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HomeMy WebLinkAboutHansen, Don - 2009 FPPC Campaign Disclosure Forms - Don Hans Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period Summary page to whole dollars. from 07/01/2009 ®" SEE INSTRUCTIONS ON REVERSE through 12/31/2009 Page 3 of 8 NAME OF FILER I.D. NUMBER Don Hansen for City Council 1235876 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR I Running Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTODATE g • Primary General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ 700.00 $ 4,300.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule s,Line 3 -2,000.00 5,690.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ -1,300.00 $ 9,990.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ -1,300.00 $ 9,990.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 1,187.04 $ 4,114.00 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 1,187.04 $ 4,114.00 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 -173.04 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 $ 1,014.00 $ 4,114.00 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 2,700.16 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above -1,300.00 amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts 14.Miscellaneous Increases to Cash........................... Schedule 1,Line 4 0.00 from Column B of your last reported in Column B. 15.Cash Payments.................................................. Column A,Line 8 above 1,187.04 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 213.12 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 s,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7,ands(if Y). 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 5,690.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC(8661275-3772) Schedule SCHEDULED Summary of Expenditures Type or print in ink. p Statement covers period Amounts may be rounded Supporting/Opposing Other to whole dollars. FPage Candidates, Measures and Committeesfrom o7/0l/2009 SEE INSTRUCTIONS ON REVERSE through 12/31/20096 ofF�8_ NAME OF FILER I.D. NUMBER Don Hansen for City Council 1235876 NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR DESCRIPTION CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT AMOUNT THIS CALENDAR YEAR TO DATE ORCOMMITTEE (IF REQUIRED) PERIOD (JAN.1-DEC.3 1) (IF REQUIRED) 07/09/2009 Republican Party of Orange County 500.00 500.00 Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑x Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 500.00 Schedule ® Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. 500.00 2. Unitemized contributions and independent expenditures made this period of under$100 ..................................................................................... $ 0.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 500.00 P P P � rY 9 ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Recipient Committee ------- COVER PAGE Campaign Statement Type or print in ink. Date StampiCALIFORNI r� -FORK, ' Cover Page p"" (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicable: from 01/01/2009 (Month, Day, Year) 2009 JUL 2 1 PH 4 age 1 of 13 For Official Use Only SEE INSTRUCTIONS ON REVERSE through 06/30/2009 11/04/2008 1 J 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: Fx_1 Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure E] Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee F&] Semi-annual Statement E] Special Odd-Year Report 0 Recall 0 Controlled E] Terminati ] Supplemental Preelection (Also Complete Part 5) 0 Sponsored ❑ (Also file a Form 410 Termination) Statement-Attach Form 495 (Also Complete Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) 0 Sponsored F-] Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1 1235876 COMMITTEE NAME(OR CANDIDATE'S NAM NAME OF TREASURER Don Hansen for City Council Betty Presley MAILING ADDRESS 30151 Tomas Street STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 10252 Wesley Circle Rancho Sta Margarita, CA 92688 949-858-7448 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach, CA 92646 724-964-8722 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS PO Box 5981 CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Huntington Beach, CA 92615 OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS 949-399-3164 donfh@earthlink.net 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true a n ct. 4 t Executed on By Aasurer Aqssistant Treasurer Executed on By Date Signature of Controlling Officeholder,Candidate,)ate Me sure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,-C-andidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) State of California Type or print in ink. COVER PAGE-PART 2 Recipient Committee Campaign Statement �CALIF RNIA • , Cover Page—Part 2 Page 2 of 13 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASU . Hansen OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT City Council Member Huntington Beach ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 10252 Wesley Circle Huntington Beach, CA 92646 Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of ❑ YES ❑ NO officeholder(s)or candidate(s)for which this committee is primarily formed. 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 COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS 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:866/ASK-FPPC(866/275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period Summary page to whole dollars. I from 01/01/2009 0" SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 3 of 13 NAME OF FILER I . NUMBER Don Hansen for City Council 1235876 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR Runnin//yy in Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTODATE 7 Primary General Elections 1. Monetary Contributions ........................................... Schedule A,Line $ 3,600.00 $ 3,600.00 1/1 through 6/30 7/1 to Date 2. Loans Received ScheduleB,Line3 0.00 7,690.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ 3,600.00 $ 11,290.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ••••••.....................AddLines3+4 $ 3,600.00 $ 11,290.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 2,926.96 $ 2,926.96 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made` 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 2,926.96 $ 2,926.96 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 173.04 173.04 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 3,100.00 $ 3,100.00 _�'� $ Current Cash Statement J / $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 2,027.12 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 3,600.00 amounts in Column A to the corresponding amounts 'Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 0.00 from Column B of your last reported in Column B. report. Some amounts in 15. Cash Payments.................................................. Column A,Line&above z,926.96 Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 2,700.16 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 from Lines 2, 7,and 9(if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line 9 in Column 8 above $ 7,863.04 FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772) Schedule A Type or print in ink. SCHEDULE A MOr9eta Contributions ReceivedAmounts may be rounded to whole dollars. Statement covers periodOJLIFORNI from 01/01/2009 SEE INSTRUCTIONS ON REVERSE through 06/30/2009 page 4 of 13 NAME OF FILER I.D. NUMBER Don Hansen for City Council 1235876 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED COMMITTEE,ALSND I.D NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO D (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN, 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/25/2009 Katie Ageson 0.00 100.00 G 12 100.00 ❑COM 9132 Christine Dr ❑OTH PR Projects Huntington Beach, CA ❑SCC 06/25/2009 Aida Ali ❑RIND Homemaker 100.00 100.00 G 12 100.00 ❑COM wy ❑OTH None Huntington Beach, CA 92648 ❑PTY ❑SCC 06/25/2009 Hart Cc Lighting 200.00 200.00 G 12 200.00 ❑COM 5761 Research Dr x❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 06/25/2009 John Cirino ❑RIND Owner 100.00 100.00 G 12 100.00 ❑COM 27495 Hidden Trail Rd ❑OTH Rdiva Laguna Hills, CA 92653 ❑PTY ❑SCC 06/25/2009 Dale L. Dunn ❑X IND Retired 100.00 100.00 G 12 100.00 ❑COM 17302 Almelo Ln. ❑OTH None Huntington Beach, CA 92649 ❑PTY ❑SCC SUBTOTAL$ 600.00 Schedule A Summary `Contributor Codes 1. Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.)...................... 3,6 0 0.00 COM-Recipient Committee $ (other than PTY or SCC) o.00 OTH—Other(e.g., business entity) 2. Amount received this period-unitemized monetary contributions of less than$100 ............................. $ PTY-Political Party 3. Total monetary contributions received this period. SCC-Small contributor committee Add Lines 1 and 2. Enter here and on the SummaryTOTAL $ 3,600.00 ( Page,Column A, Line 1.) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. F from 01/01/2009through 06/30/2009 5 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 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 (IF SELF-EMPLOYED,ENTER ERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) Faubel Public Affairs 06/25/2009 ❑IND 500.00 G 12 500.00 ❑COM 25 Orchard ❑x OTH Lake Forest, CA 92630 ❑PTY ❑SCC John 06/25/2009 ❑ Attorney 100.00 100.00 G 12 100.00 ❑COM 19592 Phoenix Ln ❑OTH Huntington Beach, C ❑PTY City of Huntington Beach ❑SCC 06/25/2009 Alan Gandall IND ❑ President 200.00 200 0 ❑COM 9082 Pioneer Dr ❑OTH SaveOurField.org, Inc Huntington Beach, CA 92646 El PTY ❑SCC 06/25/2009 Susan J. Gordon IND Vice President ❑ 100.00 100.00 G 12 100.00 ❑COM 16443 Lazare Ln. ❑OTH Rainbow Disposal Huntington Beach, CA 92649 ❑PTY ❑SCC 06/25/2009 Richard A. Harlow ❑xIND Consultant 100.00 100.00 G 12 100.00 ❑COM 1742 Main Street ❑OTH Richard Harlow & ❑PTY Associates Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ 1,000.00 *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period lam to whole dollars. from 01/01/2009 through 06/30/2009 Page 6 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEES SAND ZIP I.D.