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Home My WebLink AboutRoselius, Shawn R. - 2010 FPPC Campaign Disclosure Forms For (2) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee F410 FORU INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 4.Type of Committee (Continued) •• . Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑CITY Committee ❑COUNTY Committee ❑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 ContributorSmO 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) Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period , ® - Summary Page to whole dollars. � from 10/17/10 FORM SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page 5 of 12- NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR RunningIn Both the State Prima and (FROMATTACHEDSCHEDULES) TOTALTOCATE Primary General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ 0 $. 2342 2. Loans Received ...................................................... Schedule B,Line 3 -1318 1318 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines t+2 $ 0 $ 3660 20. Contributions 4. Nonmonetary Contributions............. 0 670 Received $ $ Schedule C,Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...............••..........Add Lines 3+4 $ 0 $ 4330 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 12 $ 3494 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0 0 22. Cumulative Expenditures Made" 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 12 $ 3492 (#Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add lines 8+9+10 $ 12 $ 3492 J $ Current Cash Statement ---/_--J $ 12. Beginning Cash Balance....................... Previous summary Page,Line 16 $ 280 To calculate Column B,add ...................13.Cash Receipts ................................................... column A,Line 3 above 0 amounts in Column A to the 455 corresponding amounts "Amounts in this section may be different from amounts 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 8 above 12 report. Some amounts inColumn A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 723 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 $ for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, ands(if 18. Cash Equivalents........................................ see instructions on reverse $ 0 any). 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275 3772) ScheduleA Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. WMI 111 lei- from 10/17/10 ®- • SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page y of ( 2 NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 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 ENTERI.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELFEMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ = Schedule A Summary 'Contributor Codes 1. Amount received this period—itemized monetary contributions. IND—Individual (include all Schedule A subtotals.) .......................... $ 0 COM—Recipient Committee ........................................................................... (other than PTY or C) 2. Amount received this period—unitemized monetary contributions of less than$100 .............................$ 0 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 SummaryPage, Column A Line 1.) TOTAL $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:8661ASK-FPPC(866/275-3772) Schedule C Type or print in ink. SCHEDULE C Amounts may be rounded Statementcovers period Nonmonetalry Contributions Received to whole dollars. CALIFORNIA � from 10/17/10 ® - SEE INSTRUCTIONS ON REVERSE through 12/31/10 page of 1 NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 ENTER FULL NAME,STREET ADDRESS AND CONTRIBUTOR CUMULATIVE TO PER ELECTION IF AN INDIVIDUAL, DESCRIPTION OF AMOUNT/ DATE DATE OCCUPATION AND EMPLOYER FAIR MARKET TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * R GOODS OR SERVICES CALENDAR YEAR (IF COMMITTEE,ALSO ENTER I.D. IFSELF-EMPLOYED,ENTE VALUE D.NUMBER) NAME OF BUSINESS) (JAN 1-DEC 31) OF REQUIRED) ❑IND ❑COM ❑OTH []PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC FIND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule C: Summary *Contributor Codes 1. Amount received this period—itemized nonmonetary contributions. 0 IND—Individual (Include all Schedule C subtotals.)..................................................... ................................$ COM-Recipient Committee (other than PTY or SCC) 2. Amount received this period-unitemized nonmonetary contributions of less than$100 ....................................$ 0 OTH—Other(e.g., business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. 0 SCC—Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule D SCHEDULED Summary®f Expenditures Type or print in ink. Statement covers period � Amounts may be rounded Supporting/Opposing Other to whole dollars. from 10/17/10 Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page of I NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) OR COMMITTEE PERIOD (JAN.1-DEc.31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure h SUBTOTAL $ r � Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. 