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Tam 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) 1154814 SEE INSTRUCTIONS ON REVERSE Statement covers period from 07/01/2017 Date of election if applicable: (Month, Day, Year) Date Stamp E JAN 3 1 2018 CA! IFORNIA FORM through 12/31/2017 11/08/2016 CITY OF ALAMEDA 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee O State Candidate Election Committee o Recall (Also Complete Part 5) 0 General Purpose Committee O Sponsored o Small Contributor Committee O Political Party/Central Committee 0 Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Part 6) [1] Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1387962 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Tam for Council 2016 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Alameda CA 94501 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE OPTIONAL: FAX / E-MAIL ADDRESS 1■• 1•1■1111711. AREA CODE/PHONE (510)590-4536 ZIP CODE AREA CODE/PHONE 2. Type of Statement: O Preelection Statement O Semi-annual Statement CITY CLERK'S OFF CE Termination Statement (Also file a Form 410 Termination) O Amendment (Explain below) Treasurer(s) 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 COVER PAGE 1 of 5 For Official Use Only 0 Quarterly Statement 0 Special Odd-Year Report 11 Supplemental Preelection Statement - Attach Form 495 STATE ZIP CODE CA 99501 STATE ZIP CODE AREA CODE/PHONE (510) 882-4536 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 01/31/2017 Date 01/31/2017 Date Date Date By By By By Susan Reyes Lena Tam . — 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) Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE Lena Tam 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 CONTROLLED COMMITTEE? 0 YES 0 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? 0 YES 0 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 Aan FORM 'II' 1111, ‘11F 0 SUPPORT 0 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 0 SUPPORT O OPPOSE 0 SUPPORT O OPPOSE O SUPPORT O OPPOSE 0 SUPPORT O OPPOSE FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Campaign Disclosure Statement Summary Page SEE NSTRUCTIONS ON REVERSE NAME OF FILER Tam for Council 2016 Contributions Received 1. Monetary Contributions Schedule A, Line 3 Z. Loans Received Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines /~z 4. Nonmonetary Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines x~* Expenditures Made 6. Payments Made 7. Loans Made Schedule E, Line 4 Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) Schedule * Line o 10. Nonmonetary Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines o~y~m Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash 15. Cash Payments 16. ENDING CASH BALANCE Previous Summary Page, Line 16 Cofumn A, Line 3 above Schedule 1, Line 4 Column A, Line 8 above Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. • 17. LOAN GUARANTEES RECE!VED Schedule B, Part Cash Equivalents and Outstanding Debts 18. Cash Equivalents See instructions on reverse 19. Outstanding Debts Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0.00 -867.00 -867.00 0.00 -867.00 1,325.64 0.00 1,325.64 0.00 0.00 1,325.64 z'z92.a4 -867.00 0.00 1,325.64 0.00 0.00 0.00 Add Line 2 + Line 9 in Column B above $ ».»« � Statement covers period from through Column B CALENDAR YEAR TOTALTO DATE 0.00 0.00 0.00 0.00 0.00 7,417.12 0.00 7.«17.zz 0.00 0.00 7,417.12 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your Iast report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If ths is the first report being filed for this calendar year, only carry over the amounts from Liries 2, 7, and 9 (if any). 07/01/2017 12/31/2017 SUMMARY PAGE CALIFORNIA 460 FORM 3 Page s ' ID. NUMBER 1zx7yaz |- '---'------^ -----' Calendar ¥ear Surnrnary for Candidates Running in Both the State Primary and General Elections 20. Contributions Received | 21. Expenditures Made � 1/1 through 6/30 7/1 to Date $ � Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (IT Subject m Voluntary Expenditure Limit) Date of Electio (mm/dd/yy) / / Total to Date *Amounts in this section may be differen from amounts reported in Column B. pppo Form wm(Jun/2m16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) 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 ID. NUMBER) Lena Tam Alameda, CA 94501 IND 0 COM D OTH D PTY LJ SCC -11:1 IND 0 COM 0 OTH 11] PTY SCC 1-0 IND D COM D OTH PTY SCC Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Manager El3MUD (a) OUTSTANDING BALANCE BEGINNING THIS PERIOD 867.00 SUBTOTALS $ Statement covers period from through 07/01/2017 12/31/2017 (b) (c) (d) OUTSTANDING AMOUNT AMOUNT PAID BALANCE AT RECEIVED THIS OR FORGIVEN. CLOSE OF THIS PERIOD THIS PERIOD PERIOD 0$ PAID 867.00 0.00 0 FORGIVEN 0.00 0.00 12/31/2018 DATE DUE PAID $ $ FORGIVEN DATE DUE PAID $ $ 0 FORGIVEN 0.00 $ 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 $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. 867.00$ DATE DUE 0. oo$ 0.00 867.00 NET $ -867.00 (May be a negative number) (e) INTEREST PAID THIS PERIOD 0 RATE SCHEDULE B - PART 1 CALIFORNIA 460 FORM Page 4 I.D. NUMBER 1387962 (f) ORIGINAL AMOUNT OF LOAN 867.00 0.00 08/08/2016 DATE INCURRED 5 RATE RATE 0.00 (Enter (e) on Schedule E, Line 3) of 5 (9) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR $ —867.00 PER ELECTION** CALENDAR YEAR $ DATE INCURRED DATE INCURRED 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) ' Schedule E Payments Made SEE NSTRUCTONS ON REVERSE NAME OF FILER Tam for Council 2016 Amounts may be rounded to whole dollars. Statement covers period from through 07/01/2017 12/31/2017 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. GAP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate finng8,aUc*fono fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER m.NUMBER) Susan Reyes Alameda, CA 94501 MBR MTG OFC FET PHO POL PoS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research pnuxase, delivery and messenger services professional services (|eUo|, accounting) print ads CODE PRO RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E CALIFORNIA FORM 460 Page sn of s /.o.wumasm 1387962 radio airtime and production costs returned contributions campaign workers' salaries t.^ or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, |odsino, 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. Unitemized paymerits made this period of uncier $1 00 � 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 300.00 300.00 300.00 ^'nz5.m 0.00 /'s2u.6« FPPC Form 460 (Jan/2016) pppc Toll-Free *v|pxne:ao6/Aan-FpPC(oomzrs's7rz)