l Camp Page

Cover
1

Reci

Committee

covER

Statement

TYPa

or

Ink

1eT fli f v

ZI I L CITY C
amtement Irom

Government Code Secaans 84200 5 64216

cpIvers l LO 8

perlotl

Oete or election If

applicable MOnm Day Veer

ti Za7a JLLi

I 1 L

age

o
For OIIkMI use

only

SEE INSTRUCTIONS ON REVERSE

through
All cwemlll

3 D

1
2

Type

of

Reliipient

Committee

m compl

wda 1 z a ene e

Type

of Statement

Offceholtler Cantlldate COnbolletl Committee

Primarily

Fwmetl Ballot Measure

QStale Candldate

Election Commlttae

Committee

annual seml l
Also file
a

reelectbn Statemem P Statement

Folm 410

quatteny
Spacial

Statement

Recall

eteaxnsl cmq as
General

Q Corarolled Q Sponswetl
IAaocm6rrePare Committee

Near Odd Repott

Anach Form 485

Tarminadan Statamem

Terminatlon

SupplementalPreeleNOn
Statement

Purpose

Amendment

Ezplaln below

Q Sponswetl
Q Q
3
Smell COnmbinor COmmlgea Political

PrlmeNy Formed Cantlltlate

Committee OHlceholdw Committee r e ISOCO I rl

CenVel Peny

Commlttae Information
COMMITTEE NAME OR CANDIDATE NAME If NO COMMITTE S

D I

NUMBE0

300

s Treasurer

Ltpmmi
R3a
STREET ADDR
CITY

er

a vL

LaS 4rrr 1
CITY

NAME OF

TRErSURER

CvL

na

rC

MAILING AOnftE55

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Ga
STATE ZIP CODE

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AREA CODEIPHONE

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NAME OF ABSISTANT

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AREA CODEIPHI

STATE

ZIP CDDE

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2GG q

TREASURER IF MY

MAILING ADDRESS IF DIFFERENT NO AND STREET OR P 80 O

MAILING ADDRESS

CITY

STATE

ZIP CODE

AREA COOEIPHONE

CITV

STATE

tIP CODE

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In
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have usetl ell reasonable

preparing entl reNewing

penalty of
Execlned

an

thel r ntle u perjury

This statement antl ro the best of my otthe satew Callfwnia mat mefwegoing is truce cwr

knowietlge the InformaUan

crwrtalnetl herein and In he enechetl schetlules Is True and

complete I

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FPPC Frmm 480 yalnun FPPC 9 Helpllro aedASa B8a2Ta

Committee Reci Campaign

5

Statement Cover Page Pan 2

Type

in Ink

PART2 PAGE

Page OfFCeholder
NAM OF OFF

of

or

Candidate Controlled Committee

Primarily

Formed Ballot Measure Committee

EHOLDER OR

rls

NDyDAtE CA arr N
r

NAME OF BALLOT MEASURE

za s

HELP R rtOxUnGHwTVO OFFICyE NiL U NU AJIP R T IE J f IB LI NM y S LC tICABLE

5 rwr ly

QNCLUD

LOCATION AND DISTRICT

IF

aALLOT NO LETTER OR

JURISDICTION

SUPPORT

j J

OPPOSE

SS E IAUBUSIN RESIDEooNT S A1

gODRE55

NO AND

J C y
are

TALEk fJ1 EET STIj OCITY L l 7J IYtp I

y

21P

16

Itlentiry

he

eon4olling omwholtlw

ce

ate

stets measure

proponan4 Ir any

NgME OF OFFICEHOLDER CANDIDAT

PROPONENT

Relatetl Committees Not Inclutled in this Statement

not rrcluCetl M rhle etstemenr that on9 cronbibur
or

Llsr any rommhreae

to rece lre

conrrolb9

make expntl Wre9

on

by you w em pHmaHly ormad bMalr o1 yow camllCecy

LD NUMBER

OFFICE SOUGHT OR

DISTRICT N0 IF ANV

COMMITTEE NAME

NAME OF TREASURER

CONTROLLEDC
VE5

MITTEE NO

sr Formed CandidatelOfticeholder Committee L neme9 tleA9f oMroha w centl er eirbh Nb rommhbe la pr homed 9 tleh meNly

Primarily

or

COMMITTEE ADDRESS

STREETADDRESS NO P O

BOX

NAME OF OFFICEHOLDER OR CANDIDATE

OFFICE SOUGHT OR SUPPORT OPPOSE

CITY

STATE

ZI

ODE

AREA CODEIPHONE

NAME OF OFFICEHOLDER OR CANDIDATE

OFF

50UGHT OR HELD

SUPPORT OPPOSE
COMMITTEE NAME LD NUMBER NAME Of OFFICEHOLDER OR Cq ATE

OFFICE SOUGHT OR HELD

SUPPORT
OPPOSE

NAME OF TREASURER

LONTROLLEDCOMMITTEE YES
NO

rygME OF OFFICE

DER OR CANDIDATE

OFFICE SOUGHT OR HELD

SDPPORT

OPPOSE COMMITTEEADDRE55
STREETgDDRE55

MO P aDIQ O

QTY

STATE

ZIP LOGE

AREA CODE PHONE

Attach conttnM9ttOtt shBef9

BCa99ary

Frro FPPC Tdl

Helpllm

FpPC Fonn A80 Jer uaryN5 FPPC Sd 86flrg5K Be92 2

SMb of CNlrmnle

Disclosure Camp Summary Page

SEE INSTRUCTIONS ON REVERSE NAME OF FILER

Statement

Trp
Amounts

m whale aPUara

ln a
a

Ink Statement from

covers

IIMMARYPAGE

rounded

perlotl

through

0 2
Calendar Year

Page
b I NUMBER

of

Ca rri zo s

O
for Candidates

Contributions Received
1 2

ooTMimvo0o
morannncrvcoscxminES EEAtrr 8
r

Col nBa
rorurowre

Summary

Running

in Both the State

Primary
11

and

General Elections

Monetary

Contribugons

Loans Received SUBTOTALCASH CONTRIBUTIONS

ItrJ lk
gars to ed 6trr ycs ar

D
g 2U COnvibutlons Received 21

tit Mrough 6130

to Oole

3
4

Nonmpnetary

Contributlans

Expenditures
Maw

TOTALCONTRIBUTIONS RECEIVED

Extlendlture5
6 7 B 9 10

Made
rol

Expenditure
E 3

Limit

Summary

for State

Payments

Made

Candidates
22 Cumulative

Loans Made

abr ar
Als 6

Expenditurea

Mede

SUBTOTALCASH PAYMENTS
Acrsuetl

Ia SUbfMre VelurMryErperMWnLIMA

Expenses Unpaid Bills

A9 ea d44trJ

a Da of Electlan

Tatel to Dete

Nonmonetary AdJustment

yy mMtld
8

11 TOTAL EXPENDITURES MADE

aes Jar

Current Cash Statement

12

Beginning

Cash Balance

PrebsaxneaPaAtre
CalmKtrtgtre
eb ltrr a Cdaa4s m s a tdarnrtrntra rmf B era

To calculate Column B edb amounts In COlumnAmthe

13 Cash

Receipts

corresponding

amounts

14 Miscellaneous Increases to Cash

16 Cash Pa y menu 16 ENDING CASH BALANCE

IB a
a

hom COlumnBOf your last report Some amounts in

gmounts lnmis section may be tllfferenl fromamoun s reportetllnColumn B

Column A may Da negaUVe figures Wet should be

subtracted hom

prevlaus
It this Is flletl

fem0ltrsraremeS 6 6

perlotl
aelPercl E y G

amounts

the first

report being

17 LOAN GUARANTEES RECEIVED

rot this calendar year only carry over the amounts kom Lines 2 antl 9

Cash

Equivalents
Equivalents
Debts

and

Outstanding

Debts
tre trtis oveerse

IF

any
8 E

18 Cash 19

Outstanding

agile acom e rel

Sb b

Free FPPC Toll

FPPC Form IeO lJanuary efi FPPC 3 2 Ipline ASK fi B a6e fi8612

SC11ed

onVibutions Monet
SEE INSTRUCTIONS ON REVERSE NAME OF FILE

Received

nded tlollars Amoto

r

Typ

n In Ink

SCHEDULE A statement rom

covers

period

l l08

through

3a b

yJ
Pege
D I NUMBER

0f

9300
CONTRIBUTOR CODE IF AN INDIVIDUAL ENTER OCCUPATION AND EMPLOYER EMERHSME OFSELFEMFLOVED OF WSINESSI

DATE
RECEIVED

FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR uSOEtaEBio AFCOMmmeE xuueEB

AMOUNT
RECEIVED THIS
PERIOD

CUMULATIVETO DATE CALENDAR YEAR

PER ELECTION

TOOATE

1 OAN DEC 311

IF REOUIREDI

IND
COM OTH
PTV

SCC IND COM OTH

PTV

SCC IND
COM

OTH
PTV

SCC

IND
COM OTH
PTV

SCC IND
COM

OTH
PTV

SCC UBTOTALE
y

C cvmdana cDdes

Schedule A

Summary

1 Amount receivetl this periotl monetary conVibutions itemized Inclutle all Schedule A subtotals
unitemized 2 Amount receivetl this p eriod monetar y contributionsof lessthan 100

InaMdual IND COM Recipient Committee

Other Nan PTY

oNer OTH PTY

or

SCC

g e business entity PdlBCal Party

3 Total monetary contributions received this period Atltl Lines 7 and 2 Enter here antl on the Summary Page Column A Line 1

TOTAL

y 7
FPPC TOIFFree

Small SCC COmdbinar COmminee

FPPC Fmm4so

g5 lemuuy

FPPC 275 3772 HeIpllne 8681ASK 86