Date Stamp Campaign Statement Cover Page · 2019. 12. 3. · Date Stamp JUL 31201.0 COVER PAGE 1 of...

Recipient Committee

Campaign Statement

Cover Page

SEE INSTRUCTIONS ON REVERSE

Statement covers period

from4/ 1 / 2018

30/ 2018

Date of election if applicable:

Month, Day, Year)

11/ 06/ 2018

Date Stamp

JUL 31201.0

COVER PAGE

1of

16

For Official Use Only

1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement:

iIA Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure I Preelection Statement Quarterly Statement

O State Candidate Election Committee Committee Semi- annual Statement Special Odd -Year ReportO Recall O Controlled Termination StatementAlso Complete Part 5) O Sponsored ( Also file a Form 410 Termination)

Also Complete Part 6)

F- 1General Purpose Committee Amendment ( Explain below)

O Sponsored Primarily Formed Candidate/

O Small Contributor Committee Officeholder Committee

O Political Party/ Central Committee (Also Complete Part 7)

3. Committee Information II. P ^ 11 MAM: D

1407262 _ COMMITTEE NAME (OR CANDIDATE' S NAME IF NO COMMITTEE)

Fischer for Council 2018'

STREET ADDRESS ( NO P. O. BOX)

CITY STATE ZIP CODE AREA CODE/PHONE

Petaluma CA 94952

MAILING ADDRESS ( IF DIFFERENT) NO. AND STREET OR P.O. BOX

CITY STATE ZIP CODE AREA CODE/ PHONE

OPTIONAL: FAX/ E- MAIL ADDRESS

4. Verification

Treasurer( s)

NAME OF TREASURER

Lomesh Shah

MAILING ADDRESS


Rohnert Park CA 94928

NAME OF ASSISTANT TREASURER, IF ANY

Beverly SchorMAILING ADDRESS


Petaluma CA 94952

OPTIONAL: FAX/ E- MAILADDRESS

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, certify under penalty of perjury under the laws of the State of California that the foregoing is true and

7/ 31 /2018

correct.

Executed on ByUL11-

Date r reasurerorAssistantTreasurer

Executed on7/ 31/ 2018

Date

Executed onDate

Executed onDate

By

BySignature of Controlling Officeholder, Candidate, State Measure Proponent

BySignature of Controlling Officeholder, Candidate, State Measure Proponent

FPPC Form 460 (Jan/ 2016)

FPPC Advice: advice@fDvc. ca. eov ( 866/ 275- 3772)

Recipient Committee

Campaign Statement

Cover Page — Part 2

5. Officeholder or Candidate Controlled Committee

NAME OF OFFICEHOLDER OR CANDIDATE

D' Lynda Fischer

OFFICE SOUGHT OR HELD ( INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)

Petaluma City CouncilRESIDENTIAUBUSINESS ADDRESS ( NO. ANDSTREET) CITY STATE ZIP

Petaluma CA 94952

Related Committees Not Included in this Statement: List any committeesnot included in this statement that are controlled by you or are primarily formed to receivecontributions or make expenditures on behalf of your candidacy.

Fischer for Council 2018I. D. NUMBER

1407262

NAME OF TREASURER CONTROLLED COMMITTEE?

Lomesh Shah ® YES NO

UUMMI I I LE AUDKLSS 5 I KEE I ADDRESS ( NO P.O. BOX)

CITY STATE ZIP CODE AREA CODE/ PHONE

Petaluma CA 94952

COMMITTEE NAME I. D. NUMBER

NAME OF TREASURER CONTROLLED COMMITTEE?

YES NO

COMMITTEE ADDRESS STREETADDRESS ( NO P. O. BOX)

CITYI

STATE ZIP CODE AREA CODE/ PHONE

COVER PAGE - PART 2

Page2 of 16

6. Primarily Formed Ballot Measure Committee

NAME OF BALLOT MEASURE

BALLOT NO. OR LETTER JURISDICTIONSUPPORTIEJ OPPOSE

Identify the controlling officeholder, candidate, or state measure proponent, if any.

NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT

OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY

7. Primarily Formed Candidate/ Officeholder Committee List names ofofficeholder(s) or candidate(s) for which this committee is primarily formed.

NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD

SUPPORT

OPPOSE

NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD

SUPPORT

OPPOSE

NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELDSUPPORT

OPPOSE

NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELDSUPPORT

OPPOSE

Attach continuation sheets if necessary

FPPC Form 460 ( Jan/ 2016)

FPPC Advice: advice@fppc. ca. gov ( 866/ 275- 3772)

www. fppc. ca. gov

Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE

Summary Pageto whole dollars.

Statement covers period • . ,

from/1 / 2018

I.— Un


NAME OF FILER D' Lynda Fischer

Contributions Received

1. Monetary Contributions................................................... schedule A, Line 3

2. Loans Received................................................................ schedule B, Line 3

3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2

4. Nonmonetary Contributions ............................................ schedule C, Line 3

5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+ 4

Expenditures Made

6. Payments Made................................................................ schedule E, Line 4

7. Loans Made....................................................................... schedule H, Line 3

8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+ 7

9. Accrued Expenses ( Unpaid Bills) .......................................... schedule F Line 3

10. Nonmonetary Adjustment......................................................... schedule C, Line 3

11. TOTAL EXPENDITURES MADE ........................................ Add Lines s + 9 + 10

Current Cash Statement

12. Beginning Cash Balance ............................ Previous Summary Page, Line 16

13. Cash Receipts........................................................... Column A, Line 3 above

14. Miscellaneous Increases to Cash .................................. schedule t, Line 4

15. Cash Payments......................................................... CoiumnA, Line s above

16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15

If this is a termination statement, Line 16 must be zero.

6Page /30/ 2018 3through of 16

Column ATOTALTHIS PERIOD

FROM ATTACHED SCHEDULES)

Column BCALENDAR YEAR

TOTALTO DATE

3, 685

3, 685

66

3, 751

500

500

nn

0

3, 685

500

3, 185

17. LOAN GUARANTEES RECEIVED ................................ schedule B, Parte $

Cash Equivalents and Outstanding Debts18. Cash Equivalents ................................................ see instructions on reverse $

19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $

To calculate Column B,

add amounts in Column

A to the correspondingamounts from Column B

of your last report. Some

amounts in Column A maybe negative figures that

should be subtracted from

previous period amounts. If

this is the first report beingfiled for this calendar year,

only carry over the amountsfrom Lines 2, 7, and 9 ( if

any).

I. D. NUMBER

1407262

Calendar Year' Summary for CandidatesRunning in Both the State Primary andGeneral Elections

1/ 1 through 6/ 30 7/ 1 to Date

20. Contributions

Received $ $

21. Expenditures

Made $ $

Expenditure Limit Summary for StateCandidates

22. Cumulative Expenditures Made* If Subject to Voluntary Expenditure Limit)

Date of Election

mm/ dd/ yy)

Total to Date

Amounts in this section may be different from amountsreported in Column B.

FPPC Form 460 ( 1an/ 2016)

FPPC Advice: [email protected]. gov (866/ 275-3772)

www. fppc. ca. gov

Schedule A Amounts may be rounded SCHEDULE A

Monetary Contributions Receivedto whole dollars.

Statement covers periodCALIFO- , 04/ 1/ 2018

from

6/ 30/ 2018through Page.

4 of 16SEE INSTRUCTIONS ON REVERSE

NAME OFFILERD' Lynda Fischer

I. D. NUMBER

1407262

DATE FULL NAME, STREETADDRESSAND ZIP CODE OF CONTRIBUTOR CONTRIBUTORIF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION

IF COMMITTEE, ENTER I. D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATERECEIVED CODE * ( IF SELF- EMPLOYED, ENTER NAME PERIOD ( JAN. 1 - DEC. 31) ( IF REQUIRED)

OF BUSINESS)

IND

COM

See Attached ScheduleOTH

PTY

SCC

IND

COM

OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

SUBTOTAL $

Schedule A Summary1. Amount received this period — itemized monetary contributions.

Include all Schedule A subtotals.) .............................................

2. Amount received this period — unitemized monetary contributions of less than $ 100

3. Total monetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.).......

3, 685

TOTAL $$3, 685

Contributor Codes

IND — Individual

COM — Recipient Committee

other than PTY or SCC)

OTH — Other ( e. g., business entity) PTY— Political PartySCC — Small Contributor Committee

FPPC Form 460 ( 1an/ 2016)

FPPC Advice: advice@fppc,ca. gov (866/ 275-3772)

www fnnr ra unit

SCHEDULE B - PART 1

Schedule B — Part 1 to whole dollars. Statement covers period

Loans Receivedfrom

SEE INSTRUCTIONS ON REVERSE through Page5

of16

NAME OF FILER D' Lynda Fischer I. D. NUMBER

1407262

FULL NAME, STREET ADDRESS AND ZIP CODEIF AN INDIVIDUAL, ENTER

OCCUPATION AND EMPLOYER

a

OUTSTANDING AMOUNTc)

AMOUNT PAIDOUTSTANDING INTEREST ORIGINAL CUMULATIVE

OF LENDERIF COMMITTEE, ALSO ENTER I. D. NUMBER)

IF SELF- EMPLOYED, ENTERBALANCE

BEGINNING THIS RECEIVED THIS OR FORGIVENBALANCE AT

CLOSE OF THISPAID THIS AMOUNT OF CONTRIBUTIONS

NAME OF BUSINESS) PERIOD

PERIOD THIS PERIOD PERIODPERIOD LOAN TO DATE

PAID CALENDAR YEAR

FORGIVEN PER ELECTION** RATE

t IND [_ 1 COM OTH PTY SCC DATE DUE DATE INCURRED

PAID CALENDAR YEAR

IRATE

FORGIVEN PER ELECTION**

DATE DUE DATE INCURREDt IND [ I COM OTH PTY SCC

PAID CALENDAR YEAR

FORGIVENEl FORGIVEN PER ELECTION**

t[:] IND COM OTH PTY SCC DATE DUE DATE INCURRED

SUBTOTALS $ $ $ $

Schedule B Summary1. Loans received this period....................................................................

Total Column ( b) plus unitemized loans of less than $ 100.)

2. Loans paid or forgiven this period............................................................................

Total Column ( c) plus loans under $ 100 paid or forgiven.)

Include loans paid by a third party that are also itemized on Schedule A.)

3. Net change this period. ( Subtract Line 2 from Line 1.) ...............

Enter the net here and on the Summary Page, Column A, Line 2.

Amounts forgiven or paid by another party also must be reported on Schedule A. If required.

NET $

May be a negative number)

Enter ( e) on

Schedule E, Line 3)

tContributor Codes

IND - Individual

COM - Recipient Committee

other than PTY or SCC)

OTH - Other (e.g., business entity) PTY- Political PartySCC - Small Contributor Committee


FPPC Advice: [email protected]. gov (866/ 275- 3772)

www. fppc. ca. gov

SCHEDULE B - PART 2cneauile Es — Part L r+riiounLs limy ue rounaeu

to whole dollars.

Loan GuarantorsStatement covers period

from

CALIFORNIA

FORM

SEE INSTRUCTIONS ON REVERSEthrough Page

6of

16

NAME OF FILER ' Lynda FISCher I. D. NUMBER

1407262

FULL NAME, STREETADDRESSAND

ZIP CODE OF GUARANTORIF COMMITTEE, ALSO ENTER I. D. NUMBER)

CONTRIBUTOR

CODE

IF AN INDIVIDUAL, ENTER

OCCUPATION AND EMPLOYERIF SELF- EMPLOYED, ENTER

NAME OF BUSINESS)

LOAN

AMOUNT

GUARANTEED

THIS PERIOD

CUMULATIVE

TO DATE

BALANCE

OUTSTANDING

TO DATE

F1 INDLENDER CALENDAR YEAR

COM

DATEOTH PER ELECTION

IF REQUIRED)

PTY

SCC

CALENDAR YEAR

INDLENDER

COM

OTHPER ELECTION

IF REQUIRED) DATE

PTY

SCC

INDLENDER

CALENDAR YEAR

COM

OTHPER ELECTION

IF REQUIRED) DATE

PTY

SCC

INDLENDER

CALENDAR YEAR

COM

DATEOTHPER ELECTION

IF REQUIRED)

PTY

SCC

Heron

SUBTOTAL $ Summary Page, Line 17 only.


FPPC Advice: [email protected]. gov (866/ 275- 3772)

www. fppc. ca. gov

Schedule C Amounts may be roundedSCHEDULE C

o e Uo ars.

Nonmonetary Contributions Receivedow


4/ 1/ 2018 1from FPage7through6/30/ 2018

of16


NAME OF FILERI. D. NUMBER

1407262

DATE FULL NAME, STREET ADDRESS AND CONTRIBUTORIF AN INDIVIDUAL, ENTER

DESCRIPTION OFAMOUNT/

CUMULATIVE TO

DATEPER ELECTION

RECEIVED ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER

IF SELF- EMPLOYED, ENTERGOODS OR SERVICES

FAIR MARKETVALUECALENDAR YEAR

TO DATE

IF COMMITTEE, ALSO ENTER I. D. NUMBER) NAME OF BUSINESS) JAN 1 - DEC 31)

IF REQUIRED)

5/ 29/ 18NIaureen McGui an IND Tie Petaluma Mail Dy al Mailbox 66. 00 66. 00

Petaluma, CA 9495 coM

Z OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

IND

COM

OTH

PTY

SCC

Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $

Schedule C SummaryAmount received this period — itemized nonmonetary contributions. Include all Schedule C subtotals.)......................................................

2. Amount received this period — unitemized nonmonetary contributions of less than $ 100 .............

3. Total nonmonetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) .............

466. 00

TOTAL $$66. 00

Contributor Codes

IND — Individual

COM — Recipient Committee

other than PTY or SGC)

OTH — Other ( e. g., business entity) PTY — Political PartySCC — Small Contributor Committee



www. fppc. ca. gov

Schedule DSCHEDULE D

Summary OT Expenditures Amounts may be rounded Statement covers periodto whole dollars.

Supporting/ Opposing OtherCALIFORNIA 1

Candidates, Measures and Committeesfrom

FORM

through of

16SEE INSTRUCTIONS ON REVERSE

NAME OF FILE®° Lynda Fischer I. D. NUMBER

1407262

DATENAME OF CANDIDATE, OFFICE, AND DISTRICT, OR

TYPE OF PAYMENT DESCRIPTION AMOUNTTHISCUMULATIVE TO DATE

CALENDAR YEAR

PER ELECTION

TO DATEMEASURE NUMBER OR LETTERAND JURISDICTION, IF REQUIRED)

PERIOD JAN. 1 - DEC. 31) IF REQUIRED) OR COMMITTEE

MonetaryContribution

NonmonetaryContribution

Independent

Support OpposeExpenditure



Independent




Independent

Support Oppose Expenditure

SUBTOTAL $

Schedule D Summary1. 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.................................................................................... $

3. Total contributions and independent expenditures made this period. ( Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL.. $

FPPC Form 460 ( 1an/ 2016)


www. fppc. ca. gov

Schedule D

Continuation Sheet) Amounts may be rounded 6YN71 71J 7(N" P II I

Summary of Expenditures to whole dollars.

Supporting/Opposing Other. Candidates, Measures and Committees

statement covers period

from

CALIFORNIA

through Page9

of16

NAME OF FILE

Lynda FischerI. D. NUMBER

1407262

DATENAME OF CANDIDATE, OFFICE, AND DISTRICT, OR

MEASURE NUMBER OR LETTERAND JURISDICTION,

OR COMMITTEE

TYPE OF PAYMENT DESCRIPTIONIF REQUIRED)

AMOUNT THIS

PERIOD

CUMULATIVE TO DATE

CALENDAR YEARJAN. 1 - DEC. 31 )

PER ELECTION

TO DATEIF REQUIRED)



Independent




Independent




Independent




Independent


SUBTOTAL $



www. fppc. ca. gov

Schedule E

Payments Made


NAME OF FILEE) Unda Fischer

Amounts may' be roundedto whole dollars.

Statement covers period -

from

through

CODES: If one' of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.

SCHEDULE E

of

16

1407262

CMP campaign paraphernalia/ misc. MBR member communications RAD radio airtime and production costsCNS 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 costsFIL candidate filing/ ballot fees PHO phone banks TRC candidate travel, lodging, and mealsFND fundraising events POL polling and survey research TRS staff/ spouse travel, lodging, and mealsIND independent expenditure supporting/ opposing others ( explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/ sponsorLEG 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 PAYEEIF COMMITTEE, ALSO ENTER I. D. NUMBER) CODE OR DESCRIPTION OF PAYMENT

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.)............................................................................................................. $

2. Unitemized payments made this period of under $ 100.......................................................................................................................................... $

3. Total interest paid this period on loans. ( Enter amount from Schedule B, Part 1, Column( e).)............................................................................. $

4. Total payments made this period. ( Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $

AMOUNT PAID



www. fppc. ca. gov

Schedule E Amounts may be rounded

Continuation Sheet) to whole dollars.

Payments Made


Lynda Fischer

CODES: If one of the following codes accurately describes the payment, you may enter the code. CMP campaign paraphernalia/misc. MBR member communications

CNS campaign consultants MTG meetings and appearances

CTB contribution ( explain nonmonetary)* OFC office expenses

CVC civic donations PET petition circulatingFIL candidate filing/ ballot fees PHO phone banks

FND fundraising events POL polling and survey researchIND independent expenditure supporting/ opposing others ( explain)" POS postage, delivery and messenger servicesLEG legal defense PRO professional services ( legal, accounting) LIT campaign literature and mailings PRT print ads


from

through

Otherwise, describe the payment.

SCHEDULE E ( CONT)

Page11

of16

I. D. NUMBER

1407262

RAD radio airtime and production costs

RFD returned contributions

SAL campaign workers' salaries

TEL t. v. or cable airtime and production costs

TRC candidate travel, lodging, and mealsTRS staff/ spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/ sponsor

VOT voter registration

WEB information technology costs ( internet, e- mail)

NAME AND ADDRESS OF PAYEEIF COMMITTEE, ALSO ENTER I. D. NUMBER)

CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID

Elizabeth Pfau Cmp Design 500

Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $


FPPC Advice: advice@fppc. ca. gov (866/ 275- 3772)

Schedule F

Accrued Expenses ( Unpaid Sills)

Amounts may be roundedto whole dollars.


from

SCHEDULE F


CODE OR

DESCRIPTION OF PAYMENT

a)

OUTSTANDING

BALANCE BEGINNING

OF THIS PERIOD

throughPage

12 of 16

NAME OF FILER in NI IMRFR

1407262

CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the. payment. CMP campaign paraphernalia/ misc. MBR member communications RAD radio airtime and production costs

CNS campaign consultants MTG meetings and appearances RFD returned contributions


CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costsFIL candidate filing/ ballot fees PHO phone banks TRC candidate travel, lodging, and mealsFND fundraising events POL polling and survey research TRS staff/ spouse travel, lodging, and mealsIND 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 registrationLIT campaign literature and mailings PRT print ads WEB information technology costs ( internet, e- mail)

NAME AND ADDRESS OF CREDITORIF COMMITTEE, ALSO ENTER I. D. NUMBER)

CODE OR

DESCRIPTION OF PAYMENT

a)

OUTSTANDING

BALANCE BEGINNING

OF THIS PERIOD

INAMOUNT INCURRED

THIS PERIOD

c)

AMOUNT PAID

THIS PERIODALSO REPORT ON E)

OUTSTANDING

BALANCE AT CLOSE

OF THIS PERIOD

Payments that are contributions or independent expenditures must also beSUBTOTALS $ $ $ $

summarized on Schedule D.

Schedule F Summary1. 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 $

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 $

3, Net change this period. ( Subtract Line 2 from Line 1. Enter the difference here and

onthe Summary Page, Column A, Line 9.)................................................................................................................................................................................... NET $ May be a negative number



Schedule F Amounts may be roundedSCHEDULE F ( CONT.)

Continuation Sheet) to whole dollars. Statement covers period •

a •

Accrued Expenses ( Unpaid Bills) from •

throughPage

13of

16

NAME OF FILER i n All I ARCR

1407262

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



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 mealsFND fundraising events POL polling and survey research TRS staff/ spouse travel, lodging, and mealsIND 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)

Payments that are contributions or independent expenditures must also be summarized on Schedule D.

NAME AND ADDRESS OF CREDITORIF COMMITTEE, ALSO ENTER I. D. NUMBER)

CODE OR -

DESCRIPTION OF PAYMENTOUTSTAA NDING

BALANCE BEGINNING

OF THIS PERIOD

AMOUNT INNCURRED

THIS PERIOD

c)

AMOUNT PAID

THIS PERIODALSO REPORT ON E)

OUTSTANDING

BALANCE AT CLOSE

OF THIS PERIOD

SUBTOTALS$ $ $ $



www. fppc. ca. gov

Schedule G SCHEDULE G

Payments Made by an Agent or Independent Amounts may be roundedStatement covers period

CALIFORRIA

on Behalf of This Committee) to whole dollars.

from FORM

through of

16


NAME OF FILER in NI IMRFR

1407262

NAME OF AGENT OR INDEPENDENT CONTRACTOR

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



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 mealsIND 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)

Payments that are contributions or independent expenditures must also be summarized on Schedule D.

NAME AND ADDRESS OF PAYEE OR CREDITORCODE OR DESCRIPTION OF PAYMENT AMOUNT PAID

IF COMMITTEE, ALSO ENTER I. D. NUMBER)

Attach additional information on appropriately labeled continuation sheets. TOTAL* $

Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or FPPC Form 460 (Jan/ 2016) independent contractor as reported on Schedule E. FPPC Advice: advice@fppc. ca. gov ( 866/ 275- 3772)

www. fppc. ca. gov

SCHEDULE H

Schedule H Amounts may be rounded Statement covers period

to whole dollars. 0

Loans Made to Others* from

SEE INSTRUCTIONS ON REVERSE through of 16

NAME OF FILER I. D. NUMBER

1407262

FULL NAME, STREETADDRESSAND ZIP CODEIF AN INDIVIDUAL, ENTER

OCCUPATION AND EMPLOYER

a

OUTSTANDINGb)

AMOUNTc)

REPAYMENT OR

d)

OUTSTANDING

e)

INTEREST

t)

ORIGINAL

g)

CUMULATIVEOF RECIPIENT

IF COMMITTEE, ALSO ENTER I. D. NUMBER) DYED, ENIF SELF- EMPLOYED, ENTER

BALANCE

BEGINNING THISLOANED THIS FORGIVENESS

BALANCE ATCLOSE OF THIS

RECEIVED AMOUNTOF LOANS

NAMEOFPERIOD

PERIOD THIS PERIOD* PERIODLOAN TO DATE

PAIDCALENDAR YEAR

g

FORGIVENEl FORGIVEN PER ELECTION**

DATE DUE DATE INCURRED

PAIDCALENDAR YEAR

FORGIVEN PER ELECTION** RATE

3 3 S 5DATE DUE DATE INCURRED

Loans that are contributions to another candidate or committee must

also be summarized on Schedule D. Loans forgiven must also be

reported on Schedule E. SUBTOTALS

Enter ( e) on

Schedule I, Line 3)

Schedule H Summary1. Loans made this period....................................................................................................................................................$

Total Column ( b) plus unitemized loans of less than $ 100.) — If Required

2. Payments received on loans............................................................................................................................................$

Total Column ( c) plus unitemized payments of less than $ 100.)

3. Net change this period. ( Subtract Line 2 from Line 1.)............................................................................................ NET $

Enter the net here and on the Summary Page, Column A, Line 7.) ( May be a negative number)



www.fppc. ca. gov

Schedule l H„ r,...., A- A ;( HFDtJI_F I

Miscellaneous Increases to Cash to whole dollars. Statement covers period

from

SEE INSTRUCTIONS ON REVERSEthrough e

16of

16pag

NAME OF FILER I. D. NUMBER

1407262

DATE FULL NAME AND ADDRESS OF SOURCERECEIVED ( IF COMMITTEE, ALSO ENTER I. D. NUMBER)

DESCRIPTION OF RECEIPTAMOUNT OF

INCREASE TO CASH

Attach additional information on appropriately labeled continuation sheets.

Schedule 1 Summary1. Itemized increases to cash this period............................................................................................................................$

2. Unitemized increases to cash of under $ 100 this period.................................................................................................$

3. Total of all interest received this period on loans made to others. ( Schedule H, Column ( e).) .......................................$

4. Total miscellaneous increases to cash this period. ( Add Lines 1, 2, and 3. Enter here and on the

SummaryPage, Line 14.).........................................................................................:..... I............................. TOTAL $

SUBTOTAL $



Schedule A - From 4/ 1/ 2018 to 6/ 30/ 2018

Contribution

Date _ first Last Contributor Amount This CumulativeReceived Name Name Address City State Zip Code Occupation / Employer Period To Date

6/ 1/ 18 Tina K. Orth Seattle WA 98102 Ind Designer for Fischer Properties 200. 00 200. 00

6/ 1/ 18 Richard W. Fischer Seattle WA 98102 Ind Developer for Fischer Properties 200. 00 200. 00

5/30/ 18 Teresa E. Barrett Petaluma CA 94952 Ind City Council Member City of Petaluma 200. 00 200. 00

613/ 18 Stefani Ames Culver City CA 90232 Ind Filmaker and Sculptor - Self- employed 200. 00 200. 00

6/ 4/ 18 Michael L. Frost Petaluma CA 94952 Ind General Contractor for Scout Construction 200. 00 200. 00

6/ 5/ 18 Beverly K. Schor Petaluma CA 94952 Ind Retired 200. 00 200. 00

6/ 5/ 18 David F. Powers Petaluma CA 94952 Ind Retired 200. 00 200. 00

6/ 7/ 18 Gregory S. Reisinger Petaluma CA 94952 Ind Retired 200. 00 200. 00

6/ 7/ 18 Stephanie Wilkinson Petaluma CA 94954 Ind Retired 100. 00 100. 00

619/ 18 Karin Burger Petaluma CA 94952 Ind Retired 100. 00 100. 00

6/ 10/ 18 Bob Stires Petaluma CA 94952 Ind Retired 100. 00 100. 00

6/ 11/ 18 Jerry Wilkinson Petaluma CA 94954 Ind Retired 100. 00 100. 00

6/ 11/ 18 Margaret Walter Petaluma CA ` 94954 Ind Retired 200. 00 200. 00.

6/ 12/ 18 Joyce McCart Austin TX 78704 Ind Mythologist/ Self employed 200. 00 200. 00

6113/ 18 Susan Cohen Petaluma CA 94952 Ind Retired 25. 00 25. 00'

6113/ 18 Loretta Mateik Petaluma CA 94952 Ind Retired 200. 00 200. 00

6/ 13/ 18 Cynthia Rathkey Petaluma CA 94952 Ind Nurse Practitioner/ Dr. Chappell 100. 00 100. 00

6/ 13/ 18 Pamela Mari Torliatt Petaluma CA 94952 Ind CFO/ Superior Systems 200. 00 200.00

6/ 13/ 18 Suzanne J. Clark Petaluma CA 94952 Ind Retired 50. 00 50. 00

6/ 15/ 18 Amanda F. Susskind Los Angeles CA 90048 Ind Lawyer/ Anti-Defamation League 200. 00 200. 00

6/ 15/ 18 Dale Wannen Petaluma CA 94952 Ind Investor/ Sustainvest 10. 00 10.00

6/ 15/ 18 Matt Maguire Petaluma CA 94954 Ind Tasting Room Host/ Sonoma Portworks 100. 00 100. 00

6/ 15/ 18 Annie Stuart Petaluma CA 94952 Ind Writer and Editor/ Self-Employed 100. 00 100, 00

6118/ 18 Mary Schoenbaun Culver City CA 90232 Ind Nurse Practitioner/ Keck Med Center USC 200, 00 200. 00

6/ 18/ 18 Sandra Garber Petaluma CA 94952 Ind retired 100. 00 100. 00

Date Stamp Campaign Statement Cover Page · 2019. 12. 3. · Date Stamp JUL 31201.0 COVER PAGE 1 of...

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