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Home My Public Portal AboutForm 460 (July 1 - Dec 31, 2011)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from _ July 1, 2011 through December 31, 2011 Type of Recipient Committee: All committees Officeholder, Candidate Controlled Committee — complete Parts 1, 2, 3, and 4. Q State Candidate Election Committee El Primarily Formed Ballot Measure O Recall Committee (Also Complete Parts) O Controlled Q Sponsored ❑ General Purpose Committee (Also complete Part 6) O Sponsored ❑ Small Contributor Committee ❑ Primarily Formed Candidate/ O Political Party/Central Committee Officeholder Committee (Also Complete part 7) 3. Committee Information I.D. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)1277625 Committee to Elect Cpanyi Nasiali - 2011 STREET ADDRESS (NO P.O. BOX) 220 Ferris Street CITY Claremont STATE ZIP CODE AREA CODE/PHONE MAILING ADDRCA 91711 ESS (IF DIFFERENT) N0. AND STREET OR P.O. BOX 909-625-4176 CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification COVER PAGE JAN 3 0 20f� , ��;�I ,�* Date of elLplicable: Page 1 of 5 (Monar) hep CITY CLERK For Official Use Only � OF CLAREMO T 2• Type of Statement: ❑ Preelection Statement [� Semi-annual Statement El Quarterly Statement ❑ ❑ Special Odd -Year Report Termination Statement (Also file a Form 410 Termination) ❑ Supplemental Preelection ❑ Amendment (Explain below) Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Barbara J. Miller MAILING ADDRESS 877 Connors Ct. clrY Claremont STATE ZIP CODE AREA CODE/PHONE CA 91711 NAME OF ASSISTANT TREASURER, IF ANY 909-624-1170 MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is tru under penalty of perjury under the laws of the State of California that the foregoing is true and correct. e and complete. I certify Executed on Date Executed on January 29, 2012 Date Executed on Date Executed on Date By By By Signature of Controlling Off ceholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form FPPC Toll -Free Helpline: 866/ASK-FPPC6(8661275-37/72) State of California Type or print in ink. COVER PAGE - PART 2 Recipient Committee , ,�, Campaign Statement � . ,. , Cover Page — Part 2 ❑ SUPPORT Page 2 of 5 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE OPANYI K. NASIALI OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ElSUPPORT City Council Member ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP NAME OF OFFICEHOLDER OR CANDIDATE 220 Ferris Street Claremont, CA 91711 Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Committees Not Included in this Statement: List any committees NAME OF OFFICEHOLDER OR CANDIDATE not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of 71S Y officeholder(s) or candidate(s) for which this committee is primarily formed. E ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California of Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. SUMMARY PAGE Statement covers period from July 1, 2011 through Dec 31, 2011 page 3 of 5 rvf'.Ivlt OF FILER Opanyi K. Nasiali Schedule E, Line 4 $ 16.00 $ 16.00 Contributions Received Schedule H, Line 3 ColumnA Column 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE 1. Monetary Contributions ........................................... schedule A, Linea $ 0.05 $ 145.97 2. Loans Received...................................................... Schedule e, Line 3 0 0 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 0.05 $ 145.97 4. Nonmonetary Contributions .................................... schedule C, Line 3 0 0 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0.05 $ 146.02 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 16.00 $ 16.00 7. Loans Made............................................................. Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 16.00 $ 16.00 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 0 0 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ 16.00 $ 16.00 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 13. Cash Receipts ................................................... Column A, Line 3above 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 15. Cash Payments .................................................. Column A, Line 8above 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 B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column 8 above $ 145.97 To calculate Column B, add 0.05 amounts in Column A to the corresponding amounts from Column B of your last 0 16.00 report. Some amounts in Column A may be negative 130.02 figures that should be subtracted from previous period amounts. If this is the first report being filed 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). I I.D. NUMBER 1277625 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 $_$_0 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) -J/ $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) O Schedule A Type or print in ink. Monetary Contributions Received Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Opanyi K. Nasiali DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 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 $ SCHEDULE A Statement covers period from July 1, 2011 through December 31, 2011 Page 4 of 5 I.D. NUMBER 1277625 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) Q 0.05 0.05 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) *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 Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE ,vr-, yr r!Lt:M Opanyi K. Nasiali Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from July 1, 2011 through Dec 31, 2011 Page 5 of 5 I.D. NUMBER 1277625 E CODES: If one of the following codes accurately describes the payment, you may enter the code. CMP Otherwise, describe the payment. CNS campaign paraphernalia/misc. campaign consultants MBR member communications RAD radio airtime and production costs CTB contribution (explain nonmonetary)' MTC OFC meetings and appearances office expenses RFD returned contributions CVC civic donations PET petition circulating SAL campaign workers' salaries FIL candidate filing/ballot fees PHO phone banks TEL t.v. or cable airtime and production costs FND fundraising events POL polling and survey research TRC candidate travel, lodging, and meals IND LEG independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TRS staff/spouse travel, lodging,and meals legal defense PRO professional services (legal, accounting) TSF transfer between committees of the same candidate/sponsor LIT campaign literature and mailings PRT print ads VOT voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER LD, NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Bank of America, Claremont CA Branch Service Charges $16.00 . - •• Arm ..vrruWUtrvns or maepenoent expenditures must also be summarized on Schedule D. SUBTOTAL$ 16.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................... 16.00 2. Unitemized payments made this period of under $100................................................................. 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).).......................................................................... 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 16.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) D