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Home My WebLink AboutCarlyn Christianson - Form 460 - Preelection Statement Amendment - 05-16-2013Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 01/01/2013 through 05/04/2013 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Pert 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party /Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1355988 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Carlyn Christianson for City Council 2013 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE San Luis Obispo CA 93401 805 550 9320 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX I E -MAIL ADDRESS carlynpc@gmaii.com 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my k under penalty of perjury under the laws of the State of California that the foregoing is true Executed on �J' ` �,�3 By Executed on ! I E?_ I By - .DDste SlunaWre of I Date of election If applicable: (Month, Day, Year) 06/18/2013 Date Stamp RECEIVL COVER PAGE 1 of 10 MAY 16 2013 f For Official Use Only SLO CITY CLI_ 2. Type of Statement: Z Preelection Statement ❑ Quarterly Statement ❑ Semi - annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Supplemental Preelection Statement -Attach Form 495 ® Amendment (Explain below) -r3Ve-C, U1 ►�IIl Treasurers) NAME OF TREASURER Jeri F Carroll MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE San Luis Obispo CA 93401 805 543 6156 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS jeri—carroll@aft.net the information, contained herein and in the attached schedules is true and complete. I certify Executed on By Data By of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date _ Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) State of California Recipient Committee Type or print In Ink. COVER PAGE - PART 2 Campaign Statement CALIFORNIA 460 Cover Page Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Cadyn Christianson OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, San Luis Obispo RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Luis Obispo, CA 93401 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 conbibudons or make expenditures on behalf of your candidacy. COMMITTEE NAME I I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME 1,D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE Page 2 of 10 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ 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 Candidate/Officeholder Committee List names of off ceholde►(s) or candidete(s) for which this committee Is primarily formed. 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/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772) State of Calliomia Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Carlyn Christianson for City Council 2013 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 tines e+ 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... ............ ....... Prevlous Summary Page, Line 18 13. Cash Receipts .................... ............................... column A, Line 3 above 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 15. Cash Payments ................... ............................... Column A, Line a 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. Type or print In Ink. Amounts may be rounded to whole dollars. Column A TOTALTHISPERIOD (FROM ATTACHED SCH EDULES) $ 8,887.99 760.00 $ 9,647.99 200.00 Statement covers period from 01/01/2013 through 51/-//2013 Column B CALENDAR YEAR TOTALTODATE $ 8,887.99 760.00 $ 9,647.99 200.00 $ 9,847.99 $ 9,847.99 $ 8,287.58 $ 8,287.58 $ 8,287.58 $ 8,287.58 $ 8,287.58 $ 8,287.58 $ .00 9,647.99 .00 8,287.58 $ 1,360.41 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Pert 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... see instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 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). Page 3 of 10 I.D. NUMBER 1355988 Calendar Year Summary for Candidates Running In Both the State Primary and General Elections 20, Contributions Received $ 21. Expenditures Made $ 1/1 through 6 /30 7/1 to Date Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (H Subject to voluntary Expenditure Limit) Date of Election Total to Date (mm/dd /yy) $ "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 (8661275 -3772) Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE It OF I-ILIzK Carlyn Christianson for City Council 2013 Type or print In Ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER RECEIVED (IF COMMITTEE, ALSO ENTER I.D.NUMBER) CODE* OCCURATIONANDEMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) (SEE ATTACHED CONTINUATION SHEET) ❑IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC MIND ❑ COM ❑ OTH ❑ PTY ❑ SCC SCHEDULE A Statement covers period from 01/01/2013 r CALIFO a a RM through 5/Y Y2013 Page 4 of 10 I.D, NUMBER 1355988 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) SUBTOTAL$ Schedule A Summary 1. Amount received this period — itemized monetary contributions. 