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OFBUSINESS) 06/25/2009 drew P. Kingman ❑xIND Exec 50.00 G12 250.00 ❑COM 63 Kellogg Drive ❑OTH ❑Pam, Poseidon Resources Wilton, CT 06897 ❑S ald J. Lewis XIN D 06/25/2009 ❑ Consultant 100.00 100.00 G 12 100.00 ❑COM 9532 Caithness Drive ❑ ❑Pam, Donald Lewis Company Huntington Beach, CA 92646-6002 ❑SCC Brian W. Lochrie 06/25/2009 ce President 100.00 100.00 G 12 100.00 ❑COM 360 N Pine St El OTH Faubel Public Affairs Orange, CA 92866 ❑PTY ❑SCC 06/25/2009 Scott M. Maloni ❑ IND Vice President 250.00 250.00 G 12 250.00 ❑COM 3633 Baker St. ❑OTH Poseidon Resources San Diego, CA 92117 ❑PTY ❑SCC 06/25/2009 Virginia Manfre ❑RIND Homemaker 100.00 100.00 G 12 100.00 ❑COM 10232 Wesley Circle ❑OTH ❑PTY None Huntington Beach, CA 92646 ❑SCC SUBTOTAL$ 800.00 "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Deceived Amounts may be rounded Statement covers period to whole dollars. 1UMV® s I from 01/01/2009 ® �- through 06/30/2009 Page 7 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,A ITTEE ADDRESS ZIP I.D.NUMBER)O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALEND TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 06/25/2009 vern ❑RIND Retired 100.00 100.00 G 12 100.00 [:]COM 208 8th St. ❑OTH Huntington Beach, ❑PTY None ❑SCC 06/25/2009 dam Minow, [ZIND CPA 100.00 100.00 G 12 100.00 ❑COM 726 14th St ❑OTH ❑PTY Glenn M. Gelman & Assoc Huntington Beach, CA 92648 ❑SCC 06/25/2009 et ❑IND 100.00 100.00 G 12 100.00 []COM 3130 Airway Ave ❑x OTH Costa Mesa, CA 92626 ❑PTY ❑SCC 06/25/2009 William O'Connell MIND Executive Director 100.00 100.00 G 12 100.00 ❑COM 16072 Davis Ln. ❑OTH Colette's Children's Home Huntington Beach, CA 92649 ❑PTY ❑SCC 06/25/2009 Poseidon Resources Corporation ❑IND 500.00 500.00 G 12 500.00 ❑COM 1055 Washington Blvd ❑X OTH ❑PTY Stamford, CT 06901 ❑SCC SUBTOTAL$ 900.00 *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party SCC—Small Contributor Committee FPPC Form C( 66/275 3772) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Deceived Amounts may be rounded Statement covers period to whole dollars. 460, from 01/01/2009 FORM through 06/30/2009 Page 8 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,ADDRESS ZIP I.D.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO LF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/25/2009 Retlek Management Serv ND 100.00 100.00 G 12 100.00 ❑COM 3303 Harbor Blvd., Ste D-1 ❑x OTH Costa Mesa, CA 92626 ❑PTY Ray Silver IND 06/25/2009 ❑ Consultant 100.00 100.00 G 12 100.00 ❑COM 17021 Westport Dr ❑OTH ❑Pam, Ray Silver Huntington Beach, CA 92649 ❑SCC Dianne Thompson 06/25/2009 ❑xIND Insurance Agent 100.00 100.00 G 12 100.00 ❑COM 17011 Beach Blvd, #101 ❑OTH ❑ State Farm Huntington Beach, CA 92647 PTY ❑SCC MIND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY [-]SCC SUBTOTAL$ 300.00 *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Type or print in ink. SCHEDULE B-PART 1 Schedule B—Part I Amounts may be rounded Statement covers period Loans Received to whole dollars. ol/0l/2009 e � � from SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 9 Of 13 NAME OF FILER I.D. NUMBER Don Hansen for City Council 1235876 IF AN INDIVIDUAL ENTER s (b) (c) (d) (e) (f (g) , FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE AMOUNT PAID BALANCE AT OF LENDER (IF SELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF AMOUNT OF CONTRIBUTIONS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD` PERIOD PERIOD LOAN TO DATE Donald F. Hansen Manager ❑PAID CALENDAR YEAR 10252 Wesley Circle 6,090.00 0% / $ 9,500.00 $ 0.00 Balboa Capital Huntington Beach, CA 92646 ❑FORGIVEN RATE PERELECTION- 6,090.00 0.00 0.00 0.00 10/08/2002 tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATEDUE Donald F. Hansen Manager ❑PAID CALENDARYEAR 10252 Wesley Circle 0.00 $ 600.00 0.00 $ 600.00 $ 0.00 Balboa Capital RATE - Huntington Beach, CA 92646 ❑FORGIVEN PER ELECTION $ 600.00 $ 0.00 $ 0.00 $ 0.00 07/17/2006 $ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED Donald F. Hansen Manager ❑PAID CALENDARYEAR 10252 Wesley Circle 0.00 1,000.00 0s 1,000.00 0.00 Balboa Capital $ $ $ $ Huntington Beach, CA 92646 ❑FORGIVEN RATE PER ELECTION"` 1,000.00 0.00 0.00 0.00 02/05/2008 $ $ $ $ $ tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0.00 $ 0.00 $ 7,690.00 $ o.00 ,,p ® (Enter(a)on Schedule ®ule Summary Schedule E,Line 3) 1. Loans received this period....................................................................................................................$ 0.00 (Total Column(b)plus unitemized loans of less than$100.) tContributor Codes IND-Individual 2. Loans paid or forgiven this period ......................................................................................................... $ 0.00 COM-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.)............................................................... NET $ 0.00 SCC—Small Contributor Committee Enter the net here and on the Summary Page,Column A, Line 2. (May be a negative number) "Amounts forgiven or paid by another party also must be reported on Schedule A. "if required. 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 Payments Made Amounts may be rounded to whole dollars. from 01/01/2009 SEE INSTRUCTIONS ON REVERSE through 06/30/2009 F 10 of 13 NAME OF FILER I.D. NUMBER Don Hansen for City Council 1235876 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 servic ting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE F COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUN bration Ball Committee MTG 1/31 Candidate & Spouse Tickets to attend Gala Dinner 400.00 2000 Main Street Huntington Beach, CA 92648 Betty Presley & Associates, Inc. PRO 450.00 30151 Tomas Rncho Snta Margarita, CA 92688 Huntington Harbour Philharmonic Committee CVC 250.00 2082 Business Center Drive Irvine, CA 92614 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,100.00 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 2,747.46 2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ 179.50 3. Total interest aid this period on loans. Enter amount from Schedule B, Part 1,Column e . $ 0.o0 4. Total payments made this period. Add Lines 1,2,and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 2,926.96 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule E SCHEDULE E(CONT.) Type or print in ink. (Continuation Sheet) Amounts may be rounded Statement covers period ® . to whole dollars. ® / Payments Made from o1/o1/zoo9 • 06/30/2009 h SEE INSTRUCTIONS ON REVERSE through Page 11 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants WG 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 pr tion technology costs (internet, e-mail) NAME AND ADDRE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) California Women's Leadership Association PO Box 60235 Irvine, CA 92606 CVC 200.00 Shorebreak Hotel 500 Pacific Coast Highway FND 500.00 Huntington Beach, CA 92648 Shorebreak Hotel 500 Pacific Coast Highway FND 947.46 Huntington Beach, CA 92648 ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,647.46 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULEF Schedule F Type or print in ink. Amounts may be rounded Statement covers period CALIFORNIAAccrued Expenses (Unpaid Bills) to whole dollars. 01/01/2009 FORM from SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 12 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 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 FIND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals ND 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 Lrr campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR CODE OR (OUTSTANDING (c) ( OUTSTAA NDING AMOUNT IN 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 Sara Hansen LIT 0.00 173.04 0.00 173.04 10252 Wesley Circle Huntington Beach, CA 92648 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 0.00 $ 173.04 $ 0.00$ 173.04 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b)subtotals for accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ 173.04 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c)subtotals for payments on accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.).................................PAID TOTALS $ 0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.) ................................................................................................................................................ NET$ 173.04 May be a negative number FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule G Type or print in ink. SCHEDULE G d i covers period Payments Made by an Agent or Independent Amounts may be rounded StatementCALIFORNIA Contractor(on Behalf of This Committee) to whole dollars. from 01/01/2009 F• - I • 1 SEE INSTRUCTIONS ON REVERSE through 06/30/2009 Page 13 of 13 NAME OF FILER I.D.NUMBER Don Hansen for City Council 1235876 NAME OF AGENT OR INDEPENDENT CONTRACTOR Sara Hansen 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-m ts 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 VistaPrint LIT 173.04 95 Hayden Avenue Lexington MA 02421 Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 173.04 *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)