0 2. Unitemized contributions and independent expenditures made this period of under$100............................... ................... $ 0 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 0 p P P ( rY 9 ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULEE Schedule E Type or print in ink. Statement covers period , Amounts may be rounded ® �; I60' Payments Made to whole dollars. 10/17/10 ® ") from i SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page of I a NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/mist. 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 M 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 UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period, Include all Schedule E subtotals. .......................... $ 0 2. Unitemized payments made this period of under$100 ....................................................... 12 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).) .................................. $ 0 4. Total payments made this period. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A, Line 6.) 12 ............................. TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE F Schedule F Type or print in ink. Statement covers period _ a ' Amounts may be rounded 46,0 Accrued Expenses (Unpaid Bills) to whole dollars. from 10/17/10 m ' throw h 12/31/10 �' f� SEE INSTRUCTIONS ON REVERSE g Page of NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 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 RAD 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 PFIO 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 (al (b) (c) ( OUTSTANDING AMOUNTINCURRED AMOUNT PAID OUTSTAA NDING (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 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 0 accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0 accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 0 on the Summary Page, Column A, Line 9.) ......................... NET $ May e a negative nun er FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/2753772) Schedule G SCHEDULE G Type or print in ink. Payments Made by an Argent or Independent Amounts may be rounded statement covers period , ® . Contractor(on Behalf of This Committee) to whole dollars. from 10/17/10 e • 1 SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page lb of I NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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) "Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 *Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule H Type or print in ink. Statement covers period SCHEDULE H CALIFORNIA. Amounts may be rounded 10/17/10 • Loans Made to Others* to whole dollars. from SEE INSTRUCTIONS ON REVERSE through 12/31/10 Page i of / NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 IF AN INDIVIDUAL,ENTER (a) (b) (c) A� (e) M (g) FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTST DING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER REPAYMENT OR OF RECIPIENT BALANCE LOANED THIS BALANCEAT THIS RECEIVED AMOUNTOF LOANS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER BEGINNING THIS FORGIVENESS CLOSE OF THIS NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD" PERIOD LOAN TO DATE PAID CALENDAR YEAR FORGIVEN RATE PER ELECTION- DATE DUE DATE INCURRED PAID CALENDAR YEAR FORGIVEN (LATE PER ELECTION" DATE DUE DATE INCURRED "Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ also be reported on Schedule E. (Enter(e)on Schedule I,Line 3) Schedule H Summary 1. Loans made this period ..................................................................................................................................................$ 0 (Total Column(b)plus unitemized loans of less than$100.) **If Required 2. Payments received on loans ...........................................................................................................................................$ 0 (Total Column(c)plus unitemized payments of less than$100.) 3. Net change this period. Subtract Line 2 from Line 1. 0 9 P ( ).......................................................................................... NET $ (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Type or print in ink. SUMMARY PAGE Campaign Disclosure Statement Amounts may be rounded Statement covers period Summary Rage to whole dollars, ® - d from 10/01/10 • - m SEE INSTRUCTIONS ON REVERSE through 10/16/10 Page 3 of 12 NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROMATTACHED SCHEDULES) TOTAL TO DATE g ma ry n 1. Monetary Contributions ........................................... schedule A,Line 3 $ 50 $ 2342 General Elections 2, Loans Received ...................................................... schedule e,Line 3 0 1318 1/1 through 6130 7/1 to Date Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ................:........ Add Lines 1 +z $ 50 $ 3660 20. Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0 670 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 50 $ 4330 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 0 $ 3322 Candidates 7. Loans Made..................... Schedule H,Line 3 0 0 .............................. 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 0 $ 3322 (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................schedule C,Line 3 0 670 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 0 $ 3992 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 388 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 50 amounts in Column A to the 0 corresponding amounts 'Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1,Line 4 from Column B of your last reported in Column B. 0 report. Some amounts in 15.Cash Payments.................................................. Column A,Line 8 above Column A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 438 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 8,Part 2 $ 0 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9(if 0 any). 18. Cash Equivalents........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 1318 FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. 10/17/10 CALIFORNIA from RKI SEE INSTRUCTIONS ON REVERSE. through 11/01/10 Page 4 of 12 NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 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 TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM []OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ Schedule A Summary 'Contributor Codes 1. Amount received this period—itemized monetary contributions. IND—Individual ee (Include all Schedule A subtotals.) , $ COM—Recipi thannt PTY or ............................................................................................ (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 .............................$ OTH—Other business entity) PTY—Politicall Part 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 $ FPPC Form 460(Januaryl05) FPPC Toll-Free Helpiine:866/ASK-FPPC(86612753772) Schedule C Type or print in ink. SCHEDULE C Amounts may be rounded Statement covers period ICI®nmonetary Contributions Received to whole dollars. ® - � from 10/17/10 e - F SEE INSTRUCTIONS ON REVERSE through 11/01/10 page6 of NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 CUMULATIVE TO IFAN INDIVIDUAL,ENTER AMOUNT! PER ELECTION FULL NAME,STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE DATE OCCUPATION AND EMPLOYER FAIR MARKET TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * (IFSELF-EMPLOYED,ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) (JAN 1-DEC 31) (IF REQUIRED) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PT' ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule C Summary "contributor Codes 1. Amount received this period—itemized nonmonetary contributions. 0 IND—Individual (Include all Schedule C subtotals.) ...............................................................$ COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period—unitemized nonmonetary contributions of less than$100 ....................................$ 0 OTH—Other(e.g., business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. 0 SCC—Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule D SCHEDULED Summary®f Expenditures Type or print in ink. _ Amounts may be rounded �Statement covers period � � Supporting/Opposing Other to whole donors. 10/17/10 ®® 40 Candidates, Measures and Committees from through — 11/01/10 Page 7 of 12 row SEE INSTRUCTIONS ON REVERSE 9 g NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUMULATIVE TO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) CALENDAR YEAR TO DATE ORCOMMITTEE PERIOD (JAN.1-Dec.31) (IF REQUIRED) Monetary Contribution Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure 0 Monetary Contribution ❑ Nonmonetary Contribution Q Independent ❑ Support ❑ Oppose Expenditure h SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. ..................................... $ 0 2. Unitemized contributions and independent expenditures made this period of under$100..................................................................................... $ 0 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 0 P P P ( rY g ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE F Schedule F Type or print in ink. Statement covers period ® ' Amounts may be rounded � NIA Accrued Expenses (Unpaid Ails) to whole dollars. from 10/17/10 FGRIVIr through 11/01/10 Page 9 _ of 12 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 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 RAD 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 candidatelsponsor 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 ( ( ( ( OUTSTANDING INCURRED AMOUNT NCURRED 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 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 0 accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0 accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 0 on the Summary Page, Column A, Line 9.) .................. ........................... NET$ May e a ne9 alive num er FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule G SCHEDULEG Type or print in ink. Payments Made by an Agent or Independent Amounts may be rounded Statement covers period A e , Contractor(on Behalf of This Committee) to whole dollars. from 10/17/10 . . SEE INSTRUCTIONS ON REVERSE through 11/01/10 Page 10 of 12 NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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 RAD 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 M 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) *Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 *Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SC+IEDULE H Schedule H Type or print in ink. Statement covers period Amounts may be rounded 10/17/10 - Loans Made to Others* to whole dollars. from SEE INSTRUCTIONS ON REVERSE through 11/01/10 gage 11 of 12 NAME OF FILER LD. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 IF AN INDIVIDUAL,ENTER (a) (b) Ic) {{d (e) M M FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER REPAYMENT OR OF RECIPIENT BALANCE BALANCE LOANED THIS RECEIVED AMOUNTOF LOANS (IF SELF-EMPLOYED,ENTER BEGINNING THIS FORGIVENESS CLOSE OF THH IS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD LOAN TO DATE PAID CALENDAR YEAR FORGIVEN RATE PER ELECTION** DATE DUE DATE INCURRED PAID CALENDAR YEAR FORGIVEN RATE PERELECTION** DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee eA must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ '" also be reported on Schedule E. (Enter(e)on Schedule 1,Line 3) Schedule H Summary 1. Loans made this period ...........$ 0....................................................................................................................................... **If Required (Total Column(b)plus unitemized loans of less than$100.) 2. Payments received on loans $ 0 (Total Column(c)plus unitemized payments of less than$100.) 3. Net change this period. Subtract Line 2 from Line 1. .. NET $ 0 (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule I Type or print in ink. SCHEDULE I Miscellaneous Increases to Cash Amounts may be rounded Statement covers periodIIIIIIIIIIIIIIIIIIQALIF® . to whole dollars. 10/17/10 ® ' I , f rom SEE INSTRUCTIONS ON REVERSE through 11/01/10 Page 12 of NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule I Summary 1. Itemized increases to cash this period. .......................................................................................................................$ 0 2. Unitemized increases to cash of under$100 this period. ...............................................$ 0 3. Total of all interest received this period on loans made to others. Schedule H Column e . 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) .......... TOTAL $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/2753772) Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Summary gage Amotots may be rounded Statement covers period1!!l from01/01/10SEE INSTRUCTIONS ON REVERSE through 09/30/10 NAME OF FILER Shawn Roselius for Huntington Beach City Council 2010 Contributions Received ColumnA Column B Calendar Year Summary for Candidates TATACH DSCHED CALENDARYEAR Running In Both the State Prima and (FROMATTACHEDSCHEDUIES) TOTALTODATE g Primary 1. Monetary Contributions General Elections ........................................... Schedule A,Line 3 $ 2292 $ _ 2292 2. Loans Received ...................................................... schedule e,Line 3 1318 1318 1/1 through 6130 7/1 to Date 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 3610 $ 3610 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 670 670 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 4280 $ 4280 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 3322 $ 3322 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0 0 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 3322 $ 3322 (11 Subjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................schedule c,Line 3 670 670 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 3992 $ 3992 $ Current Cash Statement --f $ 12. Beginning Cash Balance....................... Previous summary Page,Line 16 $ 0 To calculate Column 8,add 13.Cash Receipts ................................................... column A,Line 3 above 3610 amounts in Column A to the 100 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash........................... Schedule I,Line 4 from Column B of your last reported in Column B. 15.Cash Payments.................................................. Column A,Line 8 above 3322 report. Some amounts in Column A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 388 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 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7,ands(if q 9 0 any). 18. Cash Equivalents........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2+Line 9 in Column 8 above $ 1318 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Lugar, Robin From: Lugar, Robin Sent: Friday, October 29, 2010 2:49 PM To: 'wroselius@msn.com' Cc: 'sroselius@msn.com'; Flynn, Joan Subject: Request for 460 Pre-Election Amendment(1-01-10 to 9-30-10)-Sean Roselius Hi Wendy, The City Clerk has completed her review of pre-election statements filed in Huntington Beach.on October 5, 2010 and requests that you file a 460 Amendment for Sean Roselius that corrects the following identified errors: "Statement Covers Period" (top of pages 1-15) should read 1-01-10 to 9-30-10 Information included in Item Nos. 20 and 21 (Calendar Year Summary for Candidates Running in Both the State Primary and General Elections) does not apply—resubmit page with this area left blank If you have any questions, please contact the FPPC at 1-866-275-3772. Thank you! Robin Lugar, CMC Assistant City Clerk City of Huntington Beach 2000 (plain Street Huntington Beach CA 9264 (714) 536-5405 Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period / - Summary Page to whole dollars. 10/01/10 •' s from SEE INSTRUCTIONS ON REVERSE through 10/16/10 Page �— of_ NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR (FROMATTACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... schedule A,Line 3 $ 50 $ 2342 1/1 through 6/30 7/1 to Date 2. Loans Received Schedules,Line 3 0 1318 ...................................................... 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 50 $ 3660 20. Contributions 0 4330 Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0 670 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 50 $ 4330 Made $ 0 $ 3692 Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... schedule E,Line 4 $ 0 $ 3322 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0 0 22.Cumulative Expenditures Made" 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 0 $ 3322 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................schedule i,Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................schedule C,Line 3 0 670 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 0 $ 3692 -J $ Current Cash Statement —J $ 12. Beginning Cash Balance....................... Previous summary Page,Line 16 $ 388 Tc calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 50 amounts in Column A to the 0 corresponding amounts Amounts in this section may be different from amounts 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 a above 0 report. Some amounts in Column A may be negative 16.ENDING CASH BALANCE.......... Add lines 12+13+14,then subtract Line 15 $ 438 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 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,7, and 9(if any). 18. Cash Equivalents........................................ See instructions on reverse $ 0 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A Type or print in ink, SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. from 10/01/10 ®- SEE INSTRUCTIONS ON REVERSE through 10/16/10 Page of NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 0 _ Schedule A Summary *Contributor Codes 1. Amount received this period—itemized monetary contributions. IND—individual (Include all Schedule A subtotals.).................................................................................... $ 0 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 .............................$ 50 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 SummaryPage, Column A Line 1.) TOTAL $ 50 FPPC Form 460(Januaryl05) FPPC Toll-Free Helpline:866IASK-FPPC(866/275-3772) Schedule C Type or print in ink. SCHEDULE C Amounts may be rounded Statementcovers period N®nB� onetery Contributions Received to whole dollars. e ' NIX from 10/01/10 through 10/16/10 page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 FULL NAME,STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL,ENTER DESCRIPT ION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION DATE OCCUPATION AND EMPLOYER FAIR MARKET TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE* (IF SELF-EM PLOYED,ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) (JAN 1-DEC 31) (IF REQUIRED) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ n Schedule C Summary Contributor Codes 1. Amount received this period-itemized nonmonetary contributions. 0 IND-individual (Include all Schedule C subtotals.) „$_ COM-Recipient Committee .................................................................................................................._ 0 (other than PTY or SCC) 2. Amount received this period-unitemized nonmonetary contributions of less than$100 ....................................$ OTH—Other(e.g., business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. 0 SCC—Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ......................TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule Summary r Ot Expenditures Type SCHEDULED P T e or print in ink. Statement covers period Amounts may be rounded ' 0 " ` . - � ® S Supporting/Opposing Other to whole dollars. 