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Tam 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) 1191695 SEE INSTRUCTIONS ON REVERSE 1. Type of Recipient Committee: All Committees Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee O Recall (Also Complete Part 5) 0 General Purpose Committee O Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information Statement covers period from 01/01/2017 through 06/30/2017 Date of election if applicable: (Month, Day, Year) 11/08/2016 g I CAW I a Complete Parts 1, 2, 3, and 4. O Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Pan 6) • Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 11.D. NUMBER 1387962 COMMITTEE NAME (OR CANDIDATES NAME IF NO COMMITTEE) Tam for Council 2016 STREET ADDRESS (NO P.O. BOX) CITY STATE Alameda CA ZIP CODE 94501 MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE OPTIONAL: FAX / E-MAIL ADDRESS WIS10111■■ M■1 AREA CODE/PHONE (510)590-9536 ZIP CODE AREA CODE/PHONE 2. Type of Statement: Preelection Statement Semi-annual Statement II CA, ,IFC 1NIA COVER PAGE JUL 27 201 Page of 7 CITY OF ALAM DA For Official Use Only CITY CLERK'S 0 FICE O Termination Statement (Also file a Form 410 Termination) 0 Amendment (Explain be)ow) Treasurer(s) O Quarterly Statement O Special Odd-Year Report 0 Supplemental Preelection Statement - Attach Form 495 NAME OF TREASURER Susan Reyes MAILING ADDRESS CITY Alameda NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS ssjreyes@comcast.net IMIIK■1111 STATE ZIP CODE CA 94501 STATE ZIP CODE 1110111■Willa AREA CODE/PHONE (510)882-9536 AREA CODE/PHONE 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 Executed on Executed on Executed on www.neffile.com 07/29/2017 07/29/2017 Date Date Date By By By By Susan Reyes / Date Responsible Officer of Sponsor Signature of Controlling Officeholder, Candidate, State Measure Proponent 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 Lena Tarn OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member: City of Alameda 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 COMMITTEE ADDRESS CITY COMMITTEE NAME CONTROLLED COMMITTEE? ❑ YES ❑ NO STREETADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODE /PHONE I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY www.neffile.com 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 FORM Page 2 460 of 7 ❑ 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 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 ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Tarn for Council 2016 Contributions Received 1. Monetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED 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 $ 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 $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule 1, Line 4 15. Cash Payments Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ 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 $ www.neffile.com Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0.00 0.00 0.00 0.00 0.00 6,091.98 0.00 6,091.98 0.00 0.00 6,091.98 8,284.12 0.00 0.00 6,091.48 2,192.64 Statement covers period from through 01/01/2017 SUMMARY PAGE CALIFORNIA Ag A FORM -Irww 06/30/2017 Page 3 I.D. NUMBER 1387962 of 7 Column B Calendar Year Summary for Candidates CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 0.00 867.00 867.00 0.00 867.00 6,091.98 0.00 6,091.98 0.00 0.00 6,091.98 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 0.00 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 0.00 867.00 20. Contributions Received 1/1 through 6/30 7/1 to Date $ $ 21. Expenditures Made Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) / / / / $ Total to Date *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 B — Part 1 Loans Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Tam for Council 2016 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Lena Tam Alameda, CA 94501 1- 0 IND 0 COM 0 OTH PTY D SCC to IND 0 COM OTH 0 PTY 0 SCC tO IND 0 COM 0 OTH PTY 0 SCC Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Manager EBMUD OUTSTANDING BALANCE BEGINNING THIS PERIOD 867.00 SUBTOTALS $ Statement covers period from through (b) (c) AMOUNT AMOUNT PAID RECEIVED THIS OR FORGIVEN PERIOD THIS PERIOD* 0.00 0.00 $ 0 PAID 0.00 jJ FORGIVEN 0.00 0 PAID FORGIVEN PAID fl FORGIVEN $ Schedule B Summary 1. Loans received this period (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. www.netfile.com o . oo$ 01/01/2017 06/30/2017 (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD 867.00 12/31/2018 DATE DUE DATE DUE DATE DUE 867.00$ 0.00 0.00 NET $ 0.00 (May be a negative number) (0) INTEREST PAID THIS PERIOD 0 RATE SCHEDULE B - PART 1 CALIFORNIA 460 FORM Page 4 I.D. NUMBER of 7 1387962 ORIGINAL CUMULATIVE AMOUNT OF CONTRIBUTIONS LOAN TO DATE 867.00 CALENDAR YEAR 0.00 PER ELECTION** 0.00 08/08/2016 s G2016 8E7 .00 DATE INCURRED RATE DATE INCURRED RATE DATE INCURRED 0.00 (Enter (e) on Schedule E, Line 3) CALENDAR YEAR PER ELECTION ** CALENDAR YEAR PER ELECTION** tContributor 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 D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER Tam for Council 201* DATE NAME OF CANDIDATE OFFICE, AND DISTRICT, OR MEASURE NUMSER OR LETTER AND JURISDICTION, onoowwITss 03/04/2017 Re Elect Benny Lee For City Council 2016 District 4 Support 0 Oppose 06/29/2017 John Chiang for Governor 2018 0 Support [] Oppose 0 Support 0 Oppose Amounts may be rounded to whole dollars. TYPE OF PAYMENT Monetary • Nonmonetary Contribution O Independent Expenditure Monetary Contribution Nonmonetary Contribution LJ Independent Expenditure O Monetary Contribution • Nonmonetary Contribution • Independent Expenditure DESCRIPTION Statement covers period from 01/01/2017 SCHEDULE D CALIFORNIA A FORM through 06/30/e017 Page 5 of 7 uzNUMBER 1387962 CUMULATIVE PER ELECTION AMOUNT THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 300.00 300.00 02016 S300.00 2,500.00 2'500.00s2016 $2,500.00 SUBTOTAL $ 2.800.00 Schedule D Summary 1. Contributions and independent expenditures made this period of $100 or more. (Include all Schedule D subtotals.) � 2. Unitemized contributions and independent expenditures made this period of under $100 � 3. Total contributions and independent expenditures made this pehod. (Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ pppc Form wm(Jamu 16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from through 01/01/2017 06/30/2017 Tam for Council 2016 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc campaign cons |tants contribution (explain nonmonetary)* civic donations candidate filing/baliot fees fundraising events indeperident expenditure supporting/opposing others (explain)* legal defense campaign Iiterature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ^moEwTEn/uwm^BEm Angel Island Immigration San Francisco, CA 94103 MBR MTG OFC FET nHO POL pos PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research pnxtaoo, delivery and messenger services professional services (|eoa|, accounting) print ads Re Elect Benny Lee For City Council 2016 District 4 (ID# 1348446) San Leandro, CA e4573 City of Alameda Alameda, CA 94501 CODE CVC CTB FIL RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E 6 Page r o /o.wumaEn 1387962 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, |nuoinn, 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. AMOUNT PAID 250.00 300.00 1,914.98 SVBTOlAL* 2'464.98 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) � 2. Unitemized payments made this period ofunder$100 s 3. Total interes paid this period on Ioans. (Enter amount from Schedule a. Part 1. Column (n).) � 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 5,771.48 320.00 0.00 6,091.48 FPPC Form 460 (Jan/20 6) pppo Toll-Free xe/nxnp:xaovSK-FppoNsnors-3rru www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from 01/01/2017 through 06/30/2017 Tam for Council 2016 • CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. ClvP CNS CTB CVC FIL FND IND LEG UT 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 NAMEANDADDRESSOFPAYEE (IF COMMITTEE, ALSO ENTER I.D, NUMBER) Alameda County APA Democratic Caucus (ID4 1288862) San Leandro, CA 94577 Chinese Railroad Workers San Francisco, CA 94108 Daily Bowl Newark, CA 94560 John Chiang for Governor 2018 (1D4 1385799) Encino, CA 91436 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 OR MTG CVC CVC CTB * Payments that are contributions or independent expenditures must also be summarized on Schedule D. www.netfile.com RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E (CONT.) CALIFORNIA A an FORM 1.111,0 Page 7 of LD. NUMBER 1387962 7 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) DESCRIPTION OF PAYMENT SUBTOTAL $ ------■ AMOUNT PAID 250.00 399.00 157.50 2,500.00 3,306.50 FPPC Form 460 (Jan/2016) FPPC Toll-Free Help line: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov