Rich 460Recipient Committee
Campaign Statement
Cover Page
Type or print in ink.
(Government Code Sections 84200-84216.5)
Statement covers period
SEE INSTRUCTIONS ON REVERSE
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee
O State Candidate Election Committee
0 Recall
(Also Complete Part 5)
General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
Ballot Measure Committee
0 Primarily Formed
0 Controlled
0 Sponsored
(Also Comp/ere Part 6)
Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
1.0. NUMBER
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
4. Verification
Date of election if a
(Month, Day, Y
2. Type of Statement:
Preelection Statement
Semi-annual Statement
Termination Statement
O Amendment (Explain below)
Treasurer(s)
For Official Use Only
Quarterly Statement
Special Odd· Year Report
0 Supplemental Preelection
Statement • Attach Form 495
I have used all reasonable diligence in preparing and reviewing this statement and
certify under penalty of perjury under the laws of the State of California that the
of my knowledge the information contained herein and in the attact1ed schedules is true and complete.
Executed on-------------Date
Executed on _____ _,
0
,..a_
10
______ _
is true and
BY------------.,.-.-.--------~-----~~-~ Signature of Controlling Officeholder, Candidate. State Measure Proponent
Type or print in ink. COVER PAGE· PART 2
Recipient Committee
Campaign Statement
Cover Page -Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF
Related Committees Not Included in this Statement: List any committees
r10t 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 l.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
COMMITTEE NAME l.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
0 YES NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
6. Ballot Measure Committee
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME Of OFFICEHOLDER, CANDIDATE, OR PROPONENT
7. Primarily Formed Committee List names of officeholder(s) or candidate(s) tor
which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT
0 OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT
0 OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK·FPPC
State of California
Schedule A Type or print in ink. SCHEDULE A
Monetary Contributions Received Amounts may be rounded
to whole dollars. Statement covers period
SEE INSTRUCTIONS ON REVERSE
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER
(IFCOMMITTEE,ALSOENTERLD.NUMBER) CODE* OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
PERIOD
l.D. NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 ·DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
~-~~~+-~--~~~-~~~--~~-~~~~~~--1~~··:---~-t~-~---:;-~~~~-t-~~~-~~+--~--~~-+~~~~-~~-
~IND
DCOM
DOTH
DPTY
DSCC
~IND
DCOM
DOTH
DPTY
DSCC
~~~~~+-.~~~--~~---~~-~~-----~,.-------+~ ~~--f--7~---~-·~-~-~----1----~-~~~~---+~~--·---~~-+--~~~~~~
12§JND
DCOM
DOTH
Schedule A Summary
1. Amount received this period-contributions of $100 or more.
DPTY
DSCC
[;3JJND
DCOM
DOTH
DPTY
DSCC
OIND
DCOM
DOTH
DPTY
DSCC
SUBTOTAL$
(Include all Schedule A subtotals.) ........................................................................................................ $ --"--"--1-L-=---=-'--=
2. Amount received this period -unitemized 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 $ _ _:_µ__,_.c..._c-=-=-
*Contributor Codes
IND-Individual
COM -Recipient Committee
(other than PTY or SCC) .
OTH-Other
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 460 (June/01)
FPPC Toll·Free Helpline: 866/ASK-FPPC
ScheduleC
Nonmonetary Contributions Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND
ZIP CODE OF CONTRIBUTOR
[IF COMMITIEE, ALSO ENTER LD. NUMBER)
CONTRIBUTOR
CODE*
()!IND
DCOM
DOTH
DPTY
DIND
DCOM
DOTH
PTY
DSCC
DIND
QCOM
DOTH
DPTY
DSCC
~---·-·!----~---~-~---------·~--+---~
DIND
DCOM
DOTH
OPTY
Type or print in ink.
Amounts may be rounded
to whole dollars.
Attach additional information on appropriately labeled continuation sheets.
