HomeMy WebLinkAboutPeterson, Erik H. - 2010 FPPC Campaign Disclosure Forms For (2) Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period •
Summary Page to whole dollars. IPa
from 10/17/201040)
SEE INSTRUCTIONS ON REVERSE through 12/31/2010 3 of 5
NAME OF FILER NUMBER
Erik Peterson for City Council 2010
Pending
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDARYEAR Running i Both the State Pi and
(FROM ATTACHED SCHEDULES) TOTALTODATE gn o e Primary
General Elections
1. Monetary Contributions ........................................... Schedule A,Line 3 $ $0.00 $ $3,170.00
2. Loans Received ........................ $0.00 $0.00
..........................:... Schedule 8,Line 3 1i1 through 6/30 7/1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $0.00 $ $3,170.00 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... schedule C,Line 3 $0.00 $o.o0
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ••...............•....•....AddLines3+4 $ $0.00 $ $3,170.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $596.28 $ $2,930.58 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made"
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $596.28 $ $2,930.58 (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F,,Line 3 $0.00 $128.33
Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 $0:0 0 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $596.28 $ $3,058.91 $
Current Cash Statement $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $955.70
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3above $0.00 amounts in Column A to the
corresponding amounts "Amounts in this section may be different from amounts
14. Miscellaneous Increases to Cash........................... Schedule/,Line 4 $0.00 from Column B of your last reported in Column B.
report. Some amounts in
15. Cash Payments.................................................. Column A,Line 8 above $596.28 Column A may be negative
16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $359.42 figures that should be
subtracted from previous
If this is a termination statement, Line 16 must be zero. period amounts. If this is
the first report being filed
17.LOAN GUARANTEES RECEIVED ........................... Schedule e,Part 2 $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2, 7,and 9(if
any)
18. Cash Equivalents........................................ See instructions on reverse $
$0.00
19. Outstanding Debts......................... Add Line 2+Line 9 in Column e above $ $128.33 FPPC Form 460(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Recipient Committee COVERPAGE
Type or print in ink. Date Stamp ® ,
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Statement covers period Date of election if applicable:
2 Page 1 of 6
(Month, Day, Year) 011 JUL 29 Ac
from 10/O1/2010 Jew ItI For Official Use Only
SEE INSTRUCTIONS ON REVERSE through 10/16/2010 ��� � if✓
1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement:
❑X Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑x Preelection Statement ❑ Quarterly Statement
Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report
Q Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection
(Also Complete Part5) O Sponsored (Also file a Form 410 Terminatioly) Statement-Attach Form 495
(Also Complete Part 6)
❑ General Purpose Committee J' Amendment(Explain below)
Q Sponsored ❑ Primarily Formed Candidate/
Q Small Contributor Committee Officeholder Committee
Political Party/Central Committee (Also Complete Part 7)
3. Committee Information I.D. NUMBER Pending Treasurer(s)
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER
Erik Peterson for City Council 2010
Erik Peterson
MAILING ADDRESS
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
Huntington Beach CA 92649 (714) 580-6980
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
Huntington Beach CA 92649 (714) 580-6980
MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle ation contained herein an rue and complete. I certify
under penalty of perjury under the laws of the State of California that the foregoing is true and coii
Executed on- la// By
Dale/ rer or Assistant Treasurer
Executed on " � � ` I B
Pate Sign ontrolling Officeholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
State of California
Type or print in ink. COVER PAGE-PART 2
Recipient Committee
CALIFORNIA
Campaign Statement . 4e 1
Cover Page— Part 2
Page 2 of 6
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE
Erik Peterson
OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT
❑ OPPOSE
City Council Member
RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP
Identify the controlling officeholder, candidate, or state measure proponent, if any.
Huntington Beach CA 92649 NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT
Related Committees Not Included in this Statement: List any committees
not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY
contributions or make expenditures on behalf of your candidacy.
COMMITTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of
officeholder(s)or candidates)for which this committee is primarily formed.
❑ YES ❑ NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
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. SUMMARYPAGE
Amounts may be rounded Statement covers period A a .
Summary Page to whole dollars. I • ,
from
10/01/2010 e
SEE INSTRUCTIONS ON REVERSE through 10/16/2010 Page 3 of 6
NAME OF FILER I.D. NUMBER
Erik Peterson for City Council 2010 Pending
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDARYEAR Running In Both the State Prima and
(FROM ATTACHED SCHEDULES) TOTALTODATE g Primary
General Elections
1. Monetary Contributions ........................................... Schedule A,Line 3 $ $400.00 $ $3,170.00
2. Loans Received ...................................................... Schedule e,Line 3 $0.00 $0.00 1/1 through 6/30 7/1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $400.00 $ $3,170.00 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 $0.00
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $400.00 $ $3,170.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $7.55 $ $2,334.30 Candidates
7. Loans Made............................................................. schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made"
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $7.55 $ $2,334.30 (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F,Line 3 $0.00 $128.33
Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................ScheduleC,Line $0.00 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $7.55 $ $2,462.63 � $
Current Cash Statement $
12.Beginning Cash Balance....................... Previous summary Page,Line 16 $ $563.25
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3 above $400.00 amounts in Column A to the
$o.oo 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 $7.55 report. Some amounts in
Column A may be negative
16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $955.70 figures that should be
subtracted from previous
If this is a termination statement, Line 16 must be zero. period amounts. If this is
the first report being filed
17.LOAN GUARANTEES RECEIVED ........................... schedule e,Part 2 $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2, 7,and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ $0.00 any).
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $128.33 FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
ScheduleA Type or print in ink. SCHEDULE A
Nloneta Contributions Received Amounts may be rounded p
ry to whole dollars. Statement covers period CALIFORNIA
from 10/01/2010 FORK
SEE INSTRUCTIONS ON REVERSE
through 10/16/2010 Page 4 of 6
NAME OF FILER.
LD. NUMBER
Erik Peterson for City Council 2010 Pending
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
RECEIVED (E COMMITTEE,RALSAND ZIP
I.D.NUMBER)O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE
(IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED)
OF BUSINESS)
10/01/2010 RPH Investments, Inc. ❑IND $150.00 $150.00 G10 $150.00
❑COM
❑x OTH
La Mirada CA 90637 ❑PTY
❑SCC
10/11/2010 Susan Dunne-Jervik ®IND Nurse $250.00 $250.00 G10 $250.00
❑COM
[_1 OTH Hospital
Huntington Beach CA 92649 ❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
SUBTOTAL$ $400.00
Schedule A Summary Contributor Codes
1. Amount received this period—itemized monetary contributions. IND-Individual
(Include all Schedule A subtotals.)........................................................................................................$ $400.00 COM-RecipientCommittee
(other than PTY or SCC)
2. Amount received this period—unitemized monetary contributions of less than$100 ............................. $ $0.00 OTH-Other(e.g., business entity)
PTY-Political Party
3. Total monetary contributions received this period. SCC-Small Contributor committee
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)....................... TOTAL $ $400.00
FPPC Form 460(January/05)
FPPC Toli-Free Helpline:866/ASK-FPPC(866/275-3772)
Schedule E Type or print in ink. SCHEDULEE
Statement covers period ® . ,
Payments Made Amounts may be rounded
Y to whole dollars.
from 10/01/2010
SEE INSTRUCTIONS ON REVERSE through 10/16/2010 Page 5 of 6
NAME OF FILER I.D. NUMBER
Erik Peterson for City Council 2010 Pending
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs
CNS campaign consultants MTG meetings and appearances RFD returned contributions
CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries
CVC civic donations PET' petition circulating TEL t.v. or cable airtime and production costs
FIL candidate filing/ballot fees PHO phone banks TRC candidate travel,lodging,and meals
FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
IND independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO professional services (legal, accounting) VOT voter registration
LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
1. Itemized payments made this period.(Include all Schedule E subtotals.).............................................................................................................. $ $0.00
2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ $7.55
3. Total interest paid this period on loans.(Enter amount from Schedule B, Part 1, Column(e).)............................................................................... $ $0.00
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ $7.55
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772)
SCHEDULEF
Schedule F Type or print in ink.
Amounts may be rounded Statement covers period
Accrued Expenses (Unpaid Bills) to whole dollars. from 10/01/2010
through 10/16/2010 FPage 6 of 6
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
I.D.NUMBER
Erik Peterson for City Council 2010
Pending
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CW campaign paraphernalia/misc. MBR member communications RAD 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 print ads WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF CREDITOR CODE OR (a) ( (c) (
OUTSTANDING AMOUNTIN 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
Staples LIT $128.33 $0.00 $0.00 $128.33
Huntington Beach CA 92647
*Payments that are contributions or independent expenditures must also be SUBTOTALS $ $128.33$ $0.00$ $0.00$ $128.33
summarized on Schedule D.
Schedule F Summary
1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for
accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ $0.00
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
on the Summary Page, Column A, Line 9.) NET $ $0.00
......................................................................................
May be a negative number
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
Lugar, Robin
To: erikpetersonhb@gmail.com'
Cc: Flynn, Joan
Subject: 460 Amendment Required
Attachments: 0371_001.pdf
Importance: High
Erik,
Our Netfile system does not yet show a Committee ID for you and I'm having an Assistant in our department check our
records to see if we received anything from the Secretary of State.
In addition to the amendment we discussed earlier today,your second Pre-election statement for 10-01-2010 through
10-16-2010 identifies the wrong election date so I request that you file an amendment for that statement(only the
cover sheet is required—see attached page).
Always feel free to contact us for assistance,or the FPPC at 866-275-3772.
Thank you!
Robin Lugar, CIVIC
Assistant City Clerk
City of Huntington Beach
2000 Main Street
Huntington Beach CA 92648
(714) 536-5405
From: CityClerkCanon7200 [mailto:CityClerkCanon@surfcity-hb.org]
Sent: Wednesday, January 19, 2011 6:08 PM
To: Lugar, Robin
Subject: Attached Image
Importance: High
1
Schedule SCHEDULEE
Type or print in ink. Statement covers period
Payments Made to
may be rounded • I
to whole dollars. from 10/01/2010
SEE INSTRUCTIONS ON REVERSE through 10/16/2010 Page 5 Of 6
NAME OF FILER I.D. NUMBER
Erik Peterson for City Council 2010 Pending
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMF` 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.).............................................................................................................. $ $0.00
2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ $7.55
3. Total interest paid this period on loans.(Enter amount from Schedule B, Part 1,Column(e).)............................................................................... $ $0.00
4. Total payments made this period.(Add Lines 1,2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ $7.55
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
January 19, 2011
Note to file:
Requested amendment from Mr. Peterson to include explanation of TRS codes listed on
Page 7 of 1st Preelection Statement covering 11/01/09 through 10/05/10.
Robin Lugar Q
Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period ® -
Summary Page to whole dollars. d
from 11/01/2009
SEE INSTRUCTIONS ON REVERSE through 10/05/2010 Page 3 of 9
NAME OF FILER I.D. NUMBER
Erik Peterson for City Council 2010
Pending
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHISPERIOD CALENDARYEAR Running in Both the State Primary and
(FROM ATTACHED SCHEDULES) TOTALTODATE g r
General Elections
1. Monetary Contributions ........................................... Schedule A,Line $ $3,020.00 $ $3,040.00
2. Loans Received Schedule B,Line 3 1 $0.00 $0.00 1/1 through 6/30 7/1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ $3,020.00 $ $3,040.00 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 $0.00
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ......••••..............•••AddLines3+4 $ $3,020.00 $ $3,040.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $2,326.75 $ $2,326.75 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $2,326.75 $ $2,326.75 (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 $128.33 $128.33
Date of Election Total 10 Date
10.Nonmonetary Adjustment ..........................................ScheduleC,Linea $0.00 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $2,455.08 $ $2,455.08 $
Current Cash Statement - / $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $20.00
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3 above $3,020.0o amounts in Column A to the
$o.o o 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 8above $2,326.75 report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE. $713.z s figures that should be
......... Add Lines 12+13+14,then subtract Line 15 $ 9
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 $ $0.00 for this calendar year, only
carry over the amounts
om
Cash Equivalents and Outstanding Debts $0.00 any Lines 2,7,and 9(if
v)�
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $128.33 FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNI 1
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME 1 D NUMBER
Erik Peterson for City Council 2010
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 ®STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
•• • • List additional sponsors on an attachment
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO AND STREET CITY STATE ZIP CODE
SIP411"Cootribut,or Coinmitb�e
-J� Check box and provide the date this committee qualified as a small contributor committee If the committee qualified as a small
Date qualified contributor committee on January 1 2001 enter 1/1/01
rJ Termination Requirements By signing the verification thetreasurer assistant treasurer and/or candidate officeholder or proponent certify that all ofthe 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
Additional filing obligations will be incurred if after terminating the committee receives or spends any funds or receives the forgiveness of a loan
repayments of loans made to others or any other receipts
FPPC Form 410(Jan/01)
FPPC Toll Free Helpline 866/ASK FPPC
Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period
Summary Page to whole dollars. 9 IVup-
SEE04 from lo/O1/2010 INSTRUCTIONS ON REVERSE through 10/16/2010 Page 3 of 6
NAME OF FILER I.D. NUMBER
Erik Peterson for City Council 2010 Pending
Contributions Received TColumn A Column B Calendar Year Summary for Candidates
T HDSCHE Running D CALENDAR YEAR R
(FROM ATTACHED SCHEDULES) TOTALTO DATE g in Both the State Primary and
General Elections
1. Monetary Contributions ........................................... Schedule A,Line 3 $ $400.00 $ $3,170.00
1/1 through 6/30 7/1 to Date
2. Loans Received ...................................................... Schedule B,Line 3 $0.00 $0.00
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+2 $ S400.00 $ $3,170.00 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 $0.00
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $400.00 $ $3,170.00 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $7.55 $ $2,334.30 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $7.55 $ $2,334.30 (if Subjectto Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 , $0.00 $128.33 Date of Election Total to Date
10.Nonmonetary Adjustment ..........................................Schedule C,Line 3 $0.00 $0.00 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $7.55 $ $2,462.63 $
Current Cash Statement $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $563.25
To calculate Column B,add
13.Cash Receipts ................................................... column A,Line 3above
$400.00 amounts in Column A to the
corresponding amounts *Amounts in this section may be different from amounts
$0.00
14. Miscellaneous Increases t0 Cash........................... Schedule 1,Line 4 from Column B of your last reported in Column B.
15.Cash Payments....................................I.............. Column A,Line 8above $7.55 report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $955.70 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 $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts $0.00 an
Lines 2, 7,and 9(if
v).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $128.33 FPPC Form 460(January/05)
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