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Home My Public Portal AboutForm 460 (Jan 1 - Jan 22, 2011) • RECEVED • JAN 27 2011 CITY CLERK CITY OF CLAREMONT Recipient COVER PAGE p Type or print in ink. Date Stamp Campaign Statement CALIFORNIA ,460 Cover Page .'FORM (Government Code Sections 84200-84216.5) Page 1 of Statement covers period Date of election if applicable: (Month,Day,Year) For Official Use Only from March 8,2011 SEE INSTRUCTIONS ON REVERSE through 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 ❑ Semi-annual Statement ❑ Special Odd-Year Report 0 Recall 0 Controlled Termination Statement (Also Complete Part 5) 0 Sponsored ❑ (Also file a Form 410 Termination) ❑ Supplemental-Attach Formrn Statement-Attach 495 (Also Complete Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) Q Sponsored ja Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) I3. Committee Information D.NUMBER Treasurer(s) 1292533 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Committee to Elect Sam Pedroza,Claremont City Council 2011 Brian Teuber MAILING ADDRESS 553 Redlands Ave STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE 580 Cinderella Dr Claremont CA 91711 (909)488-1568 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER.IF ANY Claremont CA 91711 (909)621-0615 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 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 By t Siiggnif ure of Trea urer or Assistant Treasurer Executed on I J`r��/•` By Date ignature fControllin Officeholder,Carts' State 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) I-.- ------- - - ---------- FPPC Toll-Free Helpline:866/ASK-FPPC(866/275.3772) Clear Cover PO Print Form State of California .444 Type or print in ink. COVER PAGE-PART2 Recipient Committee CALIFORNIA Campaign Statement FORM 46O Cover Page—Part 2 Page of • 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Sam Pedroza OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑SUPPORT ❑OPPOSE City Councilmember RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. 580 Cinderella Dr Claremont CA 91711 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 STREET ADDRESS(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 COMMITTEE ADDRESS STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary Clear Cover Pg2 'Print Form FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(8661275.3772) State of California w ,,` ' õC O Y M 511 d -12 Q11a2 0 O C N Q 41 a+ N O ,° cÕ *Y� is o .. vr E �� 2 s y ... a c6 ca E m ro 'C L' n V) õ E m (n Q c R y E 12 o V Ua Z. 4 a co E f» F» 0 2 n E a U • `.. -.C'.3d OLL p"' CO a Z, . & 69- e» ° w u_'sp ° w a> o ca c w ä ä &J � Z O E äa a aro V"<a;fif O) p y, -c K c .a w t0 if i,„ _.dlCO a E a t2 j o CO C 7 4.' N r N ü C a ., O E_ Ci I O 0 ä+ NTD � N� J Ew >, a c y Am V C y 0 a) � y E d ä } c 2 •° -O �Z U) U W Z õ LL w L _ W ä > ä +�+ N õ E 5U õ co 01_ � a)c c a E ,n 5 I- C = C C.) cx @ c f° v c - U ü y = c UCC w2 ä.0 õ ) a. TO c d õ X ca E ä u_ C U ct 0 N N W U ¢ 2 a)E m .c NO)' 'O 0 7 N NEo õ .N (L)i C � =o N m c . N me O 0: C a) N•- ".= - C a) . •.r. ..- COm EEE .- ° Q).° 0- -- (T) CO . 0C Q� c cÕC c >Q EE 2m E N Eäo 0 `° O E õ ? mm 0 a � c° r cOH Vo2 ° m r o r E ° cE002°3cEE - V V õ ° 03 EN W - COfn 0 CD Q YUUC CD CU nN N O JU 'O `T° O O °) .. O w w . O O 0 a E v ea (a v) E» v) ca H m c0) o E 0 w CD ä ° a o m d v c C O ` y ° 9 C m 'c'cav as iciä O. O CwNä ÜõN iOaE p r a2 c F-'0 _ ~0 E Q 63 v) EA v) EA v) N <A 69 69 69 M M N M V V M 0. M M O (0 0 V 0 v) N 0 a) CC + C + (0 0CO 0 o 0 a) a) 0 0 + J J J 0 J J o .. .. O J ,p .7 p a 0Q) M c0 CO C U c W = Cco COi 0 C d m > C _ Ü 0 0 -0 0 a QJ a > QNN 7 a 0O C C O Q)) Q ü mQ < `) 0ü 0Q Ü ü C o C ü 0 U ch 0 0 hh E j j . o U)Q c co Ü U võ Ca) o' + ä ❑ v) + S ^ N + 0 0) 0 a C C 4-• _l G) '1E C sc E 0 PRI d Z _ w ä y O w ) Q c 0 +-' *-. U CO 'm õ �' U J >_ O m u) w I- ¢ C o w i > CT C u) w 73 @ 2 C� E U 'a w a N E Ü u) W 0 W C O co Z O w Q) ¢ im C W ,. v) Üm CO 4,4 0 Zd12 0Z C � mm C °iN a o ° ❑ a z 0 O o O Z z i a) O n o WW v) U . ° , > ? 0) U U c° O a. CO o E ¢ < C 0 w o _ c ¢ wo o X O a' e) c m 0 m D Q c J C O co o H °) C ++ c a Z ") z W Cn Q LI- I- o C CO E ¢ C E c co 2 E ¢ C. s -c - ° CO C H a) u) 0 ¢ S `0 ° +.+c ° oo C p G) m °o o O i (1)) c° c° Z w O Ü O CC M w 2 0 X 0 CO õi z U c�i ri ' ui W cõ r- co ai - � U l- l- `° 1- V eõ ai 'W Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period c CALIFORNIA`- V O from FORM SEE INSTRUCTIONS ON REVERSE through_ Pap-- -of .. NAME OF FILER I.D.NUMBER Committee to Elect Sam Pedroza,Claremont City Council 2011 1292533 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 ENTERI.D.NUMBER) CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE BE SELF-EMPLOYED.ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Barbara Rugeley BIND retired 1/24/11 1436 Mural Dr ❑coM 100 Claremont 91711 00TH ❑PTY ❑SCC John and Carolee Monroe 0IND ❑coM retired 1/20/11 1015 N.Indian Hill Blvd 100 Claremont 91711 DOTH ❑PTY ❑SCC J.Michael Faye 0coM IND retired 1/22/11 4085 Olive Hill Dr 100 Claremont, 91711 00TH ❑PTY ❑SCC Joan Presecan BIND retired 1/23/11 727 Alamosa Dr ❑COM 100 Claremont 91711 00TH ❑PTY ❑SCC Kevin Bostwick ®IND Graphic Arts 1/23/11 982 Northwestern Dr ❑coM 100 Claremont 91711 ❑OTH ❑PTY ❑SCC SUBTOTAL$ Schedule A Summary *Contributor Codes 1.Amount received this period-itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.) $ COM-Recipient Committee (other than PTY or SCC) 2.Amount received this period—unitemized monetarycontributions of less than$100 $ ia37 0TH—Other(e.g.,business entity) PTY-Political Party 3. Total monetary contributions received this period. 66 SCC-Small Contributor Committee (Add Lines 1 and 2.Enter here and on the Summary Page,Column A,Line 1.) TOTAL $5- FPPC Form 460(January/05) -- FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) ( Clear Sch.A Print Form 8 170 Schedule A(Continuation Sheet) Type or print in ink. SCHEDULEA(CONT.) MonetaryContributions Received Amounts may be rounded Statement covers period CALFORNIA A a0 to whole dollars. ISFV from `FORM _. through Pa, .. 5 of a. NAME OF FILER I.D.NUMBER Committee to Elect Sam Pedroza,Claremont City Council 2011 1292533 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE.ALSO ENTER I.D.NUMBER) CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Buth and Rosemary Henderson ®IND retired 1/20/11 606 Delaware Dr [10TH 100 Claremont 91711 00TH ❑PTY ❑SCC Jim Keith ®IND retired 1/09/11 337 Marygrove Rd ❑COM 100 Claremont 91711 ❑0TH ❑PTY ❑SCC Diann and Robert Ring 0IND retired 1/22/11 816 Pennisula Ave ❑cOM 100 Claremont 91711 [10TH ❑PTY ❑SCC I . . J i ._ Li LOM ❑OTH ❑PTY • ❑SCC Bill and Cindy Fox IND Real Estate Investor 1/22/11 831 Mary Place ❑COM 200 ❑OTH ❑PTY ❑SCC SUBTOTALS Se C/ *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) `Clear Sch.A Con. Print Form 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(866/275-3772) wr Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 4'Eo from FORMI I through Page - of 41 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER 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 EN TERI.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) Ti��Soeviti0C SuA /I'22%1! 00TH 7% 4" /direm õsä D JT%� s r]COM `' ❑OTH ) 11 aai3 c��ia ��1 IIISCC l-- �� CV-Ai-Pat M ❑O\ disID ChartNTC) �D4fI ,,99f ❑COM Jar 1404 cloorYti' õ sc AtaAL i(Gtt,,r,,.$II °MOTH Sv �5 [a��li ls p. ( AA -<<c os c f I 4 Ili .. SP4I-Ual +477....e.S I\ OCOM LIOTHPTY • -�)l 3a, � � r�!4 c ,po R49� ❑SCC SUBTOTALS Schedule A Summary ' -Contributor Codes 1.Amount received this period-itemized monetary contributions. IND-Individual IncludSchedule A subtotals.) $ Coro-Recipient Committee ( e all (other than PTY or SCC) 2.Amount received this period-unitemized monetarycontributions of less than$100 $ 0TH-Other(e.g.,business entity) PTY-Political Party 3. Total monetary contributions received this period. I %i SCC-Small Contributor Committee (Add Lines 1 and 2.Enter here and on the Summary Page,Column A,Line 1.) TOTAL $ V FPPC Form 460(January/05) --- ---- FPPC Toll-Free Helpline:866/ASK-FPPC(86612753772) Clear Sch.A Print Form Schedule A Type or print In Ink. SCHEDULE A Amounts may be rounded Statement covers period •1,r c °,c�N,)s Monetary Contributions Received to Whole dollars. CALIFORNIA.' from .7 FORM1`4 •`,.V. SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER 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) may- pg� ,,,) OF BUSINESS) (( r4/11. 1 Ili �`;�C1,Y, �❑COM fl'gr9vkli�G4( ' mac ��T/1� OOTH �1 �� cis, �I ►7/( 0SC gall i t-a,,i -i ! 5 \f`l Oma, oM ,r. . -2) ID OTHV 6.06 C-1Prb» PI Caw , j17' õs cc atINyy��/� D fI' "f it IVN 6, I P r ❑COM 00TH ri. .. \ 4 0,--0 a*IG Br 1cc ❑ TYscc ' tsr/�fn � ❑ Is)COM �v ��11�/V`-/L 8.. --0 %r � N. ►r d n o uaw O sPcc J ;O - L_I;OM 0 OTH • - 0 PTY 0 SCC , SUBTOTALS . • Schedule A Summary -Contributor Codes 1.,Amount received this period—itemized monetary contributions: IND-Individual .(Include all Schedule Asubtotals.) $ COM-Recipient Committee (other than PTY or SCC) 2. Amount received this period—unitemized monetarycontributions of less than$100 $ OTH-Other(e.g.,business entity) • • PTY-Political Party 3. Total monetary contributions received this period. . SCC-Small Contributor Committe• e (Add Lines 1 and 2.Enter here and on the Summary Page,Column A,Line 1.) TOTAL $ i ®o 6 FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Clear Sch.A Print Form Type or in ink. I SCHEDULEE Schedule E yp print Statement covers period CALIFORNIA Amounts may be rounded '46,0; Payments Made to whole dollars. from FORM Ai b`. r ` I SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER 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 FL candidate fling/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 • %.‘„,,,,,L6k., [\ incx\-in- 1 bel9 • • *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS Schedule E Summary 1. Itemized payments made this period.(Include all Schedule E subtotals.) $ 2. Unitemized payments made this period of under$100 $ 3. Total interest paid this period on loans.(Enter amount from Schedule B,Part 1,Column(e).) , $ 4. Total payments made this period.(Add Lines 1,2,and 3.Enter here and on the Summary Page,Column A,Line 6.) TOTAL $ ' FPPC Form 460(January/05) Clear Sch.E j Print Form FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)