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HomeMy WebLinkAbout2015 Recipient Committee Type or print in ink. Date Stamp e !Fo!r!Oi! Campaign StatementCoverPage (Government Code Sections 84200-84216.5) iRECEMED Statement covers period Date of election if applicable:January 1, 2015 (Month, Day, Year) MAR :1.6 2015 Page of from fcial Use Only SEE INSTRUCTIONS ON REVERSE March 13, 2015 CITY CLERKS DEP'l through 1. Type of Recipient Committee: All Committees-complete Parts 1,2,3,and 4. 2. Type of Statement: ® Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee ❑ Primarily Formed ❑ Semi-annual Statement ❑ Special Odd-Year Report ❑ Recall ❑ Controlled © Termination Statement ❑ Supplemental Preelection (Also ComptetePad 5) ❑ Sponsored ❑ Amendment(Explain below) Statement-Attach Form 495 (Also Complete Parts) ❑ General Purpose Committee ❑ Sponsored ❑ Primarily Formed Candidate/ ❑ Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also comptele Part]) 3. Committee Information LID NUMBER NUMBER 12 Treasurers) 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 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 CODEIPHONE OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS 951-699-7786 951-699-5706 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. Executed on 6/1,5/1 5 1, ) 3 tureof Tre rn Assistant Treaty er Executed on /� J` By Date SigmtumOCo L MMIderuar,71e,bmtemeasumvmponentaResmnsiUeO iiwrof Sponsor Executed on By Date SignaWre of Controlling Officeholder,Candidate,Slate Measure Proponent Executed on By FPPC Form 460(June/01) Dale Signature of Controlling Otticeholtler,Candidate,Stele Measure Proponent FPPC Toll-Free Helpllne:666/ASK-FPPC State of California Recipient Committee Type or print in ink. COVER PAGE-PART2 CALIFORNIA Campaign Statement FORM 4 • 1 Cover Page—Part 2 �J Page `� of N 6. Officeholder or Candidate Controlled Committee 6. 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 I 1 ❑ 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 DISTRICT NO not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD . IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO PO.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(June/01) FPPC Toll-Free Helpline:866/ASK-FPPC 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. e ' from January 1, 2015 •- SEE INSTRUCTIONS ON REVERSE through March 13, 2015 Page 3 Of NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 Contributions Received ColumnA Column B Calendar Year Summary for Candidates iATTACHEHDSCHETOTAIT DATE Running in Both the State Prima and (FROM ATAL PERIODULEe)D C ALEND RYEA g Primary 1. Monetary Contributions ........................... _.......... .. Schedule A,u 762.62 762.62 General Elections Line $ $ 2. Loans Received ....................................._.........._... Schedule E,Line 5000.00 -5000.00 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ... ....... ............. Add Lines 1,2 $ -4237.38 $ -4237.38 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule c,Line 3 00.00 00.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED _ _. Add Lines 3+4 $ -4237.38 $ -4237.38 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made.................................. .................... Schedule E,Line 4 $ 500.00 $ 500.00 Candidates 7. Loans Made............................................................. Schedule H,Line 3 00.00 00.00 500.00 500.00 22. Cumulative Expenditures Made` 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ $ (If Subject to voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ...............................Schedule F Line 3 00.00 00.00 Dale 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 a+9+io $ 500.00 $ 500.00 $ Current Cash Statement $ 12. Beginning Cash Balance....................... Previous Summary Page,Line 16 $ 4737.38 To calculate Column B,add $ 13. Cash Receipts ................................................... Column A,Line 3 above -4237.38 amounts in Column A to the 00.00 corresponding amounts 14. Miscellaneous Increases to Cash........................... Schedule 1,Line 4 from Column B of your last $ 15. Cash Payments......._... 500.00 report. Some amounts in ..................................... Column A,Line&above Column A may be negative 16. ENDING CASH BALANCE.......... Add Lines 12+13+14,then subtract Line 15 $ 00.00 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 'Since January 1,2001. Amounts in this section may be Cash Equivalents and Outstanding Debts from Lines 2, 7,and 9(if different from amounts reported in Column B. 4 9 any). 18. Cash Equivalents........................................ See instructions on reverse $ 00.00 19, OutstandingDebts.. Add Line 2+Line 9 in Column B above $ 00.00 FPPC Form 460 June/01 ( ) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers eriod Monetary Contributions Received to whole dollars. pCALIFORNIA from January 1, 2015 FORM • SEE INSTRUCTIONS ON REVERSE through March 13, 2015 Page 77 of 6 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,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) OFBUSINESS) 3/13/15 Chuck Washington ®❑COD IND County Supervisor 762.62 762.62 31205 Kahwea Rd. ❑OTH Riverside County Temecula, CA 92591 ❑PTY [-]SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 762.62 Schedule A Summary "Contributor Codes 1. Amount received this period—contributions of$100 or more. IND-Individual (Include all Schedule A subtotals.)........................................................................................................ $ 762.62 COM-RecipientCommittee (other than PTY or SCC) 2. Amount received this period—uniternized contributions of less than$100............................................. $ 00.00 OTH-Other PTY-Political Party 3. Total monetary contributions received this period. SCC-Small Contributor committee Add Lines 1 and 2. Enter here and on the SummaryPa TOTAL $ 762.62 ( 9e, Column A, Line 1.) FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866IASK-FPPC Schedule B- Part 1 Type or print in ink. Statement covers period SCHEDULEB-PART1 Amounts may be rounded P CALIFORNIA Loans Received to whole dollars. from January 1, 2015 FORM 4// • SEE INSTRUCTIONS ON REVERSE through March 13, 2015 Page 5 of b NAME OF FILER I.D. NUMBER Committee to Elect Chuck Washington City Council 2012 1236008 IF AN INDIVIDUAL, ENTER a Ibl (c) (a) (e) Ip (9) FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE AMOUNT PAID 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) NAM E OF BUSINESS) PERIOD THIS PERIOD` PERT D PERIOD PERIOD LOAN TO DATE Chuck Washington County Supervisor R PAID CALENDARYEAR 31205 Kahwea Rd. Riverside County s 4237.38 $ 00.00 0.00 % $ 5000.00 $ 00.00 Temecula, CA 92591 R FORGIVEN RATE PER ELECTION` $ 5000.00 $ 00.00 $ 762.62 NA $ 00.00 10/15/12 $ t® IND ❑ COM ❑ OTH ❑ PITY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDARYEAR E $ _% E $ ❑FORGIVEN RATE PER ELECTION" t $ $ E DATE DUE E DATE INCURRED $ ❑ IND ❑ COM ❑ OTH ❑ PTV ❑ SCC ❑PAID CALENDAR YEAR E $ % $ $ ❑FORGIVEN RATE PER ELECTION" E $ $ $ $ t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 00.00 $ 5000.00 $ 00.00 $ 00.00 (Enter(e)on Schedule B Summary Schedule E,Line 3) 1. Loans received this period.................................................................................................................... $ 00.00 `Amounts forgiven or paid by (Total Column(b)plus unitemized loans less than$100.) another party also must be 2. loans paid orforgiven this period ......................................................................................................... $ 5000.00 reported on Schedule A. (Total Column(c)plus loans under$100 paid orforgiven.) "If required. (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. Subtract Line 2 from Line 1. NET $ -5000.00 9 P ( )............................................................... Enter the net here and on the Summary Page, Column A, Line 2. (Maybe aneaacva numbep t Contributor Codes IND—Individual COM—Recipient Committee(other than PTYor SCC) OTH—Other PTY—Political Party SCC—Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Type or print in ink. SCHEDULEE Amounts may be rounded Statement covers period e_ I Payments Made to whole dollars. January 1, 2015 •0 ' from SEE INSTRUCTIONS ON REVERSE through March 13, 2015 page y 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. CfvP campaign paraphernalia/misc. MBR member communications FAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v, or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging,and meals FIND fundraising events POI- polling and survey research TRS staff/spouse travel, lodging, and meals UD 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 (FOOMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID NAACP Branch 1034 Donation PO Box 543 CVC 500.00 Lake Elsinore, CA 92531 ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 500.00 Schedule E Summary 1. Payments made this period of$100 or more. Include all Schedule E subtotals. 500.00 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. 500.00 p Y P ( rY 9 ) ............................. TOTAL $ FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC