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Sullwold 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-842165) Type or print in ink. Statement covers period October 1, 2012 from SEE INSTRUCTIONS ON REVERSE through October 20, 2012 Date of election if appli, (Month, Day, Year November 6, 2012 2. Type of Statement: Preelection Statement ri Semi-annual Statement PI Termination Statement (Also file a Form 410 Termination) Li Amendment (Explain below) 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. vi Officeholder, Candidate Controlled Committee C) State Candidate Election Committee C) Recall (Ais Ca mple40 1544 51 LI General Purpose Committee 0 Sponsored („) Small Contributor Committee CD Political Party/Central Cornmittee 3. Committee Information 1349912 ri Primarily Formed Ballot Measure Committee C) Controlled 0 Sponsored Cornoaro Fan 67 El Primarily Formed Candidate/ Officeholder Committee (liseifn 'DO:* Pit rt 7) OCT 2 5 arY OF ALA COVER PAGE CALIFORNIA 460 FORM '4Pag 8 For Official Use Only FDA I.U. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAM( If NO enrowiTEFI Jane Sullwold for City Council 2012 S I I liE T ADDRESS P 1101,i CITY STATE 71F-' C OEM" Alameda CA 94501 MAILING ADDRESS IF DIFFERENT) NO AND STREET OR CO , liOX CITY STATE ZIP CODE OPTIONAL F AX / L-MAIL ADDRESS jcs@jane4council.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best La -, .41 ft I Oil koe;hpll',..0 C.:011,101104 C.31141140,4.: St87, rae o' "Ii, al al 9 .1;k■I` „ FPPC Fenn 460 panuary(05) FPPC Toll-Free Helpline 866/ASK-FPPC (866'275-3772I State of California Recipient Committee Campaign Statement Cover Page — Part 2 Type or print in ink. 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE Jane Sullwold OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Alameda City Council RESIDENTIAL /BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Alameda CA 94501 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 NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 CALIFORNIA A an FRM �,. Page 2 of 8 ❑ 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 primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD Attach continuation sheets if necessary ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE FPPC Form 460 (January /05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2012 Contributions Received 1. Monetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED • Expenditures Made 6. Payments Made Schedule E, Line 4 7. Loans Made Schedule H, Line 3 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 Type or print in ink. Amounts may be rounded to whole dollars. Schedule A, Line 3 $ Schedule B, Line 3 Add Lines 1 + 2 $ Schedule C, Line 3 Add Lines 3 + 4 $ Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash 15. Cash Payments 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. Previous Summary Page, Line 16 Column A, Line 3 above Schedule 1, Line 4 Column A, Line 8 above 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 B above Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 3,184.00 0.00 3,184.00 0.00 3,184.00 6,699.20 0.00 6,699.20 - 783.37 0.00 5,915.83 9,188.77 3,184.00 0.00 6,699.20 5,673.57 0.00 0.00 0.00 $ Statement covers period October 1, 2012 from through Column B CALENDAR YEAR TOTALTO DATE 14,186.00 1,000.00 15,186.00 200.00 15,386.00 9,512.33 0.00 9,512.33 - 783.37 0.00 8,724.96 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). October 20, 2012 SUMMARY PAGE CALIFORNIA: "/� 6 V FORM .. ,' '"f' {, Page 3 of I.D. NUMBER 1349912 8 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 Total to Date (mm /dd /yy) / / $ / / $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2012 DATE RECEIVED 10/03/12 10/04/12 10/10/12 10/11/12 10/13/12 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER LD. NUMBER) Frank Ghiglione Inc. , San Leandro, CA 94578 Andy Weber , Alameda, CA 94501 Dave and Joanne Archer Alameda, CA 94501 Bill Armstrong Walnut Creek, CA 94501 Victor Jin Alameda, CA 94501 Type or print in ink. Amounts may be rounded to whole dollars. CONTRIBUTOR CODE * ❑IND ❑ COM OTH ❑ PTY ❑ SCC ® IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC ® IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC IND ❑ COM ❑ OTH ❑ PTY ❑ SCC VINE/ ❑ COM ❑ 0TH ❑ PTY ❑ SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) Owner /A.T. Weber Plumbing & Mechanical Services Inc,. Sales /Pump Repair Service Co. Attorney /Armstrong & Associates Real Estate Broker/ Property Investment Services 