Type or print in ink.
FILECOVER PAGE
acipient Committeeampaign Statementover Pagewernment Code Sections 84200-84216 5)
CITY STATE ZIP CODE
San Luis Obispo CA 93401AREA CODE/PHONE
(805) 550-7916
CITY
Arroyo GrandeNAME OF ASSISTANT TREASURER, IF ANY
AREA CODE/PHONE
(805) 481-0268STREET ADDRESS (NO P.O. BOX)260 Sandercock
STATE ZIP C ODE
CA 93420
AREA CODE/PHONESTATE ZIP CODEAREA CODE/PHONE CITY
OPTIONAL: FAX / E-MAIL ADDRESS
, CITY STATE ZIP CODE
Grover Beach CA 93483 OPTIONAL: FAX / E-MAIL ADDRESS
By N \ V4-,An"-- NCYv
By
Signatur7f Tr urer or ssistant Treasurer
By
Signature o holder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
By
Sgnature of Controlling Officeholder, Candidate, State Measure Proponent
Signatureof Controlling Officeholder, Candidate, State Mena Proponent FPPC Form 460 (January/05)
Executed on
Executed on
Executed on
Executed on Date
\ a (,) \
Date
Statement covers period01/01/2012from
Date of election if applicable:(Month, Day, Year) MAR 2 1 2012 For Official Use Only
JULIE L RODEWALD COUNTY CLEP03/17/2012through 06/05/2012 -90444.4Z
Complete Parts 1, 2, 3, and 4.L,CYL/ p T2. Type of Statement:
Primarily Formed Ballot Measure 2 Preelection Statement ID Quarterly StatementCommittee D Semi-annual Statement D Special Odd-Year Report
Controlled 0 Termination Statement 0 Supplemental Preelection0 Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495(Nso Complete Part 6) 0 Amendment (Explain below)Primarily Formed Candidate/Officeholder Committee(Also Complete Part 7)
I.D. NUMBER Treasurer(s)1294032
a INSTRUCTIONS ON REVERSE
Type of Recipient Committee: All Committees• Officeholder, Candidate Controlled Committee 0O State Candidate Election Committee
O Recall(Also Complete Pert 5)
O General Purpose CommitteeO Sponsored0 Small Contributor CommitteeO Political Party/Central Committee
Committee InformationCOMMITTEE NAME (OR CANDIDATES NAME IF NO COMM! EE)
Friends of Adam Hill, County Supervisor 2012NAME OF TREASURERSharon A. McMahanMAILING ADDRESS765 Mesa View Drive #21
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR RO. BOX
P.O. Box 1248MAILING ADDRESS
VerificationI 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 certifyunder penalty of perjury under the laws of the State of California that the foregoing is true and correct.
FPPC Toll-Free HelplIne: 866/ASK-FPPC (866 1275-3772)State of California
tecipient Committee:ampaign Statement:over Page — Part 2
Type or print in ink. COVER PAGE - PART 2
BALLOT NO. OR LETTER JURISDICTION 0 SUPPORTOPPOSE
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 HELD0 SUPPORT• OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD • SUPPORT• OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT• OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD • SUPPORT0 OPPOSE
Attach continuation sheets if necessary
Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure CommitteeNAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE
Adam HillOFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
San Luis Obispo County Supervisor, District 3RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZI P
260 Sandercock San Luis Obispo, CA 93401
Related Committees Not Included in this Statement: List any committeesnot included in this statement that are controlled by you o are primarily formed to receivecontributions or make expenditures on behalf of your candidacy.
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
COMMITTEE NAME LD. NUMBER
7.NAME OF TREASURER CONTROLLED COMMITTEE?YES 0 NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME .D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?YES EI NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
FPPC Form 460 (January/05)FPPC Toll-Free HelplIne: 856/ASK-FPPC (8661275-3772)
State of California
Statement covers period01/01/2012 from
CALIFORNIA 460FORM
03/17/20123 19through Page ofSEE INSTRUCTIONS ON REVERSE
lype or print In Ink.Amounts may be rounded
to whole dollars.Campaign Disclosure StatementSummary Page
SUMMARY PAGE
NAME OF FILER ID. NUMBERFriends of Adam Hill County Supervisor 2012 1294032
$ 0
$ 953.00
$
To calculate Column B, addamounts in Column A to thecorresponding amountsfrom Column B of your lastreport. Some amounts inColumn A may be negativefigures that should besubtracted from previousperiod amounts. If this isthe fi rst report being filedfor this calendar year, onlycarry over the amountsfrom Lines 2, 7, and 9 ( ifany).
Contributions Received
Monetary Contributions Schechae A, Line 3
Column ATOTALMS PERIM
(FIROMATTACHED SCHEDULES)
19,985.00o2. Loans Received Schedule B, Line 3
19,985.003. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2638.404. Nonmonetary Contributions Schedule C, Line 3
20,623.405. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 + 4
Expenditures Made6. Payments Made Schedule E, Line 4 $ 14,295.927. Loans Made Schedule H, Line 3 08. SUBTOTALCASH PAYMENTS Add Lines 6 + 7 $ 14,295.929. Accrued Expenses (Unpaid Bills) Schedule F Line 3 953.00la Nonmonetary Adjustment Schedule C. Line 3 638.4011. TOTAL EXPENDITURES MADE Add Lines 13 + 9 + 10 $ 15,887.32
Current Cash Statement12. Beginning Cash Balance Previous Summery Page, Line 18 61,770.66
19,985.0013. Cash Receipts Column A, Line 3 above014. Miscellaneous Increases to Cash Schedule I, line 0
14,295.9215. Cash Payments Column A, Line 8 above
16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 67,459.74II this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED Schedule s, Part 2 $
Cash Equivalents and Outstanding Debts18. Cash Equivalents See insbuctions on reverse 67,459.774
5,253.0019. Outstanding Debts Add Line 2 + Line 9 in Column B above
Calendar Year Summary for CandidatesRunning in Both the State Primary andGeneral Elections
1/1 through 6/30 7/1 to Date
20.ContributionsReceived $
21.ExpendituresMade
Expenditure Limit Summary for StateCandidates
22.Cumulative Expenditures Made'Sub}act to voluntary Expenditure Limiti
Date of Election Total to Date(mm/dd/yy)
'Amounts in this section may be different from amountsreported in Column B.
FPPC Form 480 (January/05)FPPC Toil-Free Helpline: 866/ASK-FPPC (866 1275-3772)
Column BCALENDAR YEAR
TOTALTO tan
4300.00
hedule A• Type or print in ink. SCHEDULE AAmounts may be roundedmetary Contributions Received to whole dollars.
INSTRUCTIONS ON REVERSE
Statement covers period01/01/2012from
Page
CALIFORNIAFORM 460
4of \ CA
03/17/2012throughIE OF FILERFriends of Adam Hill, County Supervisor 2012
I.D. NUMBER1294032
DATE2ECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR
CODE *IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
MAOUNTRECEIVED THIS
PERIODCUMULATIVE TO DATE
CALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
13/12 & Norm Adams3337 Kiler CanyonPaso Robles, CA 93446
INDRetired 150.00• COM
DOTH• PTY• SCC
2/6/12 Stella Jenkins285 Buena VistaSan Luis Obispo, CA 93405
12] NDRetired 100.00• COM• OTH• PTY• SCC
2/6/12 Peter Keith865 CharlesGrover Beach, CA 93433
gj INDSelf-Employed, Investor 1500.00• cm• OTH• PTY• SCC
2/6/12 Kurt P. Kupper8888 Toro Creek Rd.Atascadero, CA 93422
Retired 100.00IND• COM• OTH• PTY• SCC
2/6/12Mike Ritter120 Highway 28Crystal Bay, NV 89402
INDRetired 250.00• Coro• OTH• PTV0 SCC
SUBTOTALS 2100.00hedule A Summary\ mount received this period — itemized monetary contributions.Include all Schedule A subtotals.)
1, mount received this period — unitemized monetary contributions of less than $100rotal monetary contributions received this period.Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 19,°036,00
\ 1l00.0061%aS.uo
*Contributor CodesIND —IndividualCOM — Recipient Committee
(other than PTY or SCC)OTH — Other (e.g., business entity)PTY — Political PartySCC —Small Contributor Committee
FPPC Form 460 (January/06)FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
:hedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.)onetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
01/01/2012fromCALIFORNIA 460
FORM
Page 5 of N `I03/17/2012throughAE OF FILERr riends of Adam Hill, County Supervisor 2012
I.D. NUMBER1294032
DATERECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOROF COMMITTEE) ALSO ENTER La NUMBER) CONTRIBUTOR
CODE *IF AN INDIVIDUAL, ENTER AMOUNT
OCCUPATION AND EMPLOYER RECEIVED THISOF SELF-EMPLOYEO ENTER NAME PERIOD
OF BUSINESS)
CUMULATIVE TO DATECALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
2/22/12 Ray Weymann7610 San Marcos RoadAtascadero, CA 93422
Retired 190.00IND• COM• OTHDPW
E scc
2/16/12 Marion Wolff3128 Spring StreetSan Luis Obispo, CA 93401
q IND Retired 100.00• COM• OTH• PTV• SCC
3/11/12 Robert Vessely1745 Garden StreetSan Luis Obispo, CA 93401
Self-Employed, Structural Engineer 485.00
•4 IND• c0m• OTH• PTV• SCC
2/06/12 Lawrence Vierheilig950 Waypoint DriveNipomo, CA 93444
Retired 100.00r/ IND• COM• OTH• PTY• SCC
2/15/12 John Carsel3285 Shearer AvenueCayucos, CA 93430
I INDDCOM Self-Employed, Attorney
At Law 300.00• OTH• PTVEl sccSUBTOTALS 1175.00
FPPC Form 460 (January/05)FPPC Toll-Free Helpline: 866/ASK-FPPC (866 1275-3772)
i:ontributor CodesID — IndividualOM —Recipient Committee
(other than PTY or SCC)TH — Other (e.g., business entity)TY — Political PartyCC —Small Contributor Committee
;hedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.)onetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
01/01/2012fromCALIFORNIA 460
FORM
Page 6 of k c \03/17/2012through.01E OF FILERr riends of Adam Hill, County Supervisor 2012
L D. NUMBER 1294032
DATERECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR
CODE *IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYERBF SELF-EMPLOYEET ENTER NAME
OF BUSINESS)
AMOUNTRECEIVED THIS
PERIODCUMULATIVE TO DATE
CALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
3/11/12 Lisen A. Bonnier6015 Los Osos Valley Rd.San Luis Obispo, CA 93405
IND Self-Employed, Farmer 100.00• COM• OTH• PTY• SCC
2/17/12 Muril Clift1011 Suffolk StreetCambria, CA 93428
IND Retired 300.00• COMIJOTH• PTV• SCC
1/06/12 Burke L. Dambly1201 Longview AvenuePismo Beach, CA 93449
ZI INDECOM Retired 200.00• OTH0 PTV• SCC
2/14/12 Ed Eby520 Camino RobleNipomo, CA 93444
Retired 340.00Ir/ IND• com• OTHn PTY• SCC
3/6/12 Tracy Del Rio135 Whiteley StreetArroyo Grande, CA 93420
IZ INDOcom Mediator, SLO County
Superior Court 180.00• OTH• PTY• SCC
SUBTOTAL $ 1120.00
FPPC Form 460 (January/05)FPPC Toll-Free HelplIne: 8661ASK-FPPC (866/275-3772)
ontributor CodesID —IndividualOM —Recipient Committee
(other than PTY or 5CC)TI-1 — Other (e.g., business entity)TY — Political PartyCC — Small Contributor Committee
;hedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT)onetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
from 01/01/2012CALIFORNIA 460
FORM
Page 7 of ‘e%03/17/2012throughAE OF FILER'--riends of Adam Hill, County Supervisor 2012
ID. NUMBER1294032
DATERECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOROF COMMITTEE, ALSO ENTER 1.1). NUMBER)
CONTRIBUTORCODE *
_IF AN INDIVIDUAL. ENTER AMOUNT
OCCUPATION AND EMPLOYER RECEIVED THISOF SELF-EMPLOYED, ENTER NAME PERIOD
OF BUSINESS) 1...
CUMULATIVE TO DATECALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
2/10/12 Castlerock Development, A California Corp.445 Green Gate Rd.San Luis Obispo, CA 93401
• ND5000.00COM• OTH• PTY
0 SCC
2/06/12 Verdin Marketing Ink689 Tank Farm Rd #210San Luis Obispo, CA 93401
0 INDZCOM 100.00• OTH0 PTY• SCC
1/25/12 George Lewis1852 6th StreetLos Osos, CA 93402
100.00Retiredq IND• COM• OTH0 PTY• SCC
3/07/12 Allyn Arnold777 North Ocean AveCayucos, CA 93430
100.00Retired1 !A IND0 COM• OTH• PTY• SCC
2/21/12 Sheila Blake1320 Longview AvenuePismo Beach, CA 93449
0 IND Retired 245.00• COM• OTH• PTY• SCC
SUBTOTAL S 5545.00
FPPC Form 460 (January/05)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
3ontributor CodesID —IndividualOM — Recipient Committee
(other than PTY or SCC).TH — Other (e.g., business entity)TY — Political PartyCC —Small Contributor Committee
:hedule A Continuation Sheet e or print in ink. SCHEDULE A (CONT.). . .. .onetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
from 01/01/2012
Page
CALIFORNIAFORM
4608 of \ P'"03/17/2012through
AE OF FILERrriends of Adam Hill, County Supervisor 2012
I.D. NUMBER
1294032
DATERECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(IF COMMITTEE, ALSO ENTER I a NUMBER)
CONTRIBUTORCODE *
IF AN INDIVIDUAL, ENTER AMOUNTOCCUPATION AND EMPLOYER RECEIVED THIS
(IF SELF-EMPLOYED, ENTER NAME PERIODOF BUSINESS)
CUMULATIVE TO DATECALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
3/05/12 Walter Brothers Construction Company, Inc.3220 S. Higuera StreetSan Luis Obispo, CA 93401
• IND250.00COM• OTH• PTY• SCC
1/06/12 Lynne Landwehr2644 Flora StreetSan Luis Obispo, CA 93401
!I IND Retired 150.00• COmfj OTH• PTY0 SCC
2/21/12 Dawn Legg2480 Parkland TerraceSan Luis Obispo, CA 93401
Assistant ProjectManager, First Solar 135.00
vál IND• Com• OTH• PTY• SCC
3/03/12 Pricilla Kiessig460 Tessa CourtTempleton, CA 93465
Director, Sea Life Center 135.00%IND•com00TH• PTV• SCC
3/01/12 Jerry Williams5365 CandelabraSan Luis Obispo, CA 93401
IN NDIm Builder, JW Design &
Construction, Inc. 500.00•co• OTH• PTY• SCC
SUBTOTALS 1170.00
FPPC Form 460 (January/05)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
3ontributor CodesID —IndividualOM — Recipient Committee
(other than PTY or SCC)TH — Other (e.g., business entity)TY— Political PartyCC —Small Contributor Committee
:hedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.)onetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
01/01/2012from
,CALIFORNIA 460
FORM
Page 9 of \ c‘03117/2012throughAE OF FILER:riends of Adam Hill, County Supervisor 2012
ID. NUMBER1294032
DATERECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOROF COMMITTEE, ALSO ENTER I D. NUMBER) CONTRIBUTOR
CODE *IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYEROF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNTRECEIVED THIS
PERIOD
CUMULATIVE TO DATECALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
2/22/12 David Ogren1016 Willow CircleSan Luis Obispo, CA 93401
IND Senior Deputy PublicDefender, County ofSanta Barbara
190.00• COM• OTHEl PTYIliSCC
2/16/12 Dr. Bradford Parkinson236 Camino EdnaSan Luis Obispo, CA 93401
IND Retired 100.00• COMill OTH• Pr(0 scc
3/11/12 Kayla Ann Plourde745 Evans RoadSan Luis Obispo, CA 93401
Self-Employed, BookSales 160.00
rj INDEl COM• OTH• PTY• SCC
1/03/12 Christine Rogers735 Tank Farm Road #264San Luis Obispo, CA 93401
Program Manager,Economic VitalityCorporation
190.00.4 IND• COM• OTH• PTV• scc
2/06/12 Ernest Roide88 Bena VistaSan Luis Obispo, CA 93405
21IND Owner, Promotions Plus• OTH• PTY• SCC
SUBTOTALS 890.00
FPPC Form 460 (January/05)FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
:;ontributor CodesID — IndividualOM — Recipient Committee
(other than PTY or SCC)TH — Other (e.g., business entity)TY — Political PartyCC —Small Contributor Committee
;hedule A (Continuation Sheet) Type or print in Ink. SCHEDULE A (cormonetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
01/01/2012fromCALIFORNIA 460
FORM
Page 10 of \ ck03/17/2012throughAE OF FILERzriends of Adam Hill, County Supervisor 2012
I.D. NUMBER12 032
DATERECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(IF COMMITTEE, ALSO ENTER W. NUMBER) CONTRIBUTOR
CODE *IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNTRECEIVED THIS
PERIOD
CUMULATIVE TO DATECALENDAR YEAR(JAN. 1 - DEC. 31)
PER ELECTIONTO DATE
(IF REQUIRED)
2/16/12 Charles Senn178 Broad StreetSan Luis Obispo, CA 93401
IND Self-Employed, Sales 100.000 COM• OTH• PTY• SCC
2/23/12 San Luis Obispo Democratic Club1406 Broad StreetSan Luis Obispo, CA 93401
• IND FPPC # 862266 100.00• cOm• OTHru PTY• SCC
3/11/12 Jennifer Skinner5420 Huasna Township RoadArroyo Grande, CA 93420
Owner, Huasna ValleyFarms 170.00
•41 IND•COm• OTH• PTY• SCC
2/06/12 Mary E. Smith1111 Vista Del LagoSan Luis Obispo, CA 93405
Retired 300.00w4 INDMom00TH0 PTY0 SCC
2/06/12 John Spatafore1303 Garden StreetSan Luis Obispo, CA 93401
r NDAl I Self-Employed,John A.Spatafore, Attorney AtLaw
250.000 COM0 OTH• PTY• SCC
SUBTOTALS 920.00
FPPC Form 460 (January/05)FPPC Toll-Free HelplIne: 866/ASK-FPPC (866/275-3772)
3ontributor CodesJD -IndividualOM - Recipient Committee
(other than PTY or SCC)TH - Other (e.g., business entity)TY - Political PartyCC -Small Contributor Committee
Schedule A Continuation Sheet) or print In Ink. SCHEDULE A (CONT.)Monetary Contributions Received Amounts may be rounded
to whole dollars.Statement covers period
from 011/2012CALIFORNIA 460
FORM
Page 1% of \ ek03/17/2012throughNAME OF FILER
Friends of Adam Hill, County Supervisor 2012ID. NUMBER1294032
DATERECEIVED
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOROF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTORCODE *
IF AN INDIVIDUAL ENTER AMOUNTOCCUPATION AND EMPLOYER RECEIVED THIS OF SELF-EMPLOYEA ENTER NAME PERIOD
OF BUS INES51
DATE31)
PER ELECTIONTO DATE
(IF REQUIRED)CUMULATIVE TO
CALENDAR YEAR(JAN. 1 - DEC.
3/11/12Jenifer Rescola1323 Balboa StreetSan Luis Obispo, CA 93401
ND• OM• OTH• PTY• SCC
Psychiatric Technician,Atascadero State 140.00Hospital
01/06/12 Teddy Bear Homes896 Tanis PlaceNipomo, CA 93444
• INDrACOM• OTHEl PTY0 SCC
100.00
END• COM0 OTH• PTY• SCC• IND• COM00TH• PTY0 SCC• IND• COM• OTH0 PTY0 SCC
SUBTOTALS 240.00
FPPC Form 460 (January/05)FPPC Toll-Free HelplIne: 8661ASK-FP PC (866/2754772)
*Contributor Codes
COM — Recipient Committee(other than PTY or SCC)
OTH — Other (e.g., business entity)PTY — Political PartySCC —Small Conhibutor Committee
*Amounts forgiven or paid by another party also must be reported on Schedule A.** If required. FPPC Form 460 (January/05)
FPPC Toll-Free Mainline: 866/ASK-FPPC (866 1275-3772)
SCHEDULE B - PART 1Schedule B — Part 1 Inn vai in nit 1 el •• 1 n.
Amounts may be roundedLoans Received to whole dollars.
SEE INSTRUCTIONS ON REVERSE
from
Statement covers period01/01/2012
CALIFORNIAFORM
12Page
460of \ C\through 03/17/2012
NAME OF FILER
Friends of Adam Hill, County Supervisor 2012
I.D. NUMBER
1294032
FULL NAME, STREET ADDRESS AND ZIP CODEOF LENDER
(IF COMMITTEE ! ALSO ENTER ID. NUMBER)
IF AN INDIVIDUAL, ENTEROCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTERNAME OF BUSINESS)
(I)OUTSTANDING
BALANCE H IsBEGIMItNIAT
(b)AMOUNT
RECEIVED THISPERIOD
(ciAMOUNT PAIDOR FORGIVENTHIS PERIOD - PFRIOD
OUTSTP,I4DINGBALANCEAT
CLOSE OF THISINTE(eRESTPAID THISPERIOD
( nORIGINAL
AMOUNT OFLOAN
19)CUMULATIVE
CONTRIBUTIONSTO DATE
Adam Hill260 SandercockSan Luis Obispo, CA 93401
to IND 0 COM 0 OTH 0 PTY 0 SCC
Candidate-Supervisor SLO CountyDistrict 3
4300.005 0$
0 PAID
s 0 $ 4300.00 0 k $ 10,300CALENDAR YEAR
$
0 FORGIVEN
5 0
RATEt
s
PER ELECTION'.
sDATE DUE DATE INCURRED
t 0 IND 0 COM 0 OTH 0 PTY 0 SCC$ $
0 PAID
5 S %
CALENDAR YEAR
$
0 FORGNEN
S
RATE
s
PER ELECTION**
$DATE DUE DATE INCURRED
TO IND 0 COM 0 OTH 0 PTY O SCC$ S
0 PAID
S $ % 5
CALENDAR YEAR
S
C FORGIVEN
$
RATE
5
PER ELECTION**
$DATE DUE DATE INCURRED
SUBTOTALS $ 0 $ 0 $ 4300.00 $ 0
Schedule B Summary(Enter (et) on
Sthedule E, Lino 3)
1. Loans received this period (Total Column (b) plus unitemized loans of less than $100.)
0
tConhibutor Codes0 ND—Individual
2. Loans paid or forgiven this period COM — Recipient Committee(Total Column (c) plus loans under $100 paid or forgiven.) (other than PTY or SCC)
(Include loans paid by a third party that are also itemized on Schedule A.) OTH — Other (e.g., business entity)PTY —Political Party
0 SCC — Small Contributor Committee3. Net change this period. (Subtract Line 2 from Line 1.) NET $
(May be • negafiVe nurnbar)Enter the net here and on the Summary Page, Column A, Line 2.
Type or print in Ink. SCHEDULE C— — - -- ---- — Amounts may be roundedNonmonetary Contributions Received to whole dollars.
SEE INSTRUCTIONS ON REVERSE
statement covers period
from 01/01/2012CALIFORNIA 460
FORM
13 19Page ofthrough 03/17/2012
NAME OF FILER
Friends of Adam Hill County Supervisor 2012ID. NUMBER
1294032
DATERECEIVED
FULL NAME. STREET ADDRESS ANDZIP CODE OF CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER 70. NUMBER)
CONTRIBUTORCODE *
IF AN INDIVIDUAL, ENTEROCCUPATIONAND EMPLOYER
(IF SELF-EMPLOVED, EN7F_RNAME OF BUSINESS)
DESCRIPTION OFGOODS OR SERVICES
AMOUNT/FAIR MARKET
VALUE
CUMULATIVE TODATE
CALENDAR YEAR(JAN 1 - DEC 31)
PER ELECTIONTO DATE
(IF REQUIRED)
2/24/12 Adam Hill260 SandercockSan Luis Obispo, CA 93401
District 3 Supervisor Wine Basketsand other itemsfor raffle
$600.000% IND5COM• OTHEj Pr(•SCC• IND• COMDOTH0 PTY• SCCIDIND• COMEIOTH• PTY• SCC• NoDCOM0 OW0 PTY5SOO
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 600.00
Schedule C Summary *Contributor Codes1. Amount received this period — itemized nonmonetary contributions.
(Include all Schedule C subtotals.) 600.00 IND—IndividualCOM —Recipient Committee
(other than PTY or SCC)2. Amount received this period — unitemized nonmonetary contributions of less than $100 38.40 OTH — Other (e.g., business entity)
PTY —Political Party3. Total nonmonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) TOTAL $ re 38.40 SCC — Small Contributor Committee
FP PC Form 460 (January/05)FPPC Toll-Free HelplIne: 866/ASK-FP PC (86612754772)
SCHEDULEESchedule EPayments Made
Type or print in ink.Amounts may be rounded
to whole dollars.
through 03/17/2012 Page 1 LI of \ :LEE INSTRUCTIONS ON REVERSENAME OF FILER
Friends of Adam Hill, County Supervisor 2012I.D. NUMBER
1294032
Statement covers period011/2012 from
RADRFDSALTEL1RCTRSTSFVOTNEB
CM° campaign paraphernata/misc.ChIS campaign consultants0113 contribution (explain nonmonetary)*OVC civic nonationsFL candidate filing/ballot feesFt fundraising events
independent expenditure supporting/opposing others (explain)*LEG legal defenseLIT campaign literature and mailings
MBR member communicationsMTG meetings and appearancesOFC office expensesPET petition circulatingPHO phone banksPOL polling and survey researchPOS postage, delivery and messenger servicesPRO professional services (legal, accounting)FRT print ads
escribe the payment.radio airtime and production costsreturned contributionscampaign workers' salariesLv. or cable airtime and production costscandidate travel, lodging, and mealsstaff/spouse travel, lodging, and mealstransfer between committees of the sarne candidate/sponsorvoter registrationinformation technology costs (*Internet, e-mail)
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, d
NAME AND ADDRESS OF PAYEEocCOMMITTEE ALSO ENTER 1.1). NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
poliARC286 Aspen Street #220EArroyo Grande, CA 93420
Web Management300.00
Pismo Beach Chamber of Commerce581 Do!liver StreetPismo Beach, CA 93449
Dues 71.00
Grover Beach Chamber of Commerce180 Highway OneGrover Beach, CA 93433
Installation Dinner 100.00
Payments that ore contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 471.00
Schedule E SummaryI. Itemized payments made this period. (Include all Schedule E subtotals.) 2. Uniterni zed payments made this period of under $100 3 Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e) )t. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $
14,136.80159.12
014,295.92
FPPC Form 460 (January/05)FPPC Toll-Free HelplIne: 866/ASK-FPPC (866/276-3772)
SEE INSTRUCTIONS ON REVERSENAME OF FILER
Friends of Adam Hill, County Supervisor 2012
03/17/2012through 1 5 Page of ID. NUMBER1294032
SCHEDULE E (CONT.)Statement covers period
from 011/2012
Schedule E(Continuation Sheet)Payments Made
Type or print In Ink.Amounts may be rounded
to whole dollars.
payment, you may enter the code.member communicationsmeetings and appearancesoffice expensespetition circulatingphone bankspolling and survey researchpostage, delivery and messenger servicesprofessional services (legal, accounting)print ads
Otherwise, describe the payment.RAD radio airtime and production costsRFD returned contributionsSAL campaign workers salariesTEL tv. or cable airtime and production costsITC candidate travel, lodging, and mealsWS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB Information technology costs (Internet, e-mail)
CODES: If one of the following codes accurately describes thecampaign paraphernalia/misc. MBR
CNS campaign consultants MTGCTB contribution (explain nonmonetary)* OFCCVC civic donations FETFIL candidate filing/ballot fees PHOFND fundraising events POLIC independent expenditure supporting/opposing others (explain)* POSLEG legal defense PROUT campaign literature and mailings Ffit
NAME AND ADDRESS OF PAYEE(IF COMMITTEE, ALSO ENTER to NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Political Data Inc.1251 Imperial Highway, Suite 200Norwalk, CA 90650
On-Line Voter File, Software, Bar Code Wand476.50
Pacific Coast Business Times14 East Carrillo Street #ASanta Barbara, CA 93101
Reprints of article, including high resolution PDF's169.00
Pismo Beach Chamber of Commerce581 Dolliver StreetPismo Beach, CA 93449
Installation Dinner50.00
Susan Devine1845 Garden StreetSan Luis Obispo, CA 93401
Reimburse for Auction items at Grover BeachInstallation Dinner 860.00
Susan Devine1845 Garden StreetSan Luis Obispo, CA 93401
Reimburse for Auction items at Pismo BeachInstallation Dinner 500.00
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL 2,055.50FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (86612754772)
SCHEDULE E (CONT.)Type or print in ink.
Amounts may be roundedto whole dollars.
Statement covers period
from 011/2012
03/17/2012 through Page 16 of \C La NUMBER1294032
Schedule E(Continuation Sheet)Payments MadeSEE INSTRUCTIONS ON REVERSE NAME OF FILER
Friends of Adam Hill, County Supervisor 2012
QvV campaign paraphernalia/misc.CNS campaign consultantsC1B contribution (explain nonmonetary)*CVC civic donationsFIL candidate filing/ballot teesEND fundraising events
independent expenditure supporting/opposing others (explain)*LEG legal defenseLif campaign literature and mailings
MBR member communicationsMTG meetings and appearancesOFC office expensesFET petition circulatingPHO phone banksPOL polling and survey researchPOS postage, delivery and messenger servicesPRO professional services (legal, accounting)FRT print ads
Otherwise, describe the payment.RAD radio airtime and production costsRFD returned contributionsSAL campaign workers salariesra tv. or cable airtime and production costs1RC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB information technology costs (Internet, e-mail)
CODES: If one of the following codes accurately describes the payment, you may enter the code.
NAME AND ADDRESS OF PAYEEBF COMMITTEE. N-50 ENTER LE NUMBER)
CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
poliARC296 Aspen Street #220EArroyo Grande, CA 93420
Web Management, Walk Piece printing1179.65
Clint Weirich380 SaratogaGrover Beach, CA 93433
Campaign worker salary500.00
Political Data Inc.12501 Imperial Highway, Suite 200Norwalk, CA 90650
On-Line Voter File, Software, Bar Code Wand476.50
PPS - Public Policy Solutions979 Osos Street, Suite ESan Luis Obispo, CA 93401
Office supplies for precinct walk k ts186.16
San Luis Obispo Chamber of Commerce1039 Chorro StreetSan Luis Obispo, CA 93420
State of the State Luncheon280.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2,622.31FPPC Fonn 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (86612764772)
SCHEDULE E (CONT.)Type or print in Ink.Amounts may be rounded
to whole dollars.Statement covers period
011/2012 from
Schedule E(Continuation Sheet)Payments Made
03/17/2012through of \ Page 17SEE INSTRUCTIONS ON REVERSE NAME OF FILER
Friends of Adam Hill, County Supervisor 2012ID. NUMBER1294032
CODES: if one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.CM° campaign paraphernalia/misc.CNS campaign consultantsCTB contribution (explain nonmonetary)*CVC civic donationsFIL candidate filing/ballot feesFWD fundraising eventsBID independent expenditure supporting/opposing others (explain)*LEG legal defenseUT campaign literature and mailings
MBR member communicationsMTG meetings and appearancesOFC office expensesPET pefition circulatingPI-10 phone banksPOL polling and survey researchPOS postage, delivery and messenger servicesPRO professional services (legal, accounting)PRT print ads
RAD radio airtime and production costsRFD returned contributionsSAL campaign workers' salariesTEL t.v. or cable airtime and production costsTRC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF(IF COMMITTEE, ALSO ENTER ID.NUMBER)
PMEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
San Luis Obispo County Clerk1055 Monterey StreetSan LuisObispo, CA 93401
Filing Fee820.14
Pismo Beach Chamber of Commerce581 Dolliver StreetPismo Beach, CA 93449
Mailing List35.00
Political Data Inc.12501 Imperial Highway, Suite 200Norwalk, CA 90650
Precinct Map81.56
•PPS - Public Policy Solutions979 Osos Street, Suite ESan Luis Obispo, CA 93401
Campaign Consultant, Voter List2555.00
San Luis Obispo Chamber of Commerce1039 Chorro StreetSan Luis Obispo, CA 93420
Mailing List175.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3,666.70FPPC Form 460 (January(05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (86612754772)
Statement covers period
from 011/2012
SEE INSTRUCTIONS ON REVERSENAME OF FILER
Friends of Adam Hill, County Supervisor 2012
03/17/2012through Page 18 of I.D. NUMBER1294032
SCHEDULE E (CONT.)Schedule E(Continuation Sheet)Payments Made
Type or print In Ink.Amounts may be rounded
to whole dollars.
CODES: If one of the following codes accurately describes thecm, campaign paraphernalia/misc. MBR
campaign consultants MTGCTB contribution (explain nonmonetary) OFCCVC civic donations PETFIL candidate fi ling/ballot fees PHO
fundraising events POLnu independent expenditure supporting/opposing others (explain)* POSLEG legal defense PROUT campaign literature and mailings PRT
member communicationsmeetings and appearancesoffice expensespetition circulafingphone bankspolling and survey researchpostage, delivery and messenger servicesprofessional services (legal, accounting)print ads
payment, you may enter the code. Otherwise, describe the payment.RAD radio airtime and production costsRFD returned contributionsSAL campaign workers' salariesTa ty. or cable airtime and production costsNC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB information technology costs ( internet, e-mail)
NAME AND ADDRESS OF PAYEE(IF coMMITTEE, ALS0 ENTER 1.1) NUMBER)
CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
San Luis Obispo County Clerk1055 Monterey StreetSan LuisObispo, CA 93401
Spanish Ballot970.00
Grover Beach Chamber of Commerce180 Highway OneGrover Beach, CA 93433
Membership and Mailing List200.50
poliARC296 Aspen Street #220EArroyo Grande, CA 93420
Campaign Literature and Mailings2805.53
Patricia Harris218 Via La PazSan Luis Obispo, CA 93401
Campaign Management500.00
San Luis Obispo Chamber of Commerce1039 Chorro StreetSan Luis Obispo, CA 93420
Good Morning SLO Breakfast148.00
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 4,624.03FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8664275-3772)
Statement covers period011/2012 from03/17/2012 through
SCHEDULE E (CONT.)Type or print in Ink.Amounts may be rounded
to whole dollars.
Schedule E(Continuation Sheet)Payments MadeSEE INSTRUCTIONS ON REVERSE NAME OF FILER
Friends of Adam Hill, County Supervisor 2012
payment, you may enter the code. Otherwise, describe the payment.CODES: If one of the following codes accurately describes theGIP campaign paraphernalia/misc. MBR
campaign consultants MTGCTB contribution (explain nonmonetary)* OFCCVC civic donationsFIL candidate filing/ballot fees PHOFND fundraising events POLIND independent expenditure supporting/opposing others (explain)* FOSLEG legal defense PROLIT campaign literature and mailings FRT
member communicationsmeetings and appearancesoffice expensespetition circulabngphone bankspolling and survey researchpostage, delivery and messenger servicesprofessional services (legal, accounfing)print ads
RAD radio airtime and production costsRFD returned contributionsSAL campaign workers' salariesTEL t.v. or cable airtime and producbon costsTRC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationNEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEESE COMMITTEE, ALSO ENTER LO. NUMBER/ CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Denis Degher8650 Centra RoadPaso Robles, CA 93446
Music for Cayucos Fund Raiser175.00
Patricia Harris218 Via LaPazSan Luis Obispo, CA 93401
Reimburse for food, tables & chairs for Cayucos FundRaiser 522.26
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 697.26
•
FPPC Form 460 (January/OS)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/2754712)
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