HomeMy WebLinkAbout401 - 12/20/2021_RedactedSlate Mailer Organization
Campaign Statement
m (Gmement Code Sections 84218 - 84219)
❑ Amendment
Type or print In ink.
Statement covers period I S F r 20 20211 Page
CITY OF
CITY I
of_
If this Slate Mailer Organization is also a "general purpose committee' as defined in
Government Code Section 82027.5, check box and attach the committee's campaign
disclosure report to this statement.
OCommittee Repod ID Number If
Attached Recipient Committee
Summary of Payments A) (8)
Total cumulerne to Date
This Period (aince January 1 of
calendaryearcovered)
1. TOTAL PAYMENTS RECEIVED............................................................................................$ $
77yy SA.R. Une3
2. TOTALPAYMENTS MADE .............. TG..................................................................................... $ � $
", 8, Lim 3
I have used all reasonable diligence in pre ring, and reviewirl� this statement and to the best of my knowledge the information Contained herein and in the
attached schedules is true and complete. certify under penalty off perjury under the laws of the State of Cal omia that the foregoing is true and correct.
Executed on 12
2e70Z/ At 44MO(A - —^' V �h A, ey
DATE TT I CITY,1AANDSTATc
L
Name of Responsible Officer QQA L Title
TYPEoanalm
FOR INFORMATION REOUIREDTO BEPRONceDTOYOU PURBWMTOTHE INFORMATION PRACTICESACTOF n7.. ME INFORFUTONIAMU LONCAWAIGN DISCLOSURE PROASONS OFTHE FOIfTIMNEFORMACTFOR SLATE MAILER ORGANPATOMS.
FPPC Form 401 fAugM2)
FPPC Ton -Free Kalpline: 866IASK.FPPC (86rd2754772)
Srharll da A
SCHEDULE A
Payments Received
Staumenrcovers period .• . �'
from
through Pege Oi
SEE INSTRUCTIONS ON REVERSE
NAME OF SLATE MAILER ORGANIZATION I.D. NUMBER
A B
IDENTIFICATION OF PERSONS FROM WHOM CHECK BOX TO INDICATE IF CUMULATNE
NT
AMOUNT NT
DATE $100 OR MORE HAS BEEN RECEIVED NAME, OFFICE SOUGHT, AND JURISDICTION OF CANDIDATE/ PAYMENTWAS RECEIVED TO RECEIVED RECMOU SINCE
RECEIVED THIS PERIOD NAME.JURISDICTION. AND NUMBER OR LETTER OF BALLOT SUPPORT OR OPPOSE THIS JANUARY1
(SEE IMPORTANT INSTRUCTIONS ON CANDIDATE OR MEASURE
MEASURE SUPPORTED OR OPPOSED PERIOD PER CANDIDATE
REVERSE INCLUDED
(IF DIFFERENTTHAN COLUMN 2) OR MEASURE
SUPPORT Oppose
q.
N
SUBTOTAL
$
$
Summary
1. Amount Received— Itemized payments
(include all Schedule A subtotals) ........................
2. Amount Received —Payments of less than $100
3. Total Payments Received (Line 1 + Line 2). Enter here and in
Column A, Line 1, of the Summary of Payments section on Page 1 ...................................................E FPPC Form 401 (Aug/12)
FPPC Toll -Free Helpline. 8661ASK-FPPC (866(215-3772)
Schedule A
Payments Received
(Continuation Sheet)
MAILER ORGANIZATION
Stden Int coven "dad
from
through
A
e"
IOENTIFICR ION WHOM
CUMULATIVE
CHECKBOXAS INDICATE IF
GATE
E100 OR MOREHASRECEIVED
MORE HASPERSONSRECEIVED
NAME, OFFICE SOUGHTNDNUMBERO
PAYMENORT RECEIVED TO
AMOUNT
RECEIVED
T
AMOUNT
RECEIVEDSINCE
RECEIVED
THIS PERIOD
LETTER OF
NAME. JURISDICTION. OF BALLOT
OPPOSE
SUPPORT OR OPPOSE
THIS
(SEE IMPORTANT INSTRUCTIONS ON
MEA PORTEDRORLETTER
CANDIDATE ORME
PERIOD
RCANDIID
PER CANDIDATE
REVERSE)
DIFFERENT THAN COR OLUMN 2)
(IF DIFFERENT THAN COLUMN 2)
MAILS
INCLUDED IN SLATE MAILER
OR MEASURE
suPAOAT
06ibsE ,."j
nn
V
SUBTOTAL
$
$
FPPC Farm 401 (Aug112)
FPPC TOII-Free Helpline! 8661ASK.FPPC (866127541772)
Schedule B-1 SCHEDULEB-1
Payments Made By An Agent or Stetemerdcovers period
Independent Contractor on Behalf of from
A Slate Mailer Organization
Page _of_
TOTAL
*Do not transfer to arty other schedule or to Me Summary. This rota) may not equal he amount paid to the agerd or Independent wntraclor as reported on Schedule B by the Slate MallerOMan¢etbn.
FPPC Form 601 (AugM2)
FPPC Toll-Frw Helpllne: taMIAMFPpC (86612754772)
Schedule C SCHEDULE c
Persons Receiving Statement Caere period
$1000 or More from
SEE INSTRUCTIONS ON REVERSE
NAME OF SLATE MAILER ORGANI2
You must Identify each individual listed on your Statement of Organization (Form 400) who received, directly or indirectly,
$1,000 or more from the organization during the period. (See instructions on reverse regarding "Indirect" payments.)
NAMES OF . . Itl OR MORE AMOUNT THIS PERIOD CUMULATIVE SINCE'
FPPC Form e81 (Augn2)
FPPC TOII-Fme Helpllne: 8661ASK-FPPC )866275.=2)
Schedule D
Candidates and Measures
Not Listed on Schedule A
SEE INSTRUCTIONS ON REVERSE
SCHEDULE ❑
Statement covers p•rlod
through I Pag• _of_
I.U. NUMBER
You must identify each candidate and measure supported or opposed In a slate mailer sent by you during the period for which you did
not receive a payment of $100 or more (either from the candidate or ballot measure committee or from any other person).
r
NAmr OF CANDIDATE OR MEASURESUPPOflT
CHECK •
OPPOSE
JURISDICTION •CANDIDATE'
•
FPPC Form 601 (Augl12)
FPPC Tall -Free Helpline: 6661ASK-FPPC (8651275-3772)