HomeMy WebLinkAboutBohr, Keith - 2012 FPPC Campaign Disclosure Forms - Successf S STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee .s
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME r l C � � � I.D.NUMBER
4.Type of Committee (Continued) `
.o . Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
6Z CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY ,L 4sr- I U,&AC-1-_C5!5 r...L
r. o�•e . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO.AND STREET CITY STATE ZIP CODE
❑
Date qualified
5.Term i nation 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(April/2011)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
COVER PAGE
Recipient Committee
Type or print in Ink. date Stamp
Campaign Statement F, For
® ,CoverPage ,, , _;(Government Code Sections 84200-8421e.5) 20 ? �krr' { ImIL— of3Statement o rs period Date of election if applicable:
(Month, Day,Year) fficial Use Only
from
SEE INSTRUCTIONS ON REVERSE through
1. Type of Recipient Committee: Ali Committees—Complete Parts 1,2,3,and 4, 2. Type of Statement:
Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ 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) Q Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495
(Also Complete Part 6) C P�
❑ General Purpose Committee �,"
�► '_ndme t(Exp in below)
s
Q Sponsored ❑ Primarily Formed Candidate/ V
Q Small Contributor Committee Officeholder Committee
ft
Q Political Party/Central Committee (Also Complete Part 7)
3. Committee Information I.J.oNNUUM R� ` n Treasurer(s)
COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) `V NAME OF TREASURER
/� . �- rjti �L� C4+�-s 6� �1{,� 19041 MAILING ADDRESS
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
CIT STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
10
...Ckge4,0�
MAILING ADDR (IF DIFFERENT) NO.AND STREET OR PrO.BOX MAILING ADDRESS
CITY ST E ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
� �aLrk� :4stile' .fd
OPTIONAL: FAX/E-MAIL ADDRESSI.J 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 knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under th aws of the State of California that the foregoing is true and correct.
Executed on ® By
Dateture of Treasurer Assistant Treasurer
Executed on /ZZ' 24, Z. By
Oats Signature of Controlling Officeholder,Candidate,Slate Measure Proponent or Responsible Officer cf Sponsor
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent
Executed on By
Dale Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/Os)
FPPC Toll-Free Helpline:866/ASK-FPPC(8661276.3772)
State of California
Campaign Disclosure Statement Type or print in Ink. SUMMARY PAGE
Amounts may be rounded Statement covers period 11-
Summary Page to whole dollars. ® 460
from FORM
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER i G C� ` ��41, I.D. UMBERElf, D
'_ks
Contributions Received f/ To olu�m a oD ColumnB Calendar Year Summary for Candidates
- LENDARYEAR
(FROMATTACHEDSCHEDULES) TOTALTO DATE Running in Both the State Primary and
General Elections
1. Monetary Contributions ........................................... Schedule A,Line 3 $ $
1l1 through 6/30 7/1 to Date
2, Loans Received ...................................................... Schedule e,Line 3
3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $ 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ..................•........Add Lines 3+4 $ $ Made $ $
Expenditures Made Expenditure Limit Summary for State
pp
6. Payments Made....................................................... schedule e,Line 4 $ 1 . $ Candidates
7. Loans Made............................................................. schedule H,Line s
22. Cumulative Expenditures Made`
J
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ �•'& $ (lf subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills)...............................Schedule F Lines le Date of Election Total to Date
10. Nonmonetary Adjustment..........................................ScheduleC,Line 3 (mmlddlyy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+e+10 $ lq.74 $ i/�J $
Current Cash Statement --%-/ $
12,Beginning Cash Balance....................... Previous Summary Page,Line 16 $ To calculate Column B,add
13,Cash Receipts ................................................... Column A,Line 3 above 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 from Column B of your last reported in Column B.
15. Cash Payments.................................................. Column A,Line 8 above 6 report. Some amounts ti
""""""""" Column A may 6e negative
16.ENDING CASH BALANCE..........Add Lines 12+13+14,then subtract Line 15 $ 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 $ 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 $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ FPPC Form 460(Januaryl05)
FPPC Toll-Free Helpllne:666IASK-FPPC(866/275-3772)
COVER PAGE
Recipient Committee Type or print in ink. Date Stamp
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Statement over period Date of election if a licable: n ) � n , P ge of
p (Month, Day,Year) �' 2 ""'._C ` 1 f 1` r v °For Official Use Only
from wG
SEE INSTRUCTIONS ON REVERSE through 3
1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement:
AM Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ 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 Termination) Statement-Attach Form 495
❑ General Purpose Committee (Also complete Part6) Amendment xplain be5w)
Q Sponsored ❑ Primarily Formed Candidate/
Q Small Contributor Committee Officeholder Committee
O Political Party/Central Committee (Also complete Part7)
3. Committee Information I.D. NUM ER Treasurer(s)
2- t
COMMITTEE NAME(OR CANDIDATE'S NAME IFJ,NNO)O COMMITTEE) NAME OF TREASURER
A "tiV�N MAILING ADDRESS �C—
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE
C TY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
�7 A
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
l_r. 4�'• �Ohl'2GIN1tL���
OPTIONAL: FAX/E-MAIL ADORd5SS 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 knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under th 7raws oft State of California that the foregoing is true and correct.
Executed on I� By /
Date Signature of Treasurer or Assistant Treasurer
Executed on l' By
ate Signature of Controlling Officeholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor
Executed of 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
Recipient Committee Type or print in ink. Date Stamp .. ` COVER PAGE
Campaign Statement ' •
Cover Page p^ g p
(Government Code Sections 84200-84218.5) 2 fY 1 t D I_..G 2 1 4 M Pa of
Statement ov ris period Date of election if applicable:
(Month, Day,Year) For Official Use only
from
SEE INSTRUCTIONS ON REVERSE through
1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement:
Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ 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) 0 Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495
(Also Complete Part 6)
❑ General Purpose Committee Amendment(E plain bel )
Q Sponsored ❑ Primarily Formed Candidate/ G
Q Small Contributor Committee Officeholder Comm!ttee
Q Political Party/Central Committee (Also Complete Part7)
3. Committee Information I. . M R w ` n Treasurer(s) I C
COMMITTEE NAME(OR CANDAIDATE'S NAME IF NO COMMITTEE) 1`V NAME OF TREASURER .Ire
4+ I4( di 4 MAILING ADDRESS _
STREET ADDRESS(((SJS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
CIT STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
AN4 c o J - - y
MAILING ADDR (IF DIFFERENT)NO.AND STREET OR FrO.BOX MAILING ADDRESS
CITY STA E ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAMAIL 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 knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury underth laws the State of California that the foregoing is true and correct.
Executed on �® By
Da S r/e of Treasureror Assistant Treasurer
Executed on ` Z- By C! /
D Signature of Controlling Officeholder,Candidate,State Measure Proponent or esponslbreDfficerotsponsor
Executed on By
Date Signature of Controlling Officeholder.Candidate,State Measure Proponent -
Executed on 8y
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form460(January/06)
FPPC Toil-Free Heipiine:8661ASK-FPPC(8661276-3772)
State of California
COVER PAGE
Recipient Committee
p Type or print in ink. Date Stamp
Campaign Statement LEMR, ® ,
Cover Page FOMM
(Government Code Sections 84200-84216.5)
Statemen co ers period Date of election if applicable t 4 y- Page of
f p (Month, Day, Year) i;) $ I t` 4 For Official Use Only
from 9 1
SEE INSTRUCTIONS ON REVERSE through
1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement:
Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ quarterly Statement
O State Candidate Election Committee Committee '� Semi-annual Statement ❑ Special Odd-Year Report
O Recall O Cont ❑ Termination Statement ❑ Supplemental Preelection
(A/so Complete Part5) O Sponsored Also file a Form 410 Termination)) Statement-Attach Form 495
(Also Complete Part 6)
❑ General Purpose Committee ❑ Amendment(Explain below)
O Sponsored ❑ Primarily Formed Candidate/
O Small Contributor Committee Officeholder Committee
C) Political Party/Central Committee (Also Complete Part 7)
3. Committee Information I.D. NUMB R Treasurer(s)
COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) a� NAME OF TREASURER
FIA
- r J C MAILING IL ADDRESS
STR�E��®SS (NO P.O. BOX) �• CITY STATE ZIP CODE AREA CODE/PHONE
CITY ^ STA E ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
'W
MAILING ADDRESS ( DIFFERENT) NO.AND STREET OR P.O. BO MAILING ADDRESS
CITY STA E ZIP CO 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 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 and correct.
Executed on 2131 `ft By
e o'Signature of Treasurer or Assistant Treasurer
Executed on By
Date/ Signature of Controlling Officeholde�Candidate,State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder,Candidate,Stale Measure Proponent
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent
FPPC Form 460(Januaryl05)
FPPC Toll-Free Helpline:8661ASK-FPPC(8661275.3772)
State of California
Type or print in ink. COVERPAGE-PART2
Recipient Committee 'CALIFORNIA
Campaign Statement FORM 46
Cover Page—Part 2
Page of
6. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFI EHOLDER OR CANDIDAT NAME OF BALLOT MEASURE
Iz
OFFICE SOUGH OR HEL (INCLU E LOCATION NO DISTRIC
SE
RESIDENTIAL/BUSI S ADDRESS (NO.ANDS REET) C Y STATE ZIP
���n �p/�(�r ��� / %s �� �� Identify the controlling officeholder, candidate, or state measure proponent, if any.
�!/ -��d{- /Sa NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT
Related Committees Not Included in this Statement: Listanycommittees
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
7. Primarily Formed Candidate/Officeholder Committee List names of
NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s)or candidate(s)for which this committee is primarily formed.
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT
❑ OPPOSE
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
COMMITTEE NAME I.D. NUMBER
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT
❑ OPPOSE
NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
❑ YES ❑ NO ❑ SUPPORT .
❑ OPPOSE
COMMITTEE ADDRESS 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 ®-
Summary Page to whole dollars. I
from s-
SEE INSTRUCTIONS ON REVERSE
3
through � Page of
NAME OF FILE I.D. NUMBER
0_� 19oze
ro Column
IOD DColu�mn B Calendar Year Summary for Candidates
Contributions Received Running in Both the State Prima and
(FROM ATTACHED SCHEDULES) TOTALTO DATE g Primary
General Elections
1. Monetary Contributions ........................................... Schedule A,Line a $ $
111 through 6130 711 to Date
2. Loans Received ...................................................... Schedule B,Line 3 _
3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $ 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $ Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $ Candidates
7. Loans Made............................................................. Schedule H,Line 3
22. Cumulative Expenditures Made*
8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ $ (if subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $ J $
Current Cash Statement ) $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ �• 76 To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3 above 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 from Column B of your last reported in Column B.
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 $ 76 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 $ for this calendar year, only
carry over the amounts
Cash E uivalents and Outstanding Debts from Lines 2,7,and 9(if
q g any).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC (866/275-3772)