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Sullwold 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period 10-21-14 from through 12-31-14 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. • Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee O Recall (Also Complete Part 5) O General Purpose Committee O Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Primarily Formed Ballot Measure Committee o Controlled 0 Sponsored (Also Complete Part 6) El Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER 12349912 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Jane Sullwold for City Council 2014 STREET ADDRESS (NO P.O. BOX) ITY Alameda STATE CA ZIP CODE 94501 MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE OPTIONAL: FAX / E-MAIL ADDRESS jcs@jane4council.com 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. AREA CODE/PHONE 510-864-7026 ZIP CODE AREA CODE/PHONE Date of election if applicable: (Month, Day, Year) 11-04-14 .■■111111111L CAI. IF0,1NIA COVER PAGE JAN 2 6 201 5 of For Official Use Only CITY OF ALAMEDA CITY CLERK'S OFFICE 2. Type of Statement: O Preelection Statement O Semi-annual Statement WI Termination Statement (Also file a Form 410 Termination) 0 Amendment (Explain below) Treasurer(s) NAME OF TREASURER Robert T. Sullwold MAILING ADDRESS CITY Alameda NAME OF ASSISTANT TREASURER, IF ANY Jane Sullwold MAILING ADDRESS CITY Alameda OPTIONAL: FAX / E-MAIL ADDRESS jcs@jane4council.com STATE CA 0 Quarterly Statement 0 Special Odd-Year Report 0 Supplemental Preelection Statement - Attach Form 495 ZIP CODE 94501 STATE ZIP CODE CA 94501 JAMIN101111801100■1 AREA CODE/PHONE 510-864-7026 AREA CODE/PHONE 510-864-7026 Executed on Executed on Executed on . Executed on January 24, 2015 Dale January 24, 2015 Date Date Date By By By By Signature of Controllin State Measure Propon t or Responsible Officer of Sponsor Officeholder, Candidate, State Measure Proponent Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee Type or print in ink. NAME OF OFFICEHOLDER OR CANDIDATE Jane Sullwold OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, Alameda, CA RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Alameda, CA 94501 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? 0 YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME ID. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? El YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 CALIFORNIA 460 FORM Page 2 of 5 0 SUPPORT El 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 candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Attach continuation sheets if necessary O SUPPORT 0 OPPOSE Ej SUPPORT O OPPOSE 0 SUPPORT 0 OPPOSE 0 SUPPORT 0 OPPOSE FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275-3772) State of California CALIFORNIA 460� FORM - Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane SuIIwoId for City Council 2014 Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. 1 Monetary Contributions Schedule A, Line 3 $ 2. Loans Received Schedule 6, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 4. Nonmonetary Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Line 3 + 4 $ Expenditures Made 6. Payments Made Schedule E, Line 4 $ 7. Loans Made Schedule H, Line 3 O. SUBTOTAL CASH PAYMENTS Add Lines e~r $ 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 10. Nonmonetary Adjustment Schedule C, Line 11. TOTAL EXPENDITURES MADE Add Lines 8 + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 13. Cash Receipts Column ^ Line oabove 14. Miscellaneous Increases to Cash Schedule I, Line * 15. Cash Payments Column A, Line oabove 16. ENDING CASH BALANCE Add Lines /2~m~/4, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule ��u $ Cash Equivalents and Outs Outstanding Debts 18. Cash Equivalents See instructions onreverse $ 19. Outstanding Debts Add Lino 2 + Line 9 in Column B above $ Column A TOTAL HIS PERIOD (FROM ATTACHED SCHEDULES) O O 0 0 0 Statement covers period 10-21-14 from through MBE 12-31-14 SUMMARY PAGE 3 Page of /.D.wumnsn 12349912 5 Column B Calendar Year Summary for Candidates CALENDAR ,�n | �� . Running in Both the State Primary and General Elections o 0 Contributions Received $ � 0 21. Expenditures 0 Made 1/1 through 6/30 7/1 to Date 5170.96 5829.96 0 0 5170.96 5829.96 � � � n 0 - - Date of Election 0 0 (mm/dd/yy) 5170.96 5829.96 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (1! Subject to Voluntary Expendituro Limit) Total to Date 5170.96 To calculate Column B, add 0 amounts in Column A to the O corresponding amounts *Amounts n this section may be different from amounts from Column B of your Iast - reported in Column B. 5170.98 report. Some amounts in Column A may be negative 0 figures that should be subtracted from previous period amounts. If this is the first report being filed 0 for this calendar year, only � carry over the amounts ' —' --' from Lines 2, 7, and 9 (if any). 0 . 0 i FPPC Form 460 (January/05) pppu Toll-Free *olpxno:0000vom-FppuNnomro-3rru Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane SuIIwoId for City Council 2014 Type or prin in ink. Amounts may be rounded to whole dollars. Statement covers period 10-21-14 from through 12-31-14 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. mNIP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate fi|inomanmmeu fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ^mocwTEp/D.wumBER) Alameda Junior Golf Club Alameda, CA 94502 Alameda Friends of8ePodm Alameda, CA 94501 Friends of the Alameda Animal Shelter Alameda, CA 94501 MBR MTG OFC FET PHO POL POS PRO PRT member communication meetings and appearances office expenses petition circulating phone banks polling and survey research nostaou, delivery and messenger services professional services (|aua|, accounting) print ads CODE CVC CVC CVC RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE CALIFORNIA Ann FORM -11.1.0 4 5 Page of /o.momasn 12349912 • radio airtime and production costs returned contributions campaign workers' salaries t.x or cable airtime and production costs candidate travel, lodging, and meals otamopnvsnoavo|. |nuoinu, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) OR DESCRIPTION OF PAYMENT * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) � 2. Unibsmized payments made this period of under $1O0 � 3. Total interest paid this period on Ioans. (Enter amountfrom 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 $ AMOUNT PAID 500.00 500.00 500.00 1,500.00 5170.96 0 0 5170.96 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2014 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period 10-21-14 from SCHEDULE E (CONT.) CALIFORNIA 460 12-31-14 5 5 through Page of -- -- - - ID. NUMBER 12349912 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwiae, describe the paymenL oVP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate fihing/bailot fees fundraising events independent supporting/opposing others (explain)* legal defense campaign hterature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER ID. NUMBER) Alameda Homeless Network / Midwa Shelter Alameda, CA 94501 Alameda Food Bank Alameda, CA 94501 A!ameda Meals on Wheels Alameda, CA 94501 MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postaoo, delivery and messenger services professional services (|poo|, accounting) print ads CODE CVC CVC CVC * Payments tha are contributjons or independent expenditures must also be summarized on Schedule D. mm radio airtime costs RFD returned contributions SAL campaign workers' salaries TEL tv. or cable airtime and production costs TRC candidate travel, lodging, d meals TRS staff/spouse travel, muuinu, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) OR DESCRIPTION OF PAYMENT AMOUNT PAID 1.223.65 1,223.65 1,223.66 SUBTOTAL $ 3.670.96 rppo Form wm(Junuary/05) pppc Toll-Free *e/none:onowam+ppo(uoo/2ro-3rrx)