HomeMy WebLinkAboutKalmick, Dan - 2008 FPPC Campaign Disclosure Forms For 2008 (2) Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee ® ' , 1
� -
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Dan Kalmick for HB City Council 1308462
4.Type of Committee (Continued)
SOME= ow•• 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
•o . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP ORAFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
• • • a
❑ -J „_� Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1,2001,enter 1/1/01.
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.
FPPC Form 410 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)
Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE
Amounts may be rounded Statement covers period
Summary Page to whole dollars. •
from 10/19/2008 FORM
SEE INSTRUCTIONS ON REVERSE
through 12/31/2008 Page 3 of 7
NAME OF FILER I.D. NUMBER
Dan Kalmick for HB City Council
1308462
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHIS PERIOD CALENDARYEAR(FROMATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and
General Elections
1. Monetary Contributions ........................................... Schedule A, Line 3 $ $1,600.00 $ $4,394.00
1/1 through 6/30 7/1 to Date
2. Loans Received ...................................................... Schedule B,Line 3 -$1,350.00 $0.00
3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $250.oo $ $4,394.00 20. Contributions
Received $ $
4. Nonmonetary Contributions..... Schedule C,Line 3 $0.00 $108.25 21, Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $250.00 $ $4,502.25 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $1,895.68 $ $4,917.35 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ $1,895.68 $ $4,917.35 (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F,Line 3 $0.00 $o.00 Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................ScheduleC,Linea $0.00 $108.25 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $1,895.68 $ $5,025.60 $
Current Cash Statement $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $1,122.33
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3 above $250.00 amounts in Column A to the
corresponding amounts *Amounts in this section may be different from amounts
14. Miscellaneous Increases to Cash........................... Schedule/,Line 4 $1,565.oo from Column B of your last reported in Column B.
15.Cash Payments.................................................. Column A,Line 8above $1,895.68 report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE .......... Add Lines 12+13+14, then subtract Line 15 $ $1,041.65 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, Part2 $ $0.00 for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9(if
Cash Equivalents and Outstanding Debts $0.00 any).
18. Cash Equivalents........................................ See instructions on reverse $
19. 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)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee ORNIA ,
. -
10
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Dan Kalmick for HB City Council 1308462
4.Type of Committee (Continued)
eneral •• • 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 OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
❑ _J_� Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1,2001,enter 1/1/01.
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 ReformAct 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.
FPPC Form 410 (January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(8661275-3772)
CASH RECEIPT
CITY OF HUNTINGTON BEACH
City Treasurer— Shari L. Freidenrich
®
HUNTINGTON BEACH, CALIFORNIA 92648
DATEf
Department Contact Phone#
SS /y
(`
U) AMOUNT RECEIVED ✓
L"Cash eck# ` f Credit Card ,
® 0 . Prred ` Received Finance
Ely By Approval
+ 0 IF OCT= 50000 TH 90000,FINANCE APPROVAL REQUIRED Approval Date
WBusiness Unit Object Subs- Sub-Ledger Tpe
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——————— ---- -- — —--- ———— —
DANIEL E KALMOCK 1001
®AN KALMICK FOR HB CITY COUNCIL
16772 GLENHAVEN LN ( /)4 13
220
HUNTINGTON BEACH,CA 92647 DATE V V f} C) ts-ss/i 132
132
PAY a/rly
�G �//�/�/�OR THE O 1 ( IV 1 T�N c1 s / 400ORDER OF
(,t.C7' �G�yN!t�✓� by 60/
DOLLARS ! k °
Bank of America
Seal Beach ®�
208 Main St
Seal Beach 8 s%
_ 562.868.1445 /
FORi ��7 t q/TC STTcuV��b1 T &'
-_ _ - .�________ ____..__
I+a00 100 Lila ea L 2 200066 L110 0 L 3
Please do not write in the box below
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RN ANOE COPY
City ®f Huntington Beach
r 3 2000 Main Street ® Huntington Beach, CA 92648
OFFICE OF THE CITY CLERK
JOAN L. F
12, 2008
Mr. Dan Kalmick
16772 Glenbaven Ln
Huntington Beach, CA 92647
Dear Dan:
Enclosed is your Candidate Statement refund check in the amount of $1565.
It was a pleasure to meet you during this year's pre-election period. Although it was your first attempt
at running for City Council, it was apparent to me that you garnered much respect throughout the
community and achieved some name recognition. I hope we will see you again in 2010 when there
will be four seats up for election, three of which will definitely be filled by new members due to term
limits.
If I can be of service to you in the future, Dan, please be sure to call me. In the meantime, I'm sending
my best wishes to you and your family for a pleasant holiday season.
Most sincere A,
��
J an Flynn
City Clerk
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Encl.
GARoss\CorrespondenceVKahnic-retd check 2008.doc
Sister Cities: Anjo, Japan • Waitakere, New Zealand
1 Telephone:714-536-5227)
CITY OF HUNTINGTON BEACH
Request for Supplemental Check
Department: City Clerk
Date Check Desired: 12/11/08
Vendor Name: Dan Kalmick for HB City Council
Purchase Order (if applicable): OD
Invoice Numbers (if applicable):
TOTAL AMOUNT OF CHECK $ 1565.00
A supplemental check is required for one of the following reasons (check one):
❑ The City will lose substantial cash if the check is not prepared.
® The City is legally required to make payment on the above date.
❑ The City will be extraordinarily inconvenienced by not preparing check.
❑ Payroll check for less than $5,000 requires approval by Accounting only,
Please provide justification for above and why the normal processing deadlines
could not be met.
This is a refund for the candidate statement and the election code gives us 30 days
for the refund and we are now over that deadline, but just received the accounting
from the County ROV.
Account 10000100.48550
I
a
12/11/08
Depa meat ea Approval Date
12/11/08
City Treasurer Approval Date
12/11/08
Finance Administration Approval Date
l r CASH RECEIPT
CITY OF HUNTINGTON BEACH
L _ City Treasurer — Shari L. Freidenrich
IL P. O. BOX 711
r ""'' HUNTINGTON BEACH, CALIFORNIA 92648
1
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Z FUNDS RECEIVED FROM )01'nl �� /rivt 1 C f J
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ADDRESS Jt it� t7 ' r4
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FOR
AMOUNT RECEIVED
C Cash eck# ^Credit Cards , _�-
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Z Pr�red Received Fin
= 50000 TH 90000,FINANCE APPROVAL REQUIRED A rovai
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DA NIEL F K ALMICK 1001
DA N KALMICK FOR HR CITE(COUNCIL
1677VEN LN
HUNTINGTON
ONN BEACH,CA 92647 DATE as-ss;12za
132
TO THE
PAY
ORDER OE_ STY Of-- t rt11�.i"rI i�trlblJ v�"�Gf"+
—' --- DOLLARS
Bankof America
Seal Beach
208 Main St
Seal Beach CA
562-868-1448 s�
-OR �i� T
"'00 b00 Ill® ash 2 2000 6 6 bo: 0 L 3 20-6AL
03 Please do not write in the box below
—
SuPplder #
Order
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HiNANCE COPY
CANDIDATE STATEMENT ACTUAL COST-November 4,2008
1 OFF.ASST.@ 17.90 X 2 HR 35.80 ALTERNATE LANGUAGE PAMPHLET- SPANISH 575 CHINESE 425
DEPARTMENT OVERHEAD(291.11%) 104.22 VIETNAMESE 1,350 KOREAN 425
TOTAL LABOR PER CAND.STMT, 140.02
ENGLISH SPANISH VIETNAMESE CHINESE KOREAN
City of Huntington Beach
PAGE SETUP 32.00 32.00 32.00 32.00 32.00
NUMBER OF 200 WORD STATEMENTS 4 TYPSET-PER#OF PAGE FOR CONTEST 2.75 2.75 2,75 2.75 2.75
NUMBER OF 400 WORD STATEMENTS 0 TRANSLATION(200 WORD) 0.00 46.00 46.00 46,00 46.00
NUMBER OF PAGES FOR CONTEST 1 TRANSLATION(400 WORD) 0.00 92.00 92.00 92.00 92.00
MULTIPLE LANGUAGES IN SAMPLE BALLOT 0 TYPESET(PER CANDIDATE STATEMENT) 0.00 45.00 45.00 45.00 45,00
ALT. LANG. PAGES(VRA) 0 TYPESET(400 WORD) 0.00 0.00 0.00 0.00 0.00
SAMPLE BALLOT ORDER 149,850 RUN CHARGE PER 1,000 330.00 330.00 330.00 1 330.00 330.00
ENGLISH ALTERNATE I
**CALCULATIONS** SPANISH VIETNAMESE
200 WORD 400 WORD 200 WORD 400 WORD 200 WORD 400 WORD
PAGE SETUP PLUS TYPSET PER#OF PAGES FOR CONTEST 34.75 34.75 34.75 34.75 34.75 34.75
RUN CHARGE(S/B ORDER X RUN CHG/1000) 49,450.50 49,450.50 189.75 189.75 445.50 445.50
PAGE CHARGE(RUN CHARGE DIVIDED BY PAGES OF SAMPLE 1,766.09 1,766.09 6.78 6.78 15.91 15.91
ALTERNATE LANGUAGE(DIVIDED BY PAGES OF SAMPLE BALLOT)
PAGE CHG X#PGS DIVIDED BY#CANDIDATE STATEMENTS 441.52 883.04 1,69 3.39 3.98 7.96
PAGE SETUP AND TYPSET PER#OF PAGES FOR CONTEST 8.69 17.38 8.69 17.38 8,69 17.38
CHARGES DIVIDED BY SHARING CANDIDATES
400 WORD DOUBLES 200 WORD CHARGES.
TRANSLATE 0.00 0.00 46.00 92.00 46.00 92.00
TYPESET(PER CANDIDATE STATEMENT) 0.00 0.00 45.00 45.00 I 45.00 45.00
SUBTOTAL PER STATEMENT 450.21 900,42 101.38 157.76 103.67 162.33
0%DISCOUNT 0.00 0.00 0.00 0,00 0.00 0.00
7.75%SALES TAX 34.89 69.78 0.80 I 1.61 ! 0.98 I 1,96
TOTAL 485.10 970.20 102.19 159.37 104.65 164.29
TOTAL LABOR PER CANDIDATE STATEMENT 140.02 140.02 0.00 0.00 0.00 0.00
SUBTOTAL CANDIDATE COST 625.12 1,110.22 1 102.19 159.37 104.65 164.29
200 WORD 400 WORD
TOTAL CANDIDATE COST INCLUDING
VRA REQUIREMENTS 1,035.00 1,751.00
s
LANGUAGES
CHINESE KOREAN
200 WORD 400 WORD 200 WORD 400 WORD
34.75 34.75 34.75 34.75
140.25 140.25 140.25 140.25I
5,01 5.01 5.01 5.01
1.25 2.50 1.25 2,50
8.69 17.38 8.69 17.38
46.00 92.00 46.00 92,00
45.00 45.00 45.00 45.00
100.94 156.88 100,94 156.88
0.00 0,00 0.00 0.00
0.77 1.54 I 0.77 I 1.54
101,71 158.42 101.71 158.42
0.00 0.00 0.00 0.00
101.71 158.42 101.71 158A2
Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period ® -
Summary Page to whole dollars. _ 4
from
10/01/2008 °
SEE INSTRUCTIONS ON REVERSE through 10/18/2008 Page 3 Of 6
NAME OF FILER I.D. NUMBER
Dan Kalmick for HB City Council
1308462
ColumnA Column B Calendar Year Summary for Candidates
Contributions Received TOTALTHIS PERIOD CALENDAR YEAR Running In Both the State Primary and
(FROM ATTACHED SCHEDULES) TOTALTO DATE g J
General Elections
1. Monetary Contributions ........................................... Schedule A,Line 3 $ $624.00 $ $2,794.00
1/1 through 6/30 7/1 to Date
2. Loans Received ...................................................... Schedule e,Line 3 $0.00 $1,350.00
3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $624.oo $ $4,144.o0 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 $o.00 $108.25 21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $624.00 $ $4,252.25 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $16.52 $ $3,008.67 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.00 $0.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .................................... Add Lines s+7 $ $16.52 $ $3,008.67 (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 $0.30 $0.00 Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................ScheduleC,Line $0.00 $108.25 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $16.52 $ $3,116.92 J- � $
Current Cash Statement $
12. Beginning Cash Balance ....................... Previous Summary Page,Line 16 $ $527.85
To calculate Column B,add
13. Cash Receipts ................................................... Column A,Line 3 above $624.00 amounts in Column A to the
corresponding amounts *Amounts in this section may be different from amounts
14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 $0 00 from Column B of your last reported in Column B.
