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Home My WebLink AboutPeterson, Erik H. - 2011 FPPC Campaign Disclosure Forms - Er (2) t Recipient Committee T COVER PAGE ype or print in ink. Date stamp � � Campaign Statement ®® Cover Page E-filed on: ;I 7, (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicable: f t i r,,s 4 Page 1 of 4 07/01/2011 (Month, Day, Year) 6 �6;-'.,, �; .}. g from For Official Use Only SEE INSTRUCTIONS ON REVERSE through 12/31/2011 1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: x Officeholder,Candidate Controlled Committee Primarily Formed Ballot Measure ❑ Preelection Statement ❑ ❑ y ❑ Quarterly Statement Q State Candidate Election Committee Committee ® Semi-annual Statement ® Special Odd-Year Report Q Recall p Controlled [� Termination Statement ® Supplemental Preelection (Also Complete Parts) o Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 ❑ General Purpose Committee (Also Complete Pert 6) ❑ Amendment (Explain below) Q Sponsored [] Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part7) 3. Committee Information ILD4NUM ER Treasurer(s) COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Erik Peterson for City Council'2e" 2 Erik Peterson MAILING ADDRESS STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Huntington Beach CA 92649 (714) 580-6980 CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach CA 92649 (714) 580-6980 MAILING ADDRESS(IF DIFFERENT) NO, AND STREET OR PO. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/ E-MAIL ADDRESS erikoetersonhbeclmail.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowled the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury underthe laws of he State of California that the foregoing is true and correct. Executed on By Date gnatureofTreas ssistantTreasurer i Executed on / -� � By We ur oiling Officeholder,Candidate,State Measure Proponent or Responsible 0fficerofSponsor 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:8661ASK-FPPC(8661276-3772) State of California Type or print in ink. COVERPAGE-PART2 Recipient Committee Campaign Statement mOM; • 1 Cover Page—Part 2 Page 2 of 4 6. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Erik Peterson OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE City Council Member RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. Huntington Beach CA 92649 NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: List any committees not Included In this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets If necessary FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866127"772) State of California Campaign Disclosure Statement Type or print in ink, SUMMARY PAGE Amounts may be rounded Statement covers period . ®- Summary Page to whole dollars. e from 07/01/2011 ® - through 12/31/2011 IPge SEE INSTRUCTIONS ON REVERSE 3 of 4 NAME OF FILER I.D. NUMBER Erik Peterson for City Councili-@- 9- C"Z 1342225 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR Running i Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTODATE n e Primary 1. Monetary Contributions ........................ $0.00 $0.00 General Elections ................... Schedule A,tine 3 $ $ - 2, Loans Received $0.00 $0.00 1/1 through 6/30 7/1 to Date ............................ Schedule 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $0.00 $ $0.00 20. Contributions Received $ $ 4. Nonmonetary Contributions..... Schedule C,Line 3 $0'00 $0.00 21, Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ,.................... .....Add Lines 3+4 $ $0.00 $ $0.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ $0.00 $ $0.00 Candidates 7. Loans Made.............................. Schedule H,Line 3 $0.00 $0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $0.00 $ $0.00 (If Subject toVoiunlary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................schedule F,,Line 3 $0.00 $128.33 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................schedule C,Line 3 $0.00 $0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................AddLlnes6+9+10 $ $0.00 $ $128.33 $ Current Cash Statement -J----f $ 12. Beginning Cash Balance....................... Prewous summary Page,Line 16 $ $359.42 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3above $0.00 amounts in Column A to the 00 corresponding amounts *Amounts in this section may be different from amounts0 14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 $ from Column B of your last reported in Column B. 15. Cash Payments.................................................. Column A,Line 8above $0.00 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE,......... Add Lines 12+13+14,then subtract Line 15 $ $359'42 figures that should be subtracted from previous if this is a termination statement, Line 16 must be zero, period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule e,Part 2 $ $o.oo for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts aruy)�m Lines 2,7,and 9 (if $o.00 18. Cash Equivalents........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2+Line 9in Column 8above $ _ $128.33 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772) SCHEDULE F Schedule F Type or print in ink. Amounts maybe rounded Statement covers period ® - 1 Accrued Expenses (Unpaid Bills) to whole dollars. FORK from 07/01/2011 through 12/31/2011 Page 4 of 4 SEE INSTRUCTIONS ON REVERSE — NAME OF FILER I.D.NUMBER Erik Peterson for City Council-*@- b 2L) 1 Z 1342226 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t,v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel,lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF CREDITOR CODE OR ( ( (c) OUTSTAA NDING AMOUNTIN (d)CURRIED AMOUNT PAID OUTSTANDING (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Staples LIT $128.33 $0.00 $0.00 $1219.33 Huntington Beach CA 92647 " Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS$ $128.33$ $ $$0.00 $0.00 $128.33 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ $0.0o 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ $0.0n 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.) ................................................................................................................................................ NET$ so.on May be a negative number FPPC Form 460(January/06) FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALlFOqNlA 410 ® - INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME LD:NUMBER 4.Type of Committee (Continued) .. a Not formed to support or oppose specific candidates or measures in a single election. Check only one box: QX CITY Committee []COUNTY Committee ❑STATE Committee ROVIDE BRIEF DESCRIPTION OF ACTIVITY .. omnjjpteol List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE Date qualified 5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditions have been met: This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; This committee has eliminated Or has no intention Or ability to discharge all debts, loans received, and other obligations; This committee has no surplus funds; and This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(June/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Lugar, Robin From: Lugar, Robin Sent: Wednesday, August 17, 2011 4:33 PM To: Ierikpetersonhb@gmail.com' Cc: Flynn, Joan Subject: Campaign Filing Request Mr. Peterson, I need your assistance in amending one of your 460 campaign documents (10-01-10 to 10-16-10) -the form needs to be marked "Amendment", and the Election year changed from 2011 to 2010. You can simply stop by our office and handwrite the changes on the form you submitted and we will be good to go. Also, we would like to know the status of your committee id number with the California Secretary of State's Office. We still do not have a number on file for your committee. Let me know, and thanks! Robin Lugar, CIVIC Assistant City Clerk City of Huntington Beach 2000 Main Street Huntington Beach CA 92648 (714) 536-5405 Campaign ®ISC�®SUre Statement Amounts or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period Summary Page to whole dollars. � ®RM ® t from o1/01/2011 SEE INSTRUCTIONS ON REVERSE through 06/30/2011 Page 3 of 4 NAME OF FILER I.D. NUMBER Erik Peterson for City Council 2010 Pending CContributions A Column B Calendar Year Summary for Candidates ontributions Deceived TOTALTHISPERIOD CALENDARYEAR(FROM ATTACHED SCHEDULES) TOTALTODATE 7 Runnin((�11 r In Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ $0.00 $ $0.00 2. Loans Received ...................................................... Schedule a,Line 3 $0.00 $0.00 1/1 through 6l30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $0.00 $ $0.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 20.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $0.00 $ $0.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ $0.00 $ $0.00 Candidates 7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $0.00 $ $0.00 (if Subjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 $0.00 $128.33 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 $0.00 $0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $0.00 $ $128.33 $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page,Line 16 $ $359.42 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above $0.00 amounts in Column A to the corresponding amounts 'Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 $0.00 from Column B of your last reported in Column B. 00 report. Some amounts in 15. Cash Payments.................................................. column A,Line 8 above $0. Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $359.42 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17.LOAN GUARANTEES RECEIVED ........................... Schedule e,Part 2 $ $0.00 for this calendar year, only carry over the amounts om Cash Equivalents and Outstanding Debts any)' Lines 2, 7,and 9(if $o.00 18. Cash Equivalents........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $128.33 FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)