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Alameda Firefighters 465 (2)Supplemental Independent Expenditure Report (Government Code Section 84203.5) SEE INSTRUCTIONS ON REVERSE 1. Committee/Filer Information COMMITTEE/FILER'S NAME Type or print in ink. Amounts may be rounded to whole dollars. D Amendment (Explain Below) l.D. NUMBER (If recipient committee) Alameda Firefighters Association Political Action Committee STREET ADDRESS (NO P.O. BOX) 2027 Clement Ave . Suite B CITY Alameda OPTIONAL: FAX I E-MAIL ADDRESS STATE ZIP CODE Ca 94501 AREA CODE/PHONE (510)337-2010 2. Name of Candidate or Measure Supported or Opposed Report covers period from 10/19/2014 through 12/31/2014 Date of election if applicable: (Month, Day, Year) Treasurer 111 rec1p1ent comm1ttee1 NAME OF TR.EASURER William klump MAILING ADDRESS B CITY Alameda OPTIONAL: FAX I E-MAIL ADDRESS SUPPLEMENTAL INDEPENDENT EXPENDITURE Date Stamp &.£Zl&JJdl£. 5 c I CI TY QF ALAMEDA CITY CLER K'S OFFI CE STATE ZIP CODE AREA CODE/PHONE Ca 94501 (510)337-2010 CHECK ONE NAME OF CANDIDIVE OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE SUPPORT OPPOSE Silicon Valley Health & Safety Coalition NAME OF BALLOT MEASURE BALLOT NO./LETTER JURISDICTION 3. Independent Expenditures Made Attach additional infor mation on appropriately labeled continuation sheets. DATE NAME AND ADDRESS OF PAYEE DESCRIPTION OF EXPENDITURE 10/30/2014 Silicon Valley Health & Safety Coalition Contribution AMOUNT 5,000.00 x SUPPORT OPPOSE CUMULATIVE TO DATE CALENDAR YEAR -···-·. ---· -· 5,000.00 FPPC Form 465 (June/09) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3n2) Supplemental Independent Expenditure Report SEE INSTRUCTIONS ON REVERSE NAME OF FILER Alameda Firefighters Association Political Action Committee 4. Summary Type or print in Ink. Amounts may be rounded to whole dollars. SUPPLEMENTAL INDEPENDENT EXPENDITURE ..--~~~~~~~~~~~~ Report covers period from 10/19/2014 through 12/31/2014 CALIFORNIA 4 6 5 FORM Page __ ~-of __ _ l.D. NUMBER (If rec ipient com .) 1. Total independent expenditures of $100 or more made this period . (Part 3.) ...... . $ 5,000.00 2 . Total independent expenditures under $100 made this period . (Not itemized.) $ 0 3 . Total independent expenditures made this period (Add Lines 1 + 2 .) TOTAL $ 5,000.00 5. Filing Officers Enter the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been filed. 1) NAME OF FILING OFFICER William Klump ADDRESS 2027 Clement Ave. Suite B CITY Alameda 2) NAME OF FILING OFFICER ADDRESS CITY 6. Verification (NO. AND STREET) (NO . AND STREET) STATE Ca STATE ZIP CODE 94501 ZIP CODE 3) NAME OF FILING OFFICER ADDRESS (NO. AND STREET) CITY STATE ZIP CODE 4) NAME OF FILING OFFICER ADDRESS (NO . AND STREET) CITY STATE ZIP CODE I certify that the "independent expenditure(s)" disclosed in this statement were not "made at the behest or the candidate or committee that benefitted from the expenditure(s) as those terms are defined in Government Code Section 82031 and FPPC Regulation 18225 .7. I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and complete. I c~ under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 12/31/2014 DATE Executed on DATE Executed on DATE Executed on DATE By \ > < By ,~ SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE URE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR By~~~~~=== SIGNATURE OF CONTROLLING OFFICEHOLDER , CANDIDATE , STATE MEASURE PROPONENT By===~~~~= SIGNATURE OF CONTROLLING OFFICEHOLDER , CANDIDATE, STATE MEASURE PROPONENT FPPC Form 465 (June/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)