Schedule C Summary
1. Amount received this period-nonmonetary contributions of $100 or more.
Statement covers period
DESCRIPTION OF
GOODS OR SERVICES
SUBTOTAL$
AMOUNT/
FAIR MARKET
VALUE
$1
LD. NUMBER
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN 1 ·DEC 31)
*Contributor Codes
IND-Individual
PER ELECTION
TO DATE
(IF REQUIRED)
(Include all Schedule C subtotals.) ..................................................................................................................... $_,__ _ __,_ __ COM -Recipient Committee
(other than PTY or SCC)
OTH Other 2. Amount received this period-unitemized non monetary contributions of less than $100 .................................... $ ______ _ PTY -Political Party
3. Total nonmonetary contributions received this period. SCC -Small Contributor Committee
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ ___,_-i-:-..:..=..:::...... __
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK·FPPC
ScheduleE
Payments Made
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
l.D.NUMBER
Ov'f' campaign paraphernalia/misc. MBA member communications RAD radio airtime and production costs
CNS campaign consultants rvrrG meetings and appearances RFD returned contributions
CT8 contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries
CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs
FIL candidate filing/ballot fees FHJ phone banks TAC candidate travel, lodging, and meals
FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
SCHEDULEE
of__,_ __
IND Independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PFD professional services (legal, accounting) VOT voter registration
LIT campaign literature and mailings PAT print ads WEB information technology costs (internet, e-mail)
NAME ANO ADDRESS OF PAYEE
(IF COMMIITEE, ALSO ENTER l.D. NUMBER) CODE OR
* Payments that are contributions or independent expenditures must afso be summarized on Schedule D.
Schedule E Summary
DESCRIPTION OF PAYMENT AMOUNT PAID
SUBTOTAL$
i. Payments made this period of $100 or more. (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 i, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ ~-----
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK·FPPC
Schedule E
{Continuation Sheet)
Payments Made
Type or print in ink.
SCHEDULE E (CONT.)
Amounts may be rounded
to whole dollars.
Statement covers period
CODES: If one of the following codes accurately describes the payment. you may enter the code. Otherwise, describe the payment.
l.D.NUMBER
CIVP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs
CNS campaign consultants MTG meetings and appearances RFD returned contributions
CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries
eve civic donations PET petition circulating TEL t.v. br cable airtime and production costs
FIL candidate filing/ballot fees PHJ phone banks TRC candidate travel, lodging, and meals
FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO professional services (legal, accounting) VOT voter registration
UT campaign literature and mailings PFIT print ads WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER LO, NUMBER) CODE
*Payments that are contributions or independent expenditures must also be summarized on Schedule D.
OR DESCRIPTION OF PAYMENT AMOUNT PAID
FPPC Form 460
FPPC Toll-Free Helpline: 866/ASK-FPPC
Type or print in ink. SUMMARY PAGE ,campaign Disclosure Statement
Summary Page Amounts may be rounded
to whole dollars. Statement covers period
NAME OF FILER
Contributions Received
1. Monetary Contributions ............ ......................... ...... Schedule A, Line 3 $
2. Loans Received ...................................................... Schedule 8, Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Md Lines 1 + 2 $
4. Nonmonetary Contributions.................................... Schedule c, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED ........................... Md Lines 3 + 4 $
Expenditures Made
6. Payments Made....................................................... Schedule E, Line 4 $
7. Loans Made............................................................. Schedule H, Line 7
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines a+ 7 $
9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3
10. Non monetary Adjustment .......................................... Schedule c, Line 3
11. TOTAL EXPENDITURES MADE ................................ Add Lines a+ 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 ........................... Scfledule 1, Line 4
15. Cash Payments.................................................. Column A, Line 8 above
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 1s $
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 8 above $
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
$
$
$
$
$
$
ColumnB
CALENDAR YEAR
TOTAL TO DATE
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 thi.s is
the first report being filed
for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (if
any).
LD. NUMBER
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
(mm/dd/yy)
Total to Date
$ _____ _
$ ___ _
$ ___ _
$ __ _
$ _____ _
$ ______ _
*Since January 1, 2001. Amounts in this section may be
different from amounts reported in Column 8.
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC