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HomeMy WebLinkAboutSLO Citizens for Measure G - Form 460 - Termination - 02-02-15Statement of Organization Recipient Committee Statement Type ❑ Initial ❑ Amendment Not yet qualified ❑ or List I.D. number: #1368735 Date qualified as committee Date qualified as committee (IF applicable) 1. Committee NAME OF COMMITTEE SLO CITIZENS FOR MEASURE G _ E= 8 2015 0 Termination — See Part 5 List I.D. number: #1368735 01 /30 /2015 Date of Termination STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)544 -7774 MAILING ADDRESS (IF DIFFERENT) SAN LUIS OBISPO, CA 93406 FAX 1 E -MAIL ADDRESS I NFO @CITIZENSFORG.COM COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE SAN LUIS OBISPO SAN LUIS OBISPO Attach additional information on appropriately labeled continuation sheets. Date Stamp FUX-0 in the office of the Secretary of State of the State of Callfomla FEB 0 2 2015 FE8 1 1 2015 TOMMY (GONG, (COUNTY CLERK 2. Treasurer and Other Principal Officers NAME OF TREASURER HILLARY TROUT TY CLEW STREET ADDRESS (NO P.O. BOX) CITY STATE SAN LUIS OBISPO CA ZIP CODE 93401 AREA CODE /PHONE (805)541 -0839 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) SEE CONTINUATION SHEET STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Ueri 'cation . I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of Calif9qLraiqhat the toreggoainngiLtwe and correct. Executed on 01/30/2015 By DATE t. SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on DATE Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. . NUMBER SLO CITIZENS FOR MEASURE G 11368735 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION COAST NATIONAL BANK ADDRESS AREA CODE /PHONE (805)541 -0400 CITY BANK ACCOUNT NUMBER 101023818 STATE ZIP CODE 500 MARSH STREET SAN LUIS OBISPO CA 93401 4. Type of Committee Complete the applicable sec. ops. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO. CITY OR COUNTY. AS APPI ICARI F) MEASURE G -14 ESSENTIAL SERVICES CITY OF SAN LUIS OBISPO SUPPORT 71 OPPOSE E] TRASACTION (SALES) AND USE TAX Su n p FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER SLO CITIZENS FOR MEASURE G 11368735 4. Type.of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE r r r r r ❑ Date qualified 5. Termination, Requirem "ents a By 31gNhg3h� UpFiTic�tlmi'Yhe treasurer; a3slstai9t treaSUref.nd /o� 2andid�te; dfficeholde�, or proponent certify thaE all of the fol,loiNing condltidh5 have beeh mpt • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CALIFORNIA FORM 410 CONTINUATION SHEET NAMES OF PRINCIPAL OFFICERS PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: END OF CONTINUATION SHEET PIERRE RADEMAKER 1041 CHORRO STREET #230 SAN LUIS OBISPO CA 93401 (805) 544 -7774 CLINT PEARCE 284 HIGUERA STREET SAN LUIS OBISPO CA 93401 (805) 748 -9097 ANDREA PEASE 2410 LEO NA AVENUE SAN LUIS OBISPO CA 93401 (805) 235 -6355 Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE SLO CITIZENS FOR MEASURE G STREET ADDRESS (NO P.O. BOX) 1041 CHORRO STREET #230 �E � , 8 2015 ❑ Amendment is Termination — See Part 5 List I.D. number: List I.D. number: # 1368735 # 1368735 in 01 /3��2015 Date qualified as committee Date of Termination (If applicable) CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)544 -7774 MAILING ADDRESS (IF DIFFERENT) PO BOX 15728, SAN LUIS OBISPO, CA 93406 FAX / E -MAIL ADDRESS INFO @CITIZENSFORG.COM COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE 15ACTIVE SAN LUIS OBISPO SAN LUIS OBISPO Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and 4. 0e NAME OF TREASURER HILLARY TROUT Date Stamp X , -�, FiL ice of the Secretary of State the State of Califomra FEB 0 2 2015 STREET ADDRESS (NO P.O BOX) 1175 BUCHON STREET FEB 1 1 2015 TOMMY GONG, COUNTY CLERK CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)541 -0839 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) SEE CONTINUATION SHEET STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of Califo ' at the foregai a and correct. Executed on 01/30/2015 By DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on DATE Executed on DATE Executed on DATE By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (8661275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME - - - I,D.NUMBER SLO CITIZENS FOR MEASURE G 11368735 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION COAST NATIONAL BANK ADDRESS AREA CODE /PHONE (805)541 -0400 CITY BANK ACCOUNT NUMBER 101023818 STATE ZIP CODE 500 MARSH STREET SAN LUIS OBISPO CA 93401 4. Type of Committee Complete the,applicab €e sections. .J • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) MEASURE G -14 ESSENTIAL SERVICES CITY OF SAN LUIS OBISPO SUPPORT ❑✓ OPPOSE EL TRASACTION (SALES) AND USE TAX SU T O FPPCForm 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME I D. NUMBER SLO CITIZENS FOR MEASURE G 11368735 4. Type. of Committee Kontinuedi General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE Date qualified S. Termination Requirements By signing the verification, the treasurer, assistant treasurer bnd/or candidate, Wceholder, or proponent certify that all of the followiiigcondltions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CALIFORNIA FORM 410 CONTINUATION SHEET NAMES OF PRINCIPAL OFFICERS PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: END OF CONTINUATION SHEET PIERRE RADEMAKER 1041 CHORRO STREET #230 SAN LUIS OBISPO CA 93401 (805) 544 -7774 CLINT PEARCE 284 HIGUERA STREET SAN LUIS OBISPO CA 93401 (805) 748 -9097 ANDREA PEASE 2410 LEONA AVENUE SAN LUIS OBISPO CA 93401 (805) 235 -6355 Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or ❑ Amendment List I.D. number: # 1368735 Date qualified as committee Date qualified as committee (If applicable) ® Termination — See Part 5 List I.D. number: # 1368735 01-30 2015 Date of Termination 1. Committee Information NAME OF COMMITTEE SLO CITIZENS FOR MEASURE G STREET ADDRESS (NO P.O BOX) 1041 CHORRO STREET #230 CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)544 -7774 MAILING ADDRESS (IF DIFFERENT) PO BOX 15728, SAN LUIS OBISPO, CA 93406 FAX I E -MAIL ADDRESS INFO @CITIZENSFORG.COM COUNTY OF DOMICILE JIUR11DICTION WHERE COMMITTEE IS ACTIVE SAN LUIS OBISPO SAN LUIS OBISPO Attach additional information on appropriately labeled continuation sheets. Date Stamp For Official Use Only FEB 0 2 2015 2. Treasurer and Other Principal Officers -- NAME OF TREASURER HILLARY TROUT STREET ADDRESS (NO P.O BOX) 1175 BUCHON STREET CITY STATE ZIP CODE SAN LUIS OBISPO CA 93401 AREA CODE /PHONE (805)541 -0839 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) SEE CONTINUATION SHEET STREET ADDRESS (NO P.O- BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of Ca—UoLri.La th e foregoing is true and correct. Executed on 01/30/2015 B Executed on Executed on Executed on DATE DATE DATE DATE By SIGNATURE OF TREASURER OR ASSISTANT TREASURER SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFOW11A Recipient Committee t INSTRUCTIONS ON REVERSE CITY OF SAN LUIS OBISPO Page 2 COMMITTEE NAME - ... -.. TRASACTION (SALES) AND USE TAX I D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION COAST NATIONAL BANK ADDRESS AREA CODE /PHONE (805)541 -0400 CITY BANK ACCOUNT NUMBER 101023818 STATE ZIP CODE 500 MARSH STREET SAN LUIS OBISPO CA 93401 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CAN MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) rucrr nNc MEASURE G -14 ESSENTIAL SERVICES CITY OF SAN LUIS OBISPO SUPPORT 0 OPPOSE ❑ - ... -.. TRASACTION (SALES) AND USE TAX - - SUPT ORME EL FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization ' - ' , 1 Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMMEE NAME LD. NUMBER SLO CITIZENS FOR MEASURE G 11368735 4. Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CALIFORNIA FORM 410 CONTINUATION SHEET NAMES OF PRINCIPAL OFFICERS PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: PIERRE RADEMAKER 1041 CHORRO STREET #230 SAN LUIS OBISPO CA 93401 (805) 544 -7774 PRINCIPAL OFFICER: CLINT PEARCE STREET ADDRESS: 284 HIGUERA STREET CITY: SAN LUIS OBISPO STATE: CA ZIP CODE: 93401 AREA CODE /PHONE: (805) 748 -9097 PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: END OF CONTINUATION SHEET ANDREA PEASE 2410 LEONA AVENUE SAN LUIS OBISPO CA 93401 (805) 235 -6355 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 10/19/2014 through 01/30/2015 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 Part 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 I.D. NUMBER 1368735 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 4. SLO CITIZENS FOR MEASURE G STREET ADDRESS (NO P.O. BOX) 1041 CHORRO STREET #230 CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 805 - 544 -7774 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO BOX 15728 CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 805 - 544 -7774 OPTIONAL: FAX / E -MAIL ADDRESS INFO @CITIZENSFORG.COM COVER PAGE Date Stamp Date of election