15. Cash Payments.................................................. Column A,Line 8 above $16.52 report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE.......... Add Lines 12+ 13+14,then subtract Line 15 $ $1,135.33 figures that should be
subtracted from previous
If this is a termination statement, Line 16 must be zero. period amounts. If this is
the first report being filed
17. LOAN GUARANTEES RECEIVED ........................... Schedule a,Part $ $0.00 for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2, 7, ands (if
� g $0.00 any).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts......................... Add Line 2+Line 9 in Column B above $ $1,350.00 FPPC Form 460(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(8661275-3772)
SCHEDULEE
Schedule E Type or print in ink. Statement covers period
Amounts may be rounded CALIFORNIA
Payments Made to whole dollars. •
from to/ol/zoos
SEE INSTRUCTIONS ON REVERSE through 10/18/2008 Page 6 of 6
NAME OF FILER I.D. NUMBER
Dan Kalmick for HB City Council 1308462
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CNP campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs
CNS campaign consultants NfTG meetings and appearances RFD returned contributions
CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries
CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs
FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals
FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO professional services (legal, accounting) VOT voter registration
LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE,ALSO ENTER LD.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.).............................................................................................................. $ $o.00
2. Unitemized payments made this period of under$100 .......................................................................................................................................... $ $16.52
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................... $ $o.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 $ $16.52
FPPC Form 460(January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE
Amounts may be rounded Statement covers period CALIFORNIA,Summary Page to whole dollars.
from 07/01/2008 ® -
IMI
SEE INSTRUCTIONS ON REVERSE through 09/30/2008 Page 3 of 8
NAME OF FILER I.D. NUMBER
Dan Kalmick for HE City Council
1308462
Contributions Received Column Column Calendar Year Summary for Candidates
TOTALTHIS PERIOD CALENDAR YEAR Running In Both the State Primary and
(FROM ATTACHED SCHEDULES) TOTALTO DATE 9 •�
General Elections
1. Monetary Contributions ........................................... Schedule A, Line 3 $ $2,170.00 $ $2,170.00
1/1 through 6/30 7/1 to Date
2. Loans Received ...................................................... Schedule B,Line 3 $1,350.00 $1,350.00
3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1+2 $ $3,520.00 $ $3,520.00 20. Contributions
Received $ $
4. Nonmonetary Contributions.................................... Schedule C,Line 3 $108.25 $108.25
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ...........................Add Lines 3+4 $ $3,628.25 $ $3,628.25 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made....................................................... Schedule E,Line 4 $ $2,992.15 $ $2,992.15 Candidates
7. Loans Made............................................................. Schedule H,Line 3 $0.0 0 $o.00
22. Cumulative Expenditures Made*
8. SUBTOTAL CASH PAYMENTS .........................:.......... Add Lines 6+7 $ $2,992.15 $ $2,992.15 (if Subject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 $o.00 $o.00 Date of Election Total to Date
10. Nonmonetary Adjustment ..........................................ScheduleC,Line $108.25 $108.25 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE................................Add Lines 8+9+10 $ $3,100.40 $ $3,100.40 $
Current Cash Statement - / J $
12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ $0.00
To calculate Column B,add
13.Cash Receipts ................................................... Column A,Line 3 above $3,520.00 amounts in Column A to the
14. Miscellaneous Increases to Cash........................... schedule 1, Line 4 $o.oo 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 6 above $2,992.15 report. Some amounts inColumn A may be negative
16. ENDING CASH BALANCE.......... Add Lines 12+13+14, then subtract Line 15 $ $527.85 figures that should be
subtracted from previous
If this is a termination statement, Line 16 must be zero. period amounts. If this is
the first report being filed
17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ $0.00 for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (if
Cash Equivalents and Outstanding Debts $o.00 any).
18. Cash Equivalents........................................ See instructions on reverse $
19. Outstanding Debts ......................... Add Line 2+Line 9 in Column B above $ $1,350.00 FPPC Form 460(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
S STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee '.C_A'lLi'F6RNlAa
® -
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Dan Kalmick for HB City Council 1308462
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
•• • Em List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
❑ __/�_,/ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1,2001,enter 1/1/01.
5.Termination Requi rementS 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.
FPPC Form 410(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)
S STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee •'
. -
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Dan Kalmick for HB City Council
4.Type of Committee Complete the applicable sections.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check"non-partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
® Non-Partisan
Dan Kalmick Huntington Beach City Council 2008
❑ Non-Partisan
• List the financial institution where the campaign bank account is located(controlled"candidate election"committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
N/A
ADDRESS CITY STATE ZIP CODE
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO..CITY OR COUNTY.ASAPPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)
a •
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee • 'R. a
® -
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Dan Kalmick for HB City Council
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 OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1,2001,enter 1/1/01.
5.Termination Requ i rementS 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.
FPPC Form 410(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(8661275-3772)