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Home My Public Portal AboutForm 460 Amendment (Feb 18 - June 30, 2007) 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to thebest 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. ~-_':J-O D.18 C - s--07 Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print In ink. SEE INSTRUCTIONS ON REVERSE Statement covers period from Q. -It- J 7 (;..-'2.()-07 through ,L 1. TYje of Recipient Committee: All Committees-Complete Parts 1, 2, 3, and 4. [It' Officeholder, Candidate Controlled Committee 0 Primarily Formed Ballot Measure o State Candidate Election Committee Committee o Recall 0 Controlled (AIS/) Complete Pari 5) 0 Sponsored (Also CompIfitfi Part 6) o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee o Primarily Formed Candidate! Officeholder Committee (AJsocomp/fJtfJParl7) 3. Committee Information Cj ~ 5- COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) {1mm',.He~ -1:6 'i./oeL.-/ .::ktki~ ~-tJe Vl'rj ~V6A7RES~ ~:r~t CITY C(4 y'''t! Y>> ~^t MAILING ADDRESS (IF DIFFERENT) NO. STATE CA AND STREET OR P.O. BOX ZIP CODE 1/7// AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Executed on By Executed on By D.18 Executed on By D.. Executed on By D"'" COVER PAGE Date Stamp CALIFORNIA 460 FORM Date of election if applicable: (Month, Day, Year) Page of For Official Use Only ::; -6- 07 2. Type of Statement: o Preelection Statement o Semi-annual Statement o Termination Statement (Also file a Form 410 Termination) tsl. AJ;lendment (Explain below) fJ ,',~1 f.; r./1 /(;. '< {, o Quarter1y Statem.ent o Special Odd-Year Report o Supplemental Preelection statement - Attach Form 495 ~ 0"'( f,\j <; V ,11 tIle. r V 0 1\ f'O r )1,\ ' Treasurer(s) NAME OF TREASURER MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAil ADDRESS easurfi Proponentor Responsible Officer of Sponsor Signature of Coolrolling Officeholder, Candidate, State Measure Proponent Sii11ature of Controlling Officeholder. Candidate, State Measure Proponent fPPC Form 460 (January/OS) fPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) 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 Cfl 111 JYi JCx..Gkt 'e mG t'1I r OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRI NUMBER IF APPLICABLE) Cify Council frJemMr 1 Ci-f-v o-{CfctY'Lmo'lf- RESIDENTI'AUBUSINESS ADDRESS (NO. AND STREET) CfTY STATE ZIP A(67 u..x;r;d d Cf4 I'YWltfiYlT err 9/7// 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 D NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES D NO, COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COVER PAGE - PART 2 6. Primarily Formed 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 I DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of offlceholder(s) or candidate(s) for which this committee is primarily formed. 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE Attach continuation sheets If necessary FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3n2) State of California Schedule A Monetary Contributions Received Type or print in ink. Amounts may be founded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER SCHEDULE A Statement covers period CALIFORNIA 460 FORM from through Page of J.D. 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 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 . DEC. 31) PER ELECTION IODATE (IF REQUIRED) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF.EMPlOYED, ENTER NAME OFBUSINESSj OIND oeoM OOTH OPTY osee OIND oeoM OOTH OPTY osee OIND o COM OOTH OPTY osee OIND oeoM OOTH OPTY osee OIND o COM OOTH OPTY osee , SUBTOTAL $ <<- '-7f-'~1 '-"\'~f~:\:j~j.- Schedule A Summary 1. Amount received this period- itemized monetary contributions. (Include all Schedule A subtotals.) ........................................................................................................ $ 2. Amount received this period - unitemized monetary 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 $ I~. <c. . ,. 0 'J .J -:;..1 C: (;, i/ ;)../ b *Contributor Codes INO -Individual COM - Recipient Committee (other than PTY or SCe) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPpe Toli-Free Helpline: 866fASK.FPpe (8661275-3772) Type or print in ink. Amounts may be rounded to who6e dollars. SCHEDULE H from 2-18-07 CALIFORNIA 460 FORM Schedule H Loans Made to Others" Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 6-30-07 Page of 1.0. NUMBER Committee to Elect Jackie McHenry 1249955 FULL NAME. STREET ADDRESS AND ZIP CODE OF RECIPIENT ~F COMMITTEE, ALSO ENTER LD. NUM6ER) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF.EMPlOYED, ENTER NAME OF BUSINESS) (.) OUTSTANDING BALANCE BEGINNING THtS PERIOD (bj AMOUNT LOANED THIS PERIOD (el REPAYMENT OR FORGIVENESS THIS PERIOD. OUTSTlcr..D1NG BALANCE AT CLOSE OF THIS PERIOD (.) INTEREST RECEIVED ~ ORIGINAL AMOUNT OF lOAN (gJ CUMULATIVE LOANS TO DATE NONE o PAID CALENDAR YEAR $ o FORGIVEN -, "'" PER 8.ECT1ON.... DATE DUE DATE INCURRED o PAID CALENDAR YEAR $ DFORGlVEN $ -' "''' PER aECTlON.... DATE DUE DATE INCURRED *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 $ $ $ $ (Erter(e) on Schedule I, Line J) Schedule H Summary 1. Loans made this period ........................................................................ ......................................................................... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans ........................................... .............................. ...,............................................................ $ (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Une 2 from Une 1.) .................................................................................... ..... NET $ (Enter the net here and on the Summary Page, Column A, Line 7,) o ~eqUired I o o (May bea negatJielnumber) FPPC Form 460 (JanuaryroS) FPPC TolI-Free Helpline: 868/ASK-FPPC (866/275-377Z) Schedule I Miscellaneous Increases to Cash Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE I from 2-18-07 6-30-07 CALIFORNIA 460 FORM Statement covers period see INSTRUCll0NS ON REVERSE NAME OF FILER through Page of 1.0. NUMBER Committee to Elect Jackie McHenry 1249955 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF CQMMIT"TEE, ALSO ENTER I D. NUMBER) OESCRIP110N OF RECEIPT AMOUNT OF INCREASE TO CASH NONE Attach additional infonnation on appropriately labeled continuation sheets. SUBTOTAL $ o Schedule I Summary 1. Itemized increases to cash this period. ...................... ................................................................................................ $ 2. Unitemized increases to cash of 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.) .........................................................................................................................l. TOTAL $ o o FPPC Form 460 (JanuarylOS) FPPC Toll-Free Helpline: 8661ASK-FPPC (886I27&3m)