if applicable: - Page 1 of 17 (Month, Day, Year) For Official Use Only FEB 0 2 2015 11/4/2014 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi - annual Statement ❑ Special Odd -Year Report Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER HILLARY TROUT MAILING ADDRESS 1175 BUCHON STREET CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 805 - 541 -0839 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E -MAIL ADDRESS INFO @CITIZENSFORG.COM STATE ZIP CODE AREA CODE /PHONE Verification 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 true and complete. I certify under penalty of perjury and 7 the laws of the State of California that the foregoing is true and correct. t. Executed on By Dale Sittnaturea firrasurerorAssistantTreasurer Executed on Date Executed on Date Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661276 -3772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL /BUSINESS ADDRESS (NO. AND STREET) 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. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (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 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE COVER PAGE - PART 2 IPage 2 of 17 6. Primarily Formed Ballot Measure Committee II NAME OF BALLOT MEASURE ESSENTIAL SERVICES TRASACTION (SALES) AND USE TAX BALLOT NO. OR LETTER JURISDICTION m SUPPORT G -14 CITY OF SAN LUIS OBISP ❑ 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 officeholder(s) or candidate(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/OS) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/2753772) State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER SLO CITIZENS FOR MEASURE G Statement covers period from 10/19/2014 through 01/30/2015 SUMMARY PAGE 0_ • Page 3 of 17 I.D. NUMBER 1368735 Contributions Received A Column B Calendar Year Summary for Candidates 8,187.62 13. Cash Receipts .................... ............................... Column A, Line 3 above rColumn D (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and g ma rY 0.00 15. Cash Payments ................... ............................... Column A, Line 8above General Elections 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 1,200.00 $ 25,890.00 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 0.00 0.00 1/1 through 6/30 7/1 to Date 2. Loans Received ....................... ............................... schedule a, Line 3 18. Cash Equivalents ................ ............. See instructions on reverse $ 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 1,200.00 $ 25,890.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... Schedule C, Line 3 9,135.00 10,958.29 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 10,335.00 $ 36,848.29 Made $ $ Expenditures Made 6. Payments Made .................... Schedule E, Line 4 $ 9,387.62 7. Loans Made .............................. ............................... Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS .......... .... ... ......... .--------- Add Lines 6 +7 $ 9,387.62 9. Accrued Expenses (Unpaid Bills ............ Schedule F, Line 3 0.00 10. Nonmonetary Adjustment ........... ---------- - - - - -- Schedule C, Line 3 9,135.00 11. TOTAL EXPENDITURES MADE ....... ......................... Add Lines 8 +9 +10 $ 18,522.62 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 8,187.62 13. Cash Receipts .................... ............................... Column A, Line 3 above 1,200.00 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0.00 15. Cash Payments ................... ............................... Column A, Line 8above 9,387.62 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0.00 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................ ............. See instructions on reverse $ 0.00 19. Outstanding Debts ............. . ........... Add Line 2 + Line 9 in Column B above $ 0.00 $ 25,890.00 0.00 $ 25,890.00 0.00 10, 958.29 $ 36,848.29 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). 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) $ -/ $ 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) Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may rounded to dollars. lars. Statement covers period CALIFORNIA whole 460 from 10/19/2014 FORM 01/30/2015 4 17 SEE INSTRUCTIONS ON REVERSE i through Page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE RECEIVED THIS CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTERID- NUMBER) CODE* (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) BIND STEPHEN GESELL 10/20/14 STEPHEN HEN GE ❑COM POLICE CHIEF 250.00 250.00 LANE E] OTH CITY OF SAN LUIS ATASCADERO, CA 93422 ❑ PTY OBISPO ❑ SCC ®wD MARY VERDIN 10/21/14 ❑COM MARKETING 100.00 100.00 3580 SACRAMENTO DR #110 E] OTH VERDIN MARKETING SAN LUIS OBISPO, CA 93401 El PTY ❑ SCC ®IND 10/23/14 BROOKE LANGLE ❑COM Founding Principal, Terra 100.00 100.00 672 SERRANO DRIVE #4 E] OTH Verde Environmental SAN LUIS OBISPO, CA 93405 ❑ PTY Consulting ❑ SCC ❑IND 10/26/14 TENET 1400 SOUTH DOUGLASS SUITE 250 ❑COM 6fl OTH NA 500.00 500.00 ANAHEIM, CA 92806 ❑ PTY DAVID LOUGHRAN ❑ SCC ❑IND ❑COM PRESIDENT 10/31/14 PO BOX 1919 ❑ OTH D -KALE ENGINEERING 100.00 100.00 SAN LUIS OBISPO, CA 93401 ❑ PTY ❑ SCC SUBTOTAL$ 1,050.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) $ 1,050.00 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.) ....... ...... ... ..... ... .... .. $ ....1... TOTAL $ 150.00 1,200.00 '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/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. CALIFORNIA 460 10/19/2014 from FOR M 01/30/2015 5 17 through page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED ( IFCOMMITfEE, ALSO ENTER ID.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ❑IND NONE ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM []OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND . .......... _W. .... - ❑ COM ❑ OTH ❑ PTY ❑ SCC '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 SUBTOTAL $ 0.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) �Yy :lg bill 8Q 13M1 461 Schedule B — Part 1 Amou"n- t �m' a"y­ ­ b' ­ ro­ u...n nded Statement covers P eriod Loans Received to whole dollars. 10/19/2014 CALIFORNIA 460 from FORM 01/30/2015 6 17 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER L.D. NUMBER SLID CITIZENS FOR MEASURE G 1368735 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER tat OUTSTANDING (b) AMOUNT (c) AMOUNT PAID (a) OUTSTANDING (e) INTEREST (t) ORIGINAL (g) CUMULATIVE LENDER (IFSELF- EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE,ALSO ENTERI.D NUMBER) E, NAMEOFBUSINESS) p Rt PERIOD THIS PERIOD' PERIOD PERIOD LOAN TO DATE NONE ❑ PAID CALENDARYEAR $ s % $ $ ❑ FORGIVEN RATE PER ELECTION- to IND El COM [-I OTH El PTY F-1 SCC $ $ $ $ DATE INCURRED $ DATE DUE ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION"* RATE DATE DUE tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDARYEAR $ $ % $ $ ❑ FORGIVEN RATE PERELECTION- t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ $ $ $ $ DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ 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 party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ................................ ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. =1 (May be a negative number) (Enter (e) on Schedule E, Line 3) tContributor 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/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule B — Part 2 Type or print in ink. _ _ SCHEDULEB -PART2 Amounts may be rounded Statement covers period CALIFORNIA Loan Guarantors to whole dollars. from 10/19/2014 FORM t through 01/30/2015 7 17 SEE INSTRUCTIONS ON REVERSE 9 Page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 FULL NAME, STREET ADDRESS AND ZIP CODE OF GUARANTOR (IF COMMITTEE, ALSO ENTER I. D NUMBER) CONTRIBUTOR CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) LOAN AMOUNT GUARANTEED THIS PERIOD CUMULATIVE TO DATE BALANCE OUTSTANDING TO DATE NONE ❑IND LENDER CALENDARYEAR ❑ COM $ DATE ❑ OTH ❑ PTY PER ELECTION (IF REQUIRED) ❑ SCC s CALENDARYEAR ❑ IND LENDER ❑ COM $ ❑ OTH PER ELECTION (IF REQUIRED) DATE ❑ PTY ❑ SCC $ CALENDARYEAR ❑ IND LENDER ❑ COM $ ❑ OTH F-1 PTY PER ELECTION (IF REQUIRED) DATE ❑ SCC __ $ ❑ IND LENDER CALENDARYEAR ❑ COM $ DATE ❑ OTH PER ELECTION (IF REQUIRED) ❑ PTY ❑ SCC $ nlsr on SUBTOTAL a 0.00 S ;-- ary Page, Line 17-dy. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule C Type or print in ink. g1rHFnill F C rkmounis may oe rounaea Nonmoneta Contributions Received �/ to whole dollars. "` Statement covers period CALIFORNIA 10/19/2014 • - � 6 ' from 01/30/2015 8 17 SEE INSTRUCTIONS ON REVERSE_ through Page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF COMMITTEE, ALSO ENTER I..D, NUMBER) NAME OF BUSINESS) (JAN 1 -DEC 31) (IF REQUIRED) — ........... E] IND BARNETT COX & ASSOCIATES N/A N/A DESIGN 11/2/14 711 TANK FARM ROAD ®OTH SERVICES 9,135.00 10,635.00 SAN LUIS OBISPO, CA 93401 ❑PTY - -- ❑SCC I ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 9,135.00 1 ` 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 ..... ............................... $ 9,135.00 1 11 3. Total nonmonetary contributions received this period. 9,135.00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ *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/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule D cw,Hp ,t 11 F n bumma OT tX enanures Type or print in ink. Amounts may be rounded Supporting /Opposing Other to whole dollars. Candidates, Measures and Committees Statement covers period 10/19/2014 from _ J . - • ' SEE INSTRUCTIONS ON REVERSE through 01/30/2015 Page 9 of 17 NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, ORCOMMITTEE NONE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN.1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ._._............. ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) .......................... ............................... $ 2. Unitemized contributions and independent expenditures made this period of under $100 ...................................................... ............................... $ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ............ TOTAL $ = FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule D (Continuation Sheet) Type or print in ink. SCHEDULED (CONT.) Summary of Expenditures Amounts may be rounded Statement covers period _ to whole dollars. i ' Supporting /Opposing Other 10/19/2014 FORM from Candidates, Measures and Committees 01/30/201.5 10 17 through � ........ ... .. _. _ _ Page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OR COMMITTEE NONE ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 0.00 4 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER SLO CITIZENS FOR MEASURE G Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/19/2014 through 01/30/2015 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment Page 11 of 17 I.D. NUMBER 1368735 CMP 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 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 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) I CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID BARNETT COX & ASSOCIATES DIRECT MAILER 711 TANK FARM ROAD LIT 5,784.13 SAN LUIS OBISPO, CA 93401 BARNETT COX & ASSOCIATES NEWSPAPER ADVERTISEMENT 711 TANK FARM ROAD PRT 948.62 SAN LUIS OBISPO, CA 93401 BARNETT COX & ASSOCIATES PHONE & WALKING LISTS 711 TANK FARM ROAD CMP 256.92 SAN LUIS OBISPO, CA 93401 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 6,989.67 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 9,148.52 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 239.10 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. .... TOTAL $ _ 9,387.62 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E Type or print in ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. Statement covers period from 10/19/2014 SCHEDULE E (CONT.) through 01/30/2015 Page 12 of 17 SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP 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 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 FIND 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 Lrr 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 BARNETT COX & ASSOCIATES FLYER & MAILER 711 TANK FARM ROAD LIT 464.40 SAN LUIS OBISPO, CA 93401 SAN LUIS OBISPO CHAMBER OF COMMERCE BUTTONS 895 MONTEREY STREET CMP 147.28 SAN LUIS OBISPO, CA 93401 SAN LUIS OBISPO CHAMBER OF COMMERCE PAPER & MAILING SUPPLIES 895 MONTEREY STREET OFC 144.33 SAN LUIS OBISPO, CA 93401 SAN LUIS OBISPO CHAMBER OF COMMERCE MAILING TO CHAMBER LISTS 895 MONTEREY STREET LIT 204.17 SAN LUIS OBISPO, CA 93401 COMMUNITY FOUNDATION SLO COUNTY DONATION TO OPEN SPACE PRESERVATION 550 DANA STREET CVC FUND 1,198.67 SAN LUIS OBISPO, CA 93401 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2,158.85 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER SLO CITIZENS FOR MEASURE G Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/19/2014 through 01/30/2015 SCHEDULEF Page 13 of 17 I.D. NUMBER 1368735 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP 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 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 surrey 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 CREDITOR (IF COMMITTEE, ALSO ENTER I NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNTIN CURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD NONE * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $ 100.) ................................ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) .......... 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ....................................................................... ............................... .. - - -. INCURRED TOTALS $ ................ PAID TOTALS $ NET $ _- 0.00 May De a negative number FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) SLO CITIZENS FOR MEASURE G Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/19/2014 through 01/30/2015 SCHEDULE F (CONT) Page 14 of 17 I.D. NUMBER 1368735 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/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 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 WD 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR CODE OR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNTIN CURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD NONE I SUBTOTALS $ $ $ $ 0.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule G CODE OR DESCRIPTION OF PAYMENT Type or print in ink. NONE SCHEDULE G , Payments Made by an Agent or Independent Amounts may be rounded Statement covers period Contractor (on Behalf of This Committee) to whole dollars. from 10/19/2014 • through 01/30/2015 Page 15 of 17 SEE INSTRUCTIONS ON REVERSE ! NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CUP campaign paraphernalia/misc. MBR member communications RAID 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 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 14D 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I -D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID NONE Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0.00 * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) SCHEDULEH Schedule H Type or print in ink. Statement covers period Amounts may be rounded 10/19/2014 Loans Made to Others * ' • ki to whole dollars. from 01/30/2015 16 17 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER SLO CITIZENS FOR MEASURE G 1368735 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER (a) OUTSTANDING (b) AMOUNT (c) REPAYMENT OR ( OUTSTANDING (e) INTEREST ORIGINAL CUMULATIVE OF RECIPIENT OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER BALANCE BEGINNING THIS LOANED THIS FORGIVENESS BALANCE AT CLOSE OF THIS RECEIVED AMOUNT OF LOANS (IF COMMITTEE, ALSO ENTER I.D- NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD" PERIOD I LOAN TO DATE NONE 9 PAID CALENDAR YEAR FORGIVEN PER ELECTION— RATE DATE DUE DATE INCURRED PAID CALENDAR YEAR FORGIVEN PER ELECTION— RATE DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. SUBTOTALS $ $ $ $ (Enter (e) on Schedule I, Line 3) Schedule H Summary 1. Loans made this period ........................................................................................................... ...................... ... ... . .. .. . .. $ (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans ............................................................................................................ ........... .................... $ (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. Subtract Line 2 from Line 1. , NET $ 0.00 (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) "If Required FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule I Type or print in ink. Miscellaneous Increases to Cash Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER SLO CITIZENS FOR MEASURE G DATE FULL NAME AND ADDRESS OF SOURCE RECEIVED (IF COMMITTEE, ALSO ENTER I D NUMBER) NONE Statement covers period from 10/19/2014 through 01/30/2015 DESCRIPTION OF RECEIPT Me Page 17 of 17 I.D. NUMBER 1368735 AMOUNTOF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule I Summary 1. Itemized increases to cash this period ............................... .......... $ 2. Unitemized increases to cash of under $100 this period ................................ ............................... $ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .. ............................... $ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Page, Line 14. 0.00 Summary 9 ) ............................................................................................ ............................... TOTAL $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)