10/01/10 Candidates, Measures and Committees from 10/16/10 Page of h SEE INSTRUCTIONS ON REVERSE through � —'= NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUMULATIVE TO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (JAN.1-DEC.31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ p Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. ....................................... $ 0 2. Unitemized contributions and independent expenditures made this period of under$100..................................... ............... $ 0 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 0 P P P ( rY 9 ) .,.......... FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) SCHEDULEE Schedule E Type or print in ink. Statement covers period Amounts may be rounded ®R , 4160 Payments blade to whole dollars. from 10/01/10 FOR through 10/16/10 Page of SEE INSTRUCTIONS ON REVERSE 9 9 NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 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 RAD 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 PAYEE (IF COMMITTEE,ALSO ENTER I,D,NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period.(Include all Schedule E subtotals.).................................................................... ........................... $ 0 2. Unitemized payments made this period of under$100 ..................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............. 0 4. Total payments made this period. (Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A Line 6.) TOTAL $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/27&3772) SCHEDULE F Schedule F Type or print in ink. Amounts may be rounded Statement covers period ` •I' ` Accrued Expenses (Unpaid Bills) to whole dollars. 10/01/10 from 10/16/10 } SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CARP campaign paraphernalialmisc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MITG 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 ( ( ( ( OUTSTANDING AMOUNT INCURRED 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 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. 0 $ 0 $ 0 $ 0 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 0 accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0 accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 0 onthe Summary Page, Column A, Line 9.) ................................................................................................................................................ NET$ May be a negative number FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275.3772) Schedule G _ SCHEDULEG Type or print in ink. Statement id Payments Made by an,Agent covers per Agent or independent Amounts may be rounded s �Contractor(on Behalf of This Committee) to whole dollars. from 10/01/10 e e through 10/16/10 Page�_ of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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 RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTS 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 PI O 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) *Payments that are contributions or independent expenditures mustalso be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 "Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE H Schedule I•I Type or print in ink. Statement covers period N * Amounts may be rounded 10/01/10 FPage Loans Made to Others to whole dollars. from SEEINSTRUCTIONS ON REVERSE through 10/16/10 — of_J Z NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 IF AN INDIVIDUAL,ENTER (a) (b) (c) d (e) M (g) FULL NAME,STREET ADDRESS AND ZIP CODE OUT AMOUNT OUTSTADING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER REPAYMENT OR OF RECIPIENT BALANCE LOANED THIS BALANCEAT RECEIVED AMOUNT OF LOANS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER BEGINNING THIS PERIOD FORGIVENESS CLOSE OF THIS LOAN TO DATE NAME OF BUSINESS) PERIOD THIS PERIOD PERIOD PAID CALENDAR YEAR FORGIVEN RATE PER ELECTION** S S $ $ $ DATE DUE DATE INCURRED PAID CALENDAR YEAR Ej FORGIVEN RATE PER ELECTION** $ S S $ $ DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ 0 $ 0 $ 0 $ 0 also be reported on Schedule E. (Enter(a)an Schedule 1,Line 3) Schedule H Summary 1. Loans made this period ......................................................$ 0 ............................................................................................ **If Required (Total Column(b)plus unitemized loans of less than$100.) 2. Payments received on loans $ 0 ............................................................................................................ (Total Column(c)plus unitemized payments of less than$100.) 3. Net change this period. Subtract Line 2 from Line 1. 0 (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule 6 Type or print in ink. SCHEDULE I ill Miscellaneous Increases t® Cash may be rounded Statement covers period ;''CALIFORNIA- to whole dollars. 10/01 i 10 F0,11W from SEE INSTRUCTIONS ON REVERSE through 10/16/10 Page Of of�� NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF RECEIVED (WCOMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ 0 Schedule 0 Summary 1. Itemized increases to cash this period. .........$ 0 2. Unitemized increases to cash of under$100 this period. ............................................................................................$ 0 3. Total of all interest received this period on loans made to others. Schedule H, Column e . 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the 0 SummaryPage, Line 14.) ........................................................................................................................... TOTAL $ FPPC Form 460(Januaryf05) FPPC Toll-Free Helpline:8661ASK-FPPC(866/275-3772) Type or print in ink. SUMMARY PAGE Campaign Disclosure Statement Amounts may be rounded Statement covers period ® - Summary Page to whole dollars. 01/01/10 a ' ® ® 1 from SEE INSTRUCTIONS ON REVERSE through 10/05/10 FPage of 1's NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR (FROMATTACHEDSCHEDULES) TOTALTO DATE Running in Both the State Primary and 1. Monetary Contributions ........................................... schedule A,Line 3 $ 2292 $ 2292 General Elections 2. Loans Received ...................................................... Schedule e,line 3 1318 1318 1/1 through 6/30 7/1 to Date 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 3610 $ 3610 20. Contributions 4280 Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 670 670 21. Expenditures 4280 4280 Made $ $ 3692 5. TOTAL CONTRIBUTIONS RECEIVED ...•.•....•.......•...•....Add Lines 3+4 $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 3322 $ 3322 Candidates 7. Loans Made............................................................. schedule H,Line 3 0 0 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 3322 $ 3322 (IfSubjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 670 670 (mm/dd/yy) 11.TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 3692 $ 3692 J $ Current Cash Statement $ 12.Beginning Cash Balance....................... Previous summary Page,Line 16 $ 0 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 3610 amounts in Column A to the 100 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash........................... Schedule/,Line 4 from Column B of your last reported in Column B. 15.Cash Payments.................................................. column A,Line 8 above 3322 report. Some amounts inColumn A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 388 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 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,7 and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ 0 any). 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 0 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULEB-PART2 Schedule B—Part 2 Type or print in ink. Statement covers period Amounts may be rounded Loan Guarantors to whole dollars. from 01/01/10 SEE INSTRUCTIONS ON REVERSE through 10/05/10 71.DNUMBER of NAME OF FILER Shawn Roselius for Huntington Beach City Council 2010 1331483 FULL NAME,STREET ADDRESS AND IF AN INDIVIDUAL, ENTER AMOUNT BALANCE ZIP CODE OF GUARANTOR CONTRIBUTOR OCCUPATION AND EMPLOYER LOAN GUARANTEED CUMULATIVE OUTSTANDING (IFCOMMITTEE,ALSO ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED,ENTER THIS PERIOD TO DATE TO DATE NAME OF BUSINESS ❑IND LENDER CALENDAR YEAR ❑COM $ ❑OTH DATE PER ELECTION (IF REQUIRED) FIFTY ❑SCC $ CALENDAR YEAR ❑IND LENDER ❑COM $ ❑OTH PER ELECTION DATE (IF REQUIRED) ❑PTY ❑SCC $ CALENDAR YEAR ❑IND LENDER ❑COM $ PER ELECTION ❑OTH (IF REQUIRED) DATE ❑PTY ❑SCC $ CALENDAR YEAR ❑IND LENDER ❑COM $ ❑OTH DATE PER ELECTION (IF REQUIRED) ❑PTY ❑SCC $ Enteron SUBTOTAL $ 0 Summary Page, Line 17 only. FPPC Form 460(January/05) FPPC Tall-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule Type p Summary of Expenditures SCHEDULED T e or print in ink. Statement covers period Amounts may be rounded Supporting/Opposing Other to whole dollars, 01/01/10 0- Candidates,Measures and Committees from through 10/05/10 Pa of SEE INSTRUCTIONS ON REVERSE 9 Page NAME OF FILER I.D. NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUM TO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) CALL ENDAENDA R YEAR TO DATE ORCOMMITTEE PERIOD (JAN.1-DEG.31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 0 s Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. ............................................ $ 0 2. Unitemized contributions and independent expenditures made this period of under$100................................................................................. $ 0 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 0 P P P ( rY 9 } ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275.3772) SCHEDULEF Schedule F Type or print in ink. Statement covers period 11D. o ' Amounts may be rounded I Accrued Expenses (Unpaid Bills) to whole dollars. from 01/01/10 !)i2 through 10/05/10 of t SEE INSTRUCTIONS ON REVERSE NAME OF FILER MBER Shawn Roselius for Huntington Beach City Council 2010 1331483 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CUP campaign paraphernalia/misc. MBR member communications RAD 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 FL 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 ( ( ( ( OUTSTANDING AMOUNTINGURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCEAT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD * Payments that are contributions or Independent expenditures must also be SUBTOTALS $ Q $ $ $ Q summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 0 accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0 accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and Q on the Summary Page, Column A, Line 9.) .......................................................................................................................................I........ NET$ My be a negative num er FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule G Type or print in ink. SCHEDULE G Payments Made by an Agent or Independent Amounts may be rounded Statement covers period , Contractor(on Behalf of This Committee) to whole dollars. from 01/01/10 ® . I • through 10/05/10 SEE INSTRUCTIONS ON REVERSE pa ge of (cQ NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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 RAD 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) "Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 *Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460(January/05) FPPC Toll-free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE H Schedule H Type or print in ink. Statement covers period � � e � WON * Amounts may be rounded 01/01/10 L®a9�S Dade to ® hers to whole dollars. from through 10/05/10 page L� of t SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D.NUMBER Shawn Roselius for Huntington Beach City Council 2010 1331483 IF AN INDIVIDUAL,ENTER (a) (b) (c) (d) (e) (rl (g) FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTS T DING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER REPAYMENT OR OF RECIPIENT BALANCE LOANED THIS FORGIVENESS BALANCE AT RECEIVED AMOUNTOF LOANS (IF SELF-EMPLOYED,ENTER BEGINNING THIS CLOSE OF THIS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD LOAN TO DATE PAID CALENDAR YEAR FORGIVEN RATE PER ELECTION** $ $ $ $ $ DATE DUE DATE INCURRED PAID CALENDAR YEAR $ $ % $ $ FORGIVEN RATE PER ELECTION** $ $ $ $ $ DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ also be reported on Schedule E. (Enter(e)on Schedule I,Line 3) Schedule H Summary 1. Loans made this period ........................ .......$ 0................................................................................................................... **If Required (Total Column(b)plus unitemized loans of less than$100.) 2. Payments received on loans 0 (Total Column(c)plus unitemized payments of less than$100.) 3. Net change this period. Subtract Line 2 from Line 1. 0 9 p ( ).......................................................................................... NET $ (May be a negative number) (Enter the net here and on the Summary Page, Column A, Line 7.) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275X72) CANDIDATE INTENTION STATEMENT Candidate Intention Statement Type or Print in Ink Date stamp ® Ij �If , ill I For Official Use Only Check One ® Initial ❑ Amendment (Explain) !n rr r)l.lu �} 1 Candidate Information t, q 5 k16d, I i NAME OF CANDIDATE (La t Fi st Middle Iryhal) DAYTIME TELEPHONE NUMBER FAX NUMBER iopta a) E MAIL(ptton i) Roselius Shawn R ( 714 ) 330 5086 ( ) s roselius@yahoo corn STREET ADDRESS CITY STATE ZIP CODE 20321 Mansard Lane Huntington Beach CA 92646 OFFICE SOUGHT(POSITION TITLE) AGENCY NAME DISTRICT NUMBER it apoi bie ®NON PARTISAN Huntington Beach City Council PARTY OFFICE JURISDICTION ❑ State (Con plete Pa 2) Huntington Beach 2010 ®City ❑County ❑ Multi County (N �e P u dr tion) (Y r Election) 2 State Candidate Expenditure Limit Statement Voluntary Expenditure Ceilings (Candidates for statewide office are not required to complete Part 2 until 1116102 CalPERS candidates (Gov Code Section 85400) )edges judicial candidates and candidates for local offices are not required to complete Part 2) Office Primary or General or (Ye r of Elector) Primarylgenera (Ye r oPFlect }l election Special/runoff elect►on Special Special Run off (Effective 1/1/01) (CAe k on b X) Assembly $400 000 $700 000 ❑I accept the voluntary expenditure ceiling for the election stated above Senate $600 000 $900 000 ❑ I do not accept the voluntary expenditure telling for the election stated above (Effective 11/6102) Amendment Board of Equalization $1 000 000 $1 500 000 O 1 did not exceed the expenditure ceiling In the primary or special Governor $6 000 000 $10 000 000 election held on �j_J and I accept the voluntary expenditure ceiling for the general or special run off election Lieutenant Governor Attorney General $4 000 000 $6 000 000 _ Insurance Commissioner Controller Secretary of State Supt of Public Instruction (M rk f apphc bye) Treasurer ❑ On 1__1 I contributed personal funds in excess of the expenditure ceding for the election stated above 3 Verification I certify under penalty of penury under the laws of the State of California that the foregoing Is true and correct 02/23/2010 Leo , Executed on Signature ,� (month day year) (Candidate) FPPC Form 501 (June/01) FPPC Toll Free Helpime 866/ASK FPPC 8661275-3T72