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Hardy, Jill - 2012 FPPC Campaign Disclosure Forms for 2012 E
Type or print in ink. COVERPAGE-PART2 Recipient Committee NIA Campaign Statement FORM 460 Cover Page—Part 2 Page 2 of 11 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Jill Hardy OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT City Council Huntington Beach Huntington Beach ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 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 NAMEOFTREASURER 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 STREET ADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(Januaryl05) FPPC Toll-Free Helpline: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 from 10/21/2012 ®' SEE INSTRUCTIONS ON REVERSE through 12/31/2012 Page 3 of 11 NAME OF FILER I.D. NUMBER Committee to Elect Jill Hardy 1244691 Column Column 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 $ 3,566.53 $ 25,950.53 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule 8,Line 3 0.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 3,566.53 $ 25,950.53 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 3,566.53 $ 25,950.53 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 16,692.41 $ 20,547.86 Candidates 7. Loans Made............................................................. Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 16,692.41 $ 20,547.86 (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 0.00 952.00 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................ScheduleC,Line 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................AddLines8+9+10 $ 16,692.41 $ 21,499.86 $ Current Cash Statement / / $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 25,908.03 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 3,566.53 amounts in Column A to the 14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 392.00 corresponding amounts *Amounts in this section may be different from amountsfrom Column B of your last reported in Column B. 15. Cash Payments.................................................. Column A,Line 8 above 16,692.41 report. Some amounts In Column A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 13,174.15 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED........................... Schedule s,Part 2 $ 0.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts am j Lines 2,7,and 9(if v 18. Cash Equivalents........................................ See instructions on reverse $ 0.00 19. Outstanding Debts......................... Add Line 2+Line 9 in Column 8 above $ 952.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) www.neffile.com ientlCoi'1'�mit$ee C'OVERPA� eCi am�a9gr0 StatementType or print in ink. Date Stamp e e over Page E-filed on: ®. ft overnment Code Sections 84200-84216.5) ' Statement covers period Date of election if ap )� . _ 1-7 0: , Page 1 of 9 (Month, Day, Yea �. 3 .r:) fin �• � g from 10/01/2012 For Official Use Only EINSTRUCTIONS ON REVERSE through 10/20/2012 e Type of Recipient Committee: All Committees-Complete Parts 1,2,s,and 4. 2. Type of Statement: ® Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑x Preelection Statement ❑ Quarterly Statement Q State Candidate Elec e Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report Q Recall 0 Controlled Termination Statement (Also Complete Part5) Sponsored ❑ ❑ Supplemental Preelection p (Also file a Form 410 Termination) Statement-Attach Form 495 ❑ (Also Complete Part 6)General Purpose Committee ❑ Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part7) Committee Info D. NUMBER Treasurer(s) 1244691 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Jill Hardy Andrew Farley MAILING ADDRESS 4702 Madrid Way STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHOI` 19082 Hamden Huntington Beach CA 92649 (714) 612-2243 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach CA 92646 (714) 593-5839 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHO� OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS fill@iillhardv.com blair@surfcitylocals.com Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the awlaws of the State of California that the foregoing is true and correct. Executed on OR/ 3 By 44 - Date Signature ofTreas a rAssistantTreasurer Executed on /o 07 S t By Date ignatur ontrolling i hol er,Candid ,Stafe Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Data Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January) FPPC Toll-Free Helpline:866/ASK-FPPC(866/27637 State of Califor Type or print in ink. COVER PAGE-PART lecipient Committee 'CALIFORNIA .Oampaign Statement a A a ® U '.over Page—Part 2 Page 2 of 9 Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Jill Hardy OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE City Council Member RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if an,, 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 officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME LD. 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(Januaryl FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-37 State of Califor ampalign Disclosure Statement Type or print in ink. SUMMARYPW Amounts may be rounded Statement covers period imm Ummary page to whole dollars. from 10/01/2012 EINSTRUCTIONS ON REVERSE through 10/20/2012 Page 3 of 9 ME OF FILER I.D. NUMBER mmittee to Elect Jill Hardy 1244691 Column A Column B Calendar Year Summary for Candidates Dntributions Received TOTALTHISPERIOD CALENDARYEAR Running In Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE 9 r General Elections Monetary Contributions ........................................... Schedule A,Line $ $7,220.00 $ $22,384.00 1/1 through 8/30 7/1 to Date Loans Received ...................................................... Schedule B,Line 3 $0.00 $0.00 SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines l+2 $ $7,220.00 $ 522,3e4.00 20, Contributions Received $ $ Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 $0.00 21. Expenditures TOTAL CONTRIBUTIONS RECEIVED ...•..•....................AddLines3+4 $ $7,220.00 $ $22,384.00 Made $ $ tpenditures Made Expenditure Limit Summary for State Payments Made....................................................... Schedule E,Line 4 $ $0.00 $ $3,855.45 Candidates Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00 22. Cumulative Expenditures Made* SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ $0.00 $ $3,855.45 (if Subjectto Voluntary Expenditure Limit) Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 $0.00 $952.00 Date of Election Total to Date Nonmonetary Adjustment ..........................................Schedule C,Line 3 $0.00 $0.00 (mm/dd/yy) TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $0.00 $ $4,807.45 J J $ urrent Cash Statement $ Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $18,688.03 To calculate Column B,add Cash Receipts ................................................... Column A,Line 3above $7,220.00 amounts in Column A to the $0.00 corresponding amounts *Amounts in this section may be different from amounts Miscellaneous Increases to Cash........................... Schedule I,Line 4 from Column B of your last reported in Column B. 00 report. Some amounts in Cash Payments.................................................. Column A,Line 8 above $0. Column A may be negative ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $25,908.03 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 LOAN GUARANTEES RECEIVED ........................... Schedule B,Part 2 $ $0.00 for this calendar year, only carry over the amounts ash Equivalents and Outstanding Debts arny)lines 2, �, ands(if $o.00 Cash Equivalents........................................ See instructions on reverse $ Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $952.00 FPPC Form 460(Januaryh FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-37' .heduleA Type or print in ink. SCHEDUL ������ ®��������®�� ��C��V�� Amounts may be rounded Statement covers period ® e to whole dollars. 46' from 10/01/2012 ®' :INSTRUCTIONS ON REVERSE through 10/20/2012 Page 4 of 9 IE OF FILER I.D. NUMBER ¢nittee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED (EET A IT RE,ALSAND ZIP I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS R YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 1/01 tt ®IND student $100.00 $100.00 G12 $100 PO Box 8346 ❑COM student ❑OTH Fountain valley CA 9272 ❑SCC 1/01/2012 Mike McClanahan ®IND fire captain $100.00 $100.00 G12 $100 ❑COM ach 2822 Ellesmere Ave. ❑OTH g Costa Mesa CA 92626 ❑PTY ❑SCC 1/01/2012 Eileen Murphy [ZIND none $200.00 ❑COM 201-21st Street ❑OTH none Huntington Beach CA 92648 ❑PTY ❑SCC 1/10/2012 Patricia Bril ❑RIND retired $200.00 $200.00 G12 $200 19682 Island Bay Ln ❑COM retired ❑OTH Huntington Beach CA 92648 ❑PTY ❑SCC 1/10/2012 Huntington Beach Auto Dealers (#903138) ❑IND $520.00 $520.00 G12 $520 ❑x COM 2124 Main Street, Ste 195 [:]OTH Huntington Beach CA 92648 [:]PTY ❑SCC SUBTOTAL$ $1,120.00 ;hedule A Summary *Contributor Codes Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.)...................... $6,500.00 COM-RecipientCommittee $ (other than PTY or SCC) Amount received this period-unitemized monetary contributions of less than$100 ............................. $ $720.00 OTH-Other(e.g., business entity, PTY-Political Party Total monetary contributions received this period. SCC-Small contributor committee (Add Lines 1 and 2. Enter here and on the SummaryLine 1. . .. TOTAL $ $7,220.o0 Page, Column A, L )���������������� FPPC Form 460(January/I FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-37' Chedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CC ®netaay Contributions Received Amounts may be rounded Statement covers period ® . , to whole dollars. e from 10/01/2012 through 10/20/2012 Page 5 of 9 ME OF FILER I.D.NUMBER mmittee to Elect Jill Hardy 1244691 FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL ( COMMITTEE,ALSNNTERI.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALE ATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 0/10/2012 Plumbers Local 582 (#8904 00 $520.00 G12 $521 ®COM 3904 W. lst Street ❑OTH Santa Ana CA 92703 ❑PTY ❑ Southern California Pipe Trades District ❑IND $520.00 $520.00 G12 $521 Council #16 (#760715) ®COM Suite 400 ❑OTH Los Angeles CA 90020 ❑PTY ❑SCC 0/10/2012 Sprinkler Fitters Local 709 (#901643) .00 $500.00 G12 $501 ®COM 12140 Rivera Road ❑OTH Whittier CA 90606 ❑PTY ❑SCC 0/15/2012 Glenda Secor ❑RIND optometrist $100.00 $100.00 G12 $101 18801 Rockinghorse ❑COM self❑OTH Huntington Beach CA 92648 ❑PTY ❑SCC 0/16/2012 John Geroch ®IND Engineer $100.00 $100.00 G12 $101 ❑460 Las Palmas ❑OTH COM Div. Oil Gas and ❑PTY Geothermal Resources Irvine CA 92602 ❑SCC SUBTOTAL$ $1,740.00 Contributor Codes VD—Individual :OM—Recipient Committee (other than PTY or SCC) )TH—Other(e.g., business entity) 'TY—Political Party FPPC Form 460(January/1 ;CC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-37' r.hedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CC onetauy Contributions Received Amounts may be rounded Statement covers period e . to whole dollars. from 10/01/2012 ® " through 10/20/2012 page 6 of 9 ME OF FILER I.D.NUMBER mmittee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CORE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COADDRE,ALSAND ZIP I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEA (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 0/18/2012 Gabriel Andrews ®IND sales $100.00 $10 21-5th Street ❑COM❑OTH Western Republic ❑PTY Insurance Services Huntington Beach CA 9264 SCC 0/18/2012 Angeles Chapter of the Sierra Club (#990434) ❑IND $400.00 $400.00 G12 $401 ®COM lvd, #320 ❑OTH Los Angeles CA 90010 ❑PTY ❑SCC 0/18/2012 John Earl ®IND journalist $60.00 $110. ❑COM 616 Crest ❑OTH unemployed Huntington Beach CA 92648 ❑PTY❑SCC 0/18/2012 Suzanne Hart ❑RIND retired $300.00 $300.00 G12 $301 419-6th Street ❑COM retired❑OTH Huntington Beach CA 92648 ❑PTY []SCC 0/18/2012 Donna Horn ®IND realtor $100.00 $250.00 G12 $251 18528 Bentley Lane ❑COM❑OTH Star Real Estate Huntington Beach CA 92648 ❑PTY ❑SCC SUBTOTAL$ $960.00 Contributor Codes VD-Individual :OM-Recipient Committee (other than PTY or SCC) )TH-Other(e.g., business entity) 'TY-Political Party FPPC Form 460(January/1 ;CC-Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(8661276-37' Chedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CC onetaiy Contributions Received Amounts may be rounded Statement covers period ® ' to whole dollars. d from 10/01/2012 through 10/20/2012 page 7 of 9 ME OF FILER I.D.NUMBER mmittee to Elect Jill Hardy 1244691 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 ZIPD.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVE NDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC.31) (IF REQUIRED) OF BUSINESS) 0/18/2012 Murat Roc - owner $100.00 $100.00 G12 $101 ❑200 Main St. 105 ❑OTH COM Coach's Mediterrenian [:]PTY l Huntington Beach CA 92648 ❑SCC 0/18/2012 Kim Kramer ®IND marketing specialist $520. 21 ❑COM 419 Main St, #321 ❑OTH Marketing Momentum Huntington Beach CA 92648 ❑PTY ❑SCC 0/18/2012 KSK Fin ❑IND $520.00 $520.00 G12 $521 ❑COM 419 Main Street #321 ®OTH Huntington Beach CA 92648 ❑PTY ❑SCC 0/18/2012 Linda Moon MIND attorney $100.00 $200.00 G12 $201 ❑COM Law offices of Linda 2134 Main Street #140 ❑OTH Huntington Beach CA 92648 El PTY Sapiro Moon ❑SCC 0/18/2012 Joe Shaw ®IND retailer $320.00 $320.00 G12 $32( 8401 Sweetwater ❑COM❑OTH Bloomingdales Huntington Beach CA 92646 ❑PTY ❑SCC SUBTOTAL$ $1,560.00 Contributor Codes VD—Individual :OM—Recipient Committee (other than PTY or SCC) )TH—Other(e.g., business entity) 'TY—Political Party FPPC Form 460(January/i (CC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-37' SCHEDUI ;hedule F Type or print in ink. Statement covers period e Amounts may be rounded46, ,".creed Expenses (Unpaid Bolls) to whole dollars. 10/01/2012 � from through 10/20/2012 Page 9 of 9 INSTRUCTIONS ON REVERSE dE OF FILER I.D.NUMBER nmittee to Elect Jill Hardy 1244691 ODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. P campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs S campaign consultants MTG meetings and appearances RFD returned contributions B contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries C civic donations PET petition circulating TEL t.v. or cable airtime and production costs candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals 0 fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals ) independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponst 3 legal defense PRO professional services (legal, accounting) VOT voter registration campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) CODE OR (a) (b) (c) NAME AND ADDRESS OF CREDITOR OUTSTANDING AMOUNT INCURRED AMOUNT PAID DING (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOS OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Ll Hardy OFC post office box $52.00 $0.00 $0.00 $52 )82 Hamden ztington Beach CA 92646 L1 Hardy POS stamps $900.00 $0.00 $0.00 $900 )82 Hamden ztington Beach CA 92646 ayments that are contributions or independent expenditures must also be SUBTOTALS $ $952.00$ $0.00$ $0.00$ $952 nmarized on Schedule D. chedule F Summary Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ $0.00 Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ $0.00 Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.) ..........................................................................................................................................I..... NET$ so.00 May be a negative number FPPC Form 460(January/' FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-37' COVER PAI eCipient Committee Type or punt Irr mk Date Stamp ampaign Statement � s . 1 over Page E-filed on: 10/05/201..2 12 08 24 e �°y overnment Code Sections 84200-84216.5) Statement covers.period Date of election if applicabl r�tt 1 °L� f 07/O1/2012 (Month, Day, Year) L � U f a t er �} Page 1; Of 19 :670366 from For Official Use Only .E INSTRUCTIONS ON REVERSE through 09/30/2012 Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: ❑x Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure x . Preelection Statement ❑ Quarterly'.Statement Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report p Recall Q Controlled Termination Statement Sponsored " ❑' ❑ Supplemental Preelection (Also Complete Part5) 0 P (Also file a For n) Statement-Attach Form 495 ❑ General Purpose Committee lete Part 6) ❑ Amendment(Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee - 0 Political Party/Central Committee (Also Complete Part7) Committee Information I.D. NUMBER Treasurer(s) 1244691 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Jill Hardy Andrew Farley MAILING ADDRESS 4702 Madrid Way STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHOP 19082 Hamden Huntington Beach CA 92649- (714) 612-224 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach CA 92646 (714) 593-5839 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHOP OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS jill@iillhardy.com blair@surfcitylocals.com Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kno edge the information contained herein and in the attached schedules is true,and.complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and rre Executed on 10/05/2012 gy Date reas rer or Assistant Treasurer Executed on 10/05/2012 By Date Si e o Contr Ili g cehol ,Candidat ,State Measure Proponent or Responsible Officer of Sponsor Executed on BY Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on BY Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 480(January) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-37 State of Califor Type or print in ink. COVER PAGE-PART 2 Recipient Committee Campaign Statement ®- Cover Page—Pant 2 Page 2 Of 19 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD(INCLUDE LOCATIONAND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 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 Listnamesof 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(866/275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period a - Summary Page to whole dollars. t from 07/01/2012 - through 09/30/2012 Page 3 of 19 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I . NUMBER Committee to Elect Jill Hardy 1244691 Column Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR Running i Both the State Pi and (FROM ATTACHED SCHEDULES) TOTALTO DATE gn o e ae Primary General Elections 1. Monetary Contributions ........................................... schedule A,Line 3 $ $15,164.00 $ $15,164.00, 1/1 through 6130 7/1 to Date 2. Loans Received ...................................................... schedule e,Line 3 $0.00 $0.00 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $15,164.00 $ $15,164.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 $0.00 $0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $15,164.00 $ $15,164.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... ScheduleE,Line $ $3,855.45 $ $3,855.45 Candidates 7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00 22. Cumulative Expenditures Made" 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $3,855.45 $ $3,855.45 (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills Schedule F,Line 3 $952.00 $952.00 Date of Election Total to Date 10. Nonmonetary Adjustment ..........................................ScheduleC,Line 3 $0.00 $0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE................................Add Lines 8+s+lo $ $4,807.45 $ $4,807.45 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $7,379.48 To calculate Column B,add 13.Cash Receipts ................................................... Column A,Line 3 above $15,164.00 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. $3,855,45 report. Some amounts in 15.Cash Payments.................................................. Column A,Line 8 aboveColumn A may be negative 16.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $18,688.03 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 $0.00 any)Lines 2,7,and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $952.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) JCheduBeA Type or print in ink. SCHEDULE Amounts may be rounded Statement covers period Monetary Contributions Received to Whole dollars. CALIFORNIA, , ® 1 from 07/01/2012 FORK through 09/30/2012 Page 4 of 19 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMIDRE,ALSAND ZI I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/02/2012 Gerald Daggett KIND l - $100.00 G12 $100.00 PO Box 8346 ❑COM LISPS ❑OTH Fountain Valley CA 92728 ❑PTY ❑SCC Baretich ®IND Engineer, Consultant $100.00 $100.00 G12 $100.00 ❑COM 21752 Pacific Coast Hwy #23A [I OTH D Huntington Beach CA 92646 ❑PTY❑SCC 08/16/2012 Kimberly Carr WIND National Sales Manager $500.00 $500.00 ❑COM 7226 Rockridge Drive [I OTH KUSI-TV Huntington Beach CA 92648 ❑PTY ❑SCC 08/16/2012 Mark Dixon MIND Holistic Health $100.00 $100.00 G12 $100.00 ❑COM Practitioner 21612 Bahama Lane ❑OTH self Huntington Beach CA 92646 ❑PTY ❑SCC 08/16/2012 Robert Mann RIND retired $500.00 $500.00 G12 $500.00 ❑COM 22042 Newport Circle [_1OTH none Huntington Beach CA 92646 ❑PTY ❑SCC SUBTOTAL$ $1,300 00 Ft` �11+� Schedule A Summary "Contributor Codes 1. Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.) $ $12,829.00 COM-Reher thannt PTYttee ........................................................................................................ (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than$100 .............................$ $2,335.00 OTH—Other(e.g., business entity) p Y 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, Col A, Li 1. .... ... TOTAL $ $15,164.00 ( 9 Column Line )����������� � FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT) Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. ®R / ® � from o7/O1/2o12 FORm through 09/30/2012 Page 5 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED (EET AIF IT ADDRESS SAND ZIP I.D.NUMBER) CODE * OCCUPATIO CEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/16/2012 ®IND attorney $100.00 $100.00 G12 $100.00 2134 Main Street 4140 []COM❑OTH Law Offices of Linda ❑PT on Huntington Beach CA 92648 ❑SCC 08/16/2012 Raymond Sherrard ®IND writer $200.00 $200.00 G12 $200.00 4701 Los Patos [I OTH RHS Enterprises Huntington Beach CA 92649 ❑PTY❑SCC 08/16/2012 Philip Wilder ®IND retired $150. C12 $150.00 []COM 9432 Molokai Dr ❑OTH none Huntington Beach CA 92646 []PTY [1 SCC 08/16/2012 William Yarchin Ph.D. ❑xIND educator $100.00 $100.00 G12 $100.00 ❑COM Azusa Pacific University 9291 Hudson Dr ❑OTH Huntington Beach CA 92646 ❑PTY ❑SCC 08/lB/2012 Carol Comparsi ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 403-16th Street El OTH none Huntington Beach CA 92648 ❑PTY ❑SCC SUBTOTAL$ $650.00'! x I a) `Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period 't CALIFORNIA to whole dollars. from 07/01/2012 FORM through 09/30/2012 Page 6 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 ,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION FULL NAME, (IF COMMITTEE,ALSENTERI.D.NUMBER) * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDA E RECEIVED CODE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) gher ®IND retired $520.00 $520.00 G12 $520.00 ❑COM 21562 Kaneohe Ln [I OTH Huntington Beach CA 92646 ❑PTY❑SCC 08/18/2012 Richardson Gray ®IND retired $520.00 $520.00 G12 $520.00 415 Townsquare Lane #208 ❑OTH none - Huntington Beach CA 92648 ❑PTY❑SCC 08/18/2012 Donna Horn realtor $150.00 $150.00 G12 $150.00 ❑COM 18528 Bentley Lane El OTH Star Real Estate ❑PTY Huntington Beach CA 92648 ❑SCC 08/18/2012 Mary Ellen Houseal XI IND attorney $100.00 $100.00 G12 $100.00 16952 Baruna Ln ❑COM self ❑OTH Huntington Beach CA 92649 ❑PTY ❑SCC 08/18/2012 James Lane ®IND retired $520.00 $520.00 G12 $520.00 ❑COM 637 Frankfort Ave ❑OTH none Huntington Beach CA 92648 ❑PTY❑SCC SUBTOTAL$ s � "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet). Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars, C-AtIFORNI I ® / from 07/01/2012 through 09/30/2012 Page 7 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED (IF COMMITTEE,A IT RE S SAND ZIP .D.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OFBUSINESS) - 08/18/2012 Eileen Murphy ®IND none 300.00 $300.00 G12 $300.00 ❑COM 201-21st Street ❑OTH none Huntington Beach CA 9264B ❑PTY 08/18/2012 Orange County League of Conservation Voters ❑IND $500.00 $500.00 G12 $500.00 ❑COM PO Box 13D3 ❑Huntington Beach CA 92649 PTY ❑SCC 08/18/2012 Michael Sloan ®IND retired $250.00 00 ❑COM 17911 San Leandro Ln ❑OTH none Huntington Beach CA 92649 ❑PTY❑SCC 08/18/2012 Suzanne Smith MIND retired $100.00 $100.00 G12 $100.00 21352 Yarmouth Ln - ❑COMElOTH none Huntington Beach CA 92646 ❑PTY ❑SCC 08/20/2012 Linda Scott ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 22032 Capistrano Ln ❑OTH none Huntington Beach CA 92646 ❑PTY ❑SCC SUBTOTAL$ $ skb< 1,250 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/06) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772) 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. d ® 1 from 07/01/2012 IFORMi through 09/30/2012 Page 8 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,A ITTEE ADDRESS ZIP I.D.NUMBER)O CODE * OCCUPATION AND EMPLOYER RECEIVED T YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/22/2012 ND MD $250.00 $250.00 G12 $250.00 ❑COM 6811 Corral Circle ❑OTH self Huntington Beach CA 92648 ❑SCC 08/22/2012 Dr. David Keulen MIND physician $200.00 $200.00 G12 $200.00 16321 Golden M❑OTH Alta Med Health Services ❑PTY Corp. Huntington Beach CA 92649 ❑SCC 08/22/2012 Roy Lahti etired $100.00 $100.00 G12 $100.00 ❑COM 17192 Lynn St. ❑OTH none Huntington Beach CA 92649 ❑PTY❑SCC 08/22/2012 David Ling &]IND physician $100.00 $100.00 G12 $100.00 17692 Beach Blvd #305 []COM self❑OTH Huntington Beach CA 92647 [:]PTY ❑SCC 08/22/2012 Janet Vochelli WIND retired $100.00 $100.00 G12 $100.00 ❑COM 19322 Pitcairn Lane [_]OTH none Huntington Beach CA 92646 ❑PTY ❑SCC SUBTOTAL$ $75o '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) i 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. I 60, from 07/01/2012 through 09/30/2012 Page 9 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (E COMMITTEE,ALSAND ZIP .D.N DE O CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE SELF-EMPLOYED,ENTER NAME PERIOD - (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/22/2012 Dolores Wallace ®IN 100.00 $100.00 G12 $100.00 ❑COM 20591 Troon Ln. ❑OTH none Huntington Beach CA 92646 ❑PTY Jeanne Whitesell ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 17922 Shoreham Ln. ❑OTH none H 92649 ❑PTY❑SCC 08/23/2012 Mary Behrens ®IND business woman $520.00 $520.00 G12 $520.00 18381 Goldenwest St ❑ National Equestrian Huntington Beach CA 92648 ❑PTY❑SCC 08/23/2012 Debbie Cook X❑IND attorney $10().00 $200.00 G12 $200.00 6692 Shetland Cir ❑COM self❑OTH Huntington Beach CA 92648 ❑PTY ❑SCC 08/23/2012 Dewey Davide ®IND real estate developer $249.00 $249.00 C12 $249.00 ❑COM PO Box 911 El OTH self Huntington Beach CA 92649 ❑PTY ❑SCC SUBTOTAL$ $1�069 00If pF<�,��) qe �tirh �7{� �� lk�gk� *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may rounded Statement covers period ® . to whole dolof lars. d NIA from 07/01/2012 FORM through o9/30/2012 Page 10 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFGOMMIE,ALSENTERI.D.NUMBER) CODE* OCCUPATION AND EMPLOYER RECEIVED TH AR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) regory ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 4961 Los Patos ❑OTH retired untington Beach CA 92649 PTY ❑SCC 08/23/2012 Aaron Pai ®IND owner $150.00 $150.00 G12 $150.00 PCH Suite 4109 ❑COM❑OTH Huntington Surf and Sport Huntington Beach CA 92648 ❑PTY❑SCC 08/28/2012 Armida Brashears ®IND 200.00 $200.00 ❑COM 21632 Hanakai Lane ❑OTH retired Huntington Beach CA 92646 ❑PTY ❑SCC 08/28/2012 Benigno Diaz x❑IND compliance officer $100.00 $100.-00 G12 $100.00 11591 Candy Ln ❑COM State of California ❑OTH Garden Grove CA 92840 []PTY ❑SCC 08/28/2012 Patricia Goodman ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 18531 Bentley Lane ❑OTH retired Huntington Beach CA 92648 ❑PTY ❑SCC SUBTOTAL$ '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(8661275-3772) 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. 00 from 07/01/2012 through 09/30/2012 Page 11 Of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 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 S SAND ZIP LD.N DE O CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELF-E AME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 08/28/2012 Ray Hiemstra ®IND Orange County Coastkeeper $100.00 G12 $100.00 214-19th St #5 El COM❑OTH environmentalist Huntington Beach CA 92648 ❑PTY ❑SCC mick ®IND IT Consultant $250.00 $250.00 0.12 $250.00 ❑COM 16772 Glenhaven ❑OTH Huntington Beach CA 92647 ❑PTY❑SCC 08/28/2012 Rainbow Disposal ❑IND $350.00 $350.00 G12 $350.00 ❑COM 17121 Nichols Street Huntington Beach CA 92647 ❑PTY ❑SCC 08/28/2012 Grace Winchell ❑RIND unemployed $100.00 $100.00 G12 $100.00 El COM unemployed 6411 Weber Cir ❑OTH Huntington Beach CA 92647 ❑PTY ❑SCC 03/30/2012 Jeff Rokos ®IND insurance underwriter $100.00 $100.00 G12 $100.00 5902 Liege Dr. ❑COM❑OTH Catlin U.S. Huntington Beach CA 92649 ❑PTY ❑SCC 7 f SUBTOTAL$ $900 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(8661276-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® e to whole dollars. I ® 1 from 07/01/2012 through 09/30/2012 page 1z of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED (IF COMMITTEE,ALSND I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) -OF BUSINESS) 09/05/2012 Julie Bixby ®IND libr $520.00 $520.00 G12 $520.00 ❑17451 Hillgate Ln ❑OTH COM City of Huntington Beach Huntington Beach Y ❑SCC 09/05/2012 Mark Bixby ®IND software engineer $520.00 $520.00 G12 $520.00 ❑COM Ln ❑OTH QSS ❑PTY Huntington Beach CA 92649 ❑SCC 09/D5/2012 Lorraine Prinsky ®IND trustee $10D.00 $100.0 .00 ❑COM 5402 Barwood Dr. El OTH Coast Community College ❑PTY District Huntington Beach CA 92649 ❑SCC 09/05/2012 Sandra Zarcone X❑IND teacher $100.00 $100.00 G12 $100.00 ❑COM ocean View School 3303 Tempe Dr. ❑OTH District Huntington Beach CA 92649 ❑PTY ❑SCC 09/07/2012 Margaret Carlberg ®IND retired $100.00 $100.00 G12 $100.00 ❑COM 17422 Lido Ln ❑OTH retired Huntington Beach CA 92647 ❑PTY ❑SCC a SUBTOTAL$ $1,340 45 "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. AA 1 from 07/01/2012 • " through 09/30/2012 Page 13 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 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 ADDRESS SAND ZIP .D.N DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 09/07/2012 Wom (#931119) ❑IND $520.00 $520.00 G12 $520.00 ®COM 2833 Carob Street ❑OTH Newport Beach CA 92660 ❑PTY 09/12/2012 Jack Clapp ®IND owner $150.00 $150.00 G12 $150.00 ❑COM 1210 Main Street Dwight's Concession Huntington Beach CA 92648 ❑PTY❑SCC 09/12/2012 Salvador Sapien ®IND retired $100.00 $100.00 G12 ❑COM 6840 Via Kannela ❑OTH retired Huntington Beach CA 90680 ❑PTY❑SCC 09/12/2012 P.J. Williams X❑IND retired $100.00 $100.00 G12 $100.00 ❑COM retired 16351 Eagle Lane ❑OTH Huntington Beach.CA 92649 ❑PTY ❑SCC 09/14/2012 Gregory Griffin ®IND retired $100.00 $100.00 G12 $100.00 ❑COM PO Sox 1168 ❑OTH retired Sunset Beach CA 90742 ❑PTY ❑SCC SUBTOTAL$ $970 00 76 r ? yy" F< C Z 3f>C ) "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business entity) PTY—Political Party FPPC Form 460(January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ® . to whole dollars. I NK from 07/01/2012 FORM through 09/30/2012 Page 14 Of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION , DATE CONTRIBUTOR OCCUPATION AND EMPLOYER' RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED ( O ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) e Mason ®IND retired $100.00 $100.00 G12 $100.00 21641 Bahama Ln ❑COM❑OTH retired Hunting 2646 ❑PTY ❑SCC D9/20/2012 Alison Goldenberg ®IND self $100.00 $100.00 G12 $100.00 ❑OTH self Huntington Beach CA 92646 ❑PTY ❑SCC 09/20/2012 Michael VanVoorhis ales rep $100.00 $100.00 G12 $100.00 PO Box 334 ❑COMEl OTH Newport Meat Company Sunset Beach CA 90742 ❑PTY ❑SCC 09/21/2012 Jose Solorio for Senate ❑IND $250.00 $250.00 G12 $250.00 ❑COM 3605 Long Beach Blvd ❑X OTH Suite 426 ❑PTY Long Beach CA 90807 ❑SCC 09/28/2012 John Acampora ®IND VP Sales $100.00 $100.00 G12 $100.00 ❑COM 423 6th Street ❑OTH Office Solutions Huntington Beach CA 92648 ❑PTY ❑SCC SUBTOTAL$ *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 Helpiine:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT). Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. ALIFORNIA d ® 1 from 07/01/2012 FORK through 09/30/2012 page is of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (EET AIF ITTEE ADDRESS ZIP O ENTER I.O.N DE O CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YE (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) 09/28/2012 William Ay none $520.00 $520.00 G12 $520.00 ❑COM 17135 Reimer St. ❑OTH none Fountain Valley CA 927 SCC 09/28/2012 Debbie Cook WIND attorney $100.00 $200.00 C12 $200.00 ❑COM 6692 Shetland Cir ❑OTH self Hun PTY❑SCC 09/28/20,12 HBPOA (#882363) ❑IND $520.00 $520.00 G12 $520.00 W COM 20422 Beach Blvd Suite 450 ❑OTH Huntington Beach CA 92648 ❑PTY ❑SCC 09/28/2012 United Unionof Roofers, Waterproofers, and ❑IND $350.00 $350.00 G12 $350.00 Allied Workers ❑COM 1660 L Street NW Suite 800 ❑X OTH Washington DC 20036 ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ $l,490 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) SCHEDULEE Schedule E Type or print in ink. Statement covers periodCALIFORNIA, Amounts may be roundedd Payments Made to whole dollars. from 07/01/2012 FORM!SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 16 of 19 NAME OF FILER I.D. NUMBER Committee to Elect Jill Hardy 1244691 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 MfTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel,lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings EB information technology costs (internet, e-mail) N S OF PAYEE (IF COMMITTEE,ALSO ENTERI.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT PAID Spinelli Graphics LIT contribution request letter $1,094.79 10631 Bloomfield, Suite #2 Los Alamitos CA 90720 Staples OFC labels, in 103.42 7131 Yorktown Huntington Beach CA 92648 City of Huntington Beach FIL candidate statement $1,500.00 2000 Main Street Huntington Beach CA 92648 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $2,698.21 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. .................................................................. $ $3,B55.45 2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ $0.00 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 $ $3,855.45 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/276-3772) Schedule E SCHEDULE E(CONT.) Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded o 'RM ,i ' Payments Made to whole dollars. from 07/01/2012 � SEE INSTRUCTIONS ON REVERSE through 09/30/2012 Page 17 of 19 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications 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 FIND 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 literat 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) S & S Printers CMP yard signs $1,157.24 2100 W. Lincoln Ave. Anaheim CA 92801 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $1,157.24 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULEF Schedule F Type or print in ink. Statement covers period CALIFORNIA Amounts may be rounded 4,60 Accrued Expenses (Unpaid Bills) to whole dollars. from 07/01/2012 FORMthrough 09/30/2012 Pa a le of 19 SEE INSTRUCTIONS ON REVERSE 9 NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalialmisc. 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 UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) CODE OR (a) (b) (c) ( AND ADDRESS OF CREDITOR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTAN IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Jill Hardy OFC post office box $0.00 $52.00 $0.00 $52.00 19082 Hamden Huntington Beach CA 92646 Jill Hardy PCs stamps $0.00 $900.00 $0.00 $900.00 19082 Hamden Huntington Beach CA 92646 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ $0.00$ $952.00$ $0.00$ $952.00 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of$100 or more, plus total unitemized accrued expenses under$100.)............................................ INCURRED TOTALS $ $952.00 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of$100 or more, plus total unitemized payments on accrued expenses under$100.) .................................PAID TOTALS $ s0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ $952.00 May be a negative number FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Schedule G Type or print in ink. SCHEDULE G Payments Made by an Agent or Independent Amounts may be rounded Statement periodQALIFORNIA to whole dollars ! • (f Contractor(on Behalf of This Committee) from. 07/01/2012 • through 09/30/2012 Page 19 of 19 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Committee to Elect Jill Hardy 1244691 NAME OF AGENT OR INDEPENDENT CONTRACTOR Jill Hardy CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production.costs CNS campaign consultants MfG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries .CVC civic donations IPET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel,lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e- ments that are contributions or independent expenditures must also be summarized on Schedule D ND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) United States Postal Service OFC post office box $52.00 B905 Atlanta Huntington Beach'CA 92646 United States Postal Service POS stamps $900.00 8905 Atlanta Huntington Beach CA 92646 Attach additional information on appropriately labeled continuation sheets. TOTAL* $ $952.Do *Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460( 66/275 3772) FPPC Toll-Free Heipline:866/ASK-FPPC(866/275-3772) zu 14-610 FOREVER 6� Recipient Committee COVER PAGE Type or print in Ink. Date Stamp Campaign Statement FOR `® � Cover Page (}, (Gov en y 4215.5) page 1 of 11 Statement covers period Date of election if applicable: 2 CJCT —3 F11 1: from 07/01/2012 (Month, Day,Year) For Official Use only SEE INSTRUCTIONS ON REVERSE 09/30/2012 11/06/2012 kv©c k o d through 4 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: ❑ Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement Q State Candidate Election C ❑ Semi-annual Statement ❑ Special Odd-Year Report Q Recall Q Controlled (AlsoCompietePart5) Sponsored ❑ Termina ❑ Supplemental Preelection P (Also file a Form 410 Termination) Statement-Attach Form 495 ® General Purpose Committee (Also Complete Part6) ❑ (Explain ) Amendment Ex lain below 0 Sponsored ❑ Primarily Formed Candidate/ (g)Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part n 3. Committee Information I.D. NUMBER Treasurer(s) 1223961 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS Linda S. Moon MAILING ADDRESS P.O. Box 1303 STREET ADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE 2134 Main St., Suite 140 Huntington Beach CA 92647 714-960-8424 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach CA 92648 714-960-8424 MAILING ADDRESS(IF DIFFERENT) NO.AND STREET OR P.O.BOX MAILING ADDRESS P.O. BOX 1303 CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE HUNTINGTON BEACH CA 92647 714-960-8424 OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my know) a the information contain!)herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on �� U/ B, Date ' nature of Tre4durerorAssistantTreasurer Executed on By Data —Signature of Controlling Officeholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Oficeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661276-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Summary Page Amoto twhole dollars may be s nded Statement covers period o from 07/01/2012 ®- SEE INSTRUCTIONS ON REVERSE I through 09/30/2012 Page of 11 NAME OF FILER I.D. NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS 1223961 Contributions ReceivedD olumnA Column B Calendar Year Summary for Candidates TOTALTHIS CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A,Line 3 $ 100.00 $ 5980.00 2. Loans Received ...................................................... Schedule B,Line 3 00.00 00.00 111 through 6/30 7/1 to Date 00 5980.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ 100. $ Received $ $ 4. Nonmonetary Contributions.................................... Schedule C,Line 3 00.00 00.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ 100.00 $ 5980.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made....................................................... Schedule E,Line 4 $ 5499.00 $ 9187.94 Candidates 7. Loans Made............................................................. Schedule H,Line 3 00.00 00.00 5499.00 9187.94 22•Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $ (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills)...............................Schedule F Line 3 00.00 00.00 Date of Election Total to Date 10. Nonmonetary.Adjustment ..........................................scnedulec,Linea 00.00 00.00 (mm/dd/yy), 11. TOTAL EXPENDITURES MADE................................AddLiness+9+10 $ 5499.00 $ 9187.94 1 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous summary Page,Line 16 $ 10828.63 To calculate Column B,add 13. Cash Receipts ................................................... Column A,Line 3 above 100.00 amounts in Column A to the 00.00 corresponding amounts *Amounts in this section may be different from amounts 14.Miscellaneous Increases to Cash........................... Schedule!,Line 4 from Column B of your last reported in Column B. 15.Cash Payments..................... 5499.00 report. Some amounts in Column A,line 6 above Column A may be negative 16. ENDING CASH BALANCE.......... Add lines 12+13+14,then subtract Line 15 $ 5429.63 figures that should be If this is a termination statement, Line 16 must be zero. subtracted from previousperiod amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED........................... schedule B,Part 2 $ 00.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,7,and 9(if 18. Cash Equivalents........................................ See instructions on reverse $ 00.00 any). 19. Outstanding Debts......................... Add line 2+Line 9 in Column B above $ 00.00 FPPC Form 460(January/06) FPPC Toll-Free Heipiine:866/ASK-FPPC(8661276-3772) Scheduge A Type or print in ink. ®B��$� ®fE��I�IA�B®91S �eCe9Ve� Amounts may be rounded SCHEDULE A to whole dollars. Statement covers period AW ®. 7/1/2012 from • SEE INSTRUCTIONS ON REVERSE through 9/30/2012 Page 3 of '0 1 NAME OF FILER I.D. NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS /-22 394 1 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 CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) ®IND 7/6/2012 NANCY M. DONAVEN ❑COM Retired $100 $100 4831 Los Patos Avenue ❑OTH Huntington Beach, CA 92649 ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ x Schedule A Summary •Contributor Codes 1. Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule subtotals.) $ 100.00 COM-Recipient Committee (other than PTY or SCC) 00.00 OTH—Other(e.g.,business entity) 2. Amount received this period-unitemized monetary contributions of less than$100.............................$ PTY—Political Party 3. Total monetary contributions received this period. SCC-Small contributor committee (Add Lines 1 and 2.Enter here and on the SummaryPage, Column A, Line 1. TOTAL $ 100.00 g ) FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Schedule D SCHEDULED Summary ofEx Expenditures Type or print In Ink. Statement covers period Amounts may be rounded d Supporting/Opposing Other to whole dollars. 7/1/2012 IFOR Candidates,Measures and Committees from SEE INSTRUCTIONS ON REVERSE through 913012012 Page_L_ of NAME OF FILER I.D. NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS /.2 2 3 46 DATENAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUMULATIVETO DATE PER ELECTION CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN.1-DEC.31) (IF REQUIRED) OR COMMITTEE Richard Gardner ® Monetary 9/30/2012 South Coast Water District Contribution $200 $200 $200 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Rick Erkeneff Monetary 9/30/2012 South Coast Water District Contribution $200 $200 $200 #1349908 ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure 9/302012 Kitty Jarmillo ® Monetary Fullerton City Council Contribution $300 $300 $300 #1349312 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure 4 SUBTOTAL $ $700 B Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. $ $5499.00 2. Unitemized contributions and independent expenditures made this period of under$100..................................................................................... $ 00.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) .. TOTAL $ $5499.00 P P P ( ry 9 ) .......... FPPC Form 460(January/05) FPPC Toll-Free Helpline:8661ASK-FPPC(8661275-3772) Schedule® SCHEDULED Summary®f Expenditures Type or print in ink. Statement covers period or �® ®sin Other Amounts may be rounded •' Su I �� tin� �� 9 to whole dollars. 7/1/2012. ®' ® O Candidates,Measures and Committees from SEE INSTRUCTIONS ON REVERSE through 9/30/2012 Page of NAME OF FILER I.D. NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS /.Z a 3 9 6 CUMULATIVETO DATE PER ELECTION DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN.1-DEC.31) (IF REQUIRED) OR COMMITTEE A Better Fullerton/No on W Fullerton Monetary 9/30/2012 #1349684 Contribution $500 $500 $500 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure John Stephens ® Monetary 9/30/2012 Costa Mesa City Council Contribution $500 $500 $500 #1347888 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Sandra Genis ® Monetary 9/30/2012 Costa Mesa City Council Contribution $800 $800 $800 #1348966 ❑ Nonmonetary Contribution ❑ Independent jo Support ❑ Oppose Expenditure SUBTOTAL $ .FA ., Schedule D Summary 5499.00 1. Itemized contributions and independent expenditures made this period.(Include all Schedule D subtotals.)......................................................... $ 2. Unitemized contributions and independent expenditures made this period of under$100..................................................................................... $ 00.00 3. Total contributions and independent expenditures made this period.(Add Lines 1 and 2. Do not enter on the Summary Page.) ........... . TOTAL $ 5499.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Schedule D SCHEDULED Summary Of Expenditures Type or print in ink Statement covers period ®. Supporting/Opposing®that Amounts may be rounded d ® '1 to whole dollars. from 7/1/2012 FORM Candidates,Measures and Committees SEE 9/30/2012 Page 6 of INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS /.� CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN.1-DEC.31) (IF REQUIRED). OR COMMITTEE Harold Weitzberg Monetary 9/30/2012 Costa Mesa City Council Contribution $500 $500 $500 #1348236 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Monetary 9/30/2012 Peng Kong Wong Contribution $250 Irvine City Council $250 $250 #1349692 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Verna Rollinger ® Monetary 9/30/2012 Laguna Beach City Council Contribution $300 $300 $300 #1340706 ❑ Nonmonetary Contribution ❑ Independent 0 Support ❑ Oppose Expenditure 051 SUBTOTAL $ 1050 Schedule D Summary 5499.00 1. Itemized contributions and independent expenditures made this period.(Include all Schedule D subtotals.)......................................................... $ 2. Unitemized contributions and independent expenditures made this period of under$100 ................... 00.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 5499.00 P P P ( rY 9 ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) Schedule D SCHEDULED Summary of Expenditures Type or print in ink. Statement covers period Supporting/Opposing � in �® ��� ® �� Amounts may be rounded '®" d pp®B pp g to whole dollars. from 7/1/2012 • Candidates,Measures and Committees SEE INSTRUCTIONS ON REVERSE through 9/30/2012 Page of /*I� NAME OF FILER I.D.NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS CUMULATIVE TO DATE PER ELECTION DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CALENDAR YEAR TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) OR COMMITTEE PERIOD (JAN.1-DEC.31) (IF REQUIRED) Jill Hardy Monetary 8/15/2012 Huntington Beach City Council Contribution $500 $500 $500 #1244691 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Beth Krom ® Monetary 8/15/2012 Irvine City Council Contribution $250 $250 $250 #1349656 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Monetary 9/30/2012 Jane Rands contribution Fullerton City Council $300 $300 $300 #1345419 ❑ Nonmonetary Contribution ❑ Independent 0 Support ❑ Oppose Expenditure SUBTOTAL $ 1050 k Schedule D Summary 1. Itemized contributions and independent expenditures made this period.(Include all Schedule D subtotals:)......................................................... $ 5499.00 2. Unitemized contributions and independent expenditures made this period Of under$100..................................................................................... $ 00.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 5499.00 P P P ( rY 9 ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helplino:866/ASK-FPPC(8661276-3772) Schedule D - SCHEDULED Summary®f Expenditures Type or print in ink. Amounts may be rounded Statement covers period Amo Supporting/Opposing®their to whole dollars. 7/1/2012 Candidates,Measures and Committees from SEE INSTRUCTIONS ON REVERSE through 9/30/2012 ILD. g ofNAME OF FILER UMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS 396 / DATE NAME OF CANDIDATE,OFFICE,AND DISTRICT,OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS C CALENDIAR YEAR VETO E PERTO DATEON MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAR 1-DEC.31) (IF REQUIRED) OR COMMITTEE Jane Monetary 9/30/2012 Laguna gBeach City Council Contribution $300 $300 $300 #1340706 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Jim Katapodis ® Monetary 9/30/2012 Huntington Beach City Council Contribution $500 $500 $500 #1328537 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure Robert"Bob" Baker ® Monetary 9/30/2012 San Clemente City Council Contribution $99 $99 $99 #1349710 ❑ Nonmonetary Contribution ❑ Independent Support ❑ Oppose Expenditure SUBTOTAL $ 899 Schedule D Summary 1. Itemized contributions and independent expenditures made this period.(Include all Schedule D subtotals.)......................................................... $ 5499.00 2. Unitemized contributions and independent expenditures made this period of under$100..................................................................................... $ 00.00 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 5499.00 P P P � rY g ) ............ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE E(CONT.) Schedule Type or print in ink. Statement covers period (Continuation Sheet) Amounts may be rounded ® s d from Payments Made to whole dollars. 7/1/2012 through 9/30/2012 g of l SEE INSTRUCTIONS ON REVERSE IPge NAME OF FILER I.D.NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS /a 3 96 / CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphernalialmisc. 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 registra mpaign literature and mailings PRT print ads _ WEB information technology co e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT (IF COMMITTEE,ALSO ENTER I.D.NUMBER) Richard Gardner(South Coas unknown) 27011 Calle Maria CTB $200 Capistra ick Erkeneff(South Coast Water District) #1349908 P.O. Box 4122 CTB $200 Dana Point, CA 92629 Kitty Jaramillo (Fullerton City Council)#13499312 1358 W. Houson Ave. CTB $300 Fullerton, CA 92835 A Better Fullerton/No on W #1349684 1849 Avenida San Lorenzo CTB $500 Fullerton CA 92833 Jane Rands (Fullerton City Council)#1345419 716 W.Wilshire Ave. CTB $300 Fullerton, CA 92835 "Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $1500 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE E(CONT.) Schedule E Type or print in ink. Statement covers period (Continuation Sheets Amounts may be rounded � R' W � sU ! i to whole dollars. 07/01/2012 ® ' Payments Made from through 09/30/2012 Page 10 of 11 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER ORANGE COUNTY LEAGUE OF CONSERVATION VOTERS 1223961 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia/misc. MBR member communications 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 meats 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 L rr campaign literature and maili t ads WEB information technology costs (internet, e-mail) NAME AND ADD CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID (IF COMMITTEE,ALSO ENTE John Stephens(Costa Mesa City Council)#1347888 $500 2004 N Court CTB Costa Mesa, CA 92626 Sandra Genis (Costa Mes 1586 Myrtlewood CTB $800 Costa Mesa, CA 92626 Harold Wietzberg (Costa Mesa City Council)#1348236 2065 Flamingo Dr. CTB $500 Costa Mesa, CA 92626 Peng Kong Wong (Irvine City Council)#1349692 9 Petria CTB $250 Irvine, CA 92606 Beth Krom (Irvine City Council)#1349656 $250 14252 Culver Drive, Suite A277 CTB Irvine, CA 92604 *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2300 FPPC Form 460(January/06) FPPC Toll-Free Helpllne:866/ASK-FPPC(8661276-3772) .. City Of Huntington Beach 2000 Main Street ♦ Huntington Beach, CA 92648 (714) 536-5227 ♦ www.huntingtonbeachca.gov a� FB n ,9o9,a Office of m Joan L. Flynn, City Clerk September 10, 2012 Jill Hardy 19082 Hamden Huntington Beach CA 92646 Re: Committee to Elect Jill Hardy 2012 — ID# 1244691 Jill, I wanted to touch base with you about the status of your campaign committee. During your August visit to deliver Council candidate forms for the November election, Robin and I shared our concerns about your campaign funds being categorized by the Fair Political Practices Commission (FPPC) as "surplus," based on FPPC guidelines and failure to re-designate their use to the current election period. We advised you to contact the FPPC directly for a definitive answer on this matter. On August 29 we received a copy of the 410 amendment you filed with the California Secretary of State's Office to rename your committee. I am contacting you to confirm that the FPPC advised you that re-designating your existing campaign funds was allowable, and that you would not be required to open a new committee. Please advise. Sincerely, Join L. Flynn, CIVIC CClerk c: File Sister Cities: Anjo, Japan ♦ Waitakere, New Zealand Statement of Organization Type or print in ink STATEMENT OF ORGANIZATION � Recipient Date Stamp Committee ® - Statement-Type AN a E ❑Initial Amendment ❑ Termination—See Part ENE f gtat r ffi i yUsg ly i List I.D.number: List I.D.number: Vice of the Seraii,farnla � r°',r"`�,7 Fri 4 Not yet qualified ❑ or in the �the Stete ofi .� #J� {-lo�i e # UG 2012 Date qualified as committee Date qualified as committee Date of Termination E RA State" (If applicable) 1. Committee information 2. Treasurer and Ot er r'ncipai Officers NAME OF COMMITTEE NAME OF TREASURER CEO rnwt`�fil ��'�i 11 1 � 2z►Z- AMytN 1611A :rA � STREETADDRESS(NO P.O.BOX)J, q�n�. w\adyad Vya�l STREETADDRESS(NO P.O.BOX) CITY STATE ZIP CODE FAREA CODE/PHONE Oub 2 ffamdsfn CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER,IFANY 7t'+- STREETADDRESS(NO P.O.BOX) MAILING ADDRESS(IF DIFFERENT) ` ' I t Vom CITY STATE ZIP CODE AREACODE/PHONE P ONAL: FAX 1E3 IL ADDRESS 4 NAME OF PRINCIPAL OFFICER(S) COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREACODE/PHONE Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 20 2 By 1 G� AT �JGNA�TURE O THE SURER OR ASSISTANT TREASURER Executed on ` I By_ TGNA URE OF C TROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT FPPC Form 410(Apri112011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) S STATEMENT OF ORGANIZATION Statement of Organization Recipient Committee ® - 1 ® - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D.NUMBER l�mM � 4.Type of Committee Complete the applicable sections. •. ao • 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 PARTY ffwtMa ID h ❑ Non-Pa he financial institution where the campaign bank account is located(controlled"candidate election"committees only) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKACCOUNTNUMBER Gehk i 373•e4 �� • o ADDRESS CITY STATE ZIP CODE l (oct Main e n 60& CA III- if 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 SOUGHT OR HELD OR MEASURE(S)JURISDICTION (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410(April/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee ©R 1 INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D.NUMBER `Ti I 20 Z 4.Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY -M , •, List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO.AND STREET CITY STATE ZIP CODE e e , ❑ Date qualified 5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (April/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) ~ . ������K���� �� �������������� Type or print in ink Date Stamp STATEMENT nponoAw�Arx�w Recipient Committee Statement Type E]Initial XAmendment El Termination sQePpr For Official Use Only Not yet qualifiedE] or List I.D.number: List I.D.number: Fit Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER STREETADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX) CITY fl STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREACODE/PHTNE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDREJIF DIFFERENT) F -tilt !W6 CITY STATE ZIP CODE AREA CODE/PHONE P NAL: FAX �JILADDRESS W -(SAM J q:!: NAME OF PRINCIPAL OFFICER(S) COUNTY OF DOMICILE COUNTY WHERE COMM TTEE IS ACTIVE IF DIFFERENT IT THAN COUNTY OF DOMICILE STREETAIDDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach ad nal information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under alifo i that the foregoing is true and correct. Executed on By_ Executed on By DATE SMA RE OF CqNTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT Executed on By —71GN—ATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT DATE pppC Form 41o (Apmxcon) pppc Toll-Free *a/p|mo: osoouaK-Fppo (uaomrs-3rr2) Statement of Organization STATEMENT OFORGANIZATION Recipient Committee ®®#PM 0 INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D.NUMBER 2-0 2- 4.Type of Committee (Continued) .. . Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY .. . . List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP ORAFFILIATION OF SPONSOR STREETADDRESS NO.AND STREET CITY STATE ZIP CODE o o ❑ Date qualified 5.Termination RequirernentS By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (April/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) s' CANDIDATE INTENTION STATEMENT Candidate Intention Statement Type or Print in Ink. Date,Stamp ® . Check One: nitlal 211 II Jl For Official Use Only [� ❑Amendment (Explain) -t ,.�...... 1. Candidate Information: NAME OF CANDIDATE (Last,First,Middle Initial) DAYTIME TELEPHONE NUMBER FAX NUMBER(optional) E-MAIL(optional) G�Y'l i'�l S• c�►��5g3•S83g c � rl'�1 @ iirl�'ird.� •eom STREET ADDRES J CITY STATE ZIP COD ---fin OFFICE SOUGHT(POSITION TITLE) AGENCY NAM E DISTRICT NUMBER,if applicable. 5d NON-PARTISAN CiillA (/) Cl V I ! PARTY: OFFICE JU ISDICTION ❑ State (Complete Part 2.) RClty ❑ County ❑ Multi-County: ((Jame of Multi-County,Jurisdiction) (��El�on) 2. State Candidate Expenditure Limit Statement: (CalPERS and CatSTRS candidates,judges,judicial candidates, and candidates for local offices do not complete Part 2.) Primary/general election Speciallrunoff election (Year of Election) (Year of Election) (Check one box) ❑I accept the voluntary expenditure ceiling for the election stated above. ❑1 do not accept the voluntary expenditure ceiling for the election stated above. Amendment: 0 1 did not exceed the expenditure ceiling in the primary or special election held on: and I accept the voluntary expenditure ceiling for the general or special run-off election. (Mark if applicable) ❑ Onl�_, I contributed personal funds in excess of the expenditure ceiling for the election stated above, 3. Verification: I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. lt Executed on ` •1 ol—, Signatur pnonth,day.year) Candidate) FPPC Form 501 (April/2011) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772) COVER PAGE Recipient Committee Type or print in ink. Date Stamp Campaign Statement [;over Page E-filed on: Government Code Sections 84200-84216.5) Statement covers period Date of election if appi from 01/01/2012 (Month, Day,Year)�IM�lUn_ 1 9 pli L: I't 3 Page 1 of 3 For Official Use Only 3EE INSTRUCTIONS ON REVERSE through - 06/30/2012 I. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: Fx_1 Officeholder,Candidate Controlled Committee Ej Primarily Formed Ballot Measure 0 Preelection Statement E] Quarterly Statement 0 State Candidate Election Committee Committee Fxj Semi-annual Statement F-1 Special Odd-Year Report 0 Recall 0 Controlled F-1 Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 F-1 General Purpose Commiftee (Also Complete Part 6) E] Amendment(Explain below) 0 Sponsored _-F-1 Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/ ttee (Also Complete Part 7) I.D. NUMBER Treasurer(s) 1. Committee Information 1244691 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Jill Hardy Andrew Farley 4702 Madrid Way STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 19082 Hamden Huntington Beach CA 92649 (714) 612-2243 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Huntington Beach CA 92646 (714) 593-5839 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS jill@jillhardy.com blair@surfcitylocals.com 1. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on )l \ a� I OIL— I bate By ig aturdgLTAasurer or Assistant Treasurer Executed on al— By DateSign to oiling Offi older,Candidate,State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Type or print in ink. COVER PAGE-PART 2 Recipient Committee CALIFORNIA Campaign Statement FORM 1 Coven-Page—Part 2 Page 2 of 3 i. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 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 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(866/275-3772) State of California :ampaign Disclosure Statement Type or print In ink. SUMMARY PAGE Amounts may be rounded Statement covers period - Wmmary Page to whole dollars. I • from 01/01/2012 ;EE INSTRUCTIONS ON REVERSE through 06/30/2012 Page 3 of 3 TAME OF FILER I.D. NUMBER 'ommittee to Elect Jill Hardy 1244691 contributions Received Column Column B Calendar Year Summary for Candidates TOTAL THISPERIOD CALENDAR YEAR Running in Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTO DATE unnn g Primary General Elections Monetary Contributions ........................................... Schedule A,Line 3 $ $0.00 $ $0.00 1/1 through 6/30 7/1 to Date Loans Received ...................................................... Schedule a,Line $o.00 $o.00 SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $0.00 $ $0.00 20. Receibutions Received $ $ Nonmonetary Contributions.................................... Schedule C,Line 3 $o.oo $o.o0 21. Expenditures i. TOTAL CONTRIBUTIONS RECEIVED ••••••..................•••AddLines3+4 $ $0.00 $ $0.00 Made $ $ :Xpenditures Made Expenditure Limit Summary for State Payments Made....................................................... Schedule E,Line 4 $ $0.00 $ $0.00 Candidates Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00 SUBTOTAL CASH PAYMENTS .............................. $0.00 $0.00 22. Cumulative Expenditures Made* i. ...... Add Lines 6+7 $ $ (If Subject to Voluntary Expenditure Limit) I. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 $0.00 $0.00 Date of Election Total to Date 0. Nonmonetary Adjustment ..........................................Schedule C,Line 3 $0.00 $0.00 (mm/dd/yy) 1. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $0.00 $ $0.00 ) ) $ :urrent Cash Statement $ 2. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $7,379.48 To calculate Column B,add 3.Cash Receipts ................................................... Column A,Line 3 above $0.00 amounts in Column A to the $0.00 corresponding amounts *Amounts in this section may be different from amounts 4. Miscellaneous Increases to Cash........................... Schedule/,Line 4from Column B of your last reported in Column B. 5.Cash Payments.................................................. column A,Line 8 above $0.00 report. Some amounts in Column A may be negative 6.ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ $7,379.48 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 7. LOAN GUARANTEES RECEIVED ........................... Schedule e,Part 2 $ $0.00 for this calendar year, only carry over the amounts .Oash Equivalents and Outstanding Debts from Lines 2,7, and 9(if $o.00 any). 8. Cash Equivalents........................................ See instructions on reverse $ 9. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $0.00 FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)