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Home My Public Portal AboutForm 460 Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period f January 2005 rom SEE INSTRUCTIONS ON REVERSE June 30, 2005 through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 0 Officeholder, Candidate Controlled Committee 0 Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ~ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee D Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3 C .tt I f t" (1.0. NUMBER " omml ee norma Ion COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Claremont Business PAC STREET ADDRESS (NO PO. BOX) 141 Spring St. CITY ZIP CODE 91711 AREA CODE/PHONE (909) 445-1001 STATE CA Claremont MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAil ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kn under penalty of perjury under the laws of the State of California that the foregoing is true and cprrêCf. / Executed on AugustB,2005 Dale c. By Executed on By Signature of Controlling Officeholder, Candidate, State Measure Proponent or Signature of Controlling OffICeholder, Candidate, State Measure Proponent Date Executed on By Date Executed on By Date COVER PAGE Date Stamp tALIFORNIA 4 6 0 FORM . Date of election if applicable: (Month, Day, Year) REC,E,IVED AUG 1 1 2005 For Official Use Only Page -:::~n ¥ (;;~t:;.I(K ~X~.y Of fts,~~niJiOKr 2. Type of Statement: 0 ~ Preelection Statement Semi-annual Statement Termination Statement (Also file a Form 410 Termination) 0 Amendment (Explain below) 0 Quarterly Statement 0 Special Odd-Year Report 0 Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Valerie E. Martinez MAILING ADDRESS 141 Spring St. CITY Claremont STATE ZIP CODE AREA CODE/PHONE (909) 445-1001 CA 91711 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS i íedge the infor'<'.~~ion r.2nta~d herein and in the attached schedules is true and complete. I certify Jbfiß~ / "" //~. Signature of 11'éasurer or Assistant Treasurer Signature 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 Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Claremont Business PAC Contributions Received 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 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 ....................... prevíousSummaryPage, 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 Bo Parl2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse 19. Outstanding Debts ......................... Add Lin~ 2 + Line 9 in Column B above Type or print in ink. Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $ 3000 0 3000 0 3000 $ $ $ 2996 0 2996 0 0 2996 $ $ $ 0 3000 0 2996 4 $ $ $ $ from through Column B CAlENDAR YEAR TOTAL TO DATE $ 3000 0 3000 0 3000 $ $ $ $ $ 0 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 carryover the amounts from Lines 2, 7, and 9 (if any). 0 0 SUMMARY PAGE Statement covers period CALIFORNIA 46 0 FORM January 2005 June 30, 2005 Page d- of :s 1.0. NUMBER 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 3000 $ Received $ 21. Expenditures 2996 $ Made $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) I ! $ I I $ Total to Date . Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Claremont Business PAC DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE, ALSO ENTER I.D NUMBER) CODE * i?]IND Valerie E. Martinez DCOM 3/3/05 141 Spring St. DOTH Claremont, CA 91711 DPTY DsCC ØIND Nicholas Quackenbos DCOM 3/3/05 675 W. Foothill Blvd., Suite 302 DOTH Claremont, CA 91711 DPTY DsCC i2IND Paul Held DCOM 3/3/05 414 Yale Ave. Suite C DOTH Claremont CA 91711 DPTY DsCC J. Michael Fay ~IND DCOM 3/3/05 464 N. Indian Hill Blvd DOTH Claremont, CA 91711 DPTY Dsee Randall S. Prout i!i1IND DCOM 3/3/05 440 W. Baseline Rd DOTH Claremont, CA 91711 DPTY DsCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Communications Consultant, VMA Communications, Inc Real Estate Broker Quackenbos-Bell Attorney, Stafford, Shea and Held Financial Planner Claremont Financial Group, Inc Insurance Agent SUBTOTAL $ Schedule A Summary 1. Amount received this period - itemized monetary contributions. (Include all Schedule A subtotals.) ..................... """"""""""" ......."....... ................."..... ."... ............... $ 2. Amount received this period - un itemized 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 $- SCHEDULE A from Statement covers period CALIFORNIA 4 6 0 FORM January 2005 Page ~3 of ~ June 30, 2005 through AMOUNT RECEIVED THIS PERIOD 100 150 100 100 100 550 I 3000 0 3000 LD. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 100 100 150 150 100 100 100 100 100 100 ~ .Contributor Codes IND -Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee '- .J FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. NAME OF FILER Claremont Business PAC DATE RECEIVED 3/3/05 3/7/2005 3/7/2005 3/7/2005 FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, AlSOENTERLD. NUMBER) CODE * Claremont Toyota 508 Auto Center Dr. Claremont. CA 91711 OIND i!?1COM OaTH OPTY OSCC ~IND OCOM OOTH OPTY OSCC ~IND OCOM OOTH OPTY OSCC OIND OCOM ~OTH OPTY OSCC OIND OCOM OOTH OPTY OSCC Judy Cody 2340 N. San Joaquin Ct. Claremont, CA 91711 John Howland 1356 Via Zurita Claremont, CA 91711 Herb Hafif, Law Offices of 265 W. Bonita Ave. Claremont. CA 91711 r .Contributor Codes 'NO -Individual COM - Recipient Committee (other than PTY or SCe) OTH - Other (e.g., business entity) pry - Political Party SCC - Small Contributor Committee ... .. IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Business Entity Nurse Attorney Law corporation SUBTOTAL $ from Statement covers period -- January 2005 through June 30, 2005 AMOUNT RECEIVED THIS PERIOD 2000 100 100 250 2450 I SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page Lf- 1.0. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 2000 100 100 250 0'5' PER ELECTION TO DATE (IF REQUIRED) 2000 100 100 250 FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) SCHEDULE E Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 2005 CALIFORNIA 46 0 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Claremont Business PAC through June 30, 2005 Page ~ 1.0. NUMBER Of.~ 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 MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary). OFC office expenses SAL campaign workers' salaries CVC civic donations ÆT petition circulating TEL tv. or cable airtime and production costs FIL candidate filing/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 II\[) 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 Ran Graphics, Inc 321 N. Banna St. Covina, CA 91724 Printing for 2 postcards LIT 950 A&M Mail Services 949 N. Cataract San Dimas, CA Postage and handling for 2 mailers 1550 POS GraphicType Inc. 10440 Pioneer Blvd Santa Fe Springs, CA Creative on mailers LIT 496 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2996 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 $ 2996 0 0 2996 FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)