Recipient

Cover
GoverllmeM

Committee

Campaign statement
Page
Cetle sections

RECEIVED CITY CLERK

1J

COVER PAGE

Type

er

print

in inh

Dme

Swmp

p5
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Sutemapt
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periotl Dele of eleGion if

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Month Day Vear

J
Only

SEE INSTRUCPONS ON REVERSE

lhrotlah
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Typggf Recipient

Committee

caPPlx

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Typo
Pr

of Statement
Mian

OTkeholder Cantlitlale COnodletl CrvnmiDee Q Sble Cantlltlate Elactbn Cammitma

PrNnsNy

FOrmetl BalblMUSbe

Sbtem@m

CommNee

anrwal5lelemeM Seml Tarrtdnatlon sbtemeM Also Ills a Form 110 Termination

AmantlmeM

OoRdmrt oartsl
General

QCanBOll
Q SPOnsoled
eFMe Ih pbCU

Wederly Slntement Veer Special Otltl Report

Suppbmerael Preeleclbn
sbtement Atbch Form a95

Plapasa Committee

Explain below

Q Sponsoretl Q SmaIlCanvlbutor Committee ttee Q POaical PartylCeMral Comm

3

PtlmarTy Falmatl Centlldete Omcehaltler CammlMee aPJr A rl

O I

Committee Information

NIIMBE0

s Treasurer
NAME OF TREASURE

COMMnTEE NAME OR LpNOIDATE NAME IF NO COMMITTEE S

ln Dla

f
S

STREET ADOflE55 NO P BO O

1A32
CITT

S r ria a cT nt P San I

pp

MpILINGAODRESS

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STATE

20 sb

rr

za

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CITY

18 3
NAM

h ci
LIP CODE

r1

lam
AREA

mA a

COOEIPHONE

QOmena
CITT OPTIONAL I MAIL FA E gODRESS

STAeTE A G
STATE

ZIP CODE

AREA

PHONE CODE

g5515TANT iREpSURER IF ANT

o 7G 9
ZIP

GO7d za gDY
MAILING gODRE55 AgEq COOEIPNONE
CITY

MgILIHG gOORESS IF DIFFERENn NO ANO STgEEi OR P BO O

CODE

STgiE

LIP CODE

ggEq COOEIPHONE

OPTIONAL

I FA EMNL gpDRESS

G Fo
4

Roq

ds E 9G
In

Icatlon Veri
have usetl ell reasonable
uMer

tllligence

preparing erM

penally Mpetjury
Executes

untlerNe ews afthe

reviewing missbtement arM to the bestM my II the InfotmaNOn conbmetl herein Iwwletlge StaleMCallfamia thatlhe foregdlg is
Br By DY
BY

on
an on M

LOnecl a buee
1
spawea

end in the atbchetl schetlules

i5bue end complMe I

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an
Executed

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FPPC Fwm 48D Jenuerylp5 FPPC Tall Hulplltle raNASN ea ee FPPL 215 11TLf SMb RI Cellbmle

Campaign Disclosure Statement

Summary Page

Type
Amounts

or

print

in ink

SUMMARY PAGE

may be rountletl to whole dollars

Statement
rrom

co

ers

period

SEE INSTROCTION60N REVERSE NAME OF

lhmugh

3 G

Page
n I

Z
NUMBER

of

FILE3g yl5 l

via

s6 y
COIdmnA Columns

9300
Calendar Year

Contributions Received
1 2 3 4 5

Summary

for Candidates

Mprq ooafFS tr HEpSEa

smeawe A Linez
scnedure e LMeB

TEn rmpoo
8

Running

in Both the State

Primary

antl

General Elections

Monetary

GOntdbutions

m mrough lisp 2a aed Lures LZ scnedwe c LmeB 9 lnesJ gdd

7n m Dare

Loans Recelvetl

SUBTOTAL CASHCONTRIBUTIONB

E
2t

Contributions
Received
8

Nonmonetary Contributions
TOTALCONTRIBUTIONS RECEIVED

Expentliwres
Mabe

Expenditures
6 7 8 9 10

Made
scmavre E Lmev EcmaweM Lmei
7 aee ones 6

Expenditure
E 8

Limll

Summary

for State

Payments

Matle

Candidates
22 Cumulative

Loans Matle SUBTOTALCASH PAYMENTS Accruetl

g
E q

Expenditures

Made

rrowivmery eN umu s mw p up Date or Election Total

Date

Expenses lUnPaid Bills

SCMVUIe F tkre3 srlrwwe c Lreea

s

Nonmonetary Atljus menL

7
E

mmltldlyy
8

11 TOTAL EXPENDITURES MADE adecnese

ro

Current Cash Statement

12

J
eriovssvmmary Lme P Page
16

Beginning

Cash Balance

13 Cash

Receiple
o

cwumn a Line3adave

To calculate Column B add amountsin Column Alo the

conespontling
Cash
SGreewe 1 Lore 4
Cdumn A LineBabove
ode

amounts

14 Miscellaneous Increases
l5 Casa

Payments

a
8

from Column B of your last report Some amountsin

gmounls in this section may be tllRerenl from anwunls

reportetl

in Column B

Column A may be negative

tfi ENDINGCASH BALANCE

ones rz roan suedaaune r5 14 13

kgures periotl

mat shoultl be

subtracted from
I this is a termination sfalemenp Line 16 must be zero amounts the first

previous
If Nis IS

report being fled

17 LOAN GUARANTEES RECEIVED

Scheeule B Part1

for this calendar year only carry over the amounts

Cash
1a
19

Equivalents and Outstanding

Equivalents
Debts

Debts
see msnun ons
on rewPrse

from Lines 2 7 and 9 it

anyi
8
8

Cash

Outstanding

Atld urlez rresincdumneabove t

FPPC Form 46a

a61 1January

FPPC Tollfree Helpline e66lASK 886 FPPC 275 72 3

Schedule A

Type
to

or

print

in ink

SCHEDULE
Statement
from
coyyers

Monetary

Contributions Received

Amounts may De rountletl

whole dollars

perlotl

D
Peg
2 P

SEE

INSTRUCTIONSON REVERSE

through

of

NAME OF FILER

D I NUMaER

DATE

FULL NAME STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR

nlso o UrcOnmirtEE ExiEal

CONTRIBUTOR
CODE

RECEIVED

hvwBExl

IF AN INDIVIDUAL ENTER OCCUPATION AND EMPLOYER Iis SEV xienrvnnE q aov u oreuswessl

JUNT AA5 RECEIVED THIS

PERIOD

CUMULATIVETODAif CALENDAR YEAR

PER ELECTION TO DATE IIF REpUIREO

JAN

1 DEC

31t

IND QCOM

OTH
PTY

SCC IND COM OTH

PTY

SCC IND COM orH PTV SCC

IND COM

OTH
PTY

SCC
IND

COM OTH
PTV SCC

CJ

SUBTOTALS

Schedule A

Summary
itemized period monetary
period
unitemized contributions

s connibutor cotl

1 Amount received this

mtllvaual IND

Include all Schedule A subtotals

2 Amount received this

Recipient coM Committee

other Ulan PTV
or

monetary

contributions of less than 100

orH PTV

other

g e

business

SCC entny7

PoliUCel

Pany

3 Total

monetary

contributions received this

on

Add Lines

er 1 and 2 En here and

periotl the Summary Page

sCC Smaacontribm Comminee

Column A Line

TOTALS
FPPC Form O60 Januaryl65 FPPC Toll Helpline 6661ASK B6N2 Free FPPC 5 2 3T

SCHEDULEE

Schedule E

Type

or

print

in ink

SWtemenl covers

Payments Made
SEE INSTRUCTIONS ON REVERSE

Amounts may be rountletl to whole tlollars

period

from

9
r1 V

lbrougb

PoDe Z
LD NUMBER

of

R NAMEpp FIL r l

na
one

N
following
codes

9
payment you may
meetings
enter he code

CODES
QvP

If

of the

accurately

describes the
MBR

Otherwise tlescrihe the payment

RAD
RFD SAL TEL TRC

CNS
CTB CVC F0 FND

misc campaign paraphernalia campaign consultants conlribwion explain nonmonetary

civic donations randidale

membercommunicalions
and appearances office expenses

MrG
OFC PET

radte airtime and protludion costs returned contributions

campaign

workers salaries

balbt fdkg
events

fees

PFq

funtlraising

POL others explain

petition circulating phone banks polling and survey

postage tlelivery

v t or cable airtime antl canGtlate travel

protludlon

costs

research

ND LEG
LR

opposing independent expentlilure supporting legal

defense

NS
Pfa PRr

campalgu

literature antl mailings

professional print atls

antl messenger services services legal accounting

TRS TSF
VOT
WEB

lotlging antl meals spouse staff travel lotlging antl meals

bansfer between committees of the same

canditlatelsponsor

registration information technology

voter

costs linlernet

meil e

NAME AND ADORESa OF PAYEE auNaenl mo nisorrvF prcomrnivee

eODE

OR

DESCRIPTION OF PAYMENT

AMOUNT PAID

Payments

Nat

are

contributions

or

independent expenditures

must also

ba summarized

on

cbetlule D

SUBTOTALS

Schedule E
1 Itemized 2

Summary
all Schedule E

payments made this Period Inclutle

subtotals

Unitemized Payments made this period of under 100

3 Total interest 4 Total

paid

his

periotl

on loans

Enter

amount from Schedule B Part L Column

on

j e
Line

payments

made this

period Add

Lines 1 2 and 3 Enter here and

the

Summary Page Column A

TOTAL

FPPC Form O6D

FPPC Tall Free

05 January

FPPC 3 ASK 5 2 Helpline 88 BfiIV2

s
Schedule I Miscellaneous Increases to Cash
Type
or

print

in ink

scHEOULE I sLaLemam
fmm

AmoNnLa mar be rnuntlatl o whole tlollars

n ers period

SEE INBTRUCTIONB ON REVERSE NAME OF FILER

IMOU9h

Page
D I NUMBER

of

93odlq
HATE

FULL NAME ANn AnnRE550F SOURCE

RECEIVED

odumrEn6o p6

o xrexi

xuMeaxl

pESCRIPTION OF RECEIPT

AMOUNT OF
INCREASETO CASH

j
i

Attach

additional inlormarion
Summary

ar

appropriately

labeled conlinuarion sheets

SUBTOTAL

Schedule I

1 Itemized incroases to cash his

period 8

2 Unitemizetl increases to cash of under 100 this 3 Total of all interest received this
4 Total

period
Schedule H Column e
on

periotl

on

loans made to others

miscellaneous

increases to cash this

period Add

Lines 7 2 and 3 Enter here and

the TOTAL
FPPC Form 000

Summary Page

Line

74

FPPC Tall Free

Halplina

FPPC B661ASN

05 January 2 5 06612