deHaan 460Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 84216.5)
Type or print in ink.
z Date .Stamp x
Statement covers period
from
SEE INSTRUCTIONS ON REVERSE throug g
Type of Recipient Com mittee: All Committees Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure
0 State Candidate Election Committee Committee
Recall Controlled
(Also Compl Part 5) Sponsored
General Purpose Committee (Also Complete Part 6)
Sponsored Primarily Formed Candidate/
Small Contributor Committee Officeholder Committee
Political Party /Central Committee (Also Complete Part 7)
ZIP CODE AREA CODE/PHONE
r i4L d 4 O� 451_04,749E*11043
3. Corrlrnittee Information I.D. NuMeER Treasure.r(s)
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF T ASURER 1��
AdAtAwl tj
71)wjel: //w APAWAZ50 1 '0""
MAILING ADDRESS kiF DIFFERENT} NO. AND STREET OR P.D. BOX MAILING ADDRESS
rITY CTATG 71D r'nr)C: ADCA r%nncfnt..rn
OPTIONAL: FAX E-MAIL ADDRESS
Executed on
Date
Executed on
Date
Date of election if applicabl f g 9 of
(Month, Day, Year) r Official use Only
0 LA
F A 7% 51:V:11
2. Type of statement:
Preelection Statement
Semi annual Statement
Termination Statement
(Also file a Form 410 Termination)
Amendment (Explain below)
Quarterly Statement
Special Odd -Year Report
Supplemental Preelection
Statement Attach Form 495
CITY STATE ZIP DUDE AREA CODE /PHONE
OPTIONAL. FAX 1 E-MAIL ADDRESS
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (January/05)
FPPC Tot! -Free Helptine; 866/ASK-FPPC (8661276 -3772)
State of California
COVER PAGE
Campai Disclosure Statemen
Summar Pa I
SEE INSTRUCTIONS ON
=VERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
SUMMARY PACE
Statement covers period
from
Wig through Page of
I.D. NUMBER
Contributions Ree'ed Column A Column B
TOTALTHIS PERIOD CALENDAR YEAR
(FROM ATTACHED SC DULES) TOTALTa DATE
1. Monetary Contributions Schedule A, Line 3
2. Loans Received Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 2
4. Nonmonetary Contributions Schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 4
Expenditures Made
6. Payments Made Schedule F, Line 4
7. Loans Made Schedule i
ule tl ne 3
8. SUBTOTALCASH 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 74
Current Cash Statement
12. Beginning Cash Balance Previous SurnmaryPage, 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 S above
16. ENDING CASH BALANCE Add Lines 12 13 14, then subtract Line 15
if this is a termination statement, Line 16 mast he zero.
17. LOAN GUARANTEES RECEIVED I......... 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 alcove
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
Calendar Yea r Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6130 711 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
(m mld dlyy)
*Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January /05)
FPPC Toil -Free Helpline: 866 /ASK -FPPC (8661275 -3772)