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Home My WebLink About2012 Recipient Committee COVER PAGE Campaign Statement Type or print in ink. Date Stamp , ' Cover Page p.EIIVED ' , (Government Code Sections 84200 - 84216.5) Statement covers period Date of election if applicable: 9 ZO�� Page —� of from October 21, 2012 (Month, Day, Year) JAN 2 For Official Use Only SEE INSTRUCTIONS ON REVERSE through December 31, 2012 Nov. 6, 2012 t Vd CLERKS 029 "T 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 Committee Committee JZ Semi - annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled (Also Complete Part S) Sponsored E] Termination Statement ❑ Supplemental Preelection P (Also file a Form 410 Termination) Statement - Attach Form 495 F General 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 Part 7) 3. Committee Information I.D. NUMBER Treasurers) 1236008 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Chuck Washington City Council 2012 Kathy Washington MAILING ADDRESS 31205 Kahwea Rd. STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 31205 Kahwea Rd. Temecula CA 92591 951 699 -5706 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 951699 -5706 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 951 699 -7786 951 699 -7786 4. 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 co rect. Executed on (/?"' / �/ By Date y nature of T ur s essistant Treasurer Executed on ' (� By / L Date Signature of lm ing Officeholder, Candid le, to 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, Slate Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/2753772) State of California Recipient Committee Type or print in ink. COVER PAGE - PART 2 Campaign Statement F CALIF • 1 Cover Page — Part 2 Q Page ` of S� 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Chuc W OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT City Counc T ❑ OPPOSE RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 31205 Kahwea Rd. Temecula, CA 92591 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 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 E] YES ❑ NO E] 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 (8661275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period - Summary Page to whole dollars. from October 21, 2012 • - SEE INSTRUCTIONS ON REVERSE through December 31, 2012 page of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 To Col R c AioD Column B Calendar Year Summary for Candidates Contributions Received Running in Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTODATE 9 Prim 1. Monetary Contributions ............ ............................... schedule A, Line 3 $ 2421.00 $ 19,639.00 General Elections 2. Loans Received ....................... ............................... schedule e, Line 3 00.00 5000.00 1/1 through 6/30 7/1 to Date 2421.00 24,639.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ $ Received $ $ 4. Nonmonetary Contributions ..... ............................... schedule C, Line 3 00.00 3955.27 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 2421.00 $ 28,594.27 Made $ $ Expenditures Made Expenditur ^Limit Summary. for State 6. Payments Made ........................ ............................... schedule E, Line 4 $ 3684.75 $ 19,162.32 CandidatE� J 7. Loans Made .............................. ............................... schedule rl, Line 3 00.00 00.00 3684.75 19,162.32 22• Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 +7 $ $ (if Subject to Voluntary Expenditure Limit) 9. Accrued Expenses ( Unpaid Bills Schedule F, Line 3 00.00 00.00 p ( p ) -- •---- •--- •••••••••••••••••••• Date of Election Total to Date 10. Nonmonetary Adjustment ........... ............................... schedule C Line 3 00.00 00.00 (mm /dd /yy) .11. TOTAL EXPENDITURES MADE . ............................... Add Lines 6 + 9 + 10 $ 3684.75 $ 19,162.32 J J $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 10,392.00 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 2421.00 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 1, Line 4 from Column B of your last reported in Column B. 75 report. Some amounts in 15. Cash Payments ................... ............................... Column A, Line 6 above 3684. Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 9128.25 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... schedule e, Part 2 $ 00.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts f j Lines 2, 7, and 9 (if 18. Cash Equivalents ......... ............................... See instructions on reverse $ 00.00 y 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 5000.00 FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded Statement covers period ry to whole dollars. CALIFORNIA October 21, 2012 • from • 4 SEE INSTRUCTIONS ON REVERSE through December 31, 2012 Page of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DDE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF EET A COMMITTEE, RS SAND ZIP I.D. NUMBER) DE O CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Norm & Kay Thomas ❑ IND Retired 10/22/12 30535 Ave. Buena Suerte E] OTH 500.00 500.00 Temecula, CA 92591 ❑ PTY ❑SCC ® IND 10/22/12 Jon Lieberg ❑COM Attorney 300.00 300.00 41911 Fifth Street Ste. 300 E] OTH Temecula, CA 92590 ❑ P - ry ❑ SCC ' WIND Donald Tucker 10/22/12 ❑COM Owner 200.00 200.00 32740 Hupa Dr. ❑OTH Hearing Aid Systems Temecula, CA 92592 ❑ PTY ❑ SCC Won Yoo ®IND 10/23/12 27431 Enterprise Circle West ❑❑OOH Consultant 250.00 250.00 Temecula, CA 92590 ❑ PTY ❑ SCC California Real Estate Political Action ❑IND 10/23/12 Committee #890106 ®COM 500.00 500.00 ❑ OTH 525 S. Virgil Ave Los Angeles, CA 90020 ❑ PTY ❑ SCC SUBTOTAL$ 1750 Schedule A Summary 'Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (Include all Schedule A subtotals.) ......................................................................... ............................... $ 2000.00 COM— Recipient Committee (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 421.00 OTH - Other (e.g., business entity) PTY — Political Party 3. Total monetary contributions received this period. SCC -Small contributor committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ........................ TOTAL $ 2421.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) 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. October 21, 2012 • CALIFORNIA 460 from through December 31, 2012 Page of a NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION ET OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED ( ALSO ENTER ZIP I.D.N DE O ) CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Corman Leigh Companies ❑IND 12/10/12 32823 Temecula Parkway COM 250.00 250.00 y ®OTH Temecula, CA 92592 ❑ PTY ❑ SCC ❑ IND ❑ COM ® OTH ❑ PTY ❑ SCC ®IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 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/OS) SCC —Small Contributor Committee FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Type or print in ink. SCHEDULE B - PART 1 Schedule B — Part 1 Amounts may be rounded Statement covers period CALIFORNIA Loans Received to whole dollars. Octobe 21 2012 .. 460 from ' � SEE INSTRUCTIONS ON REVERSE through December 31 ' 20 Page --(4P— of A_ NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING (b) (c) (d) (e) ( ) (g) AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I. D. NUMBER) NAMEOF BUSINESS) PERIOD THIS PERIOD PERIOD LOAN TO DATE Chuck Washington Airline Pilot ❑ PAID CALENDAR YEAR 31205 Kahwea Rd. $ 00.00 $ 5000.00 0.00 % $ 5000.00 $ 5000.00 Temecula, CA 92591 ❑ FORGIVEN RATE PER ELECTION $ 5000.00 $ 0.00 $ 00.00 NA $ 00.00 10/15/12 $ tZ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ k $ $ ❑ FORGIVEN RATE PER ELECTION** t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION t El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 00.00$ 00.00 $ 00.00 $ 00.00 (Enter (e) on Schedule B Summary Schedule E, Line 3) 1. Loans received this period $ 00.00 ..................................................................................... ............................... (Total Column (b) plus unitemized loans of less than $100.) tContributor Codes 00.00 IND– Individual 2. Loans paid or forgiven this period .......................................................................... ............................... $ COM - Recipient Committee (Total Column (c) plus loans under $100 paid orforgiven.) (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 Parry 3. Net change this period. (Subtract Line 2 from Line 1.) ................ NEr $ 00.00 SCC – Small Contributor Committee Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another parry also must be reported on Schedule A. *' If required. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E Type or print in ink. Statement covers period SCHEDULEE Payments Made Amounts may be rounded • 4 ' Y to whole dollars. from October 21, 2012 • SEE INSTRUCTIONS ON REVERSE through December 31, 206 page L_ of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 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 CNIS 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 M 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 (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Fred Lamb Designs 28481 Rancho California Rd. Ste. 101 LIT $1399.31 Temecula, CA 92590 Print Kwik 31285 Highway 79 Ste. C8 -140 CMP $53.08 Temecula, CA 92592 Sean Duregger 29917 Twin Lakes Rd. LIT 50.00 Menifee, CA 92585 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1502.39 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 3684.75 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 00.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column ( e).) ................................................ ............................... $ 00.00 4. Total payments made this period. Add Lines 1 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 3684.75 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612753772) Schedule E Type or print in ink. SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period . to whole dollars. F 6_ _ Payments Made from October 21, 20 • throw h December 31, 20� SEE INSTRUCTIONS ON REVERSE g Page o NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012. 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia /misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) AB Mailing 42066 Avenida Alvarado Ste. Q LIT 1581.84 Temecula, Ca 92590 AB Mailing 42066 Avenida Alvarado Ste. Q LIT 600.52 Temecula, Ca 92590 * Payments th ar co o independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2182.36 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275-3772) Recipient Committee T COVER PAGE Campaign Statement ype or print in ink. Date Stamp e . , • ' Cover Page RECENED ' (Government Code Sections 84200 - 84216.5) ()C-T 2$ 2012 Page of (_ Statement covers period Date of election if applicable: lJ from 10/1/12 (Month, Day, Year) For Official Use Only ®�� SEE INSTRUCTIONS ON REVERSE through 10/20/12 Nov 6, 2012 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 ja Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ❑ Semi - annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled Sponsored E] Termination Statement E] Supplemental Preelection (Also Complete Part S) 0 P (Also file a Form 410 Termination) Statement - Attach Form 495 F1 General Complete Part 6) General Purpose Committee J2 Amendment (Explain below) Q Sponsored ❑ Primarily Formed Candidate/ 2 Contributions were overlooked Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1236008 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Chuck Washington City Council 2012 Kathy Washington MAILING ADDRESS 31205 Kahwea Rd. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 31205 Kahwea Rd. Temecula CA 92591 951 - 699 -5706 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY T e m e c u l a CA 92591 951 - 699 -5706 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 (951) 699 -7786 (951) 699 -7786 4. 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. i Executed on Zr By i Aw ate ig r fTreas rorAs st r urer Executed on f Z / z By Date Signature of ControlliNg Officeholder, Candidate, SWa Measu roponentorResponsibleO fiicerofSponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, StateMeasure Proponent 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 - Summary Page to whole dollars. • 1 from 10/1/12 • - SEE INSTRUCTIONS ON REVERSE through 10/20/12 page of b NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and 00 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 2849. $ 17,218.00 General Elections 2. Loans Received ....................... ............................... Schedule a, Line 3 5000.00 5000.00 111 through 6/30 711 to Date 00 22,218.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 7849. $ Received $ $ 4. Nonmonetary Contributions ..... ............................... Schedule c, Line 3 00.00 3955.27 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 7849.00 $ 26,173.27 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... schedule E, Line 4 $ 10,260.21 $ 15,477.57 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 00.00 00.00 10,260.21 15,477.57 22• Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ $ ( if Sublectto 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 ........... ............................... Schedule c, Line 3 00.00 00.00 (mm /dd /yy) 11. TOTAL EXPENDITURES MADE .... ............................Add Lines 6 + g + 10 $ 10,260.21 $ 15,477.57 J $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 12,803.21 To calculate Column B, add 13. Cash Receipts .................... ............................... column A, Line 3above 7849.00 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 1, Line 4 from Column B of your last reported in Column B. 15. Cash Payments ................... ............................... Column A, Line 6 above 10,260.21 report. Some amounts in 10392.00 Column A may be negative , 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 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 e, Part 2 $ 00.00 for this calendar year, only carry over the amounts Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if Cash E a 9 00.00 any). 18. Cash Equivalents ......... ............................... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 5000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule A Type or print in ink. SCHEDULE A period Amounts may be rounded Statement covers Monetary Contributions Received to whole dollars. p • - , from 10/1/12 - SEE INSTRUCTIONS ON REVERSE through 10/20/12 page 3 of 6 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 STREET DDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF EET A COMMITTEE, RALSAND ZIP I.D. NUMBER) DE O CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Sam Alhadeff ®IND ❑COM Attorney 375.00 375.00 10/1/12 13371 Summit Circle ❑OTH Poway, CA 92064 ❑ PTY ❑ SCC Brookfield California Land Hold LLC ❑IND 10/1/12 12865 Pointe Del Mar Ste. 200 ❑COM 250.00 250.00 Del Mar, CA 92014 00TH ❑ PTY ❑ SCC Daniel Yoo ®IND Consultant ❑COM 100.00 100.00 10/9/12 1742 Stoner Ave. Unit 1 ❑OTH Los Angeles, CA 920025 ❑ PTY ❑SCC CR &R ❑IND 10/19/12 11292 Western Ave BcOM 1,000.00 2,000.00 2,000.00 Santon, CA 90680 ❑OTH ❑PTY ❑ SCC CDF Firefighters #790318 ❑IND 10/19/12 1731 J Street, Suite 1 aCOM 1,000.00 2,000.00 2,000.00 Sacramento, CA 95811 ❑OTH ❑ PTY ❑SCC SUBTOTAL$ 2725.00 Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (Include all Schedule A subtotals.) ...........................$ 2725.00 COM— Recipient Committee (other than PTY or SCC 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 124.00 OTH — Other (e.g., business entity) PTY —Political Party 3. Total monetary contributions received this period. SCC -Small contributor Committee Add Lines 1 and 2. Enter here and on the Summa e TOTAL $ 2849.00 (Add Page, Column A, Line 1. ) FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Type or print in ink. SCHEDULEB -PART1 Schedule B — Part 1 Amounts may be rounded Statement covers period CALIFORNIA Loans Received to whole dollars. from 10/1/12 FORM ' • SEE INSTRUCTIONS ON REVERSE through 10/20/12 Page Y of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 IF AN INDIVIDUAL, ENTER a (b) (o) (d) (e) (i) (g) FULL NAME, STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE . AMOUNTPAID BALANCEAT OF LENDER (IF SELF - EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAMEOF BUSINESS) ERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Chuck Washington Airline Pilot ❑ PAID CALENDARYEAR 31205 Kahwea Rd. $ 00.00 $ 5000.00 0.00 % $ 5000.00 $ 5000.00 Temecula, CA 92591 ❑ FORGIVEN RATE PER ELECTION $ 00.00 $ 5000.00 $ 00.00 na $ 00.00 10/15/12 $ tjo IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION'"* t $ $ $ DATE DUE $ DATE INCURRED $ ❑ IND ❑ COM ❑ OTH ❑PTY ❑SCC ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION" t El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 5000.00$ 00.00 $ 5000.00 $ 00.00 (Enter (e) on Schedule B Summary Schedule E, Line 3) 1. Loans received this period .......... ............................... ........................................... ............................... $ 5000.00 (Total Column (b) plus unitemized loans of less than $100.) tcontributor Codes 00.00 IND—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 3. Net change this period. (Subtract Line 2 from Line 1.) ................................ ............................... NET $ 5000.00 SCC —Small Contributor Committee Enter the net here and on the Summary Page, Column A, Line 2. (Ma be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772) Schedule E Type or print in ink. SCHEDULEE Amounts may be rounded Statement covers period CALIFORNIA , Payments Made to whole dollars. from 10/1/12 FORM • ' SEE INSTRUCTIONS ON REVERSE through 10/20/12 Page 5 of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER LID, NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID AB Mailing Solutions 42066 Avenida Alvarado Ste. Q LIT 3703.72 Temecula, CA 92590 Print Kwik Signs 31285 Temecula Parkway CMP 806.92 Temecula, CA 92590 Innovative Political Solutions 27315 Jefferson Ave. Ste. J -34 CNS 175.00 Temecula, CA 92590 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 4685.64 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 10,236.20 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 24.01 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) ............................ $ 00.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 10,260.21 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E Type or print in ink. SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period CALIFORNIA o whl oe dollars. • , Payments Made t from 10/1/12 • - 10/20/12 SEE INSTRUCTIONS ON REVERSE through Page 6 0 of 6 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Fred Lamb Designs 28481 Rancho California Rd. Ste. 101 LIT 5550.56 Temecula, CA 92590 ' Payments that are contributions or independent e must also be summarized on Schedule D. SUBTOTAL $ 5550.56 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Recipient Committee T COVER PAGE Campaign Statement T ype or print in ink. ® FFo . • ' CoverPage �� A (Government Code Sections 84200 - 84216.5) Oli 1 2 `t 202 ° � Statement covers period Date of election if applicable: of / from Oct. 1, 2012 (Month, Day, Year) I TY CLERKS DEPT fficial Use Only SEE INSTRUCTIONS ON REVERSE through Oct. 20,2012 Nov 6, 2012 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 50 Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ❑ Semi - annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled (Also Complete Part S) Sp onsored E] Termination Statement ❑ 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 Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1236008 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Chuck Washington City Council 2012 Kathy Washington MAILING ADDRESS 31205 Kahwea Rd. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 31205 Kahwea Rd. Temecula CA 92591 951 - 699 -5706 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 95 - 699 -5 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 (951) 699 -7786 (951) 699 -7786 4. 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 an sect. j Executed on 1 0 & '3112- B Date r ,!� Si ature of a u ssistant Treasurer Executed on /�) � � r z-- By --r" — Dat Signature of Controlling Officeholder,Cand at ,State Me nentor Responsible Officer ofSponsor 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 Recipient Committee Type or print in ink. COVER PAGE - PART 2 Campaign Statement O CALIFORNIA RM 4 • 1 Cover Page —Part 2 Page __zt of S. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Chuck Washington OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT C Council Teme ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (N0. AND STREET) CITY STATE ZIP 312 K Rd. Temecula CA 92591 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 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 F 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 (8661275 -3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period - Summary Page to whole dollars. ' from Oct. 1, 2012 • - SEE INSTRUCTIONS ON REVERSE through O ct. 20,2012 Page of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDARYEAR i nnn Ru In Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO DATE g r 00 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 849. $ 15,218.00 General Elections 2. Loans Received ....................... ............................... Schedule B, Line 3 5000.00 5000.00 1/1 through 6130 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 5849.00 $ 20,218.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... Schedule c, Line 3 00.00 3955.27 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 5849.00 $ 24,173.27 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 10,260.21 $ 15,477.57 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 00.00 00.00 10,260.21 15,477.57 22• Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 +7 $ $ ( if Subjectto 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 ........... ............................... Schedule c, Line 3 00.00 00.00 (mm /dd /yy) 11. TOTAL EXPENDITURES MADE . ............................... Add lines 6 + 9 + 10 $ 10,260.21 $ 15,477.57 _ J 1 $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 12,803.21 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 5849.00 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 00 from Column B of your last reported in Column B. 15. Cash Payments .................................. :............... Column A, Line 6 above 10,260.21 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 8392.00 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 $ 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 $ 5000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded Statement covers period ry to whole dollars. CALIFORNIA t from Oct. 1, 2012 a - SEE INSTRUCTIONS ON REVERSE through Oct. 20,2012 Page of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED ( COMMITTEE,ALS I.D. NUMBER) DE O CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE OF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Sam Alhadeff OIND Attorney 7COM 375.00 375.00 10/1/12 13371 Summit Circle 70TH Poway, CA 92064 ❑ PTY ❑ SCC Brookfield California Land Hold LLC ❑IND 10/1/12 12865 Pointe Del Mar Ste. 200 ❑COM 250.00 250.00 Del Mar, CA 92014 BOTH ❑ PTY ❑ SCC Daniel Yoo ®IND Consultant ❑COM 100.00 100.00 10/9/12 1742 Stoner Ave. Unit 1 El OTH Los Angeles, CA 920025 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM []OTH ❑ PTY ❑ SCC SUBTOTAL$ 725.00 Schedule A Summary 'Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - individual (Include all Schedule A subtotals.) ......................................................................... ............................... $ 725.00 COM— Recipient Committee (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 124.00 OTH — Other (e.g., business entity) PTY — Political Party 3. Total monetary contributions received this period. SCC -Small Contributor committee Add Lines 1 and 2. Enter here and on the Summa Page, Column A, Line 1. 849.00 ( Summary 9 ) ....................... TOTAL $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Type or print in ink. SCHEDULE B - PART 1 Schedule B — Part 1 Amounts may be rounded Statement covers period CALIFORNIA Loans Received to whole dollars. from Oct. 1 2012 FOR • 1 SEE INSTRUCTIONS ON REVERSE through Oct. 20,2012 Page of 7 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 IF AN INDIVIDUAL, ENTER a (b) (c) (4) (e) M (g) FULL NAME, STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D.NUMBER) NAMEOF BUSINESS) PE IOD PERIOD THIS PERIOD" PERIOD PERIOD LOAN TO DATE Chuck Washington Airline Pilot ❑ PAID CALENDARYEAR 31205 Kahwea Rd. $ 00.00 $ 5000.00 0.00 $ 5000.00 $ 5000.00 Temecula, CA 92591 ❑FORGIVEN RATE PERELECTION" $ 00.00 $ 5000.00 $ 00.00 na $ 00.00 10/15/12 $ to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION ** t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION $ $ $ $ $ t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 5000.00$ 00.00 $ 5000.00 $ 00.00 (Enter (e) on Schedule B Summary Schedule E, Line 3) 1. Loans received this period ............................. ....................................................... ............................... $ 5000.00 (Total Column (b) plus unitemized loans of less than $100.) tContributor Codes 00.00 IND—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 3. Net change this period. Subtract Line 2 from Line 1. 5000.00 SCC —Small Contributor Committee 9 p ( ) ................................ ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. (Ma be a ne number) *Amounts forgiven or paid by another party also must be reported on Schedule A. *` If required. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E Type or print in ink. SCHEDLILEE Pa I7letltS fade Amounts may be rounded Statement covers period e . , I • I y to whole dollars. Oct. 1, 2012 • from SEE INSTRUCTIONS ON REVERSE through Oct. 20,2012 page of NAME OF FILER LD. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID AB Mailing Solutions 42066 Avenida Alvarado Ste. Q LIT 3703.72 Temecula, CA 92590 Print Kwik Signs 31285 Temecula Parkway CMP 806.92 Temecula, CA 92590 Innovative Political Solutions 27315 Jefferson Ave. Ste. J -34 CNS 175.00 Temecula, CA 92590 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 4685.64 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 10,236.20 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 24.01 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ................................................ ............................... $ 00.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A Line 6.) TOTAL $ 10,260.21 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule E Type or print in ink. SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period . to whole dollars. • ' Payments Made from Oct. 1, 2012 • - �/7 SEE INSTRUCTIONS ON REVERSE through O ct. 20'2012 Page � of ` NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Fred Lamb Designs 28481 Rancho California Rd. Ste. 101 LIT 5550.56 Temecula, CA 92590 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 5550.56 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Recipient Committee co VER PAGE Campaign Statement Type or print in ink. Date stamp �. I Cover Page ' ' � � (Government Code Sections 84200-84216.5) �C�� Statement covers period Date of election if applicable: Page � of � from JUIy 1, 2012 (Month, Day, Year) �CT' 0�"j '101'l For otticia� use onry SEE INSTRUCTIONS ON REVERSE through September 30 , 2��2 11/6/12 '� ��(,$ �p'�'� 1. Type of Recipient Committee: au commi�c�$-comPiete Par� �, s, s and 4. Z . Type of Statement: � Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure . � Preelection Statement , ❑ Quarterly Statement Q State Candidate Election Committee Committee ❑ Semi-annual Statement � Special Odd-Year Report Q Recall Q Controlled (AlsoComplefePaRS) S onsored ❑ TerminationStatement ❑ SupplementalPreelection � 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 PoliticalParty/CentralCommittee (AlsoCompletePart7) 3. Committee Information I.D. NUMBER Treasurer(s) 1236008 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Chuck Washington City Council 2012 Kathy Washington MAILING ADDRESS 31205 Kahwea Rd. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 31205 Kahwea Rd. Temecula CA 92591 951 699-5706 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 951699-5706 MAILING ADDRESS (IF DIFFERENT) N0. 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 951 699-7786 951 699-7786 4. 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 certity under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct. / i - Executed on I O + `�/i � By � � e Si a reof surer Treesurer /�J � � Z� � Executed on gy Dete SignatureofControlling ceholder,Candidate eMe ntorResponsiWeOfficerofSponsor Executed on ' gy Date Signature of Controliing Officeholder, Candidate, State Measure Proponent Executed on gy Date SignatureotControllingOfficeholder,Candidate,StateMeasureProponent FPPC FOnn 460 �JanUary/05) FPPC Toll•Free Helpiine: 866/ASK-FPPC (866/2753772) State of Caiifornla Type or print in ink. COVERPAGE-PART2 Recipient Committee Campaign Statement � � � � � • 1 Cover Page — Part 2 Page 2 of (Z 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Chuck Washington OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION � SUPPORT City Council Temecula ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREE� CITY STATE ZIP 31205 Kahwea Rd. T CA 92591 �dentify 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 N0. IF ANY contributlons or make expenditures ott behall of your candidacy. COMMITTEENAME I.D. NUMBER NAMEOFTREASURER CONTROLLEDCOMMITTEE7 7. Primarily Formed Candidate/OfficeholderCommittee Listnamesof o�ceholder(sJ or candidate(s) for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ 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 COMMITfEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach coniinuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (666/275J772) State of Callfornla Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Amounts may be rounded Statement covers period �- Summary Page to Wno�a ao��a�s. �� from July 1, 2012 •' SEE INSTRUCTIONS ON REVERSE through Sep 30 , 2��2 page � of �� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR � (FROMATTACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and 11 846.00 14,369.00 General Elections 1. Monetary Contributions ........................................... scnedu�e a Line 3 $ � $ oo.o0 00.00 1/1 through 8/30 7/1 to Date 2. Loans Received ...................................................... scneduie a Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... .4dd �ines �+ 2 $ 11,846.00 $ 14,369.00 20. Contributions 1547.89 3955.27 Received $ $ 4. Nonmonetary Contributions .................................... scnedu�e c Line 3 21, Expenditures 5. TOTALCONTRIBUTIONSRECEIVED ......•..•..••...........•.Add�ines3+4 $ 13393.89 $ 18324.27 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... scneduie e Line 4 $ 4967.36 g 5217.36 Candidates 7. Loans Made ............................................................. scned��e H Line 3 00.00 00.00 4967.36 5217.36 22• Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add �ines s+ 7 $ $ (If SubJectto Voluntary Expendlture Limlt) . 9. Accrued Expenses (Unpaid Bills) ............................... scnedu�e F �ine s 00.00 00.00 Date of Eiection Total to Date 10. Nonmonetary Adjustment .......................................... scnedu�e c Line 3 00.00 00.00 (mm/dd�yy) 11. TOTAL EXPENDITURES MADE .................................4dd �ines 8+ s+ �o $ 4967.36 $ 5217.36 _ J � $ Current Cash Statement �� $ 12. Beginning Cash Balance ....................... Pre�roussummaryPage line 16 g 5924.57 To calculate Column B, add 13. Cash Receipts Column A, �ine 3 above 11 ,846.00 amounts in Column A to the ................................................... 00.00 coResponding amounts *Amounts in this section may be different from amounts 14. MiSCeilaneous InCreases to Cash ........................... Schedule l, Line a from Column B of your last �ported in Column B. . 4967.36 report. Some amounts in 15. Cash Payments .................................................. coiumn A Lme 8 above Column A may be negative 16. ENDING CASH BALANCE .......... Add �ines �2 + �3 + �4 , then su6tract Line 15 $ 12,803.21 figures that should be subtracted from previous If this is a termina6on statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Scnedu�e e Part 2 $ 00.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts arom Lines 2 , � and 9(if 18. Cash EqUivalentS ........................................ See instructions on reverse $ 00.00 y �� 19. OUtStafldlflg D@btS ......................... Add Line 2+ Line 9 in Column B above $ ��.� FPPC Form 460 (Januery/O5) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) SC�'1@C�U�@ A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded Statement covers period ry to whole doilars. • - � • ' from July 1, 2012 ' � . SEE INSTRUCTIONS ON REVERSE through Sep 30 , 20� 2 page ` of �� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR �F AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITTEE,ALSOENTER�.D.NUMBER) CODE * OCCUPATIONAND EMPLOYER RECEIVED THIS CALENDAR YEAR TODATE � (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 31) (IF REQUIRED) OF BUSINESS) Temecula Creek Inn ❑IND 7/18/12 17550 Bernardo Oaks Dr. ❑COM 1000.00 1000.00 San Diego, CA 92128 00TH ❑ PTY ❑ SCC Jeff Stone for Supervisor #1256228 ❑ � N � 7/19/12 5041 La Mart Drive Ste. 110 BCOM 1000.00 1000.00 ❑ OTH Riverside, CA 92507 ❑ PTY ❑scc Gre o McGuff �IND g ry ❑coM Home Builder 500.00 500.00 8/3/12 11920 N. Riviera ❑OTH Irvine, CA 92782 ❑ pTY ❑ scc David Dillon OcoM Self Employed 7/15/12 43517 Ridge Park Dr. Ste. 200 �OTH Urban Logic Consultants 500.00 500.00 Temecula, CA 92590 ❑ PTY " ❑ scc Gary & Yolanda Thornhill aIND Consultant 8/21/12 41861 Corte Valentine ❑coM 100.00 100.00 Temecula, CA 92592 ❑OTH ❑ PTY ❑ SCC SU BTOTAL$ 3100 . Schedule A Summary *ContributorCodes 1. Amount received this period - itemized monetary contributions. irvo-mdividuai (Include all Schedule A subtotals.) ........................ 11,400.00 COM-RecipientCommittee ................................................................................ $ (other than PTY or SCC) " 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 446.00 OTH - Other (e.g., business entity) PTY - Political Party 3. Total monetary contributions received this period. scc-smau contributorcommittee Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Line 1. 11,846.00 � ry 9 ) ....................... TOTAL $ FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772) .SCf'18dU�@ A�CiOfltlfll18t10�'1 .S�'1@@t� Type or print in ink. SCHEDULE A(CONT.) Monetary Contributions Received Amounts may be rounded Statementcovers period �. to whole dollars. � � � ' from �uly 1, 2012 • - through Sep 30 , 2012 page�,L of� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED PFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 31) (IF REQUIRED) OF BUSINESS) Allen & Patsy Orr 01ND Retired 7/18l12 27668 Sanderling Way ❑coM 100.00 100.00 Temecula, CA 92591 ❑OTH ❑ PTY ❑ SCC William & Elizabeth Bibb 01ND Retired 7/18/12 32037 Calle Marquis ❑coM 100.00 100.00 Temecula, CA 92592 ❑OTH ❑ PTY -- ❑ SCC WalterAllen �IND Architect 7/18/12 42200 Chaparral Drive ❑COM 100.00 100.00 Temecula, CA 92592 ❑OTH ❑ PTY ❑ SCC James Mitchell 01ND Retired 8/21/12 31915 Rancho California Rd. ❑COM 200.00 200.00 Temecula, CA 92591 ❑OTH ❑ PTY ❑ SCC John & Kim Kelliher �� Small business owner 8/20/12 29909 Corte Castille ❑COM Grapevine Shuttle 100.00 100.00 Temecula, CA 92591 ❑oTH ❑ PTY ❑ SCC SUBTOTAL $ 600.00 ° *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party FPPC Form 460 (January/05) SCC—Small Contributor Committee FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A,(Continuation Sheet) Type or print in ink. SCHEDULE A(CONT.) Monetary Contributions Received Amounts may be rounded Statementcovers period to whole dollars. • � � ' � from July1,2012 •- • tnrougn September30 20'� page� of I� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE* OCCUPATIONANDEMPLOYER RECEIVEDTHIS CALENDARYEAR TODATE (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 31) (IF REQUIRED) OF BUSINESS) � Ruth Ann Deakins �coM Sales 8/21/12 44024 Quiet Meadow Road ❑orH 100.00 100.00 Temecula, CA 92592 ❑ Pn ❑ scc Fred & Linda Bartz �IND Retired 8/21/12 33850 Sattui Street ❑COM 500.00 500.00 ❑ OTH Temecula, CA 92592 � Pn ❑ scc Gerald & Pamela Williams �IND Retired 8/21/12 41260 Billy Joe Lane ❑coM 250.00 250.00 ❑ OTH Temecula, CA 92592 � pn ❑ scc Matthew Fagan Consulting Services ❑IND 8/21 /12 ❑ COM 150.00 150.00 42011 Avenida Vista Ladera �OTH Temecula, CA 92591 � Prr ❑ scc Waypoint Property Group, LLC ❑IND 8/20/12 240 Newport Center Dr. Ste. 200 �� 500.00 500.00 m orH Newport Beach, CA 92660 ❑ Pn ❑ scc SUB 1 500 � �� '� - *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275�772) 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. Ju) 1 2012 '•- ��' from y ' tnrou9n September 30 20'� page� of� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * OCCUPATIONAND EMPLOYER RECEIVED THIS CALENDAR YEAR TODATE (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 31) (IF REQUIRED) � OF BUSINESS) Michael McMitlan �coM Property Manager 8/14/12 2g459 Old Town Front St. �oTH 400.00 400.00 Temecula, CA 92590 ❑ PN ❑ scc Albert A. Webb Associates ❑IND 8/7/12 3788 McCray St. ❑coM 500.00 500.00 � OTH Riverside, CA 92506 � Pn ❑ scc Mira Loma Recovery, LLC ❑IND 7/23/12 �COM 250.00 250.00 7536 Lolina Lane �OTH Los Angeles, CA 90046 � Pi ❑ scc Redhawk Investments, LLC ❑IND 7/23/12 45621 Corte Royal mOTH 500.00 500.00 Temecula, CA 92592 � pn ❑ scc Robert & Cheryl Alkema �IND Retired 7/18/12 �o�H 250.00 250.00 26975 Via Santa Rosa Temecula, CA 92590 ❑ pN ❑ scc SUB TOTAL $ 1900.00 ' *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 ContributorCommittee FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275�772) Schedule A(Continuation Sheet) Typeorprintinink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statementcovers perioa �. towholedollars. Jul 1 2012 '�- �� from y ' tnrough September 30, 201a page � ot t 2 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR �F AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION (IFCOMMITTEE,ALSOENTERI.D.NUMBER) OCCUPATIONANDEMPLOYER RECEIVEDTHIS CALENDARYEAR TODATE RECEIVED CODE * (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND Texas Lil's Corporation 01 ❑COnn 8/14/12 2g495 Old Town Front St. �oTH 500.00 500.00 Temecula, CA 92590 ❑ Pn ❑ scc Committee to Elect Jeff Comerchero ❑IND 8/21/12 41961 Avenida Vista Ladera �coM 500.00 500.00 ❑ OTH Temecula, CA 92591 #971702 p Pn p scc Rebecca Hardon-Omdahl OcoM Consultant $�2��12 9201 Cedar Trails Lane ❑oTH 100.00 100.00 Valley Center, CA 92082 ❑ PTY ❑ scc Burke Strunsky & Geraldine Schumacher �COM Energy Consultant 8/21/12 27630 Morning Glory Circle �OTH 2O0.00 200.00 Temecula, CA 92590 p Pn ❑ scc Highpoint Monte Verde, LLC ❑IND 8/27/12 20 Enterprise Ste. 320 �� 500.00 500.00 � OTH Aliso Viejo, CA 92656 ❑ PN ❑ scc SU BT O TAL$ 1800 � *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 ContributorCommittee FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275�772) Schedule A(Continuation Sheet) Type or print in ink. SCHEDULE A(CONT.) Monetary Contributions Received Amounts may be rounded Statementcovers period �. , to whole dollars. � • ' from �uly 1, 2012 • - tnrougn September 30, 20'� page �� ot ` NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE* OCCUPATIONANDEMPLOYER RECEIVEDTHIS CALENDARYEAR TODATE (IFSELF-EMPLOYED,ENTERNAME PERIOD (JAN. 1- DEC. 3�1) (IF RE�UIRED) OF BUSINESS) CDF Firefighters #790318 ❑�ND 8/27/12 � COM 1000.00 1000.00 1731 J Street Ste. 100 ❑ OTH Sacramento, CA 95811 ❑ PN ❑ sCC Melissa Lippert & Fausto Atilano �COM Small business owner 8/15/12 39865 Calle Medusa ❑OTH Fausto's Bail Bonds 500.00 500.00 Temecula, CA 92591 � Pn ❑ scc CR & R ❑IND 7/18/12 � oTH 1000.00 1000.00 11292 Western Ave. Stanton, CA 90680 ❑ pn ❑ scc ❑IND ❑ COM ❑ OTH ❑ PN ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 2500.00 'Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party FPPC Form 460 (Januaryl05) SCC — Small Contributor Committee FPPC Toll-Free Helpline: 866lASK-FPPC (8661275-3772) Schedule C Type or print in ink. Nonmoneta Contributions Received Amounts may be rounded P SCHEDULE C Statement covers eriod , n/ to whole dollars. �' �• t from July 1, 2012 • - SEE INSTRUCTIONS ON REVERSE tnrou9n September 30, 2� page �� of � 2 ' NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 IFAN INDIVIDUAL, ENTER AMOUNTI CUMULATIVE TO FULL NAME, STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE PER ELECTION DATE * OCCUPATION AND EMPLOYER FAIR MARKET TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE (IFSELF-EMPLOYED,ENTER GOODSORSERVICES CALENDAR YEAR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) VALUE ��qN 1- DEC 31) (IF REQUIRED) Rosa's Cantina ❑IND Food for 8/21/12 2g636 Old Town Front St. ❑COM fundraiser 147.89 147.89 Temecula, CA 92590 �OTH ❑ PTY ❑ SCC 8�22��2 Matthew Fagan ❑COM Musician Music for 150.00 150.00 42011 Avenida Vista Ladera ❑OTH fundraiser Temecula, CA 92591 �p�. ❑ SCC Stephen Bieri �COM Land Developer Box at Padre 1150.00 1150.00 8�22��2 16935 W. Bernardo Dr. Ste. 190 �OTH Games for San Diego, CA 92127 � fundraiser ❑ SCC ❑IND ❑COM � ❑ OTH ❑ PTY ❑ SCC � ..;� .., . Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 1447.89 Schedule C Summary • Contributor Codes 1. Amount received this period - itemized nonmonetary contributions. �N�-�ndividua� (Include all Schedule C subtotals.) ...................................................................................................................:. $ 1447.89 COM—RecipientCommittee 100.00 (other than PTY or SCC) 2. Amount received this period - unitemized nonmonetary contributions of less than $100 ..............................:..... $ OTH — Other (e.g., business entity) PTY — Political Party 3. Total nonmonetary contributions received this period. scc-smali contributorcommittee Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Lines 4 and 10. 1547.89 � �Y 9 ) ...................... TOTAL $ FPPC Form 460 (January/05) FPPC Toll-Free Helpline: S66/ASK-FPPC (8661275-3772) Schedule E Type or print in ink. SCHEDULEE Amounts may be rounded Statement covers period , I Pa ments Made � � � y to whole dollars. July 1, 2012 �' from SEE INSTRUCTIONS ON REVERSE through Sep 30 , 2012 page (� of �� NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP campaign paraphemalialmisc. MBR membercommunications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFU retumed 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 PI-10 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 (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE OR DESCRIPTIONOFPAYMENT AMOUNTPAID City of Temecula 41000 Main Street FIL 1125.00 Temecula, CA 92590 Print Kwik Signs 31285 Temecula Parkway CMP . 1481.56 Temecula, CA 92590 I Like Mike Reimbursment for expenses (voter registration list, 46450 Durango Dr. CMP Padre game fundraiser, sign stand construction) 991.00 Temecula, CA 92590 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3597.56 Schedule E Summary 1. Itemized a ments made this eriod. Include all Schedule E subtotals. ........................................................ � 4967.36 P Y p � ) ...................................................... 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ 00.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $ 00.00 4. Total a ments made this eriod. Add Lines 1, 2, and 3. Enter here and on the Summa Pa e, Column A, Line 6. 4967.36 P Y P � rY 9 ) ............................. TOTAL $ FPPC Form 460 (January105) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Type or print in ink. SCHEDULE E(CONT.) �CO�'1t117UatlOtl SIl@@t� Amountsmayberounded Statementcoversperiod � �. � Payments Made to Wno�e ao��a�. from I•' July 1, 2012 •' SEE INSTRUCTIONS ON REVERSE through Sep 30 , 2012 Pa9e ' 7 of 1Z !� NAME OF FILER ' I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 CODES: If one of the foliowing codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphemalia/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 PEf petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks 1RC 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)" P0.S 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 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Continuing the Republican Revolution #598041 Slate Mailer 1300 Bristol Street North Ste. 100 CMP 500.00 Irvine, CA 92660 Innovative Political Solutions 27315 Jefferson Ave. Ste. J-34 CNS 619.80 Temecula, CA 92590 Birdies for Bread 32552 Bergamo Court CVC 100.00 Temecula, CA 92592 Parker Kelliher Sign installation 29909 Corte Castille CMP 150.00 Temecula, CA 92591 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1369.80 FPPC Form 460 (Januaryl05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Recipient Committee COVER PAGE Campaign Statement Type or print In Ink. Date stamp Cover Page RECEIVED (Government Code Sections 84200 - 84216.5) Page ( of 7 Statement covers period Date of election if applicable: 1JULI 2 3 2012 from January 1 , 2012 (Month, Day, Year) For Official Use Only C ITY CLERKS Deter. SEE INSTRUCTIONS ON REVERSE through June 30, 2012 1. Type of Recipient Committee All Committees — Complete Parts 1 , 2, 3, and 4. 2. Type of Statement: LZ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee Semi - annual Statement ❑ Special Odd -Year Report Q Recall Q Controlled Termination Statement (Also Complete Part 5) O Sponsored ❑ Also file a Form 410 Termination ❑ Supplemental Preelection (Also Complete Part 6) (Also Statement - Attach Form 495 ❑ General Purpose Committee ❑ Amendment (Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1236008 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Chuck Washington Kathy Washington MAILING ADDRESS 31205 Kahwea Rd. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 31205 Kahwea Rd. Temecula CA 92591 (951) 699 -5706 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 (951) 699 -5706 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 (951) 699 -7786 (951) 699 -7786 4. Verification I have used all reasonable diligence in preparing and reviewing this statement an he�best y kn edge the information contained rein 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 forego' g is true and corr Executed on :!P I z-- By Date i re re rorAs to easurer Executed on 7�z 3 1 1 Z s Date \ Signature ofControlllngZWIv Candidate,State eas re Prop onento rResponsible0fficerofSponsor Executed on By Date Signature of Controlling Officeholder, ndidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) State of California Recipient Committee Type or print in ink. COVER PAGE -PART2 Campaign Statement � CALIF � • 1 Cover Page — Part 2 Page 2 of 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Chuck Washing OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT C Cou Temecula I ❑ OPPOSE RESIDENTIAL /BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 3 1205 K Rd. Temecula CA 92591 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 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 F YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276 -3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period - Summary Page to whole dollars. � � � ' from January 1, 2012 FOR SEE INSTRUCTIONS ON REVERSE through June 30, 2012 Page 3 of 7 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington 1236008 Contributions Received Column Column Calendar Year Summary for Candidates T ATTACHED PERIOD C Runni in Both the State (FROM ATTACAC TOTALT HED SCHEDULES) TOTALTO DATE DATE unnn g •7 Prima and 1. Monetary Contributions ............ ............................... Schedule A Line 3 $ 2523.00 $ 2523.00 General Elections 2. Loans Rec eived ....................... ............................... Schedule B, Line 3 00.00 00.00 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 2523.00 $ 2523.00 20. Contributions 4. Nonmonetary Contributions ..... ............................... Schedule C line 3 2407.38 2407.38 Received $ $ 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ....... .................... Add Lines 3 +4 $ 4930.38 $ 4930.38 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... Schedule E line 4 $ 250.00 $ 250.00 Candidates 7. Loans Made .............................. ............................... Schedule H Line 3 00.00 00.00 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add lines 6 + 7 $ 250.00 $ 250.00 22• Cumulative Expenditures Made* (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 ........... ............................... Schedule C Line 00.00 00.00 (mm /dd /yy) 11. TOTAL EXPENDITURES MADE . ............................... Add lines s + 9 + 10 $ 250.00 $ 250.00 $ Current Cash Statement $ 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 3651.57 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 2523.00 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. 00 report. Some amounts in 15. Cash Payments ................... ............................... Column A, Line 6 above 250. Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14 then subtract Line 15 $ 5924.57 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 $ 00.00 for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts an Lines 2, 7, ands (if 18. Cash Equivalents ......... ............................... See instructions on reverse $ 00.00 y) 19. Outstanding Debts ......................... Add line 2 + Line 9 in Column 8 above $ 00.00 FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Type or print in ink. SCHEDULE A Monetary ontributions Received Amounts may of rounded Statement covers period ry to whole dollars. CALIFORNIA from January 1, 2012 FORM • SEE INSTRUCTIONS ON REVERSE through June 30, 2012 Page I of 7 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington 1236008 FULL NAME STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION , DATE CONTRIBUTOR (IF COMMITTEE ALSO ENTER OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE , . . RECEIVED CODE (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND Creekside Gas & Food Mart ❑COM 5/23/12 2911.5 Old Town Front St. W] OTH $250.00 $250.00 Temecula, CA 92590 ❑ PTY ❑ SCC ❑ IND Dual Development Inc. ❑COM 5/23/12 43080 Calle Camellia ®OTH $500.00 $500.00 Temecula, CA 92592 ❑ PTY ❑ SCC WIND James Mitchell ❑Conn Retired 5/23/12 31915 Rancho California Rd. ❑OTH $100.00 $100.00 Temecula, CA 92591 ❑ Pn' ❑ SCC Larchmont Park LLC ❑IND 5 9201 Cedar $150.00 $150.00 9201 Cedar Trails Lane W1 OTH Valley Center, CA 92082 ❑ PTY ❑ SCC Terry L Whitington, Jr. ®IND 5/23/12 39437 Country Mill Rd. ❑COM Retired $100.00 $100.00 ❑ OTH Murrieta, CA 92562 ❑ PTY ❑ SCC SUBTOTAL$ 1100.00 Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (Include all Schedule A subtotals.) ......................................................................... ............................... $ 2150.00 COM- Recipient Committee (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 373.00 OTH - other (e.g., business entity) PTY — Political Party 3. Total monetary contributions received this period. SCC -Small Contributor committee Add Lines 1 and 2. Enter here and on the Summa Page, Column A, Line 1. TOTAL $ 2523.00 (Add g ) FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period -7 111111111111111 • . to whole dollars. ' from January 1, 2012 • - through June 30, 2012 Page 5 of "_ NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington 1236008 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Doug and Lynelle Misemer ® ❑ IoM Contractor 5/23/12 40774 Baccarat Rd. ❑CO $250.00 $250.00 Temecula, CA 92591 ❑ PTY ❑SCC Alice & Sam Yoo ®IND Engineer 5/23/12 39679 Ashland Way ❑IoM $500.00 $500.00 ❑ OTH Murrieta, CA 92592 ❑ PTY ❑ SCC 5/25/12 Julie Ngo & Trunghau Dang ®❑IoM Insurance Broker 29926 Corte Tolano ❑OTH $200.00 $200.00 Temecula, CA 92591 ❑ PTY ❑ SCC Larry & Joann Markham ®IND Consultant 5/23/12 30105 Cabrillo Ave. ❑IoM $100.00 $100.00 ❑ OTH Temecula, CA 92592 ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 1050.00 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Contributor Committee FPPCForm43772) ( FPPC Toll-Free Helpline: 866 /ASK -FPPC (866/275 661275-3772) Schedule C Type or print in ink. Amounts may be rounded SCHEDULE C N0�7monetary Contributions Received to whole dollars. State Ja nuary 1, n uary !, period 2012 CALIFO A from a FORM • SEE INSTRUCTIONS ON REVERSE through June 30, 2012 page 6 of 7 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington 1236008 ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT/ CUMULATIVE TO PER ELECTION FULL NAME, STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE DATE CODE * OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER VALUE CALENDAR YEAR NAME OF BUSINESS) (JAN 1 -DEC 31) (IF REQUIRED) The Brewer Boys Music E] Music for 5/23/12 41540 Avenida Rancho Vista ®OTH fundraiser $400.00 $400.00 Temecula, CA 92592 ❑ pN ❑SCC 5/23/12 Temecula Creek Inn ❑COD Banquet room & 44501 Rainbow Canyon Rd. ®OOH catering for $2007.38 $2007.38 Temecula, CA 92592 El PTY fundraiser ❑SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attac additional information on appropriately labeled continuation sheets. SUBTOTAL $ 240 Schedule C Summary •Contributor Codes 1. Amount received this period — itemized nonmonetary contributions. IND - Individual (Include all Schedule C subtotals.) ...................................................................................... ............................... $ 2407.38 COM- Recipient Committee 0000 (other than PTY or SCC) 2. Amount received this period — unitem . ized nonmonetary contributions of less than $100 ..... ............................... $ OTH — Other (e.g., business entity) PTY— Political Party 3. Total nonmonetary contributions received this period. SCC -Small contributor committee Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10. TOTAL $ 2407.38 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) Schedule E Type or print in ink. SCHEDULEE Amounts may be rounded Statement covers period I Payments Made to whole dollars. • ' from January 1, 2012 F ORM SEE INSTRUCTIONS ON REVERSE through June 30, 2012 Page 7 of 7 NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington 1236008 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 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 I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Temecula Valley Chamber of Commerce Chamber of Commerce membership 26790 Ynez Ct. Ste. A $250.00 Temecula, CA 92591 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 250.00 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 250.00 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 00.00 3. Total interest aid this Enter amount from Schedule B, Part 1, Column (e). 00.00 period on loans. P P)) ................................................ ............................... $ 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 250.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)