Sullwold 460Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-842165)
Type or print in ink.
Statement covers period
October 1, 2012
from
SEE INSTRUCTIONS ON REVERSE through October 20, 2012
Date of election if appli,
(Month, Day, Year
November 6, 2012
2. Type of Statement:
Preelection Statement
ri Semi-annual Statement
PI Termination Statement
(Also file a Form 410 Termination)
Li Amendment (Explain below)
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
vi Officeholder, Candidate Controlled Committee
C) State Candidate Election Committee
C) Recall
(Ais Ca mple40 1544 51
LI General Purpose Committee
0 Sponsored
(„) Small Contributor Committee
CD Political Party/Central Cornmittee
3. Committee Information
1349912
ri Primarily Formed Ballot Measure
Committee
C) Controlled
0 Sponsored
Cornoaro Fan 67
El
Primarily Formed Candidate/
Officeholder Committee
(liseifn 'DO:* Pit rt 7)
OCT 2 5
arY OF ALA
COVER PAGE
CALIFORNIA 460
FORM
'4Pag 8
For Official Use Only
FDA
I.U. NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAM( If NO enrowiTEFI
Jane Sullwold for City Council 2012
S I I liE T ADDRESS P 1101,i
CITY STATE 71F-' C OEM"
Alameda CA 94501
MAILING ADDRESS IF DIFFERENT) NO AND STREET OR CO , liOX
CITY STATE ZIP CODE
OPTIONAL F AX / L-MAIL ADDRESS
jcs@jane4council.com
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best
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FPPC Fenn 460 panuary(05)
FPPC Toll-Free Helpline 866/ASK-FPPC (866'275-3772I
State of California
Recipient Committee
Campaign Statement
Cover Page — Part 2
Type or print in ink.
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Jane Sullwold
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Alameda City Council
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?
❑ 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
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER
JURISDICTION
COVER PAGE - PART 2
CALIFORNIA A an
FRM �,.
Page
2
of
8
❑ 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 candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
OFFICE SOUGHT OR HELD
Attach continuation sheets if necessary
❑ SUPPORT
❑ OPPOSE
❑ SUPPORT
❑ OPPOSE
❑ SUPPORT
❑ OPPOSE
❑ SUPPORT
❑ OPPOSE
FPPC Form 460 (January /05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
State of California
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Jane Sullwold for City Council 2012
Contributions Received
1. Monetary Contributions
2. Loans Received
3. SUBTOTAL CASH CONTRIBUTIONS
4. Nonmonetary Contributions
5. TOTAL CONTRIBUTIONS RECEIVED
•
Expenditures Made
6. Payments Made Schedule E, Line 4
7. Loans Made Schedule H, Line 3
8. SUBTOTAL CASH PAYMENTS Add Lines 6 +7
9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3
10. Nonmonetary Adjustment Schedule C, Line 3
11. TOTAL EXPENDITURES MADE Add Lines 8 +9+ 10
Type or print in ink.
Amounts may be rounded
to whole dollars.
Schedule A, Line 3 $
Schedule B, Line 3
Add Lines 1 + 2 $
Schedule C, Line 3
Add Lines 3 + 4 $
Current Cash Statement
12. Beginning Cash Balance
13. Cash Receipts
14. Miscellaneous Increases to Cash
15. Cash Payments
16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15
If this is a termination statement, Line 16 must be zero.
Previous Summary Page, Line 16
Column A, Line 3 above
Schedule 1, Line 4
Column A, Line 8 above
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
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
3,184.00
0.00
3,184.00
0.00
3,184.00
6,699.20
0.00
6,699.20
- 783.37
0.00
5,915.83
9,188.77
3,184.00
0.00
6,699.20
5,673.57
0.00
0.00
0.00
$
Statement covers period
October 1, 2012
from
through
Column B
CALENDAR YEAR
TOTALTO DATE
14,186.00
1,000.00
15,186.00
200.00
15,386.00
9,512.33
0.00
9,512.33
- 783.37
0.00
8,724.96
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).
October 20, 2012
SUMMARY PAGE
CALIFORNIA: "/� 6 V
FORM .. ,' '"f' {,
Page 3 of
I.D. NUMBER
1349912
8
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 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 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Jane Sullwold for City Council 2012
DATE
RECEIVED
10/03/12
10/04/12
10/10/12
10/11/12
10/13/12
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER LD. NUMBER)
Frank Ghiglione Inc.
, San Leandro, CA
94578
Andy Weber
, Alameda, CA 94501
Dave and Joanne Archer
Alameda, CA 94501
Bill Armstrong
Walnut Creek, CA 94501
Victor Jin
Alameda, CA 94501
Type or print in ink.
Amounts may be rounded
to whole dollars.
CONTRIBUTOR
CODE *
❑IND
❑ COM
OTH
❑ PTY
❑ SCC
® IND
❑ COM
❑ 0TH
❑ PTY
❑ SCC
® IND
❑ COM
❑ 0TH
❑ PTY
❑ SCC
IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
VINE/
❑ COM
❑ 0TH
❑ PTY
❑ SCC
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER NAME
OF BUSINESS)
Owner /A.T. Weber
Plumbing & Mechanical
Services Inc,.
Sales /Pump Repair
Service Co.
Attorney /Armstrong &
Associates
Real Estate Broker/
Property Investment
Services
SUBTOTAL $
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.) TOTAL $
Statement covers period
from October 1, 2012
through October 20, 2012
AMOUNT
RECEIVED THIS
PERIOD
100.00
100.00
100.00
100.00
100.00
500.00
2,100.00
1,084.00
3,184.00
SCHEDULE A
CALIFORNIA Agri
ORM , —.
Page
4 of 8
I.D. NUMBER
1349912
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
100.00
100.00
100.00
100.00
100.00
PER ELECTION
TO DATE
(IF REQUIRED)
*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)
Monetary Contributions Received
NAME OF FILER
Jane Sullwold for City Council 2012
Type or print in ink.
Amounts may be rounded
to whole dollars.
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
RECEIVED (IF COMMITTEE, ALSOENTERI.D.NUMBER) CODE
10/15/12
10/17/12 Berkeley, CA 94703
Robyn Young, M.D.
Alameda, CA 94501
Carole Ungvarsky
10/19/12
Jeff and Jeanne Allen
Alameda, CA 94502
"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
IND
['COM
❑ OTH
❑ PTY
❑ SCC
IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER NAME
OF BUSINESS)
Physician /Robyn G.
Young, M.D., a
Professional Corporation
Attorney /McKesson
Corporation
Retired /None
Statement covers period
from October 1, 2012
SCHEDULE A (CONT.)
CALIFORNIA 460
FORM
through October 20, 2012 Page 5 of 8
I.D. NUMBER
1349912
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
1,000.00 1,000.00
500.00 500.00
100.00 100.00
SUBTOTAL$ 1,600.00
PER ELECTION
TO DATE
(IF REQUIRED)
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Jane Sullwold for City Council 2012
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
October 1, 2012
from
through October 20, 2012 Page of
I.D. NUMBER
1349912
SCHEDULEE
CALIFORNIA,,.
FORM
460
6
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
avlP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphernalia /misc.
campaign consultants
contribution (explain nonmonetary)*
civic donations
candidate filing /ballot fees
fundraising events
independent expenditure supporting /opposing others (explain)*
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
Daniel Ziegler Design
Berkeley, CA 94710
Alameda Copy
Alameda, CA 94501
Autumn Press
Berkeley, CA 94710
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE
LIT
LIT
LIT
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
8
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff /spouse travel, lodging, and meals
transfer between committees of the same candidate /sponsor
voter registration
information technology costs (internet, e-mail)
OR DESCRIPTION OF PAYMENT
Design of campaign postcards
Palm cards
Printing and mailing of campaign postcards, deposit
* 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. 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 $
AMOUNT PAID
800.00
116.36
2,750.00
3,566.36
6,506.92
192.28
0.00
6,699.20
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 2012
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from October 1, 2012
through October 20, 2012
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise,
CUP
CNS
CTB
CVC
FIL
FND
ND
LEG
LIT
OEM
campaign paraphernalia /misc.
campaign consultants
contribution (explain nonmonetary)"
civic donations
candidate filing /ballot fees
fundraising events
independent expenditure supporting /opposing others (explain)*
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D, NUMBER)
Autumn Press
Berkeley, CA 94710
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE
LIT
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
SCHEDULE E (CONT.)
CALIFORNIA `/� (�` Q $'
;`. FORM ,.....: "''!'VV.
Page 7 of 8
I.D. NUMBER
1349912
describe the payment.
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff /spouse travel, lodging, and meals
transfer between committees of the same candidate /sponsor
voter registration
information technology costs (internet, e-mail)
OR DESCRIPTION OF PAYMENT
Printing and mailing of campaign postcards (balance)
AMOUNT PAID
$2,840.56
SUBTOTAL $ $2,840.56
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Schedule F
Accrued Expenses (Unpaid Bills)
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Jane Sullwold for City Council 2012
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
October 1, 2012
from
through October 20, 2012
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
CMP
CNS
CTB
CVC
FIL
FND
ND
LEG
LIT
campaign paraphernalia /misc.
campaign consultants
contribution (explain nonmonetary)*
civic donations
candidate filing /ballot fees
fundraising events
independent expenditure supporting /opposing others (explain)*
legal defense
campaign literature and mailings
NAME AND ADDRESS OF CREDITOR
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
945 Camelia Street
Berkeley, CA 94710
* Payments that are contributions or independent expenditures must also be
summarized on Schedule D.
MBR member communications
MTG meetings and appearances
OFC
PET
PHO
POL
POS
PRO
PRT
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
CODE OR
DESCRIPTION OF PAYMENT
LIT
(a)
OUTSTANDING
BALANCE BEGINNING
OF THIS PERIOD
800.00
SUBTOTALS $ 800.00 $
SCHEDULE F
CALIFORNIA s /A
FORM "(,gin`:
TV
Page 8
I.D. NUMBER
1349912
of
8
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging, and meals
transfer between committees of the same candidate /sponsor
voter registration
information technology costs (internet, e-mail)
(b) (c)
AMOUNT INCURRED AMOUNT PAID
THIS PERIOD THIS PERIOD
(ALSO REPORT ON E)
0.00 800.00
0.00 $ 800.00 $
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.) INCURRED TOTALS $
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.) PAID TOTALS $
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and
on the Summary Page, Column A, Line 9.)
(d)
OUTSTANDING
BALANCE AT CLOSE
OF THIS PERIOD
0.00
0.00
16.63
800.00
NET $ -783.37
May be a negative number
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866 /ASK -FPPC (866/275 -3772)