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Home My Public Portal AboutForm 460 (Jan 1 - Jan 17, 2009) COVER PAGE Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) through 3/3/09 JAN 2 2 2008 CITY CLERK OF CLAREMONT CALIFORNIA 460 2001/02 FORM Type or print in ink. EcEfVED from 01/01/09 Date of election if applicable: (Month, Day, Year) Page of 13 Statement covers period For Official Use Only SEE INSTRUCTIONS ON REVERSE 01/17/09 CI 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. o Officeholder, Candidate Controlled Committee o State Candidate Election Committee o Recall (Also Complete Part 5) o Ballot Measure Committee o Primarily Formed o Controlled o Sponsored (Also Complele Part 6) 2. Type of Statement: iii Preelection Statement 0 Quarterly Statement 0 Semi-annual Statement 0 Special Odd-Year Report 0 Termination Statement 0 Supplemental Preelection 0 Amendment (Explain below) Statement - Attach Form 495 o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee iii Primarily Formed Candidate/ Officeholder Committee (Also Complele Part 7) 3. Committee Information 1.0. NUMBER 1272663 Treasurer(s) CITY Claremont STATE CA ZIP CODE 91711 AREA CODE/PHONE (909) 593-5913 NAME OF TREASURER Robert W. Bowcock MAILING ADDRESS 1021 Belleville Court CITY Claremont NAME OF ASSISTANT TREASURER. IF ANY STATE CA ZIP CODE 91711 AREA CODE/PHONE (909) 621-1266 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Corey Calaycay STREET ADDRESS (NO P.O. BOX) 1555 West Baseline Road 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 (909) 621-1196 / bbowcock@irmwater.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of nowle certify under penalty of perjury under the laws of the State of Califomia that the foregoing is e and corre Executed on 01/22/08 Date Executed on 01/22/08 Date Executed on Date Executed on Date By By By By Signature r:l Controlling Officeholder, Candidate, Stale Measure Proponent FPPC Fonn 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC State of California Type or print in ink. COVER PAGE - PART 2 Recipient Committee Campaign Statement Cover Page - Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Corey Calaycay OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of Claremont RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 1555 West Baseline Road; Claremont, California 91711 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 contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES ONO STREET ADDRESS (NO P.O. BOX) COMMITTEE ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES o NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION o SUPPORT o OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER. CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Committee List names of officeholder(s) or candldate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD IX! SUPPORT Corey Calaycay City Council o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE Attach continuation sheets if necessary FPPC Fonn 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Slale of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay Type or print in ink. Amounts may be rounded to whole dollars. SUMMARY PAGE from through Statement covers period CALIFORNIA 460 FORM 01/01/09 01/17/09 3 13 of Page 1.0. NUMBER Contributions Received 1272663 1. Monetary Contributions ........................................... Schedule A. Line 3 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 ... 2 4. Nonmonetary Contributions .................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3'" 4 Column A TOTAl THIS PERIOD (FROM ATTACHED SCHEDULES) $ 3,958.99 0.00 3,958.99 0.00 3,958.99 Column B CALENDAR YEAR TOTAl TO DATE $ 4,557.99 0.00 4,557.99 0.00 4,557.99 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date $ $ $ $ 20. Contributions Received $ 21. Expenditures Made $ $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E. Line 4 7. Loans Made ............................................................. Schedule H. Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6'" 7 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F. Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8'" g... 10 $ 0.00 0.00 0.00 0.00 0.00 0.00 $ 0.00 0.00 0.00 0.00 0.00 0.00 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) ---1---1_ $ ---1---1_ $ ---1---1_ $ ---1---1_ $ ---1---1_ $ ---1---1_ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A. Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule I, Line 4 15. Cash Payments .................................................. Column A. Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12'" 13'" 14. then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. $ $ $ $ 1 0,1 01.18 4,204.00 0.00 0.00 14,305.18 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2'" Line 9 in Column B above $ 0.00 0.00 'Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. CALIFORNIA 460 from 01/01/09 FORM through 01/17/09 Page 4 of 13 SEE INSTRUCTIONS ON REVERSE NAME OF FILER 1.0. NUMBER Committee to Elect Corey Calaycay 1272663 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) 01/09/09 J.P. & Lillian Lee K1IND Retired $200.00 $200.00 OCOM 426 Willamette Lane OOTH Claremont, California 91711 OPTY oscc 01/10/09 Richard Hall K1IND Retired $150.00 $150.00 OCOM 1943 Judson Court OOTH Claremont, California 91711 OPTY OSCC 01/08/09 Roy Clounts K1IND Retired $250.00 $250.00 $250.00 OCOM 118 Lincoln Avenue OOTH Pomona, California 91767 OPTY OSCC 01/11/09 Jack & Wanda Tanaka K1IND Retired $200.00 $200.00 OCOM 23805 Country View Drive OOTH Diamond Bar, California 91765 OPTY oscc 01/11/09 Thomas Lamb K1IND Retired $100.00 $100.00 OCOM 620 East Miramar Avenue OOTH Claremont, California 91711 OPTY oscc SUBTOTAL $ $900.00 I Schedule A Summary 1. Amount received this period - contributions of $1 00 or more. (Include all Schedule A subtotals.) ........................................................................................................ $ 2. Amount received this period - unitemized contributions of less than $100............................................. $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ 1,200.00 3,004.00 'Contributor Codes IND -Individual COM - Recipient Commillee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Commillee 4,204.00 FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A (Continuation Sheet) Monetary Contributions Received SCHEDULE A (CaNT.) Type or print in ink. Amounts may be rounded to whole dollars. 01/01/09 CALIFORNIA 460 FORM Statement covers period from through 01/17/09 Page 13 5 of NAME OF FILER Committee to Elect Corey Calaycay 1272663 1.0. NUMBER DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE * AMOUNT RECEIVED THIS PERIOD PER ELECTION TO DATE (IF REQUIRED) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 01/11/09 [gIIND OCOM OaTH OPTY DSCC OIND [gI COM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC OIND DCOM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC Betty Crocker 2260 North Villa Maria Claremont, California 91711 01/08/09 Smita Sanghui Mountain View Centers 1825 Pinnacle Way Upland. California 91784 Student $100.00 $100.00 Owner Mountain View Centers $200.00 $200.00 'Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee SUBTOTAL $ 300.00 I FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule B - Part 1 Loans Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay from 01/01/09 01/17/09 through SCHEDULE B - PART 1 CALIFORNIA 460 FORM Page 1.0. NUMBER 1272663 6 13 of (g) CUMULATIVE CONTRIBUTIONS TO DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I,D, NUMBER) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) a OUTSTANDING BALANCE BEGINNING THIS I (b) (e) AMOUNT AMOUNT PAID RECEIVED THIS OR FORGIVEN PERIOD THIS PERIOD. o PAID $ o FORGIVEN to IND 0 COM OOTH 0 PTY 0 SCC CALENDAR YEAR o PAID $ o FORGIVEN CALENDAR YEAR to IND 0 COM 0 OTH 0 PTY 0 SCC o PAID o FORGIVEN to IND 0 COM 0 OTH 0 PTY 0 SCC SUBTOTALS $ $ Schedule B Summary 1. Loans received this period .................................................................................................................... $ (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period.... ................... ............................... .............................. .......... ...... ..... $ (Total Column (c) plus loans under $100 paid or forgiven.) (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 $ Enter the net here and on the Summary Page, Column A, Line 2. t Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) (d) OUTSTANDING BALANCE AT CLOSE OF THIS R DATE DUE DATE DUE DATE DUE $ (May be a negative number) OTH - Other PTY - Political Party SCC - Small Contributor Committee (e) INTEREST PAID THIS PERIOD _% RATE _% RATE _% RATE $ (Enler(e)on Schedule E. Line 3) 0.00 0.00 0.00 () ORIGINAL AMOUNT OF LOAN DATE INCURRED DATE INCURRED DATE INCURRED CALENDAR YEAR PER ELECTION" PER ELECTION .. PER ELECTION" .Amounts forgiven or paid by another party also must be reported on Schedule A. .. If required, FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule C Type or print in ink. SCHEDULE C Nonmonetary Contributions Received Amounts may be rounded Statement covers period 460 to whole dollars. CALIFORNIA from 01/01/09 FORM through 01/17/09 7 13 SEE INSTRUCTIONS ON REVERSE Page_of_ NAME OF FILER I.D. NUMBER Committee to Elect Corey Calaycay 1272663 IF AN INDIVIDUAL, ENTER AMOUNT! CUMULATIVE TO PER ELECTION DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR OCCUPATION AND EMPLOYER DESCRIPTION OF FAIR MARKET DATE TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * (IF SELF-EMPLOYED. ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED) (IF COMMITTEE, ALSO ENTER LD. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) OIND DOOM OOTH OPTY OSCC OIND o COM OOTH OPTY osce OIND o COM OOTH OPTY OSCC OIND DOOM OOTH OPTY OSCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ I Schedule C Summary 1. Amount received this period - nonmonetary contributions of $1 00 or more. (Include all Schedule C subtotals.) . ............................................. .... .......... .......... .................... ........................... $ 2. Amount received this period - unitemized nonmonetary contributions ofless than $100 .................................... $ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ 0.00 0.00 'Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee 0.00 FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule 0 Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE D from 01/01/09 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 01/17/09 Page 8 of 13 I.D. NUMBER Committee to Elect Corey Calaycay 1272663 o Support o Oppose TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure SUBTOTAL $ AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1- DEC. 31) PER ELECTION TO DATE (IF REQUIRED) DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE o Support o Oppose o Support o Oppose Schedule 0 Summary 1. Contributions and independent expenditures made this period of$100 or more. (Include all Schedule 0 subtotals.) .............................................. $ 2. Unitemized contributions and independent expenditures made this period of under $100 ...................................................................................... $ 0.00 0.00 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enteron the Summary Page.) .............. TOTAL $ 0.00 FPPC Form 460 (June/01) FPPC TolI.Free Helpline: 866/ASK-FPPC Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULEE from 01/01/09 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 01/17/09 page~ of~ I.D. NUMBER Committee to Elect Corey Calaycay 1272663 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. ~ campaign paraphemalia/misc. WBR member communications RAD radio airtime and production costs CNS campaign consultants MrG meetings and appearances RFD returned contributions GTE 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 filinglballot fees PHO phone banks 1RC candidate travel, lodging, and meals FND fund raising events POL polling and survey research TRS staff/spouse travel, lodging, and meals N) 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 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 0.00 Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $ 2. Un itemized payments made this period of under $100 .......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amountfrom Schedule S, 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 $ 0.00 0.00 0.00 0.00 FPPC Form 460 (June/01) FPPC TolI.Free Helpline: 866/ASK-FPPC SCHEDULE F Schedule F Accrued Expenses (Unpaid Bills) Type or print in ink. Amounts may be rounded to whole dollars. through 01/01/09 01/17/09 CALIFORNIA 460 FORM Statement covers period from page~ of~ SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay 1.0. NUMBER 1272663 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CfvP campaign paraphernalia/misc. M3R member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CT8 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 filinglballot fees pt-() phone banks 1RC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals N) 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 CREDITOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD . Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTALS $ $ $ $ Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)............................................ INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ 0.00 0.00 0.00 May be a negative number FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE G CALIFORNIA 460 FORM from Statement covers period 01/01/09 through 01/17/09 page~ of~ 1.0. NUMBER 1272663 SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CtvP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MrG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations FEr petition circulating TEL t.v. or cable airtime and production costs FIL candidate filinglballot 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 NJ 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 Lrr campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID TOTAL * $ 0.00 Attach additional information on appropriately labeled continuation sheets. , Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule H Loans Made to Others* Type or print in ink. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay from Statement covers period 01/01/09 through 01/17/09 SCHEDULE H CALIFORNIA 460 FORM 12 Page 1.0. NUMBER 1272663 of 13 FULL NAME, STREET ADDRESS AND ZIP CODE OF RECIPIENT (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) (a) OUTSTANDING BALANCE BEGINNING THIS PERIOD (b) AMOUNT LOANED THIS PERIOD CALENDAR YEAR *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. SUBTOTALS $ (e) REPAYMENT OR FORGIVENESS THIS PERIOD< OUTST~DING BALANCE AT CLOSE OF THIS PERIOD o PAID $ o FORGIVEN DATE DUE o PAID o FORGIVEN DATE DUE $ $ Schedule H Summary 1. Loans made this period . ............... ......... ...... ......... ......... ..... ................ ........ ........ ....... ............. ........... ....... .......... ............ $ (Total Column (b) plus unitemized loans less than $100.) 2. Payments received on loans .... ..... .................. .............. ................ .............................. .......... ... ... ....... ................... .......... $ (Total Column (c) plus unitemized payments less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.) ........................................................................................ NET $ (Enter the net here and on the Summary Page. Column A, line 7.) (e) INTEREST RECEIVED _% RATE _% RATE $ (Enter (e) on Schedule I, Line 3) (May be a negative number) (I) ORIGINAL AMOUNT OF LOAN DATE INCURRED DATE INCURRED 0.00 0.00 0.00 (9) CUMULATIVE LOANS TO DATE CALENDAR YEAR PER ELECTION- PER ELECTION- **If Required FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC . . Schedule I Miscellaneous Increases to Cash Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE I SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 01/01/09 01/17/09 CALIFORNIA 460 FORM Statement covers period from page~ of~ I.D. NUMBER Committee to Elect Corey Calaycay 1272663 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 0.00 Schedule I Summary 1. Increases to cash of $100 or more this period. .......................................................................................................... $ 2. Unitemized increases to cash under $100 this period. .............................................................................................. $ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ................................. $ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL $ 0.00 0.00 0.00 0.00 FPPC Form 460 (June/01) FPPC ToII.Free Helpline: 866/ASK-FPPC