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Home My WebLink AboutForm 460 - Maribeth Bushey for Council D3 2022; 12-31-22Recipient Committee Campaign Statement Cover Page Statement covers period Date of election if appii 1 J from 10/23/2022 (Month, Day, Year) 11 SEE INSTRUCTIONS ON REVERSE through 12/31/2022 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee Q RecallO Controlled (AtsoCompbir *06) o Sponsored (Atso Compbk Part 6) ❑gneral Purpose Committee Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political PartylCentral Committee (AhoCompbkP&r7) 3. Committee Information LD NUMBER Re -Elect Maribeth Bushey San Rafael City Council District 3 2022 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY SIAIE GIF CODE AREA CODEIPHONE OPTIONAL: FAX/ E-MAIL ADDRESS 5 COVER PAGE 11146 1 of 7 1 11/08/2022 LUE CLERK'S QE MG 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Z Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Mark L. Kyle, Esq. MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 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 knowtedg Executed on Date By Sigriawte4:1Controlling Ofteho$dar. candidate. State Measure Proponent Executed on Date By nature of Corptrolirtg MAWR Car3date. 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 Maribeth Bushey OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) City Council, District 3, City of San Rafael 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 behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE STREETADDRESS (NO CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME NAME OF TREASURER ADDRESS STREETADDRESS I.D. NUMBER ❑ YES ❑ NO COVER PAGE - PART 2 Page 2 of 7 S. 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 officeholder(s) or cand/dete(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 CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets ifnecessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Cam al n Disclosure Statement Amounts may be rounded p g to whole dollars. Summary Page INSTRUCTIONS ON REVERSE SUMMARY PAGE Statement covers period from 10/23/2022 through 12/31/2022 I Page 3 of - NAME OF FILER- . 114 1"DCR Re -Elect Maribeth Bushey San Rafael City Council District 3 1452093 Expenditures Made $ Column A Column B Contributions Received schedule E, Line 4 TOTAL THIS PERIOD CALENDAR YEAR 7. Loans Made....................................................................... schedule H, Line 3 (FROM ATTACHED SCHEDULES) TOTAL TO DATE 1. Monetary Contributions................................................... schedule A, Line $ 2950.00 $ 34579.00 2. Loans Received ..................... .. Schedule B, Line 0.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS..... •....................... Add Lines 1 +2 $ 2950.00 $ 34579.00 4. Nonmonetary Contributions ........................ schedule c, Line 3 0.00 811.19 $ 0.00 2950.00 35390.19 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ $ Expenditures Made $ To calculate Column B, 12. Beginning Cash Balance ........................... Previous summary Page, Line 16 6. Payments Made ................................................. ............... schedule E, Line 4 $ 17592.35 $ 32873.99 7. Loans Made....................................................................... schedule H, Line 3 0.00 0.00 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 17592.35 $ 32873.99 9. Accrued Expenses Unpaid Bills schedule F, Line 3 0.00 0.00 10. Nonmonetary Adjustment......................................................... schedule c, Line 3 0.00 811.19 11. TOTAL EXPENDITURES MADE....................................Add Lines +9+10 $ 17592.35 $ 33685.18 Current Cash Statement $ To calculate Column B, 12. Beginning Cash Balance ........................... Previous summary Page, Line 16 $ 16347.36 13. Cash Receipts . column A, Line 3 above Amounts in this section may be different from amounts 2950.00 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 of your last report. Some 0.00 15. Cash Payments......................................................... column A, Line s above 17592.35 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ 1705.01 If this is a termination statement Line 16 must be zero. this is the first report being 17. LOAN GUARANTEES RECEIVED ............ -- ................ schedule B, Part2 $ 0.00 Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if 18. Cash Equivalents ................................................ See Instructions on reverse $ 0.00 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 0.00 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" (If Subject to voluntary EVenditure Limit) Date of Election Total to Date (mmidd/yy) $ To calculate Column B, add amounts in Column A to the corresponding Amounts in this section may be different from amounts amounts from Column B reported in 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). FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppe.ca.gov Schedule A Amounts may be rounded SCHEDULE A io wnoie uonars. Monetary Contributions Received Statement covers period CALIFORNIA 460, from 10/23n022 .RM through 12/31/2022 Page 4 of _7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Re -Elect Maribeth Bushey San Rafael City Council District 3 1452093 FULL NAME, STREETADDRESS 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 (.IAN. 1 - DEC. 31) (IF REQUIRED) 11/08/2022 Marin Professional Firefighters PAC OD030791) ❑ IND $2450.00 $4900.00 ® CoM ❑ OTH Sacramento, CA 95814 ❑ PTY ❑ SCC 11/14/2022 No. Cal. Carpenters Regional Council (ID#972104) ❑ IND 500.00 500.00 ❑ COM ❑ OTH Oakland, CA 94621 ❑ PTY ® scC 13 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC [:1 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 2950.00 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 .................. $ 2950.00 $ 0_00 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ................. _-TOTAL $ 2950.00 '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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Amounts may be rounded Statement covers period to whole dollars. Payments Made from 10/23/2022 ON REVERSE I through 12/31/2022 Page 5 of Re -Elect Maribeth Bushey San Rafael City Council District 3 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1452093 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 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) four waters media, inc. CNS 5767.75 LTr West Sacramento, CA 95691 Cornerstone Printing POS 613.58 Novato, CA 94949 Cornerstone Printing POS 546.24 Novato, CA 94949 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 6927.57 Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under $100............................................................................................................................ ........... $ 17,592.35 0.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)...................... ....................................................... $ 0.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 17,592.35 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule ESCHEDULE (Continuation Sheet) Payments Made Amounts maybe rounded to whole dollars. AMOUNT PAID E (CONT.) Statement covers penod 10/23/2022 from . • SEE INSTRUCTIONS ON REVERSE CNS through 1231/2022 Page 6 of 7 NAME OF FILER West Sacramento, CA 95691 I.D. NUMBER Re -Elect Maribeth Bushey San Rafael City Council District 3 PMCohen Public Affairs CNS 1452093 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalialmisc. 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 IND independent expenditure supporting/opposing others (explain)* POL POS polling and survey research postage, delivery and messenger services TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor LEG legal defense LIT campaign literature and mailings PRO PRT professional services (legal, accounting) print ads VOT voter registration 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) four waters media, inc. CNS 5107.50 1H West Sacramento, CA 95691 PMCohen Public Affairs CNS 1000.00 San Rafael, CA 94915-0268 Law Office of Mark Kyle PRO 2576.95 San Rafael, CA 94901 Maribeth Bushey OFC 940.33 MTG San Rafael, CA 94901 Law Office of Mark Kyle PRO 500.00 San Rafael, CA 94901 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 10124.78 FPPC Form 460 !an 201& FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule ESCHEDULE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID E (CONT.) FII. Amounts may be rounded Statement covers period (Continuation Sheet) to whole dollars. ,, •' , g ' Payments Made from 10/23/2°22 ' through 12/31/2022 7 SEE INSTRUCTIONS ON REVERSE of Page NAME OF FILER I.D. NUMBER Re -Elect Maribeth Bushey San Rafael City Council District 3 1452093 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 Maribeth Bushey San Rafael, CA 94901 FII. 540.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 540.00 FPPC Form 464 !an 2D16 FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov