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Home My Public Portal AboutForm 460 (Jan 18 - Feb 14, 2009) Amendment Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) COVER PAGE from 01/18/09 Date of election if applicable: (Month, Day, Year) '" ,. ""9 ' ' .'. -~ i ';: ~ ': i,... ~J ~Vw CALIFORNIA 460 2001/02 FORM Type or print in ink. , ~ ~ ".:>.,' Oaft! Stamp; ~ "' ,_,} iiC4..:,...: 'tr; Statement covers period SEE INSTRUCTIONS ON REVERSE through 02/14/09 3/3/09 Page~ of 13 CITY CLERK For Official Use Only CITY OF CLAREMO T 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 Complete Part 6) 2. Type of Statement: o Preelection Statement o Semi-annual Statement o Termination Statement 00 Amendment (Explain below) $2.00 math error schedule A. o Quarterly Statement o Special Odd-Year Report o Supplemental Preelection Statement - Attach Form 495 o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party!Central Committee !Xl Primarily Formed Candidate! Officeholder Committee (Also Complete Part 7) 3. Committee Information 1.0. NUMBER 1272663 Treasurer(s) COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Corey Calaycay STREET ADDRESS (NO P.O. BOX) 1555 West Baseline Road 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 STATE Claremont CA NAME OF ASSISTANT TREASURER, IF ANY ZIP CODE 91711 AREA CODE/PHONE (909) 621-1266 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 my knowledge th certify under penalty of perjury under the laws of the State of California that the foregoing is tr t. Executed on 02/23/08 Date Executed on 02/23/08 Date Executed on Date Executed on Date By herein and in the attached schedules is true and complete. By By By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (June/Oil FPPC Toll-Free Helpline: 866/ASK-FPPC State of California Type or print in ink. 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 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY 1555 West Baseline Road; Claremont, California 91711 STATE ZIP 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 I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES D NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMmEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES D NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION D SUPPORT D 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 candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD iii SUPPORT Corey Calaycay City Council D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE Attach continuation sheets if necessary FPPC Fonn 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC State of California vClI I I IoIClI!:J I I LlI~"IU~UI It: .;JLCU.lt:1 I lit: I II. Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay -,I r- - -. r-+ u._ h. __nu Amounts may be rounded to whole dollars. from through Statement covers period CALIFORNIA 460 FORM 01/18/09 02/14/09 3 of 13 Page I.D. NUMBER Contributions Received 1272663 1. Monetary Contributions ........................................... Schedule A, Line 3 2. Loans Received ...................................................... Schedule S, 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) $ 2,246.00 0.00 2,246.00 0.00 2,246.00 Column B CALENDAR YEAR TOTAL TO DATE $ 6,803.99 0.00 6,803.99 0.00 6,803.99 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 711 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) ...............................ScheduleF, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Addunes8+ 9+ 10 $ 8,804.73 0.00 8,804.73 0.00 0.00 8,804.73 $ 8,804.73 0.00 8,804.73 0.00 0.00 8,804.73 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 ................................................... ColumnA, 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. $ $ $ $ 14,305.18 2,246.00 0.00 8,804.73 7,746.45 To calculate Column S, add amounts in Column A to the corresponding amounts from Column S 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 17. LOAN GUARANTEES RECEIVED ........................... Schedule S, Part 2 $ 0.00 .Since January 1, 2001. Amounts in this section may be .....:"..............4- .f.......... .................... ...........................:... ("'...1..__ 0 Schedule A Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * 01/19/09 Gene & Maija Hawkins 855 West Tenth Street Claremont, California 91711 K1IND OCOM OOTH OPTY OSCC KJIND OCOM OOTH OPTY OSCC KJIND OCOM OOTH OPTY OSCC KJIND OCOM OOTH OPTY OSCC KJIND OCOM OOTH OPTY OSCC 01/28/09 Betty Giannos 1832 Hanover Road Claremont, California 91711 02/02/09 Rodrigo & lona Miranda 355 Garnsey Avenue Bakersfield, California 91711 02/02/09 Edward & Ruth Santana-Grace 1574 Mural Drive Claremont, California 91711 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Retired Retired Retired Doctor California Healthy Marriages Coalition SUBTOTAL $ Schedule A Summary 1. Amount received this period - contributions of $1 00 or more. (Include all Schedule A subtotals.) ........................................................................................................ $ 2. Amount received this period - un itemized 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 $ from Statement covers period SCHEDULE A through AMOUNT RECEIVED THIS PERIOD $200.00 $250.00 $200.00 $250.00 $900.00 900.00 1,346.00 2,246.00 01/18/09 02/14/09 CALIFORNIA 460 FORM 4 of 13 Page 1.0. NUMBER 1272663 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) $200.00 $150.00 $250.00 $250.00 $250.00 $250.00 .- ~.;~;;,'r'c;.\i;i: :.- 'j::}'if'C::Pi'/<'>! ':"'i':'~;';'.;" .Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee 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. from 01/18/09 Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through Committee to Elect Corey Calaycay 02/14/09 SCHEDULE B - PART 1 CALIFORNIA 460 FORM Page 5 1.0. NUMBER of 13 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) 1272663 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) a (b) (el OUTSTANDING AMOUNT AMOUNT PAID BALANCE S BEGINNING THIS RECEIVED THI OR FORGIVEN RI PERIOD THIS PERIOD' o PAID (d) OUTSTANDING BALANCE AT CLOSE OF THIS R $ o FORGIVEN to IND 0 COM 0 OTH 0 PTY 0 SCC DATE DUE CALENDAR YEAR o PAID $ o FORGIVEN to IND 0 COM 0 OTH 0 PTY 0 SCC DATE DUE CALENDAR YEAR o PAID o FORGIVEN to IND 0 COM OOTH 0 PTY 0 SCC DATE DUE (e) INTEREST PAID THIS PERIOD _% RATE _% RATE _% RATE (f) ORIGINAL AMOUNT OF LOAN (g) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR PER ELECTION** DATE INCURRED PER ELECTION ** DATE INCURRED PER ELECTION ** DATE INCURRED ~',:,:, SUBTOTALS $ $ $ Schedule B Summary 1. Loans received this period .................................................................................................................... $ (Total Column (b) plus un itemized loans less than $100.) 0.00 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. 0.00 0.00 (May be a negative number) t Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee $ (Enter (el on Schedule E, Line 3) r *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. A ts b dd SCHEDULE C Nonmonetary Contributions Received moun may e roun e Statement covers period to whole dollars. CALIFORNIA 460 from 01/18/09 FORM through 02/14/09 6 13 SEE INSTRUCTIONS ON REVERSE Page_of_ NAME OF FILER I.D. NUMBER Committee to Elect Corey Calaycay 1272663 IF AN INDIVIDUAL, ENTER AMOUNTI CUMULATIVE TO PER ELECTION FULL NAME, STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE DATE ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET TO DATE RECEIVED (IF SELF-EMPLOYED, ENTER VALUE CALENDAR YEAR (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) (IF REQUIRED) OIND o COM OOTH OPTY OSCC OIND OCOM OOTH OPTY OSCC OIND OCOM OOTH OPTY osee OIND OCOM OOTH OPTY OSCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 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 of less 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 TolI.Free Helpline: 866/ASK.FPPC Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay DATE NAME OF CANDIDATE. OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE o Support o Oppose o Support o Oppose o Support o Oppose Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE D Statement covers period CALIFORNIA 460 FORM from 01/18/09 through 02/14/09 page~ of~ 1.0. NUMBER 1272663 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 $ CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) AMOUNT THIS PERIOD 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 enter on the Summary Page.) .............. TOTAL $ 0.00 FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE E from 01/18/09 CALIFORNIA 460 FORM Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 02/14/09 Page 8 of 13 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. 0v'P 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 RL candidate filing/ballot fees PH) phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IN) 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 IlVEB 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 James L. Merrylees 834 Lawrence Circle Claremont, California 91711 OFC Reimbursement CK# 1135 $239.42 Reimbursement CK# 1143 $128.64 $368.06 Jon A. Hart 1046 Pamella Drive Claremont, California 91711 PRT Reimbursement CK# 1136 $173.64 Reimbursement CK# 1144 $216.99 $390.63 Linda Kovach 916 Glenville Drive Claremont, California 91711 FND Reimbursement CK# 1137 $522.02 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1,280.71 Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $ 2. Unitemized payments made this period of under $1 00 .......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule 8, 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 $ 8,804.73 0.00 0.00 8,804.73 FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E (Continuation Sheet) Payments Made Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay through 01/18/09 02114/09 CALIFORNIA 460 FORM Statement covers period from page~ of~ I.D. NUMBER 1272663 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. eM' campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions ClB 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 TRC 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 PAYEE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Charles Seward 112 Harvard Avenue Claremont, California 91711 PRO CK# 1139 $850.00 CK# 1141 $950.00 CK# 1146 $1 ,500.00 $3,300.00 Vista Printing 1164 Monte Vista Avenue Upland, California 91786 PRT CK# 1140 $2,800.00 CK# 1142 $174.52 $2,974.52 Time Warner Cable Indian Hill Boulevard Claremont, California 91711 TEL CK#1145 $1,249.50 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 7,524.02 FPPC Form 460 (June/01) FPPC Toll-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. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay through 01/18/09 02/14/09 CALIFORNIA 460 FORM Statement covers period from page~ of~ I.D. NUMBER 1272663 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. O.fl campaign paraphernalia/misc. ~ member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTE 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 TRC 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 PRr print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. 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 000 on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ . May be a negative number FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC 0.00 0.00 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 01/18/09 SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Corey Calaycay NAME OF AGENT OR INDEPENDENT CONTRACTOR through 02/14/09 page~ of~ I.D. NUMBER 1272663 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 0vP 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 filinglballot fees PI-k) phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS stafflspouse 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 LIT 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 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL * $ 0.00 , 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 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 *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 $ from Statement covers period 01/18/09 through (e) REPAYMENT OR FORGIVENESS THIS PERIOD" OUTSTk~DING BALANCE AT CLOSE OF THIS PERIOD D PAID $ D FORGIVEN DATE DUE D PAID D 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.) 02/14/09 Ie) INTEREST RECEIVED _% RATE _% RATE $ (Enter (e) on Schedule I. Line 3) (May be a negative number) SCHEDULE H CALIFORNIA 460 FORM 12 Page 1.0. NUMBER 1272663 (I) ORIGINAL AMOUNT OF LOAN DATE INCURRED DATE INCURRED of 13 0.00 0.00 0.00 (g) CUMULATIVE LOANS TO DATE CALENDAR YEAR PER ELECTION" CALENDAR YEAR PER ELECTION" ""If Required FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 01/18/09 02/14/09 CALIFORNIA 460 FORM SCHEDULE I Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from page~ of 13 1.0. 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 Toll-Free Helpline: 866/ASK.FPPC