HomeMy WebLinkAboutRorick, William G. - 2010 FPPC Campaign Disclosure Forms For (2) COVER PAGE
Recipient Committee Type or print in ink. Date Stamp
Campaign Statement
Cover Page E-filed on:
(Government Code Sections 84200-84216.5)
Statement covers period Date of election if=1i=eZ-4 Pi". 3: 13
from 10/17/2010 (Month, Day,Year) Page I of 7
For Official Use Only
SEE INSTRUCTIONS ON REVERSE through 12/31/2010
1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement:
Fx� Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure L],Avreelection Statement 7X Quarterly Statement
0 State Candidate Election Committee Committee M semi-annual statement ❑ Special Odd-Year Report
0 Recall 0 Controlled F-1 Termination Statement 7 Supplemental Preelection
(A/WC—PAD1eftrt5) 0 Sponsored ❑
(Also file a Form 410 Termination) Statement-Attach Form 495
7 General Purpose Committee (AboCornpkgeFaH6) ❑ Amendment(Explain below)
0 Sponsored ❑ Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Al-Complete Part 7)
J
3. Committee Information I.D. NUMBER
1330355 Treasurer(s)
COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER
Committee to Elect Rorick for Huntington Beach City Council 2010 Bill Rorick
MAILING ADDRESS
STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
Huntington Beach CA 92647 (714) 330-9389
CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY
Huntington Beach CA 92647 (714) 330-9389
MAILING ADDRESS(IF DIFFERENT) NO. AND STREET OR P.O. 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
brorick@socal.rr.com brorikesocal.rr.com
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information co ad herein and in the attached schedules is true and complete. (certify
under penalty of perjury under the 6 laws of the State of California that the foregoing is true and correct.
1
Executed on 1114,1111 By
Date Sl§ tu surer4rAWIstantTreasurer
Executed on By -7 lz4z
Date Signature or Controlling Officeholder,Candidag,SM Mfosure Proponentor Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder,Candidate,Sate Measure Proponent
Executed on Date By Signature of Controlling Officehokker,Candidate,State Measure Proponent FPPC Form 460(January/05)
FPPC Toll-Free Helpline:8661ASK-FPPC(866/275-3772)
State of California
Type or print in ink. COVER PAGE-PART 2
Recipient Committee ®o
Campaign Statement ®@ ® ® 1
Cover Page®Part 2
Page 2 of 7
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE
Bill Rorick
OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT
❑OPPOSE
City Council Member
RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP
Identify the controlling officeholder, candidate, or state measure proponent, if any.
Huntington Beach CA 92647
NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT
Related Committees Not Included in this Statement: Listany 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.
COMMITTEENAME I.D. NUMBER
NAMEOFTREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of
oflfceholder(s)or candidate(s)for which this committee is primarily formed.
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (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
COMMITTEENAME 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 STREET ADDRESS (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:066iASK-FPPC(SN/275-3772)
State of California
Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period ®� a
Summary Page to whole dollars.
from 10/17J2o10
SEE INSTRUCTIONS ON REVERSE
through 12/31/2010 Page 3 of 7
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 1330355
ColumnA Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDARYEAR Running In Both the State Primer and
(FROMATTACHED SCHEDULES) TOTALTODATE 39 y
General Elections
1. Monetary Contributions........................................... Schedule A,Linea $ $250.00 $ $250.00
111 through 6130 7/1 to Date
2. Loans Received ...................................................... Schedule B,Line 3 $0.00 $5,300.00
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $2so.oo $ $s,sso.o0 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... ScheduleC,Line $0.00 $0.00 21 Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $250.00 $ $5,550.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $455.00 $ $6,005.00 Candidates
7. Loans Made............................................................. Schedule y,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $455.00 $ $6,005.00 1 (if Subject toWluntaryExpendHureLlmit)
9. Accrued Expenses (Unpaid Bills)..............................Schedule!Linea $0.00 $0.00 Date of Election Total to Date
10.Nonmonetary Adjustment..........................................ScheduleC,Line $0.00 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $455.00 $ $6,005.00 $
Current Cash Statement -J-J $
12.Beginning Cash Balance....................... Previous Summary Page,Line 16 $ -$250.00
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3above $250.00 amounts in Column Ato the
$455.oo
corresponding amounts *Amounts in this section may be different from amounts
14.Miscellaneous Increases to Cash........................... schedule 1,line 4 from Column B of our last reported in Column B.
15.Cash Payments...... ........ . $455.00 report. Some amounts in
Column A,Line 8 above Column A may be negative
16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $0.00 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 B,Part 2 $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2,7,and s(if
$0.00 any).
18. Cash Equivalents............
............................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $5,300.00 FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/2763772)
Schedule A Type or print in ink. SCHEDULE A
Amounts may be rounded Statement covers period
Monetary Contributions Received to whole dollars. p ®" - -
from 10/17/2010 ®'
SEE INSTRUCTIONS ON REVERSE
through 12/31/2013 FPag1
4 of 7
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 1330355
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TODATE
(IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED)
OF BUSINESS)
10/19/2010 William Rorick ❑xIND Vice President - OEM $250.00 $250.00
❑COM MagTek Inc.
❑OTH
Huntington Beach CA 92647 ❑PTY
❑SCC
❑IND
❑COM
[]OTH
❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
[]SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
❑IND
❑COM
[]OTH
❑PTY
❑SCC
SUBTOTAL$ $250-00
Schedule A Summary 'Contributor Codes
1. Amount received this period-itemized monetary contributions. IND-Individual
(Include all Schedule A subtotals.)........................... ..... $ $250.00 COM—Recipient Committee
(other than PTY or SCC)
2. Amount received this period—unitemized monetary contributions of less than$100.............................$ $0.00 OTH-Other(e.g.,business entity)
PTY-Political Party
3. Total monetary contributions received this period. SCC-Small contributor committee
(Add Lines 1 and 2. Enter here and on the Summary Page,Column A, Line 1.)....................... TOTAL $ $250.00
FPPC Form 460(January/OS)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
Schedule g—Part Type or print in ink. Statement covers period
SGHEDULEB PART 1
Amounts may be rounded p ®m
Loans Received to whole dollars. ®�
from 10/17/2010
SEE INSTRUCTIONS ON REVERSE through 12/31/2010 Page 5 of 7
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 1330355
FULL NAME,STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTS ANDING AMOUNT U(ON)
OUTSTANDING INTEREST ORIGINAL CUMULATIVE
OCCUPATION AND EMPLOYER AMOUNT PAID
OF LENDER BALANCE RECEIVED THIS BALANCEAT PAID THIS AMOUNT OF CONTRIBUTIONS
(IF SELF-EMPLOYEQ,ENTER BEGINNING THIS OR FORGIVEN CLOSE OF THIS
(IF COMMITTEE,ALSO ENTER I,Q.NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE
William Rorick vice President - OEM
❑PAID CALENDAR YEAR
MagTek Inc. $ $5,300.00 0.00 $5,300.00 $250.00
$ % S $
❑FORGIVEN RATE PER ELECTION—
Huntington Beach CA 92647 $ $51300.00 $ $0.00 $ $ 08f18/2009 $
t® IND ❑ COM ❑OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED
❑PAID CALENDAR YEAR
❑FORGIVEN RATE PER ELECTION''*
$ S $ $ $
t❑ IND ❑ COM ❑OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED
❑PAID CALENDAR YEAR
❑FORGIVEN RATE PERELECTnN—
$ S S $ $
t❑ IND ❑ COM ❑OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED
SUBTOTALS $ $0.00$ $o.00$ $5,300.00$ so.0o
(ErAw(a)on
Schedule B Summary ScheduleE,Line 3)
1. Loans received this period................................ ...... ......................................... ...................... $ $0.o0
. .
(Total Column(b)plus unitemized loans of less than$100.) tContributor Codes
IND—Individual
2. Loans paid or forgiven this period ......................................................................................................... $ $0.00 Conn-Recipient committee
(Total Column(c)plus loans under$100 paid or forgiven.) (other than PTY or SCC)
(Include loans paid by a third party that are also itemized on Schedule A.) OTH-Other(e.g., business entity)
PTY-Political Party
3. Net change this period. Subtract Line 2 from Line 1. $0.oo SCC-Small Contributor Committee
9 P ( )............................................................... NET $
Enter the net here and on the Summary Page, Column A, Line 2. (Maybe a negative number)
"Amounts forgiven or paid by another party also must be reported on Schedule A.
*`If required. FPPC Form 460(January/05)
FPPG Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
SCHEDULEE
Schedule E Type or print in ink. Statement covers period
Payments
� e� ����- Amounts may be rounded
to whole dollars. ®'
from 10/17/2010
SEE INSTRUCTIONS ON REVERSE through 12/31/2010 Page 6 of 7
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 1330355
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CIVIP campaign paraphernalialmisc. MBR member communications RAD radio airtime and production costs
IONS campaign consultants MTG meetings and appearances RFD returned contributions
CTS contribution (explain nonmonetary)* OFC office expenses SAL campaign workers'salaries
CVC civic donations PEr 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
WD independent expenditure supportinglopposing 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 \AEB information technology costs(internet,e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID
Mr. William Rorick Jr. Partial repayment of loan $455.00
Huntington Beach CA 92647
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $455.00
Schedule E Summary
1. Itemized payments made this period.(Include all Schedule E subtotals.).............................................................................................................. $ $455.00
2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ $0.00
3. Total interest paid this period on loans.(Enter amount from Schedule B, Part 1, Column(e).)............................................................................... $ $0.00
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .....................I....... TOTAL $ $455.o0
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772)
Schedule I Type or print in ink. SCHEDULE I
Miscellaneous Increases to Cash - - Amounts may be rounded Statement covers period j Ir®e A
to whole dollars. ® o
from 10/17/2010
SEE INSTRUCTIONS ON REVERSE through 12/31/2010 Page 7 of 7
NA ME OF FILER I.D.NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 1330355
DATE FULL NAME ANDADDRESS OF SOURCE AMOUNT OF
RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH
12/03/2010 City od Huntington Beach Refund of portion of campaign statement fee $455.00
Huntington Beach CA 92648
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ $455.00
Schedule I Summary
1. Itemized increases to cash this period. .......................................................................................................................$ $455.00
2. Unitemized increases to cash of under$100 this period.............................................................................................$ $0.00
3. Total of all interest received this period on loans made to others. (Schedule H, Column(e).) .................................$ $0.00
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
SummaryPage, Line 14.)......... ......... ..................................................................................................... TOTAL $ $455.00
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(86612753772)
Lugar, Robin
From: Lugar, Robin
Sent: Tuesday, July 26, 2011 10:44 AM
To: 'brorick@socal.rr.com'
Subject: HB Campaign Filing
Attachments: rorick 2nd pe.pdf; rorick sa.pdf; Form 460.pdf
Mr. Rorick,
Thank you for recently submitting a 460 Campaign Disclosure Form for the period of 12-31-10 to 6-24-11, and
a 410 Statement of Organization form indicating a terminated status for your Committee to Elect Rorick for
Huntington Beach City Council 2010. Our records indicate we have yet to receive a 460 form showing
campaign activity during the final semi-annual period of 10-17-10 through 12-31-10. I've attached filings
submitted before and after this period to assist you with satisfying your requirements. Please take care of this
as soon as possible.
Thank you.
Robin Lugar, CIVIC
Assistant City Clerk
City of Huntington Beach
2000 Main Street
Huntington Beach CA 92648
(714) 536-5405
Campaign Disclosure Statement Amounts
or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers perio Fp.
Summary Page to whole dollars. A
from 10/01/2010
SEE INSTRUCTIONS ON REVERSE I
through 10/16/2010 Page 3 of 5
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City Council 2010 Pending
Contributions Received Column A Column B Calendar Year Summary for Candidates
TOTALTHISPERIOD CALENDAR YEAR Running in Both the State Primary and
(FROMATTACHEDSCHEDULES) TOTAL TO DATE g y
General Elections
1. Monetary Contributions ........................................... Schedule A,Line $ $0.00 $ $0.00
1I1 through 6C30 7I1 to Date
2. Loans Received ...................................................... Schedule B,Line $0.00 $5,300.00
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ $o.oo $ $5,300.00 20. Contributions
Received $ $
4. Nonmoneta Contributions.................................... Schedule $0.00 $0.00
ry 21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ••••••••••••......•.•••.•••Add Lines 3+4 $ $0.00 $ $5,300.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $250.00 $ $5,550.00 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $250.00 $ $5,550.00 (If Subject toWluntaryExpendItureumlt)
9. Accrued Expenses (Unpaid Bills)...............................Schedule F,Line $0.00 $0.00 Date of Election Total to Date
10.Nonmonetary Adjustment..........................................ScheduleC,Line $0.00 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $250.00 $ $5,550.00 $
Current Cash Statermnt $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $0.00
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Lane 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.oo from Column B of your last reported in Column B.
15.Cash Payments.................... $250.00 report. Some amounts in
Column A,Line 8 above Column A may be negative
16.ENDING CASH BALANCE.......... Add tines 12+13+14,then subtract Line 15 $ -$250.oo figures that should be
subtracted from previous
It'-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 B,Part 2 $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Dents from Lines 2,7,ands(if$0.00 any).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $5,300.00 FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772)
Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE
Amounts may be rounded Statement covers period , ®� ,
Summary Page to whole dollars.
from 07/01/2010
SEE INSTRUCTIONS ON REVERSE through 09/30/2010 Page 3 of 5
NAME OF FILER I.D. NUMBER
Committee to Elect Rorick for Huntington Beach City council 2010 Pending
,� a Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDAR YEAR Running in Both the State Primary and
(FROMATTACHEDSCHEDULES) TOTAL TO DATE g y
General Elections
1. Monetary Contributions ........................................... Schedule A,Linea $ $0.00 $ $0.00 1/1 through 6f30 7/1 to Date
2. Loans Received ...................................................... Schedule B,Line 3 $0.00 $5,300.00
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ $0.00 $ $5,300.00 20. Receibutions
Received $ $
4. Nonmonetary Contributions,-................................ ScheduleC,Linea $0.00 $0.00 21 Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ••••••••••••••••.•.••....•�Add Lines 3+4 $ $0.00 $ $5,300.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $5,300.00 $ $5,300.00 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $5,300.00 $ $5,300.00 (H Subject toWluntary Expenditure Umlt)
9. Accrued Expenses (Unpaid Bills)...............................Schedule F Linea $0.00 $0.00 Date of Election Total to Date
10,Nonmonetary Adjustment..................... $0.00 $0.00 (mmidd/yy)
.....................Sched uls C,Line 3
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $5,300.00 $ $5,300.00 $
Current Cash Statement --1-J $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $5,300.00 To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3above $0.00 amounts in Column Ato the
corresponding amounts *Amounts in this section may be different from amounts
14. Miscellaneous Increases to Cash............ $0 00 your last reported in Column B.
............... Schedule 1,Line 4 from Column B of
15.Cash Payments.................................................. Column A,Line 8above $5,300.00 report. Some amounts in
Column A may be negative
16.ENDINGCASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $0.00 figures that should be
subtracted from previous
ff 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 B,Part 2 $ $0.00 for this calendar year,only
carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2,7,and 9(if
$0.00
any).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $5,300.00 FPPC Form 460(January/o5)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/2753772)
Statement Of OrganizationSTATEMENT OF ORGANIZATION
Recipient Committee � 0`' n , 1
INSTRUCTIONS ON REVERSE Page 2
COMMITTEE NAME e� 10 NUMBER
4 Type Of Committee Complete the applicable sections
e e e o
® List the name of each controlling officeholder candidate or state measure proponent If candidate or officeholder controlled also list the elective office sought or held and
district number if any and the year of the election
o List the political party with which each officeholder or candidate is affiliated or check non partisan
C If this committee acts jointly with another controlled committee list the name and identification number of the other controlled committee
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Non Partisan
R ors ck �� �,�, �' �,�, 2ca
❑ Non Partisan
® List the financial institution where the campaign bank account Is located (controlled candidate election committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
e e . Primarily formed to support or oppose specific candidates or measures in a single election List below
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO OR LETTER) CANDIDATE($)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO CITY OR COUNTY A$APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (June/09)
FPPC Toll Free Helpiine 866/ASK FPPC (8661275 3772)
Statement of OrganizationSTATEMENT OF ORGANIZATION
Recipient Committee S
!FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME 10 NUMBER
e ;4 ca Zoe C7
4 Type of Committee (Continued)
.. . Not formed to support or oppose specific candidates Cr measures in a single election Check only one box
CITY Committee ❑COUNTY Committee Q STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS 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 Toil Free Helpiine 866/ASK FPPC (866/275 3772)