5,900.00 (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 $ 2,987.99 8,887.99 "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 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661276 -3772) Schedule A (Continuation Sheet) Statement covers period California Form 460 Monetary Contribution Received from 1/1/13 Page 5 of 10 Name of Filer: Carlyn Christianson for througb 6/1113 I.D. Number: 1355988 City Council 2013 Oats Name and Address Code Occupation Employer Period - - YTD Election 21-Feb Carroll, Jeri, SILO, CA 93401 IND Retired 100 100 100 4 -Mar Ed Kurtz, SLO, Ca 93401 IND Food Broker Self 100 100 100 4 -Mar David and Naoanl Blakely, Santa Margarita, Ca 93453 IND Retired 100 100 100 4 -Mar Roy & Linda Rawlings, Arroyo Grande, CA 93420 IND Retired 200 200 200 4 -Mar Barbara Christianson, Oakland, CA 94611 IND Director of Health Education, Kaiser 100 100 100 5 -Mar Diann Boyle, Pleasanton, Ca 94566 IND Airline Pilot Southwest 100 100 100 12 -Mar Susan Hirsch, SLO, Ca 93401 IND Phy. Therapist Dr. Ford 150 150 150 12 -Mar Tom Sant, SLO, Ca 93401 IND My. Therapist Dr. Ford 150 150 ISO 12 -Mar Ronald A. Yukelson, SLO, 93401 IND Hospital Administrator Sierra Vista Regional Medical Center 100 100 100 12 -Mar Anne Reese Kmetovic, Pacific Grove, CA 93950 IND R 200 200 200 12 -Mar Jan Marx, SLO, CA 93405 IND Mayor City of San Luis Obispo 200 200 200j 15 -Mar Katherine A. Barnicle, SLO Ca 93401 IND Researcher Unly of Wlsconsin- Madison 200 200 200 18 -Mar Wm Kirk & Brenda Moore, SLO Ca 93405 IND Acc'ts Manager US Health Works 100 100 100 23 -Mar Susan & James Polk, SLO Ca 93405 IND Health Ins Broker Susan Polk Ins 100 100 100 25 -Mar Jeanne Potter, SLO Ca 93401 IND c a Glenn Burdette 200 200 200 25 -Mar Raya Fleming, Arroyo Grande, Ca 93420 IND Administrator CAPSLO 100 100 100 25 -Mar Michael Boswell & Tammy Seale, SLO Ca 93401 IND Professor /Planner Cal Poly/PMC 400 400 400 25 -Mar Tanya Kiani, Marro Be , CA 93442 IND University Administrator Cal Poly 100 100 100 25 -Mar Patricia Andreen, SLO Ca 93405 IND Attorney Lozano Smith Lawfirm 2001 200 200 25 -Mar J Trey Duffy, SLO Ca 93401 IND Student Services Director Cal Poly 2001 200 200 4-Apr Adam Hill, , SLO Ca 93401 IND Coun!y Supervisor SLO County 200 200 200 --4-Apr Mary Stenger, , SLO CA 93401 IND Physician i Coastal Anestesiology 200 200 200 5-Apr Mary N Parker, SLO CA 93405 IND R 100 100 100 a -A r Thomas & Cathy Murray, Arroyo Grande, CA 93420 IND Contractor Liteaoo Cut Connt 200 200 200 9 -A r Eric Christianson, Redmond, WA 98052 IND programmer Self Employed 100 100 100 9 -Apr Dawn Legg, LO Ca 93401 IND asst project mgr First Solar 100 100 100 9-A r Nancy Bruno, , SLO CA 93401 IND R 100 100 100 9-Apr Susan Devine, SLO CA 93401 IND R 200 200 200 10 -Apr Julie & John Schutz, SLO, CA 93405 IND R 200 200 200 15 -A, r Kurt Frledma nn, SLO, CA 93401 IND :Sales Agent :Self Employed 1001 100 100 19 -A r Diann Boyle, Pleasanton, Ca 94566 IIND Pilot I Southwest 100 100 100 19 -Apr Daniel Boyle, Pleasanton, Ca 94566 IND pilot Southwest 200 200 200 26 -A r Barbara Bell, SLO CA 93401 IND Real Estate Inv Designer Self Employed 100 100 100 26-Apr Mike Heyl, SLO CA 93401 IND Teacher GUSD 200 200 200 26-Apr SLO County Democratic Party, Sacramento CA 95841 PTY Political Party Democrats 200 200 200 26 -Apr Carol Lewellen, SLO CA 93401 IND R 200 200 200 3_ -May. Patricia Harris, San Luis Obispo CA 93401 IND R 100100, 100 3 -May Planned Parenthood Action Fund of Santa Barbara Ventur and San Luis OTH Non Profit Orq. 1278950 2nn inn inn Subtotal ($ Period) _ 5,900 f Schedule B — Pala 1 Type or print In Ink. scliEnui_EB -PART1 Amounts may be rounded Statement covers period Loans Received to whole dollars. 01/01/2013 • from 013 6 10 SEE INSTRUCTIONS ON REVERSE through Pape of NAME OF FILER I.D. NUMBER Carlyn Christianson for City Council 2013 1355988 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTS A DING t °I ° OF LENDER OCCUPATION AND EMPLOYER BALANCE AMOUNT AMOUNTPAID �BATIANCEA T INTEREST p ORIGINAL CUMULATIVE COMMnTEE.ALSOEIMRI.D.NUMBER (IF SELF-EM PLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN PAID THIS (IF I CLOSE OF THIS AMOUNTOF CONTRIBUTIONS NAME Or BUSINESS) PERIOD „ THIS PERIOD PERIOD LOAN TO DATE Carlyn Christianson Medical Practice ❑PAR) CALENDARVEAR Administrator, $ s 760 0 San Luis Obispo, Ce 93401 Anesthesiology Medical ❑ FORGIVEN % RATE s $ PERELECTION" Associates $ a 760 $ 6/30/13 0 tm IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s s DATE INCURRED DATE DUE ❑ PAID CALENDAR YEAR S $ % 8 $ ❑ FORGIVEN RATE PERELECTION"" t❑ IND ❑ COM ❑ OTH C1 PTY ❑ SCC s a a ® DATE INCURRED S DATE DUE ❑ PAID CALENDAR YEAR 8 $ % 8 8 ❑ FORGIVEN RATE PER ELECTION" t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s a a DATE DUE a DATE INCURRED 8 SUBTOTALS $ 760$ $ 760 $ Schedule B Summary 1. Loans received this period .................................................................................... ............................... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period .......................................................................... ............................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third parry that are also itemized on Schedule A.) 760 3. Net change this period. Subtract Line 2 from Line 1. ...... NET $ 760 Enter the net here and on the Summary Page, Column A, Line 2. (maybe an"odvenmbeC "Amounts forgiven or paid by another party also must be reported on Schedule A. "* If required. tConhibutor Codes IND — Indivldual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Pollt cal Party SCC — Small Contributor Committee FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276.3772) Schedule C Nonmonstary Contributions Received OF Carlyn Christianson for City Council 2013 Type or print In Ink. Amounts may be rounded to whole dollars. Statement covers period from 01/01/2013 through 6/1 ! .1013 Page 7 I.D. NUMBER 1355988 DATE FULL NAME, STREET ADDRESS AND RECEIVED ZIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAI CUMULATIVE TO DATE OF COMMITTEE, ALSO ENTER I.D. NUMBER) OF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VAMLAUREKET CALENDAR YEAR (JAN 1 -DEC 31) James L. KillianhI385 , San 3/22/13 ❑IND m� Printer, San Luis Print envelope printing p p Luis Obispo, Ca 93401 pOTH & Co Copy 200 200 ❑ PTY ❑SCC ❑IND ❑COM ❑OTH ❑PW ❑SCC ❑IND ❑COM ❑OTH ❑ PTY []SCC ❑IND ❑COM ❑OTH ❑ PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 200 Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (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. $ 200 200 at 10 PER ELECTION TO DATE (IF REQUIRED) 200 *Contributor Codes IND — Indivldual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/o6) FPPC Toll -Free Hetpline: 866 1ASK -FPPC (8661276.3772) Schedule E Type or print In Ink. Statement covers period Amounts may be rounded Payments Made to whole dollars. from 01/01/2013 SEE INSTRUCTIONS ON REVERSE NAME OF FILER Cariyn Christianson for City Council 2013 through jjt12013 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 8 of 10 I.D. NUMBER 1355988 CIIIP campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costa CNS campaign consultants WG meetings and appearances RFD returned contributions CTB contribution (explain nonmonstary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. 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 I D Independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the some candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads IMEB Information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SLID Chamber of Commerce MBR 410.00 San Luis Obisbo CA 93401 Tom Meinhold Photography LIT 182.75 San Luis Obispo, Ca 93405 GFL Systems, Inc WEB 1,110.00 San Luis Obispo, Ca 93401 " Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,702.75 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 $ 7,983.72 303.86 8,287.58 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772) Schedule 9 (Continuation Sheet) Payments Made SEE INST NAME OF Cadyn Christianson for City Council 2013 Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from 01/01/2013 / through 5 / y'/2013 SC(1._ -,ULE E (CONT) Page 9 of 10 I.D. NUMBER 1355988 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia /misc. NBR member communications RAD radio airtime and production costs CNS campaign consultants VIG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating la U. or cable airtime and production costs FIL candidate flling/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 IND 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 I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Wild Donkey FND 100.00 San Luis Obispo, Ca 93401 City Clerk, SLO FIL 875.00 San Luis Obispo, CA 93401 Promotional Concepts CMP 159.96 San Luis Obispo Ca 93401 San Luis Print & Copy LIT 446.98 San Luis Obispo, CA 93401 Verdin" 689 Tank Farm Rd LIT 1646.66 San Luis Obispo, CA 93401 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3,228.60 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275-3772) Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Wells Fargo Visa SCHEDULE E (CONT.) (Continuation Sheet) Type or print in ink. Amounts may be rounded Statement covers period CALIFORNIA 460 Payments Made Des Moines IA 50306 -0347 to whole dollars. from 01/01/2013 FORM The Sign Place $1,773.75 through 05/04/2013 Page 10 of 10 SEE INSTRUCTIONS ON REVERSE San Luis Obispo, CA 93401 Sub Vendor: Political Data Inc. $330.00 POL Norwalk CA 90652 Special Olympic SLO County Bill Proll c/o SLO Police Dept. MTG 150.00 SLID CA 93401 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3,052.37 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)