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Bratzler 460Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE from Statement covers period through /0 11— / Date of election if applicab (Month, Day, Yea // 0 COVER PAGE CALIFORNIA 460 FORM of For Official Use Only 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 Pad 5) ID General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee Primarily Formed Ballot Measure Committee O Controlled O Sponsored (Also Complete Part 6) Primarily Formed Candidate/ Officeholder Committee (Also Complete Part ? 2. Type of Statement: O Preelection Statement O Semi-annual Statement O Termination Statement (Also file a Form 410 Termination) O Amendment (Explain below) O Quarterly Statement O Special Odd-Year Report I.D. NUMBER 3. Committee Information COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) / 3 e 15( /es Treasurer(s) NAME_QE_TREASURER CITY STATE ZIP CODE /2/L4 C g)) 5/03es7, 3) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX STATE ZIP CODE AREA CODE/PHONE 0' 9 (--/JW _170 3e5-6 63/ AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX! E-MAIL ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX! E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my know dge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the I s of the State of California that the foregoing is true an or Responsible Officer of Sponsor Signature of ontrolling 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) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 COVER PAGE - PART 2 CALIFORNIA Alp, n FORM 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE (d-- /Z OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) 6-00, CI ©\ C[ RESIDENTIAUBUSINESS ADDRESS (NO. ANO STREET) CITY STATE ZIP 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? ❑ YES ❑ 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? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ 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 prlmarilyformed. NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets If necessary FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. Statement covers period from through / NAME OF FILER Contributions Received 1. Monetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED Schedule A, Line 3 Schedule B, Line 3 Add Lines 1 + 2 Schedule C, Line 3 Add Lines 3 + 4 $ $ Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) -0- $ Column B CALENDAR YEAR TOTAL TO DATE 0 , SUMMARY PAGE CALIFORNIA A rtn FORM Calendar Year Summary 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 Dale $ Expenditures Made 6. Payments Made Schedule E, Line 4 $ 8 7. Loans Made..... Schedule H, Line 3 t9" 8. SUBTOTAL CASH 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 + 10 $ B 5 C)N , $ 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 Schedule I, Line 4 15. Cash Payments Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. sa, zi96. 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 $ 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (It Subject to Voluntary Expenditure Limit) Date of Election (mmidd/yy) / / $ Total to Date *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER J 617 z(e( DATE RECEIVED Amounts may be rounded to whole dollars. SCHEDULE A Statement covers period SI/6 / from through CALIFORNIA 460 FORM Page FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER ID. NUMBER) CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) AMOUNT RECEIVED THIS PERIOD I.D. NU CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) MBER PER ELECTION TO DATE (IF REQUIRED) 0 IND 0 COM LJ OTH p-ry ▪ scc 0 IND 0 COM El OTH PTY SCC 0 IND 0 COM ▪ OTH PTY 0 SCC IND O COM 0 OTH E l P-rY scc 13 IND O COM OTH • PTY ▪ SCC SUBTOTAL $ Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) 2. Amount received this period — unitemized monetary 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 $ •Contributor 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) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from through SCHEDULE E CALIFORNIA Art n FORM —1r lir CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER ID. NUMBER) MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB Page of I.D. NUMBER /3 8 6 radio airtime and production costs returned contributions campaign workers' salaries b./. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID q Ce:6-671 s pi a4/-e * 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 payments made this period of under $100 ............................... ........ ....... .... . ..... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column ...... .................... $ "er 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line TOTAL $ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov