HomeMy Public PortalAboutForm 490 (Jan 1 - Jan 16, 1999).. ,
0lfficeholder, Candidater Type orprlntlnlnk.
and Controlled Committee
Campaign Statement -Long Form
(Government Code Sections 84200-84216 S)
SEE INSTRUCTIONS ON REVERSE
CMck oru of the following boxes to Indlute the tvae of statement Delno tiled:
Pre-election Statement
Supplemental Pre-election Statement (Attach a completed Form 495 to this statement )
Special Odd-Year Campaign Report
Semi-annual Statement
Termination Statement (Attach a completed Fam 41 S to this statement.)
fc o er an f ate, an on roe ommfttee
Inclu~ed in this Statement
MAME OF OFFKEHOIDEII OR CANDEflATE 7
pl NT OA N[LD taKtUOt 1OG110N ND ON NUMata N A alt)
~~~~~ ~ , ~
asslotNruu Oa WtlNtst ADOlttff U+o. AND ST tt)
A •1 r / i
Statement courts period I Date Stamp
Irom ~ _ ~
through ` - ~U ~ GI~
Date of election ff applicable:
(Month, Day, Year)
PAGE-.LUNG FORM
RECEIVE® / ~ .~/
Page
JAN 2 1 1999 ForOflicialUseOnly
CITY OF CL~AREMONT
u>iner c.ommf[tees Not Included in this Statement: Llttanyothe-
commktees not lncludedln this consolidated statement that are controlled by you and any
committees o/which you have knowledge that art primarily loaned to rectlve contrlbutlont
a to make experdltures on behalf of your candidacy.
COMMrT1lE NAMt LD. NUMatA
~rT tTATE tl-COOf Al1tA CODE/DAYTIM[ MIONt
w mrr rcc nnm[ LD. MUMatA _,
~,, • PP zs ~~ ~~ // CSI ~s~ /~ >v~c+°l~
CONM ADOllttt tNO. AND ttA[tl)
2 2 S. I~~~ .~yC~
~Y sTAlt tl-COO! AAIA CODUDAYi1Mt -F10Nt
N OFtREASURER
l ~-c stP`' ~G~iip~eC ~l ~,
Pt11MAN[MT ADWltfsat Tw-suaa (TtO. AN tTUtT)
cONt110lltD cOMMlr1tE1
^ YTS ^ NO
coMMmu ADOUSt
(N0, ANO s/Attr1
tlTY t1A1t ZI/COOL AIItA cODt1DAY11MI -IN)Nt
coMSSmtt NAMt
NUMtrt A
NAMt 01 TI1tASl/11t11 CONIAOLLID cOMMllltt 1
^ Yts ^ No
COMMIR[I ADDIItSt (NO. ANO ST11tET)
CRY fiAlt II-CODE AR[A CODtlDAYTIMt-1/ON!
~ CNY fTATt IIP COO! AA[A COOl19AYTM1! IrrONt
C~~'y'~jl~?OY7l ( ~~ ~/ ~/~ y(/~/ ' ~~~ ~~U~~ ~ Attach addlNonal inlormatlon on approprlattly labeled contlnwtlon shetb.
er ice ion
1 have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the Met of m k ~e the Inl r ati co intd r in an the attached schedules is
true and complete. I certify and r penaky of perj under the laws of the Start of California that the loregoing I yea dt'orred.
Exetuhd on ' Z ~ -~ At (- ~ ~~~'~r-,~.~ ,f C~~ g/ ~/~ By ~
DAII - CnYANDSM ! tIGNAIURI IMASURtA
An ofllceholder a.ursdldate who controls a committee must also verify the campaign statement. 1 have used all reasonable diligence and to t knowledge the treasurer has used all
reasonable diligence In preparing this ttattmant, I have reviewed the statement and to the Mst of my knowled a the inf contai ed erei ndin th ach schedules is true and
complete. 1 certlly under penalty of perjury un r e laws of the State of /California that a fore Ing is true an c
Executed on / ~/ `` ~ At ~ L~~~J2sC~-~ /~ ~~ ~~~~ B ~*
DAT~- (nYANDSfATI SIGNAI ZANDIDAII/OI11(tHOIDlA
Executed on
oATt
At
cnY ANO s1Alc
By
LGNAlllll[ OI (ANDIDAII/OIIICIIIOI Dt11
Executed on At By __
OAIt CnY AND SIAIt
flf.Nnlnnl OI (ANpIDArr COI/RIIIr71 UI ~
1011IN/OIlMAl10N 11tOVW D 10 a[ -AOVIDtO t0 YOU 1UIItUAM 10 IHt INIOAMAiION -MC11ct 1 ACl Ot HI r. let (yl_QM~JATQI~ MAyuAI ON CAMPA14N Dlf tl QS~IP! PAOV~SIONS 01 1 ~(! -gl 111(AI Ar 1011 r.1 !IS 1
Schedule A Type or print In Ink. SC)~EDULE A
Monetar Contributions Received Amounts maybarounded Statement rovers period
y to whole dollars.
from ~ ~ ~ _
SEE INSTRUCTIONS ON REVERSE through ~ ~ ,~~ _ ~~ PaOe 'Z of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
GI~JLLI/-JM ~i(1/E3a: - e0 ~-% C~LCCi
~M, rr~c, Ta ,Q.~~ Gc~~~s ~ ~c~D ~~ ~'
FULL NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT
DATE (MCtNvIMme[.rMADOrlrOMfOCOMMR1lt'fNAMIANOA00111ff.INIIIIIONUMS[11 (~rslll•IMMOrID.ernle RECEIVED THIS CUMUTATIVETODATE CUMULATIVE TO DATE
RECEIVED Ol~lr NOI.b. NVMala r1Af a!lNAfSIGNlD,lNrta TIIIASUrIl11'f NAM[ AND ADb11ISf) NAM! a aUfMlss) PERIOD 1~ALN n1D DEC E31) (IF APPLICABLE)
~~ '~ ~~
s ~~
SUBTOTAL S ~ (~~
Monetary Contributions Summary
1. Amount received this period - contributions of S) 00 or more.
(Include all Schedule: A subtotals.) ................................................... ............................. .
2. Amount received this period - contributions of less than S )00.
~Do not itemise.) ............:........................~..... .
............................................................................
3. Total monetary contributions received this period.
g ~ Ofd.
~ 's ~.
~ 3~
(Add lines 1 and 2. Enter here and on the Summary Page, Column A, line 1.) ................................. 10TA1 S
f-
Schedule G
Payments Made by an Agent or Independent
Contractor (on Behalf of an Officeholder or
Candidate)
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts may be rounded Statement covert period
to whole dollars.
from f ~ I _ ~' G,
through
1-~7-9'~
SCHEDULE G
Page ~ of
NAME OfOFfICEHOLDERORCANDIDATEANDCONTROILEDCOMMIITEE I.O.NUMBER~/ -
lj(~l LL)/~N1 ~/L=S (: - C(/M/Vl1 FT-CC: Ta ~~ /iC C ! ~~ C.L G~~ ES t= -P-lilGf ~ 1'I
NAME OF AGENT OR INDEPENDENT CONTRACTOR
CODES FOR CLASSIFYING EXPENDITURES
If'one of the following codes accurately describes the expenditure, ou may enter the code and leave the "Description of Payment° column blank. Refer to the
.back of Schedule E-Continuation Sheet for detailed explanations ofyeach category.
'L" - LITERATURE
"B' - BROADCAST ADVERTISING
'N' - NEViISPAPERANb PERIODICAL ADVERTISING
"O" - OUTSIDE ADVERTISING
"S' - SURVEYS, SIGNATURE GATIIERING, DOOR-TO-DOOR SOLICITATIONS
"f' - FUNDRAISING EVENTS
"1' - TRAVEL, ACCOMMODATIONS AND MEALS
(MUST sE OESCRISED)
NAME AND ADDRESS OF PAYEE OR CREDITOR
(M COMMRI!!, IN AODfr10N 10 COMMRII!'f NAME ANO AOWIE SS, ENTE111.D MUhlelll 01~ Ir
NOT.D.NVYRRNASIlElNAffIGNE[I,lNIl11THlASU11E11'SNAMEANDAODIIESS) CODE OR DESCRIPiIONOFPAYMENT AMOUNT PAID
LLl1 ~ - r ~, ~ , G-cJ ~"Pf -e
Attach additional information on appropriatelylabeled continuation sheets. 101/1L• s -Z'Z ~, -
~._.
e
Campaign Disclosure Statement Type orprlntlnlnk. SUMMARY PAGE
Summer Pa a
Y 9 Amounts mar be rounded
to whole dollars. Statement covers period
Iron ~ _
- g
th
h ~ ~ ~ ~/ /./
` d `
SEE INSTRUCTIONS ON REVERSE roug page
NAME OFQEFICEHOLDERORCANDIDATEANDCONTRO DCOMMITTEE I.D.NUMBER ~
Contributions Received Column A Column e' Column C
/OIAI iHS rtr000 TOTAL MIVIOUf -EIII00 lOlAl TO DALE
OIIOM ATlAC11ID S01EDUl[!) (S[E wOTI ~[LO'MV) (ADD COlUM11S A • e)
1. Monetary Contributions ................... ............ s~hedl,k a, clue 3 s 3 'J 0 . ~~ s s 3 3 C7 . --
S Loans Received .............................. .......... ~. s<MdWle e, une ~
3. SUBTOTAL CASH CONTRIBUTIONS ........ .............. ,edldun., r . ~ f ~J 3 ~ "' s s 3 3 G --
4. Non-monetary Contributions ............. ............. ScMdiuk c, une 3
S. SUBTOTAL CONTRIBUTIONS (Exctudr Enforce able Promises) Addunesl . ~ f ~J ~ O • - s s ~J 3 O -
6. Enforceable Promises
(brduda Loan G
r
t
U
rd b
l
l .
an
na
w
ees,
e
ow
• • • • • • • • • . • • • ...... SchedlrN D, Una 7
7. TOTAL CONTRIBUTIONS RECEIVED ....... .............. Adduness . 6 : 3 30 , '~ s s 3 ~ ~ .
Expenditures Made
8. Cash Payments (Other than loans Made) ..:......... scheduN E, un. s s s s
9. loans Made ......:........................... ........... sdf.dure H une ~
10. SUBTOTAL CASH PAYMENTS .............. ............... ,addune,e . 9 s s s
11. Accrued Expenses (Unpaid Bills) ........... ............. Sd-eduN F, une s
~. TOTAL EXPENDITURES MADE ............. ............ addunes to . rr f .. i s
Current Cash Statement
13. Be~innlnp Cash Balsnce .................. Previous summary vase, cb+e rx s $-
14. Cash Receipts ...................................... Column A, Una 9 above ~3 ~J O ...~
1 S. Miscellaneous Increases to Cash ........................ Schedule ~ line a
16. Cash Payments .................................... column a, une ro above ~}
17. ENDING CASH BALANCE ..... n-deuna -9 . r~ . rs, then subhad une r6 s 3 .~ d .
M thH b a terminatlon statement une 17 must be rero. T warty usr+aAEANC! swouEo
NOf 1T A w[GATIVE AMOUM
te. LOAN GUARANTEES RECEIVED .............. ScheoLi-e e, Pert 1, Co-umn (b) E
Cash Equlvaltntx and Outstanding Debts
19. Cash Equlvalen4 .... ........ ... .............. see lnswctlo.u on -ewne s
20. Outstanding Debts ................. add Llrse ~ . li4re r r !n column c above s
• From prevltws Statement Summary Pape, Cdumn C. However. N
this b the Ifrst report 111ed for the calendar rear, Column B should be
blank ertcept for Lwro Received (Line 2), Enlorceable Promises (line
6-, LoEins Made'(Llne 9), end Aurued Efrpenses (Line 11).
Summary for Candidates in Both June and
November Elections
1/1 through t/30 7l1 to Datt
21. ~onttibUtions
ecelve s
22. ~xpenditured s
Ada .