z IND
6-29-22
Eduardo Blount
❑ COM
Open Door Legal, Attorney
100
100
❑ OTH
San Francisco, CA 94122
❑ PTY
❑ SCC
Z IND
6-29-22
Otto Randolph
❑ coM
Unemployed
100
100
❑ OTH
El Segundo, CA 90245
❑ PTY
❑ scC
V IND
6-29-22
Elbert Hill
❑ COM
Expert Witness, Bicycle
200
200
❑ OTH
Commuter Services
San Francisco, CA 94127
❑ PTY
❑ SCC
7 IND
6-30-22
Catherine Colin
❑ COM
Mayor, City of San Rafael
100
100
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
SUBTOTAL $ 700
Schedule A Summary
1. Amount received this period — itemized monetary contributions.
(Include all Schedule A subtotals.).........................................................................................................$
2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$
4250
365
3. Total monetary contributions received this period. 4615
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................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 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.)
Monetary Contributions Received to whole dollars.
Statement covers period
.
•
from 1/1/22
• -
Page 7 of 9
through 6/30/22
NAME OF FILER
I.D. NUMBER
Eli Hill
1439056
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
CONTRIBUTOR
CONTRIBUTOR
*
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
RECEIVED
CODE
(IF SELF-EMPLOYED, ENTER NAME)
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
OF BUSINESS)
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
❑ IND
1-8-22
Northern California Regional Council
V COM
ID# 972104
500
500
❑ OTH
Oakland, CA 94621
❑ PTY
❑ SCC
® IND
4-6-22
Dean Bjornson
El COM
Unemployed
250
250
❑ OTH
Squiem, WA 96382
❑ PTY
❑ SCC
Z IND
4-8-22
Da oberto Ar ueta
g g
❑ coM
Admissions Counselor,
100
100
❑ OTH
SFSU
San Francisco, CA 94131
❑ PTY
❑ SCC
❑ IND
5-23-22
Resource Conservation PAC
El COM
N/A
500
500
❑ OTH
San Rafael, CA 94901
❑ PTY
❑ SCC
❑ IND
6-8-22
Damon Connolly for Assembly 2022
® COM
N/A
500
500
FPPC ID# 1441976.
❑ OTH
❑ PTY
SCC
SUBTOTAL $ 1850
'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
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Eli Hill
Amounts may be rounded
to whole dollars.
Statement covers period
from 1/1/22
through 6/30/22
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
SCHEDULE
ORM;ALIF&MAIA
Page 8 of 9
I.D. NUMBER
1439056
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 AMOUNT PAID
Dyana Delfin Polk CNS Campaign consulting fees 1381.25
Berkeley, CA 94709
Rhett Jones Jr. Photography CMP Photos 450
Oakland, CA
Secretary of State FIL Fees 200
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2031.25
Schedule E Summary
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.) .........................
2281.25
87.7
............... $ 0
.. TOTAL $ 2368.25
FPPC Form 460 (Jan/2016))
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E Amounts may be rounded
(Continuation Sheet) to whole dollars.
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Eli Hill
Statement covers period
1/1/22
from
through 6/30/22
SCHEDULE E (CONT.)
Page 9 of 9
I.D. NUMBER
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 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
Damon Connolly for Assembly 2022
FPPC ID# 1441976.
CTB
Contribution to Damon Connolly for Assembly campaign
250
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 250
FPPC Advice: advice@fppc.ca.gov (866/275-3772)