HomeMy WebLinkAboutBohr, Keith - 2010 FPPC Campaign Disclosure Forms - Successfitt i Reci ent Committee
p
COVERPAGE
Date St
Campaign Statement
Type or print in ink,
mp
o , ,
CoverPage
(Government Code Sections 84200-84218.5)
9
2�4012 1Ji.; 2" q 2 P
�
IPage 3� {{gg of
Statement covers period
Date of election If applicable',
For Official Use Only
from
(Month, Day, Year)
SEE INSTRUCTIONS ON REVERSE
through �°� 3� • b
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4,
2. Type of Statement:
Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
❑ Preelection Statement ❑ Quarterly Statement
Q State Candidate Election Committee
Committee
❑ Semi-annual Statement ❑ Special Odd -Year Report
Q Recall
(A1soComplete Part 5)Sponsored❑
Q Controlled
Q
Termination Statement ❑ Supplemental Preelection
Also file a Form 410 Termination
( ) Statement -Attach Form 495
❑ General Purpose Committee
Q Sponsored
(Also Complete Parts)
❑ Primarily Formed Candidate/
Amendm7nt•Explain low)
-�—� (l
(/
c'
Q Small Contributor Committee
Officeholder Committee
Q Political Party/Central Committee
(Also Complete Pad 7)
3. Committee Information
1..NNUUM R2G0
Treasurer(s)
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
f f t C4s;4.� (4-- (� do 4
NAME OF TREASURER
MAILING ADDRESS
STREET ADDRESS (NO P.O. BOX)
ARIA GV
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
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 knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of pedury under the laws of the State of California that the foregoing is true and correct.
Executed on ® h.2, By
e z B Signature of Treasurer or Assistant Treasurer
ag __ y �
Executed on42! D e SignaiureofContro ingOfficeholder,Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder. Candidate, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06)
FPPC Toll -Free Heipline: 866/ASK-FPPC (866/275-3772)
State of California
Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink. Date Stamp
Stateme t co ers period Date of election if applicable:? DEC ;
/ %I (Month, Day, Year)
from ` V
through (0 30
10
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
J Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee
Committee
Q Recall
Q Controlled
(Also Complete Part5)
O Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
Q Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
Q Political Party/Central Committee
(Also Complete Part7)
3. Committee Information
1.7.� L_ -n / — —y
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Fe 1C_45 O-P I�_a14� a04r
STREET ADDRESS (NO P.O. BOX)
C TY STATE
ZIP CODE
AREA CODE/PHONE
C-
?.2c el,-
7/Y-_V -,)AK?
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
AREA CODE/PHONE
CITY STATE
ZIP CODE
`� Lr 44
l %
• Nf Orr►I- � GI fi "°C t (, cav
OPTIONAL: FAX / E-MAIL A SS
2. Type of Statement:
❑ Preelection Statement
❑ Semi-annual Statement
❑ Termination Statement
(Also file a Form 410 T
Amendment (Elplain b
Treasurer(s)
5- etc
MAILING ADDRESS
COVER PAGE
—�— of -a
For Official Use Only
❑ Quarterly Statement
❑ Special Odd -Year Report
❑ Supplemental Preelection
Statement - Attach Form 495
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
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 knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under the laws of th State of California that the foregoing is true and correct.
Executed on � /2— By
Date Signature of Treasurer or Assistant Treasurer
Executed on 0 By
Date f Signature of Controllingrufficeholder,Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent 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
r .
Contributions Received
AL, AdIte
1. Monetary Contributions ........................................... Schedule A, Line 3
2. Loans Received...................................................... Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2
4. Nonmonetary Contributions .................................... Schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4
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
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.
Type or print in ink.
Amounts may be rounded
to whole dollars.
Column A
TOTALTHIS PERIOD
(FROM ATTACHED SCHEDULES)
$
$
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 $
Statement
ttfcovers period
from pp/ , d
through
Column B
CALENDAR YEAR
TOTALTO DATE
$
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).
SUMMARY PAGE
Page -1 of _
I.D. NUMBER
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 711 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)
Campaign Disclosure Statement
Summary Page
Type or print in ink
Amounts may be rounded
to whole dollars
Statement /covers period
from 't 1/10
SUMMARYPAGE
SEE INSTRUCTIONS ON REVERSE through �, Page -3 of -3
NAME OF FILER c ID NUMBER
VC -A"
/
C " I� -l�(,O7
ColumnA Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHIS PERIOD CALENDARYEAR Running In Both the State Prima and
(FROM ATTACHED SCHEDULES) TOTALTO DATE 5 Primary
General Elections
1 Monetary Contributions Schedule A Line 3 $ $
1/1 through 6/30 7/1 to Date
2 Loans Received Schedule B Line 3
3 SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ $ 20 Contributions
Received $ $
4 Nonmonetary Contributions Schedule C Line 3 -- 21 Expenditures
5 TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ $ Made $ $
Expenditures Made
6 Payments Made
7 Loans Made
8 SUBTOTAL CASH PAYMENTS
9 Accrued Expenses (Unpaid Bills)
10 Nonmonetary Adjustment
11 TOTAL EXPENDITURES MADE
Schedule E Line 4 $
Schedule H Line 3
Add Lines 6 + 7 $
Schedule F Line 3
Schedule C Line 3
Add Lines 8 + 9 + 10 $
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 1 Line 4
15 Cash Payments Column A Line 8 above p
16 ENDING CASH BALANCE Add Lines 12 + 13 + 14 then subtract Line 15 $ -1y -3 let 7 A
If this is a termination statement Line 16 must be zero
17 LOAN GUARANTEES RECEIVED Schedule S 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 $
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
(If Subjectto 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 (Januaryl05)
FPPC Toll Free Helpline 866/ASK FPPC (8661275 3772)