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deHaan 460R ecipient Committee Campaign S tatem ent Cove Pag (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Stater pent c pv period from through 1. T� of Recipient Comt]I'� ttee: All Committees Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Fart 5) 0 Sponsored E] General Purpose Committee (Also Complete Part 6) 0 Sponsored Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Part Central Committee (Also Co mplet e Part 7) 3. Committee Information I.D. NUMaE COMMITTEE NAME (OR CANDIDATE'S NAME IF No COMMITTEE) CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX 1 E MAIL ADDRESS ,Candidate, State Measure Proponent or Responsible officer of Sponsor or Assistant Treasurer Executed on By Date Executed on Date Date of election if (Month, Day, Date C OF ALAMEDA LERK'S OFFICE 20 Type of Statement: Preelection Statement E❑ Semi annual Statement Termination Statement (Also file a Form 410 Termination) Amendment (Explain below) COVER PAGE Page of For Official Use Only �j Quarterly Statement Special Odd -Year Report Supplemental Preelection Statement Attach Form 495 Treasurer(s) Signature of Controlling officeholder, Candidate, State Measure Proponent By 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 AFWA N Campai Disclosure Statement Summar Pa SEE INSTRUCTIONS ON REVER,43E T or print in ink. SUMMARYPAGE. Amounts ma be rounded to whole dollars. Statement covers period Schedule E, Line 4 i on from Schedule H, Line 3 th rou X P a g e of NAME OF FILER Ca�/y'� rr� rV &-Z&-Cr �adC Contributions Received Collurnn A TOTAL THIS PERIOD (FROM ATTACHE© SCHEDULES) 0-N 1. Monetar Contributions Schedule A, Line 3 2. Loans Received Schedule 8, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines I 2 4. Nonmonetar Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 .1.4 20. Contributions Received 21. Expenditures Made Expenditures Made 6. Pa Made Schedule E, Line 4 7, Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6 7 9. Accrued Expenses (Un Bills) Schedule F, Line 3 10. Nonmonetar Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURE,'.") MADE Lines 8 9 10 Current Cash Statemient 12. Be Cash Balance Previous Summar Pa Line 16 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule 1, Line 4 eel/ 15. Cash Pa Column A, Line 8 above 110 16. ENDING CASH BALANCE Add Lines 12 13 14, then subtract Line 15 e If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 Cash E and Outstandin Debts 18. Cash E See instructions on reverse 19. outstandin Debts Add Line 2 Line 9 i Column B above To calculate Column B add amounts in Column A to the correspondin amounts from Column B of y our last report. Some amounts in Column A ma be ne fi that should be subtracted from previous period amounts. If this is the first report bein filed for this calendar y ear, onl carr over the amounts from Lines 2, 7, and 9 (if an Expenditure Limit Summar for State Candidates 22. Cumulative Expenditures Made* (if Su to Volunta Expen Li mit Date of Election Total to Date (mm/dd/ I *Amounts in this section ma be different from amounts reported in Column B. FPPC Form 460 Januar y /05 FPPC Tofl-Free Helpline: 866/ASK-FPPC (8661275-3772) Sc P°ft Type or print in ink. SCHEDULE B PART I Loans Re Amounts may be rounded Y to whole dollars. Statement covers period 4 from SEE INSTRUCTIONS ON REVERSE thrvugh Page of NAME OF FILER le 144 x,,. f I.D. NUMBER. FULL NAME, STREET ADDRESS AND �!P CODE OF LENDER IF AN INDIVIDUAL, ENTER OUTSTANDING OCCUPATION AND EMPLOYER BALANCE {b} (C} AMOUNT AMOUNT PAID id} OUTSTANDING (e) INTEREST ORIGINAL (9) CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) RECEIVED THIS IF SELF EMPLOYE EN BEGINNING THIS OR FORGIVEN NAME OF BUSINE55) PERIOD PERIOD THIS PERIOD BALANCEAT CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE PERIOD PAID °I CALENDAR YEAR FORGIVEN del'*% RATE PER ELECTION" t 4& sz o !ND COM OTH PTY SCC DATE DUE DATE INCURRED PAID CALENDAR YEAR FORGIVEN RATE PER ELECTION t❑ IND COM OTH PTY SCC qchedule Summar Iq DATE DUE 1. Lo received this period r r... r............ r... ...rr (Total Column fib} plus uniternized loans of less than $100.) 2. Loans paid or forgiven this period r...................., (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) I Net change this period. (Subtract Line 2 from Line 1.) r.. r..... r. r NET Enter the net here and on the Summary Page, Column A, Line 2. (May be negative number) 'Amounts forgiven or paid by another party also must be reported on Schedule A. If required. FPPG Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772) (Enter (e)on Schedule E, Line 3) tContributor Codes IND-- Individual CCM- Recipient Committee (other than PTY or SCC) 0TH Other (e.g., busine entity) PTY PolitiCal Pally SCC Small Contributor Committee