The URL can be used to link to this page

Home My WebLink AboutBohr, Keith - 2011 FPPC Campaign Disclosure Forms - SuccessfRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84218.5) Type or print in Ink. Statement Povers period I Date of election if applicable: from "�tf / ' (Month, Day, Year) SEE INSTRUCTIONS ON REVERSE I through 3( 1j 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. JK Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee Q Political Party/Central Committee 3. Committee Information fr � C 4.r 4d (4-- *d,( STREET ADDRESS (ND P.O. BOX) C ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 2. Type of Statement: Date -Stamp> Pane COVER PAGE For Official Use Only 3 ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment Explain be w) .� "7 Treasurer(s) NAME OF TREASURER MAILING ADDRESS STATE ZIP CODE AREA COD'. TREETREET OR FrO. BOX STATE ` ZIP CODE AREA COD 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 I' ws of the State of California that the foregoing is true and correct. Executed on !-allI-all za By if Data Signature of Treasurer or Assistant Treasurer Executed on �-- By �G! Date' Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer otSponsor 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 Toil -Free Helplins: 866/ASK-FPPC (866/275-3772) State of California Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84218.5) SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Statemen covers period from I' through 1, Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. gJ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Parts) O Sponsored ❑ General Purpose Committee (Also Complete Part 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also complete Part 7) 3. Committee Information 1.7. N M41R,(% x COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMK f r ( r-4567' (4--(,�/a.,' STREET ADDRESS (NO P.O. BOX) Date of election If applicable: (Month, Day, Year) 2. Type of Statement: COVER CALIFORNIA /� FORM 'T _70 a 2 k.`a` C 2 I Pt"i iy .,I of For Official Use Only ❑ Preelection Statement ❑ quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Ex ain below) Treasurer(s) �C [4�� NAME OF TREASURER MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STA E ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification 1 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. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 1.2® By 9 to �� Signature of Treasurer or Assistant Treasurer Executed on 2- � � By Dote Signature of Controlling Ofteholder,Candidate, Stale Measure Proponent or esponslbloOfficerofSponsor 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 Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER ?___o R Contributions Received 1, Monetary Contributions ........................................... schedule A, Line 3 2, Loans Received...................................................... schedule 6, line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add LrnesI+2 4, Nonmonetary Contributions .................................... Schedule C, Llne 3 5. TOTAL CONTRIBUTIONS RECEIVED.••........................AddLines3+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) .................. I. ... I....... Schedule F, Llne 3 10, Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 6 + 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 6 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) $ $ r $ W 17, LOAN GUARANTEES RECEIVED ........................... Schedule 6, 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 covers period from -7 Q through u! s u 11 Column B CALENDAR YEAR TOTALTO DATE $ 0 t� B $ cU7 $ (CLJ 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 3 of 3 I.D. NUMBER I q 11c&®7 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) .00. Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. SUMMARY PAGE Statement covers period WORK from ' r� through .301 / Page _ of 1 I.D. NUMBER A Column B Calendar Year Summary for Candidates Received Contributions Received TOTALTHISPERIOD CALENDARYEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ $ 111 through 6/30 7/1 to Date 2. Loans Received...................................................... Schedule e, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ $ 20. Contributions Id Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ $ Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule e, Line 4 $ 91 $ 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+s+10 $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ ( 3 14. ?6 13. Cash Receipts ................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 15. Cash Payments .................................................. Column A, Line a above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 1 q l Y • 76 If this is a termination statement, Line 16 must be zero. 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 $ 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 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 (8661275-3772)