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HomeMy WebLinkAboutDelgleize, Barbara. - 2012 FPPC Campaign Disclosure Forms Fo (2) Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period . - Summary Page to whole dollars. from 10/21/2012 •- SEE INSTRUCTIONS ON REVERSE through 12/31/2012 Page 3 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2014 1345651 TColumn olulmnAoD Column B Calendar Year Summary for Candidates Contributions Received Running In Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE g •7 General Elections 1. Monetary Contributions ........................................... Schedule A,Line $ 7,525.00 $ 40,435.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B,Line 3 0.00 3,000.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 7,525.00 43,435.00 20. Contributions$ Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 499.00 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 7,525.00 $ 43,934.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 14,673.66 $ 40,207.33 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 14,673.66 $ 40,207.33 (if Subject to Voluntary ExpenditureUrnit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10.Nonmonetary Adjustment ..........................................Schedule C,Line 0.00 499.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 14,673.66 $ 40,706.33 �_� Current Cash Statement $ 12.Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 10,376.33 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 7,525.00 amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts 14.Miscellaneous Increases to Cash........................... Schedule I,Line 4 0.00 from Column B of your last reported in Column B. 15.Cash Payments................... 14,673.66 report. Some amounts in Column A,Line a above Column A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 3,227.67 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 Equivalents and Outstanding Debts from Lines 2,7,and 9(if Cash E q 9 any). 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.neffile.com Type or print in ink. SUMMARY PAGE 9 ;' f3�ilR'f* � t4?fYi Qp - - r 4. a SEE INSTRUCTIONS ON REVERSE through 10/20/2012 Page 3 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2014 1345651 �� ie 4. ry__ , t s�z rs"ef t ar' �i .i.,mmary for Candidates _-.�)n .f*FbufionS Keceived TOTALTHiaPERIOD CALENDAR YU,R_iJiA,TO�,4TE '7 ht;t�hln in Both the State Primary and (FRJt,r Aii.4Ji {CSC>IcJUL'��� General Elections 1. Monetary Contributions ....... . .... ............................ Schedule A,Line $ 10,254.00 $ 32,910.00 1l1 through 6/30 7/1 to Date 2. Loans Received .................... ........... ..................... Schedule 8,Line 3 -- 0_00 3,000.00 3 10,254.0 20. Contributions S(113TC I"t_CASHCONTRIBUTIONS ......................... AddLinesl+2 $ --_--_-- ____0_ $ 35,910.00_,__ Received $ $ 4. Nonmonetary Contributions.. .. ._... ._.. .................. ScheduteC,Line 3 -.- --_- _0.00_ J____499.00 21. Expenditures 5. TOTAL.CONTRIBUTIONS RECEIVED ......•... ..............••AddLines3+4 $ 10,254.00 $ 36,409,00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 6,646.87 $ 25,533.67 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 6,646.87 $ 25,533.67 (If Subjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment ...._....................................Schedule C,Line 3 0.00 499.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 6,646.87 $ 26,032,67 J� $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 6,769.20 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 10,254.00 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 01 00 from Column B of your last reported in Column B. report. Some amounts 15. Cash Payments.................................................. Column A,Line 8 above 6,646.87 ti Column A may be negative RAC., 10,376.33 figures that should be ENDING r; y,SALANCE......,..- .(Yd Lines 12+13+14,then subtract Line 15 S 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 e,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts fro Lines 2,7, and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line9 in Column 8 above $ 3,000.00 FPPC Form 460(Januaryl05) FPPC Toil-Free 1-lelpline:866iASK-FPPC(8661275-3772) www.netfile.com Campaign Disclosure Statement Type or print In ink. SUMMARY PAGE S u rn rn a ry P a e m whollo fllnl!':��rF� SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 3 of 23 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2014 1345651 Column PE RIO A D CA C0113mr,S Calendar Year Summary for Candidates Contributions Received TOTALTHIS LENDARYEAR (FROM ATTACHED SCHEDULES) TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 14,242.00 $ 22,656.00 1/1 through 6130 7/1 to Date 2. Loans Received .........__......___..... ........... Schedule B,Line 3 0.00 3,000.00 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines I+2 14,242.00 $ 25,656.00 20. Contributions Received 4. Nonmonetary Contributions.................... ............... Schedule C.Line 3 0.00 499.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 14,242.00 $ 26,155.00 Made Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 9,102.01 $ 18,886.80 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 9,102.01 $ 18,886.80 (if Subjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment .........._.............................Schedule C,Line 3 0.00 499.00 (mmiddlyy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 9,102.01 $ 19,385.80 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 1,629.21 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 14,242.00 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 9,102.01 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 6,769.20 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,ands(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 B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Type or print in ink. SUMMARY PAGE Campaign Disclosure Statement Amounts may be rounded Statement covers period GALIFORNIASummary page to whole dollars. d from 10/21/2012 FOR SEE INSTRUCTIONS ON REVERSE through 12/31/2012 Page 3 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR (FROMATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line $ 7,525.00 $ 40,435.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B,Line 3 0.00 3 000.00 7,525.00 43,435.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $ Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 499.00 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........... ...••••••.•...AddLines3+4 $ 7,525.00 $ 43,934.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 14,763.51 $ 39,111.51 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 14,763.51 $ 39,111.51 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................ScheduleC,Line 0.00 499.00 (mm/dd/yy) 11. TOTAL EXPEN DITURES MADE................................AddLines8+s+10 $ 14,763.51 $ 39,610.51 �� Current Cash Statement $ 12. Beginning Cash Balance....................... Previous summary Page,Line 16 $ 8,653.25 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 7,525.00 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 I reported in Column B. 15. Cash Payments.................................................. Column A,Line s above 14,763.51 report. Some amounts inColumn A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 1,414.74 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED........................... Schedule B,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, �, ands(if Q � any). � 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line s in Column B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Recipient Committee COVER PAGE Campaign StatementType or print in ink. Date Stamp ® e ® • Coven-page (Government Code Sections 84200-84216.5) n;" r. 3 c J j, i Statement covers period Date of election if applicable: (Month, Day, Year) Page 1 of is from 10/01/2012 For Official Use Only SEE INSTRUCTIONS ON REVERSE through 10/20/2012 11/06/2012 1. Type of Recipient Committee: All Committees—Complete Parts t,2,3,and 4. 2. Type of Statement: x] Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee ent ❑ Special Odd-Year Report 0 Recall 0 Controlled Termination Statement (Also Complete Part 5) S E] Termination Supplemental Preelection. (Also file a Form 410 Termination) Statement-Attachtach Form 495 (Also Complete Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (A/so Complete Part7) 3. Committee Information I.D. NUMBER Treasurer(s) 1345651 COMMITTEE NAME(OR CANDIDATE'S NAME IF NAME OF TREASURER Barbara Delgleize for City Council 2012 Lysa Ray MAILING ADDRESS 603 E Alton Ave STE H STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 5901 Warner Ave #454 Santa Ana, CA 92705 714-540-2295 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach, CA 92649 714-206-4234 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS 603 E Alton Ave STE H CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Santa Ana, CA 92705 OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS barbara4hb@gmail.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge ti-felinformation 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 corr ctl 1) Executed on 10/23/2012 By Date O r p nat of Treasu r Assista T easurer Executed on 01/2-4/20I2 By Y Date Signatureof Controlling Officeholder,Candidate,StateMeasure Proponent esponsibleOffi (Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State M sur 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 www.netfile.com Type or print in ink. COVER PAGE-PART 2 Recipient Committee C Aq ®_ Campaign Statement ®_ ® 0 Cover Page— paint 2 Page 2 of 15 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF Delgleize OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT City Council Member ❑ OPPOSE Huntington Beach RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 5901 Warner Ave #454 Huntington Beach, CA 92649 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/Office holder Committee List names of 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 COMMITTEENAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(January/05) FPPC Toll-Free HelpFne:866/ASK-FPPC(8661276-3772) State of California www.netfile.com Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period Summary page to whole dollars. d NN from 10/01/2012 ®' SEE INSTRUCTIONS ON REVERSE through 10/20/2012 Page 3 of 15 NAME OF FILER I . NUMBER Barbara Delgleize for City Council 2012 1345651 Contributions Received TOCTolumn ADD ColuDmn B Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ 10,254.00 $ 32,910.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule a,Line 3 0.00 3,000.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 10,254.00 35,910.00 20. Contributions$ Received $ $ 4. Nonmonetary Contributions.................................... Srhedule C,Line 3 0.00 499.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 10,254.00 $ 36,409.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... ScheduleE,Line $ 6,995.20 $ 24,348.00 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 6,995.20 $ 24,348.00 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 0.00 499.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ 6,995.20 $ 24,847.00 J J $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 5,394.45 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 10,254.00 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. 15. Cash Payments.................... 6,995.20 report. Some amounts in Column A,Line s above Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 8,653.25 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 a,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts arny)Lines 2, 7, and 9 (if 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19, Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Schedule A Type or print in ink. SCHEDULE A MonetaryContributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA from 10/01/2012 1,0009, SEE INSTRUCTIONS ON REVERSE through 10/20/2012 page 4 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 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 FSELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 10/20/201 IND 150.00 150.00 G 12 150.00 ❑COM 1375 Logan Ave., Ste G x❑OTH Costa Mesa ❑PTY ❑SCC 10/16/2012 AES ❑IND 520.00 520.00 G 12 520.00 1450 Lake Robbins Dr., Ste. 600 ❑R OTH Woodlands, TX 77380 ❑PTY ❑SCC 10/20/2012 Aliso Elec ❑IND 150.00 150.00 G 12 150.00 ❑COM 2 Rancho Circle ElOTH Aliso Viejo, CA ❑PTY ❑SCC 10/19/2012 Marshall Armstrong RIND Realtor 100.00 100.00 G 12 100.00 ❑COM 17092 Twain Ln ❑OTH self Huntington Beach, CA 92649 ❑PTY ❑SCC 10/16/2012 Bauer Investments L.P. ❑IND 200.00 500.00 G 12 500.00 ❑COM 16511 Cotuit Cir. 0 OTH Huntington Beach, CA 92649-2121 ❑PTY ❑SCC SUBTOTAL$ 1,120.00 Schedule A Summary `Contributor Codes 1. Amount received this period—itemized monetary contributions. IND—Individual (Include all Schedule subtotals.)........................................................................................................$ 9,230.00 COM—RecipientCommittee (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 ............................. $ 1,024,00 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 SummaryPage, Column A, Line . TOTAL $ 10,254.00 l 1 9 ) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Schedule A (Continuation Sleet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® . to whole dollars. I from 10/01/2012 610 through 10/20/2012 Page 5 of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 RECEIVE ENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 10/16/201 er ❑RIND Retired 100.00 100.00 G 12 100.00 ❑COM 3351 Bounty Cir. ❑OTH Hunting A 92649 ❑PTY ❑SCC 10/20/2012 Chameleon: Merchandising and Design, Inc. ❑IND 500.00 500.00 G 12 500 ❑COM 3188-B Airway Ave. ❑x OTH Costa Mesa, c 92626 ❑PTY ❑SCC 10/20/2012 Peggy Coon al Estate Broker 100.00 100.00 G 12 100.00 ❑COM 1901 Pine St ❑OTH ReMax Huntington Beach, CA 92648 ❑PTY ❑SCC 10/20/2012 Michael David ❑xIND CEO 520.00 520.00 G12 520.00 ❑COM PO Box 1565 ❑OTH ACS Inc Huntington Beach, CA 92647 ❑PTY ❑SCC 10/20/2012 Diaz Construction Co., Inc. ❑IND 150.00 150.00 G 12 150.00 ❑COM 9782 Indiana Ave. ❑X OTH ❑PTY Riverside, CA 92503 ❑SCC SUBTOTAL$ 1,370.00 „ 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) www.neifile.com Schedule A (Continuation .Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period LIF® . NIA to whole dollars. from 10/01/2012 through 10/20/2012 Page 6 of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 TO DATE (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OFBUSINESS) 16/201 udith Flemming ❑BIND / Homemaker 100.00 100.00 G 12 100.00 ❑COM 3162 Portfino TH Huntington Beach, CA 92649 ❑PTY ❑SCC 10/19/2012 David Frank ❑xIND 150.00 G 12 150.00 ❑COM 4 Welbe Cir ❑OTH ❑PTY Self Ladera Ranch, CA 92694 10/16/2012 Frank Gibson RIND Retired 100.00 100.00 G 12 100.00 ❑COM 16991 Bolero Ln. ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 10 20/2012 Green & Hall / ElIND 200.00 200.00 G 12 200.00 ❑COM 1851 E. 1st, loth Fl000r ❑x OTH Santa Ana, CA 92705 ❑PTY ❑SCC 10/16/2012 Richard Harlow ❑xIND Government Relations 100.00 200.00 G 12 200.00 ❑COM 1742 Main St. ❑OTH Self ❑PTY Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ 650.00 , '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) www.netfile.com 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. from 10/01/2012 through 10/20/2012 Page 7 of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED ( COMMITTEE,ALSND I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 10/20/2012 Karosel, Inc. 100.00 100.00 G 12 100.00 ❑COM 1610 Pacific Coast Hwy ❑x OTH Huntington Beach, CA 92648 .SAC 10/20/2012 L.A.R.K. Industries, Inc. ❑IND 150.00 150.00 G 12 150.00 ❑COM 4900 E. Hunter Ave. Anaheim, CA 92807 ❑PTY ❑SCC William Larkin 10/16/2012 ❑RIND President 100.00 100.00 G 12 10 15938 Mcdermitt St. ❑OTH L&S Construction Fountain Valley, CA 92708 ❑PTY ❑SCC 10/20/2012 Linda Lee ❑xIND Realtor 100.00 100.00 G 12 100.00 ❑COM 3830 Valley Centre Dr. ❑OTH Keller Williams San Diego, CA 92130 ❑PTY ❑SCC 10/20/2012 LGC Geotechnical, Inc. ❑IND 150.00 150.00 G 12 150.00 ❑COM 120 Calle Iglesia, Ste. A ❑X OTH ❑PTY Santa Clemente, CA 92672 ❑SCC SUBTOTAL$ 600.00 *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) www.netfile.com 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. Lan, I I I • from 10/01/2012 through 10/20/2012 Page a of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED { COMMITTEE,ALSND D.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEA O DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 10/20/2012 Mary Matheis Lawyer 150.00 150.00 G12 150.00 ❑COM 3 Teal ❑OTH Law Offices of �PTY C Matheis Rob Norquist x IND 10/16/2012 Real Estate 100.00 00 ❑COM 9042 Rhodesia Dr. ❑OTH ❑PTY Hour Group Huntington B 92646 ❑SCC 10/16/2012 Nossaman ❑IND 250.00 500.00 G12 500.00 ❑COM 777 South Figueroa Street, 34th Floor ❑x OTH Los Angeles, CA 90017 ❑PTY ❑SCC 10/20/2012 OC Concrete, Inc. ❑IND 300.00 300.00 G 12 300.00 ❑COM 4308 E. La Palma Ave. ❑X OTH Anaheim, CA 92807 ❑PTY ❑SCC 10/16/2012 Octax PAC (#1288619) ❑IND 250.00 250.00 G 12 250.00 ❑x COM 25 Orchard ❑OTH ❑PTY Lake Forest, CA 92630 ❑SCC SUBTOTAL$ l,oso.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) www.netfile.com 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. from 10/01/2012 ® ' through 10/20/2012 Page 9 of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED ( COMMITTEE,ALSNDI.D.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR Y (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 10/20/2012 s ❑IND 150.00 150.00 G 12 150.00 ❑COM 5325 E. Hunter Ave. ❑x OTH Anaheim, CA PTY ❑SCC Rainbow Painting Service 10/16/2012 ❑IND 100.00 100.00 G 12 100.00 ❑COM orrow Way ❑R OTH Buena Park, CA 90620 ❑PTY ❑SCC Jacqueline Ritacco 10/20/2012 RIND VP G 100.00 100.00 G 12 100.00 ❑COM 17292 Apel Ln ❑OTH A1tMed Heath Services Huntington Beach, CA 92649 ❑PTY ❑SCC 10/19/2012 Adam Rodell ❑RIND Broker 100.00 250.00 G 12 250.00 ❑COM 16631 Fountain Ln. ❑OTH Re/Max SelectOne Huntington Beach, CA 92647-4326 ❑PTY ❑SCC 10/19/2012 Kathleen Rowlands ❑RIND Realtor 100.00 100.00 G 12 100.00 ❑COM 722 13th St ❑OTH Self ❑PTY Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ 550,00 '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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. _ / from 10/01/2012 through 10/20/2012 Page 10 of 15 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 CAL (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 10/19/2012 ❑IND 500.00 500.00 G 12 500.00 ❑COM 245 Fischer Ave Bldg B4 ❑x OTH Costa Mesa, CA 92626 ❑PT ❑SCC Frances Sato IND 10/16/2012 ❑ Sales Rep 250.00 300.00 G 12 300.00 ❑COM 19 ❑OTH El Pam, Bluewater Realty Huntington Beach, CA 92648 ❑SCC Marlene Schell 10/16/2012 ❑RIND Presiden 200.00 G 12 200.00 ❑COM 16931 Fairfield Cir. ❑OTH Marted Corp Huntington Beach, CA 92649 ❑PTY ❑SCC 10/16/2012 Patricia Shipley ❑xIND Realtor 100.00 100.00 G 12 100.00 ❑COM 16235 Whitecap Ln. ❑OTH New Star Realty & Inv. Huntington Beach, CA 92649 ❑PTY ❑SCC 10/16/2012 South Coast Apartment Association PAC (#745208) ❑IND 520.00 520.00 G 12 520.00 ❑x COM 980 9th St #200 El OTH ❑PTY Sacramento, CA 95814 ❑SCC I SUBTOTAL$ 1,570.00 '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) www.netfile.com Type or print in ink. SCHEDULE B-PART 1 Schedule B—Part I Amounts may be rounded Statement covers period loll Loans Received to whole dollars. 10/01/2012 ®- ® from g SEE INSTRUCTIONS ON REVERSE through 10/20/2012 Page 13 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 FULL NAME,STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS BER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE Barbara Delgleize Realtor ❑PAID CALENDAR YEAR 4952 Warner Avenue 0.00 3,000.00 3,000.00 #109 Self/Barbara Delgleize $ $ % $ $ 31 000.00 Huntington Beach, CA 92649 ❑FORGIVEN RATE PER ELECTION- 3,000.00 3,000.00 0.00 0.00 0.00 G12 3,000.00 $ $ $ $ $_ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR ❑FORGIVEN RATE PER ELECTION** t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR ❑FORGIVEN RATE PER ELECTION*' t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0.00 $ 0.00 $ 3,000.00 $ 0.00 (Enter(e)on Schedule B 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—RecipientCommittee (Total Column(c)plus loans under$100 paid or forgiven.) (other than PTY or SCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g., business entity) PTY—Political Party 3. Net change this period. Subtract Line 2 from Line 1. 0.00 SCC—Small Contributor Committee 9 p ( )............................................................... NET $ 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. '* FPPC Form 460(January/05) If required. FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com SCHEDULEE Schedule E Type or print in ink. Statement covers period Payments blade Amounts may be rounded y to whole dollars. from 10/01/2012 SEE INSTRUCTIONS ON REVERSE through 10/20/2012 page 14 of 15 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 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 FSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LI ilings PRT print ads WEB information technology cos NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER L DESCRIPTION OF PAYMENT AMOUNTPAID Bieber Communications PRT 2,909.25 3609 W. MacArthur Blvd., #812 Santa Ana, CA 92704 Bieber Communications CMP 2,559.06 3609 W. MacArthur Blvd., #812 Santa Ana, CA 92704 Lysa Ray Campaign Services PRO 250.00 603 E. Alton Ave., Suite H Santa Ana, CA 92705 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,718.31 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 6,668.25 2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ 326.95 3. Total interest aid this period on loans. Enter amount from Schedule B, Part 1, Column e . 0.00 p ) )............................................................................... $ 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 6,995.20 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com Schedule E SCHEDULE E(CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded ®R Payments Made to whole dollars. from 10/01/2012 POUR I through 10/20/2012 Pa a 15 Of 15 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 ature and mailings PRT print ads WEB information t ernet, e-mail) NAME AND ADDRESS OF PAYEE C YMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) Rally cc Processing 144 2nd St., First Floor San Fra, CA 94105 OFC 44.78 Red Zone Strategies 10252 Wesley Circle FND 615.16 Huntington Beach, CA 92646 Suzanne's Catering 9121 Atlanta Ave., Suite 227 FND 290.00 Huntington Beachh, CA 92646 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 949.94 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com p COVER PAGE IReci ip-nt Committee Date Stamp p Type or print in ink. •. Campaign Statement r % ® • 1 Cover Page (Government Code Sections 84200-84216.5) ^2 Statement covers period Date of election if appl'ictil'e `j I�� ' �i 1 23 (Month, Day,Year) Page of from 07/O1/2012 For Official Use Only SEE INSTRUCTIONS ON REVERSE through 09/30/2012 11/06/2012 t• ") 1. Type of Recipient Committee: All Committees-Complete Parts t,2,3,and 4. 2. Type of Statement: ] Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement Q State Cand tee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report O Recall O Controlled ❑ Termination Statem al Preelection (Also Complete Parts) Q Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 ❑ General Purpose Committee (Also Complete Part6) - E] Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part7) 3. Committee Information I.D. NUMBER Treasurer(s) 1345651 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMI F TREASURER Barbara Delgl.eize for City Council 2012 Lysa Ray MAILING ADDRESS 603 E Alton Ave STE H STREET ADDRESS(NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 5901 Warner Ave #454 Santa Ana, CA 92705 714-540-2295 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Hunt=naton -leach CA 92649 714-206-4234 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS 603 E Alton Ave STE H CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Santa Ana, CA 92705 OPTIONAL FAX/E-MAIL ADDRESS OPTIONAL:` FAX/E-MAIL ADDRESS barbara4hb@gmail.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the bes�o my In ledge nformation 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 an correct. Executed on 10/02/2012 By Date IF Signa ure of Treasurer or Assistant Treasurer Executed on By fate ur fContro i Officeholder,Candidate,Stat asure o one rResponsibl cerofSponsor Executed on By ae Signature of ontrollingOfficeholder,Candidate,S I Mea ua nent Executed on By Date Signature of Controlling Officeholder,Candidate,ftw measukl2lWorient FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Type or print in ink. COVERPAGE-PART2 Recipient CommitteeCALIFORNIA ® • 1 Campaign Statement FORM Cover Page—Part 2 Page 2 of 23 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE URE Barbara Delgleize OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT City Council Member ❑ OPPOSE Huntington Beach RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 5901 Warner Ave #454 Huntington Beach, CA 92649 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. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of 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 COMMITTEENAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (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(8661276-3772) State of California www.netfile.com Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period Summary page to whole dollars. I ® t from 07/01/2012FORM' SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 3 of 23 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ 14,242.00 $ 22,656.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B,Line 3 0.00 3,000.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 14,242.00 $ 25,656.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 499.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 14,242.00 $ 26,155.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 10,477.26 $ 20,262.05 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 10,477.26 $ 20,262.05 (If Subject to Vofuntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................Schedule C,Line 3 0.00 499.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines a+9+10 $ 10,477.26 _ $ 20,761.05 J J $_ Current Cash Statement JJ $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 1,629.71 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 14,242.00 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 a above 10,477.26 report. Some amounts in Column A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 5,394.45 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED........................... Schedule B,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts arum Lines 2, 7,ands(ifv). 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2.+Line 9 in Column B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com Sch6dule A Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. ®' � ® � from 07/01/2012 • SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 4 of 23 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 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 ELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 09/28/2012 Robin Anderson ®IND Financial 200.00 G12 200.00 ❑COM 256 La Salle Ave. ❑OTH Merrill Lynch Peidmont, CA 94610 PTY ❑S 012 Marshall Armstong [KIND Salesman 100.00 100.00 G 12 100.00 ❑COM 17092 Twain Lane Team Real Estate Huntington Beach, CA 92649 ❑PTY ❑SCC 09/25/2012 James Atherton ❑KIND Retired 0 G 12 100.00 ❑COM 3592 Bravata Dr. ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 09/28/2012 Frances Barron [KIND Teacher 100.00 100.00 G 12 100.00 ❑COM 16700 Norwalk Blvd. - ❑OTH ABC Unified Cerritos, CA 90703 ❑PTY ❑SCC 09/14/2012 Tomas Barry MIND Retired 100.00 100.00 G 12 100.00 ❑COM 41B2 Silliman Dr. ❑OTH 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.)........................................................................................................$ 13,010.00 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 ............................. $ l,232.oo OTH-Other business entity) p ry PTY-Political Party 3. Total monetary contributions received this period. SCC-Small contributor committee Add Lines 1 and 2. Enter here and on the Summarye TOTAL $ 14,242.00 ( Page, Column A, Line 1.) �������� ���� FPPC Form A60(January/05) FPPC Toil-Free Helpline:866/ASK-FPPC(866/275-3772) www.neffile.com Sc6eduie A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® . to whole dollars. I from 07/01/2012 ® 0 through 09/30/2012 Page 6 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) ke xIND ❑ CEO/Retired 520.00 520.00 G 12 520.00 ❑COM ❑OTH NY 10550 ❑PTY ❑SCC 08/17/2012 C.L. Mandic ❑xIND 150.00 150.00 G 12 150.00 16242 Tisbury Circle ❑OTH Huntington Beach, CA 92649 PTY ❑SCC 09/07/2012 Jack Ciulla Jr. 00 100.00 G 12 100.00 ❑COM 16531 Potter Cir. ❑OTH El PTY of Long Beach Huntington Beach, CA 92647 ❑SCC 08/24/2012 Lauren Claus ❑RIND Housewife 250.00 250.00 G 12 250.00 ❑COM 16202 Wayfarer Ln. ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 07/26/2012 CREPAC California Real Estate (#890106) ❑IND 520.00 520.00 G 12 520.00 ❑x COM 525 S. Virgil Avenue ❑OTH ❑PTY Los Angeles, CA 90020 ❑SCC SUBTOTAL$ 1,540.00 ` ;; k ..0- *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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. _ I ® ' from 07/01/2012 • through 09/30/2012 Page 7 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 IT RE,ALSAND ZIP I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THI R YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINES 2 DSSJ LLC ❑IND 100.00 100.00 G 12 100.00 [_]COM 16711 Peale Ln. Q OTH Huntington 49 ❑PTY ❑SCC 08/17/2012 Dale Dunn ❑KIND Retired 50.00 200.00 G12 200.00 17302 Almelo Lane ❑OTH Huntington Beach, Ca 92649-4621 0 PTY [:]SCC 09/07/2012 Les Fishman al Estate 100.00 100.00 G12 100.00 ❑COM 2125 Via Rivera ❑OTH ❑PTY Banker Palos Verdes, CA 90274 ❑SCC 08/17/2012 Franciscan Friars ❑IND 100.00 200.00 G12 200.00 ❑COM 20444 Magnolia St. ❑K OTH Huntington Beach, CA 92646 ❑PTY ❑SCC 09/14/2012 Wade Friedrichs ❑KIND Product Manager 100.00 100.00 G12 100.00 ❑COM 5366 Wishfield Cir. ❑OTH Tiodize ❑PTY Huntington Beach, CA 92649 ❑SCC RE SUBTOTAL$ 450.00 , '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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period • e to whole dollars. _ a from 07/01/2012 • through 09/30/2012 Page 8 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 13456SI DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION Q COMMITTEE,ALSOENTERIDNUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED . . CODE OYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/17/2012 Nancy Glass ❑XIND Escrow Agent .00 G 12 100.00 ❑COM 613 13th Street ❑OTH ❑P.I.Y Cardinal Pacific Escrow Huntington Be ❑SCC 08/17/2012 Golden West Moving, Inc. ❑IND 100.00 200.00 G 12 200.00 ❑COM 15671 Commerce Ln. [A OT Beach, CA 92649 ❑PTY ❑SCC 08/23/2012 Miguel Ali Hasan ❑ IND Film Director 100.00 ❑COM 7780 Lorenzo Dr. ❑OTH ❑Pam, Self/Miguel Ali Hasan Huntington Beach, CA 92648 ❑SCC 08/17/2012 William Holman ❑XIND VP of Planning & 100.00 100.00 G 12 100.00 ❑COM neveloping 5861 Raphael Drive ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 08/3.7/2012 Jules Hooper ❑XIND Retired 150.00 400.00 G 12 400.00 ❑COM 6822 Laurel Hurst Dr. ❑OTH ❑PTY Huntington Beach, CA 92647 ❑SCC �3 SUBTOTAL$ 550.00Mil "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) www.netfile.com Schedule Al Continuation Sheet Type or print in ink. SCHEDULE (CONT) Monetary Contributions Received Amounts may be rounded Statement covers periodCALIFONIA . to whole dollars. _ ® a from 07/01/2012 through 09/30/2012 Page 9 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION ( COMMITTEE,ALSO ENTER I.D.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALEN RECEIVED (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 09/28/2012 Hun o Dealer ❑IND 520.00 520.00 G 12 520.00 ❑COM 2124 Main St. Ste 195 ❑%OTH Huntington Beach l PTY ❑SCC 08/17/2012 Jim Silva for Assembly (#1314301) ❑IND 520.00 520.00 G12 520.00 541 Peale Lane [_]OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 09/25/2012 Kathleen Kramer ❑RIND Mor 0 100.00 G 12 100.00 [:]COM 6552 Brentwood Dr. ❑OTH ❑PTY Kramer Huntington Beach, CA 92648 ❑SCC 08/24/2012 Jean Kulemin ❑xIND Broker 100.00 100.00 G 12 100.00 ❑COM 2215 E 2nd St. Apt 12 ❑OTH California Coast Long Beach, CA 90803 ❑PTY Investment ❑SCC 08/23/2012 Linda Lang ❑xIND CEO 520.00 520.00 G12 520.00 ❑COM 76 Calls de Felicidad ❑OTH ❑PTYOC Assoc. of Realtors Rancho Santa Margari, CA 92688 ❑SCC SUBTOTAL$ 1,760.00 . .3 , '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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA, to whole dollars. � � from 07/01/2012 • RM through 09/30/2012 Page 10 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED QFCOMMITTEE,ALSND I.D.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/23/2012 Mel Lang Retired 520.00 520.00 G12 520.00 ❑COM 76 Calle De Felicidad ❑OTH Rancho Santa Margari, CA 92688 ❑PTY SCC 09/14/2012 Judith Legan ❑xIND Exec. Director 100.00 100.00 G 12 100.00 ❑COM 4912 Kron St.- ❑OTH El Pam, CAA South Coast Apt. Assn Irvine, CA 92604 ❑SCC 09/25/2012 Frank Locrasso MIN ker 100.00 100.00 G 12 100.00 ❑COM 9042 Garfield El OTH ❑PTY Self/Frank Locrasso Huntington Beach, CA 92646 [-]SCC 09/07/2012 Don Macallister MIND Retired 100.00 100.00 G 12 100.00 ❑COM 1121 Park St. ❑OTH Huntington Beach, CA 92646 ❑PTY ❑SCC 07/26/2012 Janis Mantini ❑RIND Retired 100.00 100.00 G 12 .100.00 [:]COM 19239 Beckonridge Lane ❑OTH ❑PTY Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ f 920.00 Contributor Codes IND-Individual COM-Recipient Committee (other than PTY or SCC) OTH-Other(e.g., business entity) PTY-Political Parry FPPC Form 460(January/05) SCC-Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.neffile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. from 07/01/2012 FORM through 09/30/2012 Page 11 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED ( COMMITTEE,ALSND .D.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSI NESS) Ivan M. Marks x IND 09/07/2 ❑ Unemployed 100.00 200.00 G 12 200.00 ❑COM 21161 Poston Ln. ❑OTH Huntington Beach, CA ❑SCC Ivan M. Marks ❑M IND 09/25/2012 Unemployed 100.00 200.00 G 12 200.00 ❑COM . ❑OTH Huntington Beach, CA 92646 ❑PTY ❑SCC 09/07/2012 Joseph McDonough ❑MIND Real Estate 100.00 G 12 100.00 ❑COM 2610 Point Del Mar Ave. ❑OTH El PTY Self/Joe McDonough Com, CA 92625 ❑SCC 08/23/2012 Geoff McLntosh ❑MIND Real Estate Broker 520.00 520.00 G 12 520.00 ❑COM 244 Redondo Ave. ❑OTH El PTY Main St. Realtors Long Beach, CA 90803 ❑SCC 09/25/2012 Teresa Nicholas [MIND Volunteer 200.00 200.00 G 12 200.00 ❑COM 4022 Diable Cir. ❑OTH ❑PTY Self/Nicholas Teresa Huntington Beach, CA 92649 ❑SCC SUBTOTAL$ 1,020.0o -g 1114 '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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT) Monetary Contributions Received Amounts may be rounded Statement covers periodCALIFORNIA to whole dollars. from 07/01/2012 through 09/30/2012 Page 12 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 * ON AND EMPLOYER RECEIVED THiS CALENDAR YEAR TO DATE OCCUPATI LOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSI NESS) 08/24/2012 Christian Nielsen KIND ❑ 0.00 G 12 100.00 ❑COM 16862 Baruna Ln. ❑OTH El PTY Nielson Citrus Produc 92649 ❑SCC 08/30/2012 Claudia Noble ❑KIND Homemaker 100.00 100.00 G 12 100.00 M 18091 Ivorycrest Ln ❑OTH Huntington Beach, Ca 92648 ❑PTY ❑SCC 08/30/2012 OCBC'S Bizpac (#802010) ❑I 520.00 G 12 520.00 ❑K COM 3699 Wilshire Blvd., Ste 1290 []OTH Los Angeles, Ca 90010 ❑PTY ❑SCC 09/25/2012 Laer Pearce [KIND PR Executive 150.00 150.00 G 12 150.00 ❑COM 23 Blackhawk ❑OTH El PTY Pearce & Associates Coto De Caza, CA -92679 ❑SCC 09/25/2012 Mark Preston ❑KIND Loan Officer 100.00 100.00 G 12 100.00 ❑COM 15262 Humphery Cir. ❑OTH El PTYNew American Funding Irvine, CA 92604 El SCC .s v. SUBTOTAL 970.009 r , *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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® . d to whole dollars. from 07/01/2012 through 09/30/2012 page 13 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 PLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/17/2012 David Quatman RIND Owner 100.00 100 00 [:]COM 10161 Edye Dr. ❑OTH ❑PTY Round Table Pizza Huntington Beach, CA 92646 25/2012 Jeanne Radsick ❑xIND Real Estate Sales 100.00 100.00 G 12 100.00 ❑COM norama Dr. ❑OTH El PTY Century Hometown Realty Bakersfield, CA 93306 ❑SCC 09/14/2 ❑IND 250.00 250.00 G 12 250.00 ❑COM 17541 Jacaranda Ln. Q OTH Irvine, CA 92612 ❑PTY ❑SCC 08/24/2012 Susan Roper ❑RIND retired 300.00 300.00 G 12 300.00 ❑COM 203 Sixth Street ❑OTH Huntington Beach, Ca 92648 ❑PTY ❑SCC 09/25/2012 Stan Russell ❑RIND Sales 100.00 100.00 G 12 100.00 ❑COM 16872 Bolso Chica St., Suite 110 ❑OTH Stan Russell Financial & ❑PTY Insurance Services Huntington Beach, CA 92649 ❑SCC SUBTOTAL$ 850 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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers periodCAL-IFOR191A to whole dollars. _ I ' from 07/01/2012 • through 09/30/2012 Page 14 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 IT RE,ALSAND ZIP I.D.NUMB O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CAL E (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 09/25/2012 De hroder RIND Homemaker 200.00 200.00 G12 200.00 ❑COM 24040 Martingale Way ❑OTH Te ❑PTY - ❑SCC 08/17/2012 Monika Scott-Kerce ❑xIND Realtor 0 G12 100.00 ❑COM Z Denia ❑OTH El PTY RemaxlSelectone Laguna Niguel, CA 92677 ❑KIND retired 100.00 100.00 G12 100.00 ❑COM 5240 - 39th Dr. Apt 9F ❑OTH Woodside, NY 11377 I ❑PTY ❑SCC 08/17/2012 Ronald Shenkman [KIND 150.00 150.00 G12 150.00 []COM 15682 Sunflower Ln. ❑OTH Huntington Beach, CA 92647 ❑PTY ❑SCC 07/26/2012 Elizabeth Shier-Burnett [MIND Aerospace 150.00 150.00 G12 150.00 ❑COM 419 Main Street ❑OTH Self/Elizabeth #12o ❑PTY Shier-Burnett Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ 700.00 F .e� 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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Deceived Amounts may be rounded Statement covers period �CALIF . to whole dollars. from 07/01/2012 FORM, through 09/30/2012 Page 15 Of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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.NUMB CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE -EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/17/2012 Jan Shomaker ❑xIND Realtor 300.00 G12 300.00 ❑COM 28015 Gallina ❑OTH Mission Viejo, CA 92692-2619 ❑PTY sps Realty Lisa Simpson ❑x IND 08/23/2012 Teacher 150.00 150.00 G 12 150.00 ❑COM 20352 Camfield Ln. El PTY HBUHSD Huntington Beach, CA 94646 ❑SCC 09/14/2012 Greg Smith RIND Retail Paint & Floor 12 100.00 ❑COM 6560 Westminister Blvd. ❑OTH Carrolls Paint & Westminister, CA 92683 El SC Flooring, Inc . 09/07/2012 Joel D. Smith [MIND Executive 250.00 250.00 G 12 250.00 ❑COM 4631 Stellrecht Cir. ❑OTH SureFire, LLC Huntington Beach, CA 92649 ❑PTY ❑SCC 08/17/2012 Linda Sopo ❑xIND 350.00 350.00 G 12 350.00 ❑COM 10900 Los Alamitos Blvd.# 160 ❑OTH ❑PTY Los Alamitos, CA 90720 ❑SCC �, SUBTOTAL$ 1,000.00MR *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) www.netfile.com 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. CALIFORNIAR 460 ' from 07/01/2012 FO through 09/30/2012 Page 16 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED ( COMMITTEE,ALSND I.D.NUMBER) CODE * OCCUP ED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED BUSINESS) Herbert Swanigan ❑5 IND OB/24/2012 retired 100.00 100.00 G 12 100.00 r Bluffs Cir Apt A ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 08/17/2012 Sue Taylor ❑xIND 0.00 G 12 100.00 ❑COM 16276 Pacific Cir. #A ❑OTH _ Huntington Beach, CA 92649 ❑PTY 07/26/2012 Marie Thomas ❑xIND Consultant 100.00 100.00 G 12 100.00 ❑COM 3498 W. Bahia Blanca #2C �PTY Self/Marie Thomas Laguna Woods, CA 92637 ❑SCC 09/14/2012 George J. Tous ❑ x IND cao 250.00 250.00 G 12 zso.o0 ❑COM 5171 Foxglove Dr. ❑OTH ❑PTY & Associates Huntington Beach, CA 92649 ❑SCC 08/17/2012 Michael Van Voorhis ❑x[NO 150.00 150.00 G 12 150.00 ❑COM 16923 Park Ave. ❑OTH ❑PTY Sunset Beach, CA 90742 ❑SCC SUBTOTAL$ 700.00 `. *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) www.netfile.com 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. _ from 07/01/2012 • through 09/30/2012 Page 17 of 23 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITfEE,ALSND .D.N DE CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/17/2012 W.E Financi 100.00 200.00 G12 200.00 ❑COM 4952 Warner Ave., Suite 109 ❑x OTH Huntington Beach, CA ❑SCC 08/17/2012 Jon Welfringer ❑RIND 100.00 100.00 G12 100.00 ❑COM 16701 Roosevelt Lane Huntington Beach, CA 92649 ❑PTY ❑SCC 09/14/2012 Keith Wichner ❑ RIND Sales 100.00 10 00.00 ❑COM 20951 Brookhurst St. ❑OTH ❑PTY Star Realestate Huntington Beach, CA 92646 ❑SCC 09/25/2012 Rick Williams [MIND Financial Sales Advisor 100.00 100.00 G 12 100.00 ❑COM 19241 Delaware St. ❑OTH IBM Huntington Beach, CA 92648 ❑PTY ❑SCC 08/24/2012 William Woollett ❑RIND retired 100.00 100.00 G 12 100.00 ❑COM 6 Clearwater ❑OTH ❑PTY Irvine, Ca 92604 El SCC SUBTOTAL$ � "'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) www.netfile.com Type or print in ink. SCHEDULE B-PART 1 Schedule B—Part I Amounts may be rounded Statement covers period e Loans Received to whole dollars. from 07/01/2012 • SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 18 of 23 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 IF AN INDIVIDUAL, ENTER OUTSTANDING (b) (c) OUTSTANDING (e) (f) (g) . FULL NAME,STREET ADDRESS AND ZIP CODE AMOUNT AMOUNT PAID INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS A INESS) PERIOD PERIOD THIS PERIOD" PERIOD PERIOD LOAN TO DATE Barbara Delgleize Realtor ❑PAID CALENDARYEAR 4952 Warner Avenue 0.00 3,000.00 3,000.00 #109 Self/Barbara Delgleize $ $ % $ $ 3,000.00 Huntington Beach, CA 92649 ❑FORGIVEN RATE PER ELECTION- 3,000.00 0.00 0.00 0.00 03/12/2012 G12 3,000.00 $ $ $ $ $ t© IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDARYEAR ❑FORGIVEN RATE PER ELECTION** $ $ $ $ $ to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR ❑FORGIVEN RATE PER ELECTION* to IND ❑ COM •❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ y " 0.00 0.00 3,000.00 0 00 a5 L. (Enter(e)on Schedule B SummaryScheduleE,Line3) 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(8661275-3772) www.netfile.com ScheduleSCHEDULE E(CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded CALIFORNIA � ® ' Payments Made to whole dollars. from 07/01/2012 • " through g 09/30/2012 Page 20 of 23 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 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 mai print ads WEB information technology costs (internet, e-mail) NAME AND AD CODE OR DESCRIPTION OF PAYMENT AMOUNT COMMITTEE,ALSO ENTER I.D.NUMBER) Home Run Software Services Inc. 15562 ngton Beach, CA 92649 CMP 1,481.56 Home Run So 474.10 15562 Chemical Lane CMP Huntington Beach, CA 92649 Molly Kiefer 8892 Skiff Circle CMP 150.00 Huntington Beach, CA 92646 Lysa Ray Campaign Services 250.00 603 E. Alton Ave., Suite H PRO Santa Ana, CA,92705 _ Lysa Ray Campaign Services PRO 250.00 603 E. Alton Ave., Suite H Santa Ana, CA 92705 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2,605.66 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com Schedule SCHEDULE E(CONT.) Type or print in ink. period (Continuation Sheet) Amounts may be rounded Statement covers p •� , • , Payments blade to whole dollars. from 07/01/2012 • through 09/30/2012 Page 21 of 23 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 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 registr literature and mailings PRT print ads WEB in ternet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR NT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) ign Services 603 E. Alton Ave., Suite H Santa Ana, CA 9270 250.00 Mailing US 4055 E. La Palma Ave., Ste. A CMP 164.77 Anaheim, CA 92807 Marina Football Booster Club-Program Ads 15871 Springdale St. CVC 350.00 Huntington Beach, CA 92649 Movius Mix Design 830.25 4027 E 4th St CMP Long Beach, CA 90814 Rally OFC cc processing fee 81.45 144 2nd St., First Floor San Fra, CA 94105 - ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,676.47 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com Schedule,E SCHEDULE E(CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded im= Payments Made to whole dollars. from 07/01/2012 through 09/30/2012 Pa a 22 of 23 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 campa PRT print ads WEB information technology costs (inter E AND ADDRESS OF PAYEE CODE OR DESCRIPTION AID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) Rally cessing fee 144 2nd St., First Floor San Fra, CA 94105 .40 Rally cc processing fee 144 2nd St., First Floor OFC 31.00 San Fra, CA 94105 Rally CC Processing Fee 144 2nd St., First Floor OFC 67.05 San Fra, CA 94105 Red Zone Strategies 462.48 10252 Wesley Circle CMP Huntington Beach, CA 92646 Red Zone Strategies CMP 457.00 10252 Wesley Circle Huntington Beach, CA 92646 "Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,040.93 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Schedule SCHEDULE E(CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded CALIFORNIAd Payments Made to whole dollars. from 07/01/2012 • RM through 09/30/2012 Pa a 23 of 23 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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) LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) USPS 3101 West Sunflower Ave. Santa Ana, CA 92799 POS 180.00 "Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 180.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com ReClpient Committee COVER PAGE Type or print in ink. Date Stamp CALIFORNIA Campaign Statement Cover Page -k ®-RMI (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicabler f n rt 1€ n 7 c 4e): t from 01/01/2012 (Month, Day,Year) + �'iu"t- � r PiI 1�� l Page 1 of 18 For Official Use Only SEE INSTRUCTIONS ON REVERSE through 06/30/2012 11/06/2012 I. 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 ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ® Semi-annual Statement Q Recall Q Controlled ❑ Special Odd-Year Report (Also Complete Part 5) O Sponsored ElTermi ❑ Supplemental Preelection (Also Complete Part 6) (Also file a Form 410 Termination) Statement-Attach Form 495 se Committee ❑ Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part7) 3. Committee Information I.D. NUMBER Treasurer(s) 1345651 COMMITTEE NAME(O NO COMMITTEE) NAME OF TREASURER Barbara Delgleize for City Council 2012 Lysa Ray MAILING ADDRESS 603 E Alton Ave STE H STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 5901 Warner Ave #454 Santa Ana, CA 92705 714-540-2295 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach, CA 92649 714-206-4234 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS 603 E Alton Ave STE H CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Santa Ana, CA 92705 OPTIONAL. FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS barbara4hb@gmail.com 4. Verification have used all reasonable diligence in preparing and reviewing this statement and to the best of my,knowledge the infor ation contained herein and in the attached schedules is true and complete. I certify under penalty of pe fornia that the foregoing is true nd cd ett. Executed on By Date Signature of Treasurer or Assistant Treasurer r - Executed on By Date tr 'ng c h ndi te,Sta asure Pr nento, es n ible ffi rof Sponsor Executed on � ' By Date Signature of Controlling Officeholder,Candidate,State asurel-mpon t Executed on By Date Signature of Controlling Officeholder,Candidate,State sure Proponent FPPC Form 460(Januaryl05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com State of California Recipient Committee Type or print in ink. COVERPAGE-PART2 Campaign Statement Cover Page—Part 2 FO,. • Page 2 of 18 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Barbara Delgleize LD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. LETTER JURISDICTION City Council Member ❑ SUPPORT Huntington Beach ❑ OPPOSE RESIDENTIALIBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 5901 Warner Ave #454 Huntington Beach, CA 92649 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. ❑ COMMITTEEADDRESS 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 COMMITTEE NAME ❑ OPPOSE+CONTROLLED BER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD S ❑ NO ❑ SUPPORT COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) ❑ OPPOSE 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 www.netfile.com Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period ® - Summary Page to whole dollars. d from 01/01/2012 ®- SEE INSTRUCTIONS ON REVERSE through 06/30/2012 Page 3 of 18 NAME OF FILER I . NUMBER Barbara Delgleize for City Council 2012 1345651 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTALTODATE Running In Both the State Primary and General.Elections 1. Monetary Contributions .......................................... Schedule A,Line 3 $ 8,414.00 $ 8,414.00 1/1 through 6/30 7/1 to Date 2. Loans Received Schedule B,Line 3 3,000.00 3,000.00 ...................................................... 00.414, 11,414.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... add Lines 1+2 $ 11 $ Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 499.00 499.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED •. •..............AddLines3+4 $ 11,913.00 $ 11,913.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 9,784.79 $ 9,784.79 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 9,784.79 $ 9,784.79 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F,Line 3 0.00 0.00 Date of Election Total to Date 10.Nonmonetary Adjustment ..........................................ScheduleC,Line 499.00 499.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+g+10 $ 10,283.79 $ 10,283.79 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 0.00 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above 11,414.00 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 a o.0o from Column B of your last reported in Column B. report. Some amounts in 15.Cash Payments.................................................. Column A,Line 8 above 9,784 Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 1,629.21 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 any)Lines 2,7,and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ 3,000.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(86612 7 5-3 7 7 2) www.netflle.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® . to whole dollars. from O1/O1/2012 through 06/30/2012 Page 5 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED STREET AIF COMMITTEE,ADDRESS ZIPFR D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 Joseph Daichendt ❑x 250.00 250.00 G 12 250.00 ❑COM 1 Hammond Place ❑OTH Ladera Ranch, CA 92694 SCC 06/01/2012 Nicole Daichendt QIND Homemaker 250.00 250.00 G 12 250.00 ❑COM 1 Hammond Rd. ❑OTH ra Ranch, CA 92694 ❑PTY ❑SCC 06/01/2012 Sandy Davis QIND Business Owner 520.00 520.00 G 12 520.00 S. Pacific Ave P.O. Box 339 El OTH Applied Computer Sunset Beach, CA 90742 ❑PTY Solutions ❑SCC 06/01/2012 Louis Dennis QIND Sales Rep 100.00 100.00 G 12 100.00 ❑COM 1112 Park St. ❑OTH First American Title Huntington Beach, CA 92648 ❑PTY ❑SCC 06/01/2012 Robert Dettloff ❑RIND Retired 150.00 150.00 G 12 150.00 ❑COM 6812 Laurelhurst Dr. ❑OTH ❑PTY Huntington Beach, CA 92647 ❑SCC SUBTOTAL$ 1,270.00 `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) www.netfile.com 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. F from O1/O1/2012 through 06/30/2012 6 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 Dale Dunn ❑%IND 50.00 150.00 G 12 150.00 ❑COM 17302 Almelo Lane ❑OTH Huntington Beach, Ca 92649-4621 ❑PTY 06/01/2012 Franciscan Friars ❑IND 100.00 100.00 G 12 100.00 ❑COM 20444 Magnolia St. ❑%OTH , CA 92646 ❑PTY ❑SCC 06/30/2012 Pamela Gilmour ❑xIND Attorney 100.00 100.00 G 12 100. ❑COM 2 Singletree Drive ❑OTH Newport Beach, CA 92660-4298 El PTY Not Employed ❑SCC 06/01/2012 Golden west Moving, Inc. ❑IND 100.00 100.00 G 12 100.00 [:]COM 15671 Commerce Ln. ❑X OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 06/01/2012 Lawrence Grote ❑RIND Owner 150.00 150.00 G 12 150.00 ❑COM 17151 Corbina Ln. ❑OTH El PTY Ariel Supply Huntington Beach, CA 92649 ❑SCC SUBTOTAL$ 600.00 *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 j FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period OR to whole dollars. OFM I from 01/01/2012 through 06/30/2012 Page 7 of 18'. NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 LD.NUMBER)O CODE * OCCUPATION AND EMPLOYER RECEIVED TH NDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) O 06/01/2012 Richard Harlow ❑xIND Government Relations 100.00 100.00 G 12 100.00 [-]COM 1742 Main St. ❑O on Beach, CA 92648 ❑PTY Self ❑SCC 06/01/2012 HB Digital ❑IND 100.00 100.00 ❑COM 1615 Alabama St. ❑x OTH Huntington Beach, CA 92648 ❑PTY - ❑SCC ftware Services Inc. ❑IND 150.00 150.00 G 12 150.00 ❑COM 15562 Chemical Lane ❑X OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 06/01/2012 Jules Hooper ❑RIND Retired 250.00 250.00 G 12 250.00 ❑COM 6822 Laurel Hurst Dr. ❑OTH Huntington Beach, CA 92647 ❑PTY ❑SCC 06/01/2012 Huntington Executive Park ❑IND 100.00 100.00 G 12 100.00 ❑COM 16168 Beach Blvd. STE 200 ❑x OTH ❑PTY Huntington Beach, CA 92647 ❑SCC SUBTOTAL$ 700.00 `, `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) www.netflle.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded State ment covers period' ® . to whole dollars. _ d from 01/01/2012 through 06/30/2012 Page 8 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,SS AND ZIP I.D.NUMBER)O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE ELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 Joseph A. Miller III Atto ❑IND 100.00 100.00 G 12 100.00 ❑COM 213-1 Montauk Highway ❑K OTH West Sayville, NY 11796 ❑SCC 06/30/2012 Michael Kelly ❑xIND Real Estate 100.00 100.00 G 12 100.00 ❑COM ❑OTH ❑PTY Self/Mike Kelly Santa Rosa, CA 95404 ❑SCC 06/01/2012 La Rue Busin ❑IND 250.00 0.00 G 12 0.00 ❑COM 10442 Boca Canyon Dr. 0 OTH Santa Ana, CA 92705 ❑PTY ❑SCC 06/01/2012 La Rue Business Group, INC. ❑IND 250.00 0.00 G 12 0.00 ❑COM 10442 Boca Canyon Dr. Q OTH Santa Ana, CA 92705 ❑PTY ❑SCC 06/28/2012 La Rue Business Group, INC. ❑IND -500.00 0.00 G 12 0.00 ❑COM 10442 Boca Canyon Dr. MOTH ❑PTY Santa Ana, CA 92705 ❑SCC SUBTOTAL$ 200.00 `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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period . to whole dollars. _ 2 from 01/01/2012 through 06/30/2012 page 9 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 NTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/30/2012 Melanie Linza ❑xIND Interior Designer 2 100.00 ❑COM 30 Notchbrook Ln. ❑OTH ❑PTY Self/Melanie Linza Ladera Ranch, CA ❑SCC 06/01/2012 Thomas Livengood ❑xIND Retired 100.00 100.00 G 12 100.00 ❑COM 5461 Me ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC 06/01/2012 Cathy Meschuk ❑x 50.00 G 12 150.00 ❑COM 20451 Relvingrove Ln. ❑OTH Huntington Beach, CA 92646 El PTY Self ❑SCC 06/01/2012 Michael C. Adams Associates ❑IND 100.00 100.00 G 12 100.00 ❑COM P.O. Box 382 N OTH Huntington Beach, CA 92648 ❑PTY ❑SCC 06/01/2012 Nossaman ❑IND 250.00 250.00 G 12 250.00 ❑COM 777 South Figueroa Street, 34th Floor ❑x OTH ❑PTY Los Angeles, CA 90017 ❑SCC SUBTOTAL$ '`� 700.00 *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) www.netfile.com 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. _ d from 01/01/2012 through 06/30/2012 Page 10 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 PATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION pFcoMMIrrEE, S AND ZIP CODE O OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVEDO ENTER CODE * (IF SELF-EMPLOYE OD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 non Parsons ❑RIND Mortgage Banker 150.00 150.00 G 12 ❑COM 9141 Santiago Drive ❑OTH ❑PTY Jayco Capital Huntington Beach, CA 92646 ❑SCC Diane Pearce RIND Homemaker 150.00 150.00 G 12 150.00 ❑COM 3902 Sirius Dr. ❑OTH Huntington Beach, CA 9 ❑PTY ❑SCC 06/01/2012 Cynthia Perazzo ❑xIND Senior vice President 100.00 100.00 G 12 100.00 1026 13th St. ❑OTH Huntington Beach, CA 92648 El PTY - Hoag Hospital ❑SCC 06/30/2012 Rainbow Environmental Services ❑IND 249.00 249.00 G 12 249.00 ❑COM P.O. Box 1026 ❑X OTH Huntington Beach, CA 92647-1026 ❑PTY ❑SCC 06/01/2012 Rental Express Management ❑IND 300.00 300.00 G 12 300.00 ❑COM 414 Walnut Ave. ❑X OTH ❑PTY Huntington Beach, CA 92648 ❑SCC SUBTOTAL$ 949.00 '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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions (Received Amounts may be rounded Statement covers period ® . to whole dollars, d from 01/01/2012 through 06/30/2012 Page 11 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED OFconnnDDRE,SS AN TER.D.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE E PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OE BUSINESS) 06/01/2012 Retlek Management Services, LLC 50.00 150.00 G 12 150.00 ❑COM 3303 Harbor BLVD. SUITE D-1 ❑x OTH Costa Mesa, CA 92626 ❑PTY ❑SCC 06/01 ❑xIND Broker 150.00 150.00 G 12 150.00 ❑COM 16631 Fountain Ln. ❑OTH ❑PTY Re/Max SelectOne Beach, CA 92647-4326 ❑SCC 06/01/2012 John Scandura ❑xIND Branch Manager 100.00 100.00 G 12 100.00 7492 valeworth Cir. ❑OTH CA Dept. of Toxic Huntington Beach, CA 92649 ❑PTY Substances Control ❑SCC 06/30/2012 Sempra Energy ❑IND 300.00 300.00 G 12 300.00 ❑COM 101 Ash Street ❑x OTH San Diego, CA 92101-3017 ❑PTY ❑SCC 06/01/2012 Ronald Shenkman ❑RIND President 150.00 150.00 G 12 150.00 ❑COM 15682 Sunflower Ln. ❑OTH Rainbow Enviroment ❑PTY Services Huntington Beach, CA 92647 ❑SCC SUBTOTAL$ 850.00 "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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period . to whole dollars. _ I from 01/01/2012 through 06/30/2012 Page 12 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * O(I SEPAE SELF-EMPLOYED,ETION AND NTER RECEI CALENDAR YEAR TOQUIR ( (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 Jan Shomaker ❑xIN 0.00 ❑COM 28015 Gallina El OTH - Mission Viejo, CA 92692-2619 ❑PTY SPS Realty 06/01/2012 Bruce Shuman ❑RIND president-CEO 150.00 150.00 G 12 150.00 ❑COM 17121 Nichols Street ❑OTH ❑PTY Rainbow Environment Huntington Beach, CA 92647 ❑SCC Services 06/01/2012 Signal Landmark ❑IND 500.00 500.00 G 12 50 P.O. Box 53370 ❑x OTH Irvine, CA 92619-3370 ❑PTY ❑SCC 06/01/2012 Dave Stefanides ❑RIND Governmental Affairs 150.00 150.00 G 12 150.00 ❑COM Director 25552 La Paz Road ❑OTH Orange County Laguna Bills, CA 92653 ❑PTY Association of Realtors ❑SCC 06/01/2012 Dianne Thompson ❑RIND Insurance Agent 100.00 100.00 G 12 100.00 ❑COM 7402 Yellowtail Dr., UNIT 102 ❑OTH State Farm ❑PTY Huntington Beach, CA 92648-5195 ❑SCC SUBTOTAL$ 1,050.00 `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) www.netfile.com Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. d from 01/01/2012 through 06/30/2012 Page 13 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED prcoMMITTEE,ALSAND ZIP I.D.CODE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1 -DEC.31) (IF REQUIRED) OF BUSINESS) 06/01/2012 .E Financial, INC. 00 100.00 G 12 100.00 ❑COM 4952 Warner Ave., Suite 109 ❑x OTH Huntington Beach, CA 92649 ❑PTY 06/01/2012 Celia Wheeler ❑xIND Executive Director 200.00 200.00 G12 200.00 ❑COM 19351 Sunray Ln. Unit 204 ❑OTH ❑PTY March of Dimes Huntington Beach, CA 92646 ❑SCC 06/30/2012 omen 1n Leadership ❑IND 520.00 520.00 G 12 520.00 El COM 2833 Carob Street Q OTH Newport Beach, CA 92660 ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 820.00 '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) www.netfile.com Type or print in ink. SCHEDULE B-PART 1 Schedule B—Part 1 Amounts may be rounded Statement covers period a ' Loans Received to whole dollars. from 01/01/2012 ® ' SEE INSTRUCTIONS ON REVERSE I through 06/30/2012 Page 14 of 18 NAME OF FILER I.D. NUMBER Barbara Delgleize for City Council 2012 1345651 IF AN INDIVIDUAL,ENTER (MOUNT PAID a (b) (c) (d) (e) (f) (g) FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FOR OMMITTEE,ALSO ENTER I.D.NUMBER) NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE Barbara Delgleize Realtor ❑PAID CALENDAR YEAR 4952 Warner Avenue $ 0.00 $ 3,000.00 0% % $ 3,000.00 $ 3,000.00 #109 Self/Barbara Delgleize Huntington Beach, CA 92649 ❑FORGIVEN RATE 03/12/2012 PERELECTION- 0.00 3,000.00 0.00 0.00 G12 3,000.00 $ $ $ $ $ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDARYEAR $ $ 0% % $ $ ❑FORGIVEN RATE PER ELECTION*" t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDARYEAR $ $ 0% % $ $ ❑ RATE FORGIVEN PER ELECTION*" t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 3,000.00 $ 0.00 $ 3,000.00 $ 0.00 $rt z (Enter(e)on Schedule B Summary Schedule E,Line 3) 1. Loans received this period....................................................................................................................$ 3,000.00 (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 $ 3,000.00 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) www.netfile.com Schedule C Type or print in ink. SCHEDULE C Nonmoneta Contributions Received Amounts may be rounded ry p Statement covers to whole dollars. eriod • . from O1/O1/2012 • • 6'SEE INSTRUCTIONS ON REVERSE through 06/30/2012 Page 15 of 18 NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 CUMULATIVE TO FULL NAME,STREET ADDRESS AND IF AN INDIVIDUAL,ENTER AMOUNT/ PER ELECTION CONTRIBUTOR DESCRIPTION OF DATE DATE * OCCUPATION AND EMPLOYER FAIR MARKET TO DATE ZIP CODE OF CONTRIBUTOR CODE (IF SELF-EMPLOYED,ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF COMMITTEE,ALSO ENTE NAME OF BUSINESS) (JAN 1-DEC 31) (IF REQUIRED) 06/28/2012 The Robert Mayer Corporation ❑IND Cost of Event 249.00 249.00 G 12 249.00 ❑COM 8951 Research Dr. ®OTH Irvine, CA 92618 El PTY ❑SCC 05/29/2012The waterfront Beach Resort ❑IND 250.00 250.00 G 12 250.00 ❑COM 21100 Pacific Coast Hwy. ®OTH Huntington Beach, CA 92648 ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ 499.00 Schedule C Summary 'Contributor Codes 1. Amount received this period—itemized nonmonetary contributions. IND—Individual (Include all Schedule C subtotals.).....................................................................................................................$ 499.00 COM—RecipientCommittee (other than PTY or SCC) 2. Amount received this period—unitemized nonmonetary contributions of less than$100 ....................................$ 0.00 OTH—Other(e.g.,business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. SCC—Small Contributor committee Add Lines 1 and 2.Enter here and on the Summary Page,Column A, Lines 4 and 10. 499.o0 ( rY 9 ) ......................TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netffile.com SCHEDULE E Schedule E Type or print in ink. Statement covers period BE= Pa mentS Made Amounts may be rounded from �/ to whole dollars. 01/01/2012 SEE INSTRUCTIONS ON REVERSE through 06/30/2012 Page 16 of 18 NAME OF FILER I.D. NUMBER Barbara Delgleize for city Council 2012 1345651 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 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 registrati ture and mailings PRT print ads WEB informa mail) NAME AND ADDRESS OF PAYEE (IF RLD.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Bieber Communications CMp 1,664.74 3609 W. MacArthur Blvd., #812 Santa Ana, CA 92704 Hart & Associates CNS 4,000.00 1300 Bristol Street North, Suite 1 Newport Beach, CA 92660 Milly Kiefer CMp 200.00 8892 Skiff Circle Huntington Beach, CA 92646 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,864.74 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 9,634.29 2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ 150.50 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 $ 9,784.79 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netflle.com Schedule E Type or print in ink. SCHEDULE E(CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period ® . g� Made to whole dollars. o ' • Payments Made from 01/01/2012 through 06/30/2012 page 17 of 18 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 reg gn literature and mailings PRT print ads WEB information techno ) NAME AND ADDRESS OF PAYEE CODE OR DESCR OUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) Lysa Ray Campai lton Ave., Suite H Santa Ana, CA 92705 PRO Ray Campaign Services 300.00 603 E. Alton Ave., Suite H PRO Santa Ana, CA 92705 Lysa Ray Campaign Services 603 E. Alton Ave., Suite H PRO 300.00 Santa Ana, CA 92705 Lysa Ray campaign Services 250.00 603 E. Alton Ave., Suite H PRO Santa Ana, CA 92705 Quality Offset Printing CMP 217.66 7573-B Slater Avenue Huntington Beach, CA 92647 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,667.66 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.netfile.com Schedule SCHEDULE E(CONT.) Type or print in ink. (Continuation Sheet) Amounts may be rounded Statement covers period CALIFORNIA Payments Made to whole dollars. from 01/01/2012 • through 06/30/2012 Page 18 of 18 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Barbara Delgleize for City Council 2012 1345651 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 m print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS SCRIPTION OF PAYMENT AMOUNT PAID (IF COMMI ER) Red Zone Strategies 10252 Wesley Circle Huntington Beach, CA 92646 CMP 1,008.23 Republican Party of Orange County 1422 Edinger Ave., Suite 110 CMP 250.00 Tustin, CA 92780 The Waterfront Beach Resort 21100 Pacific Coast Hwy. CMP 843.66 Huntington Beach, CA 92648 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2,101.89 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) www.netflle.com Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA 1 INSTRUCTIONS ON REVERSE . - COMMITTEE NAME 2 of 3 Barbara Delgleize for City Council 2012 I.D.NUMBER 4.Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate,or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held,and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check"non-partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAR TY City Council Member ❑X Non-Partisan Barbara Delgleize Huntington Beach 2012 ❑ Non-Partisan • List the financial institution where the campaign bank account is located(controlled"candidate election"committees only) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE -• Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE - FPPC Form 410(April/2011) www.netfile.com FPPC Toll-Free Helpline:866/ASK-FPPC Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee ® . . - INSTRUCTIONS ON REVERSE 3 of 3 COMMITTEE NAME I.D.NUMBER Barbara Delgleize for City Council 2012 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 ❑ COUNTYCommittee ❑ 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 r • r O Date qualified S.Termination Requirements By signing the verification,the treasurer,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. -- 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) www.netfile.com FPPC Toll-Free Helpline:866/ASK-FPPC