i RE P ient Committee CampaignStatement Cover Page

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COVER
in

PAGE

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Government Cotle Sections 8420084216 5

Statement from
cov

0g
la
ns p 1 z y 4 na

aPPlicable

ui9 L

Montt Dey Veer

l Ri L

il t

Oc

Fage

of
F Oaicial Use

Onry

SEEINSTRUCTIONSON REVERSE

thlOUgh
ml

ll6R l
2

b
Type
of Statemenu
StatemerH Statemem

pe y T of Recipient Committee
OffcehOltlec C

cemplma commm

Candidate COnUOIIed Committee

Primarly

Formed Ballot Measure

Q Q

State Cantlitlate Election COmmiRee Recall

Committee

annual aemi td AlsD

Preeletlicn

puarterly

Slalemem

pmcorplxa ears

Q Controlletl Q Sponsoretl
N pJSOCmpMave
Committee

Veer Special Otltl Report

Terminadon Statement
flea Form 410

Supplemental Preelec0on
ARach Statement Fwm 495

Termination

General

Purpose

Amentlment

Explain belowi

Q Sponsored Q Small COnVibutor Committee Q POldical Party Committee Central

3 Committee Information
COMMITTEE NPME

Primarily FOrmetl Candidate

ORiceholtler
Committee ArSa Oa eiOf n

LD

NUMBE

R
NO COMMIITEE

s Treasurer

nn l r S

Lq rfi Zo 0

OR

s CPNOIpgTE NPME IF

NAME OF TREASURER

rePi lnir O
STREET

rr

o i

6 I ADDRE551N0 P BO

R3
CITY

S h

l na ef l Aril FhJ
STATE

na

MAILING ADDRESS

a o s 4
CITY

g
NAME OF

3a

pan

t On b5
STATE

t1ue

21P CODE

PREP

i 41766
CODEIPHONE

4d S LZ3 9n9
AREA CODE PHONE

rQomn2a
MAILING ADORE55

21P CODE

Ass15TANT TREASURER IF ANY

Grd

9116
MAILING ADORE55 STATE ZIP CODE PREP CODEIPHONE

IF DIFFERENn NO AND STREET DR PO 80X

7 CITY
l

LL

CITY

STATE

ZIP

CODE

AREA

PHONE COOE

OPTIONAL

LEFTA ri

Corn Lo50 lD

larN

c 4a4 6 iY t a
OPTIONAL

FA EMAIL AOORE55

I FP EMAIL ADORE55

Verification
I have used all reasonable under

diligence
the

in

preparing

and

reviewing

penalty of pe jury under

Exewwd
on

aws

of Ne State Dl Celifomla that

this statement and b the best of my krrowletlge the infwmatlon containetl herein antl in the edachetl schedules is true antl act meforegoing i5lrueantl

complete I ceNfy

w
rov m 0

BY BY
BY

Executed on

Q r

M 1 J

Nnp xqa V1

Tams

raAULen Tna9lx

c aar arwangaa w sur sgi elmm

oeamrsasPwm nR

ExtatM

On

Sigaenrtf GYggXSlyd vxaRKam SUmA m CaNLL

ExewuN

On

BY
wm

slen tenemla ram yaa x gmereauaw MmsuBA01

FPPC

FPPC Form 460 JenuaryNS FPPC ZT21 ToILFree Malplina 66rJA5R B6G2T5 State of Calilamle

Recipient Committee

Type

or

print

in ink

COVER PAGE PART2

Campaign Statement Cover Page Part 2

Page
6
of

Officeholder
NAME

or

Candidate Contralletl Committee

OR

Primarily

Formed Ballot Measure Committee

OLDER 1 H DIDATE OFFICJ CAN N YLS l

d 7z r1
NO

NAME OF BALLOT MEASURE GI

NUMBER IF

r7l t ZCJ

OFFICE SOUGHT OR HELD pNCWDE LOCATION PND DISTRICT

APPLICABLE

9ALLOT NO LETTER OR

JURISDICTION

SUPPORT

n s 3 l
PNO

DPPDSE I

5 S RESID RIAINESS ADOREQS

rotirwludedln this statement drat

iREET

CITY

ATE

IM N
are on

ILKA M1ATI
candidacy
D I

g l
Liat any aommieteas

identify

the

controlling officeM1eltler

tend

or

state measure

proponent

it any

NAME OF OFFICEHOLDER CANDIDATE

PROPONENT

Relatetl Committees Not Inclutletl in this Statement

conlriWtions
w

nonfmlled by youware primarily lormedro receive

6ehall of your

OFFICE SOUGHT ORH

DISTRICT NO IF ANY

make

experWitwes

COMMITTEE NPME

NUMBER

NAME OF TREASURER

CONTROLLED

MITTEE9

Primariy

s officeholder

Formed CantlitlatelORiceholder Committee List names w candidate w which this committee is s pHmerily formed
OFFICE SOUGHT OR HELD

of

YE
COMMITTEEADDRESS
STREETADDRESS

ENO
NAME Of OFFICEHOLDER Oft CANDIDATE SDPPORT OPPOSE

INO

O P

90X1

CITY

STATE

CODE

AREA CODEIPHONE

NAME OF OFFICEHOLDER OR CANDIDATE

OFFI

OUGHT OR NELD SUPPORT OPPOSE

COMMITTEE NAME

LD

NUMBER NAME OF OFFICEHOLDER OR CAN TE

OFFICE SOUGHT OR HELD

SUPPORT OPPOSE

NAME Of TREASURER

CONTROLLEDCDMMITTEEi
VES

NAME OF OFFICE

DER OR CANDIDATE

OFFICE SOUGHT OR HELD

NO

SUPPORT

OPPOSE COMMITTEEADD 5

STREETADDRESS INO P 90X1 O

CITY

STATE

21P CODE

AREA CODE PHONE

Attach continuation sheets f necessary

FPPC Form a69

panuaryle5l

FPPC Tdl HPlpline B66IpBK B68I2T6dTT2 Free FPPC Sute of Celilornia

Campaign

Disclosure Statement

Type

or

print

in ink

SUMMARY PgGE

Umrrla ry Pa g B

Amaunls may be roundetl to whole tlollars

Statement
from

covers

period
r

SEE INETRULTION50N REVERSE

through

aa r
a0
Calentlar Vear

ot Page
O I NUMBER

NAMED

FILER

ri
ColumnA
aeawna rouT

Contributions Received
1 2

Columm B
enavena e

Summary

for Candidates

aal Eaa Ease moMnTrnc

urowre o

Running

in Both

the State Primary and

General Elections

Monetary Contributions
Loans Received

scneevrea Lines
sclwaak e Lma
Ade unast z

6f
E

111

i D
Y E

Nrwgn

30 6

It b Oa1e

3 4
5

SUBTOTALCASN CONTRIBUTIONS

20 COmnbutions Received 21

Nonmonetary

Contributions

scheeweC

Line

Expentlitures
Matle 8 Y

TOTALCONTR18UTIONS RECEIVED

a geetinesa

Expenditures Made
6 7 8 9

Expentliture
scnedwe e Linea
scnedure

Limit

Summary

for State

Payments

Made

Candidates

Loans Made SUBTOTALCASH PAYMENTS Accrued

Line

T
22 Cumulative

ARJ Lmeza r

Ezpentlitures

Made

Oranlan tawwmna aenawnumm Date of Election Taal to Date

Expenses Unpaid Bills

scneeuk ELineJ

70

Nonmonetary AtlJustmem

smeewe o Larea
ra s gaoLirrese

mrrJddlyy
E

11 TOTALEXPENDITURES MADE

Current Cash Statement

12

5
Haviws

Beginning

Cash Balance

summay Page

uire is

To calculate Column B aatl

13 Cash

Receipts

cwumn A Lire3above

f
Pr
5

em0un6 in Column Ato me

14 Miscellaneous Increases to Cash

15 Cash

correspontling
schetlvie L Line
a

amounts

gmounLS in this section

Payments

y cwumn une aeaove ACO Unes I2 tJ u men svbvacr Urre s

must be zno

from Column B o your last d re Some amounts in

from may be tliKeren amounts

reportetl

in Column B

Column A may be negative

16 ENDINGCABH BALANCE
this I is
a

figures penotl

that shoultl be

subVadetl from

termination sfammenL Line 16

previous
If this is

amounts

Ue first report being Netl

17 LOAN GUARANTEES RECEIVED

Schedwe e Panz

for mis calendar year only carry wee the amounts from Lines 2 and 9

Cash
18

Equivalents
Equivalents
Debts

and

Outstanding

Debts
see insevcaons
reverse o

if

any
8
E

Cash

stantllOg OU 79

1ne Lme AtlJ l gin CaLmn fiabove

a Q L

FPPC Form 460

January105

FPPC To14Free Helpline B6INABK FPPC

2 fiefil2yYd

Schedule A

Type
Amounts
to

or

print

In ink Statement covers

SCHEDULE A

Monetary

Contributions Received

may be rountletl

whnie doliara from

perfotl

SEE INSTRUCTION50N REVERSE NAME OF FILER

11L L through J

r I

Page
D I NUMBER

y or

rt
DATE RECEIVED

rri
CONTRI6UTOR CODES
OFCOHNmEEPtsO Ervrenr rvuueew R IF AN INDIVIDUAL ENTER OCCOPPTION PND EMPLOYER

N
AMOJNi RECEIVED THIS PERI00 NMULATIVETO DATE CALENDAR VEAR
PER ELECTION

FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRIaUTDR

TODPTE

Ervrea O sNFLOV r pvs

Of

rvune

DED DAN 33

IF REQUIRED

aV51NE55

IND

COM OTH
PTV

SCC
IND

COM

p OTH PTY SCC

IND COM OTH PTV SCC

IND COM OTH

PTY

SCC
IND COM OTH
PTV

SCC
SUBTOTALS

Schedule A Include
2 Amount

Summary
period itemized monetary subtotals
contributions

coradbatw codas nelvMUal IND

1 Amount receivetl this

all Schedule A

Redplem Ommlttee COM l

other
Than PTY a

SCC

unitemized receivedthisperiod monetary contributions of lessthan 5100

receivetl this
on

3 Total

monetary contributions

period
Summary Page
Column A Line

Other g OTH le business entity PTV Polilkel Party Small SCC Conldbutor Committee

Add Line51

and 2 Enter here and

the

TOTAL S
FPPC Form
FPPC Toll Free

05 460lJanuary

A514FPPC 5 72 3 Helpline a6fi afi62

SCHEDULEE

Schedule E
Paym eMS Made

Type

or

print

in ink

Statement

covers

Amounts may be rcundetl to whole tlollars

parlotl

Irom

SEE iNSTRUCTIONSON REVERSE

Cf1L L lhroughL

Page

of

NAME OF FILER

LD NUMBER

G l

CODES
CTP CNS

If

one

of the

tollowinq

cotles

accurately

describes the

payment
meetings

you may enter the code Otherwise describe the payment

RAD RFD SAL
TEL

campaign paraphernalia misc

campaign

consu0an15

CTa
CVC

conbibWon explain civic tlonations

cantlitlate

nonmonetery

MaR 1dTG OFC

PET PFO POL

member communications

ratlio altlime antl protlucgon costs

rewmetl contributions

antl appearances oRice expenses

campaign

workers salaries

FIL
FkD

ND

ballot gling fees fundraising events Intlepentlent expentlkure suppoNnyopposing others explain
legal defense

petition circulating phone banks

antl survey research postage tlelivery antl messenger services

v t or cable elnime end centlitlate Vevel

bn protluc

costs

polling

TRC TRS
TSF VOT WEB

lodging end meals spouse s1aR Vavel lodging and meals

transfer between committees of the
voter
same

POS
PELT

cantlitlatelsponsor

LEG
Llr

campaign

literature and

malliogs

PRr

praressionel print atls

services

legal accounting

reglsvelion

Information lechndogy costs Onternel a mail

NAME AND ADDRESS OF PAYEE

MMmEEMaa 1 NUMaaq UFO EHTE0 a

CODE

OR

DESCRIPTION OF PAYMENT

AMOUNTPAD

Paymems that

era

contributions

or

Indapandem axpendiWres

must also be summarixad on Schedule D

SUBTOTALS

Schedule E
1 Itemized

Summary
matlethis

payments

period Include period

loans

all Schedule E

subtotals

2 Unitemized

payments paitl
this

matle this

of under 1 W

3 Total interest 4 Total

period

on

Enter

amount from Schedule

Column B Part 1 e
on

E
Column A Line

payments

matle

this periotl Add Lines 1 2 and 3 Enter here and

the

Summary Page

TOTAL E

FPPC Form A50 FPPC TOII Free

05 Jarwary

FPPC 3j ASK 5d Helpline BBa a9a12