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 $ Statement covers period from October 1, 2012 through October 20, 2012 AMOUNT RECEIVED THIS PERIOD 100.00 100.00 100.00 100.00 100.00 500.00 2,100.00 1,084.00 3,184.00 SCHEDULE A CALIFORNIA Agri ORM , —. Page 4 of 8 I.D. NUMBER 1349912 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 100.00 100.00 100.00 100.00 100.00 PER ELECTION TO DATE (IF REQUIRED) *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 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Jane Sullwold for City Council 2012 Type or print in ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE, ALSOENTERI.D.NUMBER) CODE 10/15/12 10/17/12 Berkeley, CA 94703 Robyn Young, M.D. Alameda, CA 94501 Carole Ungvarsky 10/19/12 Jeff and Jeanne Allen Alameda, CA 94502 "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 IND ['COM ❑ OTH ❑ PTY ❑ SCC IND ❑ COM ❑ OTH ❑ PTY ❑ SCC IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) Physician /Robyn G. Young, M.D., a Professional Corporation Attorney /McKesson Corporation Retired /None Statement covers period from October 1, 2012 SCHEDULE A (CONT.) CALIFORNIA 460 FORM through October 20, 2012 Page 5 of 8 I.D. NUMBER 1349912 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 1,000.00 1,000.00 500.00 500.00 100.00 100.00 SUBTOTAL$ 1,600.00 PER ELECTION TO DATE (IF REQUIRED) FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2012 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period October 1, 2012 from through October 20, 2012 Page of I.D. NUMBER 1349912 SCHEDULEE CALIFORNIA,,. FORM 460 6 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. avlP 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 I.D. NUMBER) Daniel Ziegler Design Berkeley, CA 94710 Alameda Copy Alameda, CA 94501 Autumn Press Berkeley, CA 94710 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 CODE LIT LIT LIT RAD RFD SAL TEL TRC TRS TSF VOT WEB 8 radio airtime and production costs returned contributions campaign workers' salaries t.v. 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) OR DESCRIPTION OF PAYMENT Design of campaign postcards Palm cards Printing and mailing of campaign postcards, deposit * 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 (e).) $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ AMOUNT PAID 800.00 116.36 2,750.00 3,566.36 6,506.92 192.28 0.00 6,699.20 FPPC Form 460 (January /05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2012 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from October 1, 2012 through October 20, 2012 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, CUP CNS CTB CVC FIL FND ND LEG LIT OEM 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 I.D, NUMBER) Autumn Press Berkeley, CA 94710 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 CODE LIT * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E (CONT.) CALIFORNIA `/� (�` Q $' ;`. FORM ,.....: "''!'VV. Page 7 of 8 I.D. NUMBER 1349912 describe the payment. radio airtime and production costs returned contributions campaign workers' salaries t.v. 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) OR DESCRIPTION OF PAYMENT Printing and mailing of campaign postcards (balance) AMOUNT PAID $2,840.56 SUBTOTAL $ $2,840.56 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jane Sullwold for City Council 2012 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period October 1, 2012 from through October 20, 2012 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. RAD RFD SAL TEL TRC TRS TSF VOT WEB CMP CNS CTB CVC FIL FND ND 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 CREDITOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) 945 Camelia Street Berkeley, CA 94710 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. MBR member communications MTG meetings and appearances OFC PET PHO POL POS PRO PRT office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR DESCRIPTION OF PAYMENT LIT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD 800.00 SUBTOTALS $ 800.00 $ SCHEDULE F CALIFORNIA s /A FORM "(,gin`: TV Page 8 I.D. NUMBER 1349912 of 8 radio airtime and production costs returned contributions campaign workers' salaries t.v. 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) (b) (c) AMOUNT INCURRED AMOUNT PAID THIS PERIOD THIS PERIOD (ALSO REPORT ON E) 0.00 800.00 0.00 $ 800.00 $ Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD 0.00 0.00 16.63 800.00 NET $ -783.37 May be a negative number FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866 /ASK -FPPC (866/275 -3772)