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Home My Public Portal AboutForm 460 Amendment (Jan 23 - Feb 19, 2005) 2. Type of Statement: 0 0 0 IX] (1) Add nonmonetary contributions in excess of $50.00 (2) Add nonmonetary contributions on summary page line no. 10 cr) ~Ð ~plfl\fea.. I O(.C-VpAT)~,.J Treasurer(s) Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Date Stamp Statement covers period Date of election if applicable: (Month, Day, Year) from 01/23/05 SEE INSTRUCTIONS ON REVERSE 02/19/05 03/08/05 through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. IX] Officeholder, Candidate Controlled Committee 0 Ballot Measure Committee 0 State Candidate Election Committee 0 Primarily Formed 0 Recall 0 Controlled (Also Complete PartS) 0 Sponsored (Also Complete Parl6) Preelection Statement Semi-annual Statement Termination Statement Amendment (Explain below) 0 General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 0 Primarily Formed Candidate! Officeholder Committee (A/so Complete Parl7) 3 C .tt I f t. /1.0. NUMBER . omml ee norma Ion 1273509 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Sam Pedroza NAME OF TREASURER Brian Teuber STREET ADDRESS (NO P.O. BOX) 580 Cinderella Drive CITY Claremont MAILING ADDRESS 553 Redlands Avenue STATE CA AREA CODE/PHONE 909-621-0615 CITY Claremont NAME OF ASSISTANT TREASURER, IF ANY ZIP CODE 91711 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS .. COVER PAGE CALIFORNIA 4 6 0 2001/02 FORM Page 1 f." of For Official Use Only 0 Quarterly Statement 0 Special Odd-Year Report 0 Supplemental Preelection Statement - Attach Form 495 l\i.~ CD-'r1LHJÞ\I~ fJt::TT( 5.4-£.-.5 STATE CA ZIP CODE 91711 AREA CODE/PHONE 909-482 -1568 STATE ZIP CODE AREA CODE/PHONE 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knOWle~e the information contained herein and in the attached schedules is true and complete. I certify under penalty of p~rjury under the laws of the State of California that the foregoing is true tA~~( . Execuled on .:!.\ 251 0.7 By r~ ""Ie ~ - , ~'"'" . J~'"~""""rlT""';rn' Executed on By ~/---- ¡y ~ Date Signature of Controlling Officeholder, Candidate. State rfasure rro~onent or Responsible Officer of Sponsor Executed on Date By Executed on Signature of Controlling Officeholder, Candidate. State Measure Proponent Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC State of California . Type or print in ink. Reci pient Committee Campaign Statement Cover Page - Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Sam Pedroza OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City of Claremont - City Council RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) 580 Cinderella Drive Claremont, CA 91711 CITY 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. COMMITIEE NAME J.D. NUMBER NAME OF TREASURER CONTROLLED COMMITIEE? COMMITIEE ADDRESS 0 YES STREET ADDRESS (NO P.O. BOX) 0 NO CITY STATE ZIP CODE AREA CODE/PHONE COMMITIEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITIEE? 0 YES 0 NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 CALIFORNIA 4 6 0 FORM Page 2 , of 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETIER JURISDICTION 0 SUPPORT 0 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 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD 0 SUPPORT 0 OPPOSE Attach continuation sheets if necessary FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza Contributions Received 1. Monetary Contributions ........................................... Schedule A, Line 3 2. Loans Received ...................................................... Schedule a, 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 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 + 9 + 10 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 " 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. 17. LOAN GUARANTEES RECEIVED ........................... Schedule a, Part 2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column a above Type or print in ink. Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $ 3632.90 0.00 3632.90 390.04 4022.94 $ $ $ 5507.06 0.00 5507.06 -1886.81 390.04 4010.29 $ $ $ 5011.88 3632.90 0.00 5507.06 3137.72 $ $ 0.00 $ $ 0.00 6064.30 from through Column B CALENDAR YEAR TOTAl TO DATE $ 4507.90 5000.00 9507.90 390.04 9897.94 $ $ $ 6370.18 0.00 6370.18 1064.30 390.04 7824.52 $ $ 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). SUMMARY PAGE Statement covers period CALIFORNIA 4 6 0 FORM 01/23/05 02/19/05 3 of C, Page 1.0. NUMBER 1273509 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 $ $ $ 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) I / $ I I $ I I $ I I $ I I $ I I $ *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/O1) FPPC Toll-Free Helpline: 866/ASK-FPPC 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 Sam Pedroza DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE * IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) 02/01/05 IKIIND OCOM OOTH OPTY oscc DIND OCOM DOTH OPTY oscc DIND DCOM OOTH DPTY DsCC DIND OCOM DOTH OPTY Oscc OIND OCOM DOTH DPTY osec Pasadena Day Nursery Betty Salas 469 W. 11th Street Claremont, CA 91711 Executive Director 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 - 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 $ SCHEDULE A Statement covers period CALIFORNIA 4 6 0 FORM from 0 1/23/05 through 02/19/05 of " Page 4' 1.0. NUMBER 1273509 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 75.00 75.00 75.00 75.00 I No Change ,. "Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party sec - Small Contributor Committee '\ No Change ~ ~ FPPC Form 460 (June/O1) FPPC Toll-Free Helpline: 866/ASK-FPPC . Schedule C Nonmonetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza DATE RECEIVED 02/18/05 02/18/05 01/29/05 02/12/05 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER J.D. NUMBER) Integrated Resource Management 405 N. Indianhill Blvd. Claremont, CA 91711 Integrated Resource Management 405 N. Indian hill Blvd. Claremont, CA 91711 Candlelight Pavilion Dinner Theater 455 W. Foothill Blvd. Claremont, CA 91711 Candlelight Pavilion Dinner Theater 455 W. Foothill Blvd. Claremont, CA 91711 Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE C Statement covers period CALIFORNIA 460 FORM from 01/23/05 through 02/19/05 Page 5' of ~ 1.0. NUMBER 1273509 CUMULATIVE TO PER ELECTION DATE TO DATE CALENDAR YEAR (IF REQUIRED) (JAN 1 - DEC 31) 62.50 62.50 IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) DESCRIPTION OF GOODS OR SERVICES AMOUNT/ FAIR MARKET VALUE DIND DCOM !KlOTH oPTY DSCC DIND DCOM IX]OTH DPTY DSCC DIND DCOM IXIOTH DPTY DSCC DIND 0 COM iii OTH DPTY DSCC Printing for Fundraiser Invitation 62.50 ~ù úkÞctJ¿ ~ Postage for Fundraiser Invitation 247.50 247.50 185.00 fJD ~I. ~ Photocopies 50.00 50.00 50.00 A'Dt> Photocopies 10.00 60.00 60.00 A-Ðt> SUBTOTAL $ Attach additional information on appropriately labeled continuation sheets. 307.50 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 $ 389.30 .74 ~ *ContributDr Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party SCC - Small Contributor Committee 390.04 ... FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC . . Schedule C Nonmonetary Contributions Received '" Co rv T t t-JvA nt) ~ S ~..,. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE. ALSO ENTER !.D. NUMBER) 01/30/05 Julie Pedroza 580 Cinderella Drive Claremont, CA 91711 Type or print in ink. Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) DESCRIPTION OF GOODS OR SERVICES [KIIND DeeM OaTH OPTY osee OIND DeeM OaTH OPTY [KIsee OIND oeOM fX]OTH OPTY osee OIND DeeM IXIOTH OPTY osee Homemaker Food, Decorations None ~D 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 $ Statement covers period from 01/23/05 through AMOUNTI FAIR MARKET VALUE 81.80 81.80 I 02/19/05 SCHEDULE C CALIFORNIA 460 FORM Page (., of " I.D. NUMBER 1273509 CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 - DEC 31) PER ELECTION TO DATE (IF REQUIRED) 81.80 81.80 ,- *Contributor Codes 'ND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY - Political Party sce - Small Contributor Committee ... ~ FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC