September 22, /6/ Type of Statement: QI D D NAME OF TREASURER CITY. Simi Valley AREA CODE/PHONE. Keith Mashburn MAILING ADDRESS
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1 COVER PAGE Recipient Committee Campaign Statement Cover Page ate Stamp RECF.IV[U ( ry OF ~T 'I VALLEY Stat ement covers period from _J_u---'ly'-1_,2 1 _8_ SEE INSTRUCTIONS ON REVERSE through 1. Type of Recipient Committee: Ill Officeholder, Candidate Controlled Committee State Candidate Election Committee Recall /Also Complete Parl SJ Primarily Formed Ballot Measure Committee Controlled Sponsored /Also Cofllllolo Pmt 6) General Purpose Committee Sponsored Small Contributor Committee Political Party/Central Committee 46 Page 1 of ate of election if applicable: (Month, ay, Year) September 22, 21 8 All Committees -Co m plete Parts 1, 2, 3, and 4. _ CALIFORNIA At1 IQ: IO F or Official Use Only 11/6/18 2. Type of Statement: QI Preelection Statement Semi-annual Statement Quarterly Statement Special Odd-Year Report Termination Statement (Also file a Form 4 1 Termination} Amendment (Explain below} Primarily Formed Candidate/ Officeholder Committee /Also Coflll/ete Parl 7) 1.. NUMBER 3. Committee Information Treasurer(s) COMMITIEE NAME (OR CANIATE'S NAME IF NO COMMITIEE) NAME OF TREASURER Amy Ginnever Keith Mashburn for Mayor 218 MAILING ARESS STREET ARESS (NO P.O. BOX) CITY Simi Valley CITY Simi Valley STATE ZIP COE Ca 9365 AREA COE/PHONE STATE ZIP COE Z IP COE AREA COE/PHONE 9363 NAME OF ASSI STANT TREASURER. IF ANY MAILING ARESS AREA COE/PHONE CITY Simi Valley OPTI ONAL: FAX / ARESS Ca Keith Mashburn MAILING ARESS (IF IFFERENT) NO. AN STREET OR P.O. BOX CITY STATE STATE Ca Z IP COE AREA COE/PHONE 9365 OPTIONAL: FAX/ ARESS 4. 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true correct. Executed on 9/25/18 Executed on 9/25/18 Executed on Executed on ate ate ate 9 Y S-,g-n-at-u,-e -or-c-on_tr_ol-hn_g_o~ffi-,ce-h-~-de-~~c-an-d-,d-at-e.~s-ta-te_m _e-as- u-,e~p-ro-po-n-en_t _ ate ot=-=c=-on_tr_o,,.. 11,n_g...,O"'ffi:ice --,-h-, ol"" de-~...,c=an-d,,d,at,e-...,s"'" m.,... te--,m.,...e-as-u-,e-,p:ro-p-on-en - -, t BY ,S""ig-n-at-u,-e..., FPPC Form 46 (Jan/216)
2 Recipient Committee Campaign Statement Cover Page - Part 2 COVER PAGE - PART 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLER OR CANIATE Keith Mashburn OFFICE SOUGHT OR HEL (INCLUE LOCATION AN ISTRICT NUMBER IF APPLICABLE) Simi Valley Mayor RESIENTIAUBUSINESS ARESS (NO. AN STREET) CITY STATE Simi Valley Ca 9365 ZIP 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISICTION SUPPORT OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLER. CANIATE, OR PROPONENT 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. OFFICE SOUGHT OR HEL ISTRICT NO. IF ANY COMMITTEE NAME LO.NUMBER NAME OF TREASURER CONTROLLE COMMITTEE? YES NO COMMITTEE ARESS STREET ARESS (NO P.O. BOX) CITY STATE ZIP COE AREA COE/PHONE COMMITTEE NAME I.. NUMBER NAME OF TREASURER CONTROLLE COMMITTEE? YES NO COMMITTEE ARESS STREET ARESS (NO P.O. BOX) 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLER OR CANIATE NAME OF OFFICEHOLER OR CANIATE NAME OF OFFICEHOLER OR CANIATE NAME OF OFFICEHOLER OR CANIATE OFFICE SOUGHT OR HEL OFFICE SOUGHT OR HEL OFFICE SOUGHT OR HEL OFFICE SOUGHT OR HEL SUPPORT OPPOSE SUPPORT OPPOSE SUPPORT OPPOSE SUPPORT OPPOSE CITY STATE ZIP COE AREA COE/PHONE Attach continuation sheets if necessary FPPC Form 46 (Jan/216)
3 Campaign isclosure Statement Summary Page from J_u_ly_ 1_, _2_1_8 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE Keith Mashburn for Mayor 218 through Sept~mber 22, 218 Page 3_ of_\_o_ I.. NUMBER Contributions Received 1. Monetary Contributions... Schedule A. Line 3 2. Loans Received... Schedule a, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS... Add Lines Nonmonetary Contributions... Schedule c. Line 3 5. TOTAL CONTRIBUTIONS RECEIVE... Addlines3+4 Column A TOTAL THIS PERIO (FROM ATIACHE SCHEULES) 6,425 6,425 6,425 Column B CALENAR YEAR TOTAL TO ATE 24, ,123 24,123 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 613 7/1 to ate 2. Contributions Received n/a 21. Expenditures Made n/a n/a n/a Expenditures Made 6. Payments Made... Schedule E, Line Loans Made... Schedule H. Line 3 8. SUBTOTAL CASH PAYMENTS... AddUnes Accrued Expenses (Unpaid Bills)... Schedule F. Line Nonmonetary Adjustment Schedule c. Line TOTAL EXPENITURES MAE Add Lines a Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) ate of Election (mm/dd/yy) J J Total to ate n_/a _ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 23, Cash Receipts Column A. Line 3 above 6, Miscellaneous Increases to Cash... Schedule I, Line Cash Payments... Column A, Line B above ENING CASH BALANCE... Add Lines , then subtract Line 1s 27,47.27 If this is a termination statement. Line 16 must be zero. 17. LOAN GUARANTEES RECEIVE... Schedule a. Part 2 Cash Equivalents and Outstanding ebts 18. Cash Equivalents... See instructions on reverse 19. Outstanding ebts Add Line 2 + Line 9 in Column B above To calculate Column 8, 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). J J n/a * Amounts in this section may be different from amounts reported in Column B. FPPC Form 46 (Jan/216)
4 Schedule A Monetary Contributions Received from J_u_; ly_ 1 _, 2 1_8 SCHEULE A CALIFORNIA 46 SEE INSTRUCTIONS ON REVERSE Keith Mashburn for Mayor 218 through September 22, 218 Page _4- of \ I..NUMBER ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITIEE. ALSO ENTER 1.. NUMBER) COE * IF AN INIVIUAL, ENTER OCCUPATION AN EMPLOYER (IF SELF-EMPLOYE. ENTER NAME OF BUSINESS) AMOUNT RECEIVE THIS PERIO CUMULATIVE TO ATE CALENAR YEAR (JAN. 1 - EC. 31) PER ELECTION TO ATE (IF REQUIRE) 7/2/218 Neptune Plumbing Company San Fernando, Ca 9134 INO e)com PTY /5/218 Gary Seaton Simi Valley, Ca N COM PTY Farmer /1/218 Steve Manios Simi Valley, Ca 9365 ~IN com OTH PTY scc Realtor /12/218 ave Harwell Simi Valley, Ca 9365 ll]in COM PTY scc -Childcare /12/218 Susan Martinez Simi Valley, Ca 9363 ll] IN OCOM PTY scc Schedule A Summary SUBTOTAL S Amount received this period - itemized monetary contributions. (Include all Schedule A subtotals.) _,2_2_5 2. Amount received this period - unitemized monetary contributions of less than o 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)... TOTAL 6_,_22_5_ contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Form 46 (Jan/216)
5 Schedule A (Continuation Sheet) Monetary Contributions Received Keith Mashburn for Mayor 218 from...:j...:u~ly'-'-1'-',2=-=-1'-'8=---- SCHEULE A (CONT.) CALIFORNIA 46 th rough September 22, 2:1{! Page 5 of ro _ 1.. NUMBER ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.. NUMBER) COE * IF AN INIVIUAL, ENTER OCCUPATION AN EMPLOYER (IF SELF-EMPLOYE, ENTER NAME OF BUSINESS) AMOUNT RECEIVE THIS PERIO CUMULATIVE TO ATE CALENAR YEAR {JAN. 1 - EC. 31) PER ELECTION TO ATE {IF REQUIRE) 7/12/218 7/12/218 Lisa Moulton Lancaster, Ca Charles Varner Valencia, Ca Q] IN COM OTH OPTY llj IN COM OPT o scc Secretary-Republican Party of LA County 36th istrict /1 2/218 Terry Howard Thousand Oaks, Ca i;zj IN COM PTY Municipal Broadband, LLC. Co-Founder /12/218 Marie Bennett Simi Valley, Ca 9363 C2J IN com OTH PTY Self Employed-Realtor /15/218 Lee Hintlian Simi Valley, Ca 9363 Q] IN OCOM OTH PTY SUBTOTAL S 375. contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Form 46 (Jan/216)
6 Schedule A (Continuation Sheet) Monetary Contributions Received Keith Mashburn for Mayor 218 ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1.. NUMBER) COE * IF AN INIVIUAL. ENTER OCCUPATION AN EMPLOYER (IF SELF-EMPLOYE. ENTER NAME OF BUSINESS) AMOUNT RECEIVE THIS PERIO CUMULATIVE TO ATE CALENAR YEAR (JAN. 1 - EC. 31) PER ELECTION TO ATE (IF REQUIRE) 8/2/218 8/2/218 Barry Fisher Simi Valley, Ca 9363 Paula S Olson Santa Rosa, Ca 9312 Q]IN COM OPTY Q] IN COM PTY o scc - County of Ventura irector of Health Agency /2/218 Marjorie Baxter Simi Valley, Ca 9363 i;zj IN COM O PTY /3/218 Joseph Berlin Simi Valley, Ca 9365 C2J IN com PTY California Highway Patrolk..\- I vc:i\ lo..'fr~ ncjnmo--\t'\ UJ-'-Jvt.C~, Ca.. C\~'1"-3 (B'(N COM OPTY SUBTOTAL \ I 'i- 'Ob. 5t:::o. oo 'Contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Form 46 (Jan/216)
7 Schedule A (Continuation Sheet) Monetary Contributions Received from..::: J.::. u:.z. ly_1:..,.,..=2:..::c...:1..::8 SCHEULE A (CONT.) CALIFORNIA 46 through September 22, 2)5 Page _1_.c. of \ t) Keith Mashburn for Mayor 218 I.. NUMBER ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR (IF COMMITIEE. ALSO ENTER 1.. NUMBER) CONTCROIBEU\OR IF AN INIVIUAL, ENTER OCCUPATION AN EMPLOYER (IF SELF-EMPLOYE, ENTER NAME OF BUSINESS) AMOUNT RECEIVE THIS PERIO CUMULATIVE TO ATE CALENAR YEAR (JAN. 1 - EC. 31) PER ELECTION TO ATE (IF REQUIRE) 8/3/18 8/3/18 Ventura County Lincoln Club Simi Valley, Ca 9363 Charles avis Simi Valley, Ca 9363 OIN l;zj COM OPTY Ill IN COM OTH OPT Self Employed-Gold Coast Ecology /3/18 Mary Varner Valencia, Ca ZJ IN COM OTH PTY osc c Self Employed- Political Consultant /3/18 avid Sadler Simi Valley, Ca 9363 C2J IN com OTH PTY o scc /3/18 Peggy Sadler Simi Valley, Ca ZJ IN COM OTH O PTY Oscc SUBTOTALS 6 contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Form 46 (Jan/216)
8 Schedule A (Continuation Sheet) Monetary Contributions Received from J_u~ly_1,~2 1_8 SCHEULE A (CONT.) CALIFORNIA 46 through September 22, 218 Page 1 of Keith Mashburn for Mayor NUMBER ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR CONTRIBUTOR (IF COMM\TIEE, ALSO ENTER 1.. NUMBER) COE * IF AN INIVIUAL, ENTER OCCUPATION AN EMPLOYER (IF SELF-EMPLOYE, ENTER NAME OF BUSINESS) AMOUNT RECEIVE THIS PERIO CUMULATIVE TO ATE CALENAR YEAR (JAN. 1 - EC. 31) PER ELECTION TO ATE (IF REQUIRE) 8/3/18 Pamela Campeau Simi Valley, Ca 9365 i;zj IN COM OTH PTY scc Pratt & Whitney- Public Relations 8/31/18 Paula Sullivan Simi Valley, Ca 9365 J;z] IN COM OTH O PT Self Employed-CFS Income Tax /13/18 Frank Salinas Simi Valley, Ca ilj IN COM OTH PTY scc /12/18 Brent Hawker Simi Valley, Ca 9365 C2J IN c om PTY Oak Summit Real Estate, Inc. Realtor INO COM O PTY scc SUBTOTAL S 1,35 contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) PTY - Political Party sec - Small Contributor Committee FPPC Fo rm 46 (Jan/216) FPPC Advice: advice@fppc.ca.gov {866/ )
9 Schedule E Payments Made SCHEULE E from Jul:::J through SEE INSTRUCTIONS ON REVERSE l J '2..1'& Sc2\--c.rn\:,q' '22, CALIFORNIA Page _1_ 46 of ~ 1.. NUMBER Keith Mashburn for Mayor 218 COES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* eve civic donations FIL candidate filing/ballot fees FN fundraising events IN independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RA RF SAL TEL TRC TRS TSF VOT WEB radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodg ing, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, ) NAME AN ARESS OF PAYEE (IF COMMIITEE. ALSO ENTER 1.. NUMBER) Ronald Reagen Presidential Museum Simi Valley, Ca 9365 COE l(\ City Of Simi Valley OR ESCRIPTION OF PAYMENT AMOUNT PAI Check Check FIL Simi Valley, Ca 9363 Simi Valley Republican Women Simi Valley, Ca 9365 * Payments that are contributions or independent expenditures must also be summarized on Schedule. Check 159 SpoS('5\n\? ~u. If) nc.r 2 SUBTOTAL \ ':)(o1..'?;, vt Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ~(Y.) \ 3q 2. Unitemized payments made this period of under Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL?:f:X) \ ~q FPPC Form 46 (Jan/216)
10 SCHEULE E (CONT.) Schedule E (Continuati on Sheet) Payments Made t o whole dollars. CALIFORNIA 46 P a g e ~ of SEE INSTRUCTIONS ON REVERSE.J.2- I.. NUMBER \Lt?f;,COL{ Keith Mashburn for Mayor 218 COES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)' eve civic donations FIL candidate filing/ballot fees FN fundraising events IN independent expenditure supporting/opposing others (explain)" LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads NAME AN ARESS OF PAYEE (IF COMMITTEE. Al.SO ENTER 1.. NUMBER) S \(\'\l "4 ().,\\-G-'f (x\lth')\-jcx- of COE CovnmcrlG Ve;;) \ l e.,~ LJ..G\. \ :pos~ccc cds N-t-~ Cl, 1 v..\-vj V \t- * olt, c.ji\ \t... 1.,r- C::\ro...pV\lCS \J'.le:tk \..\ ~ 2)\'N\\ ~ '9 \\-e_'j I ]_cc::,. C I'5 I 2.. I \'\.S tzlll VV1 Gnr -Po v q co.t: ChlL-#- 16 I~ I t) o...\.j S * \I\/ C VJ'? t f-e_ C\ 1'.31 S\ffi\ \I co \\.e-'-{ Si.t,o c..n~~t -s 11 C,V L,l:Z.. C1.. lc:5. \ ooo ""' -..~ ov Vt --'n 6 ou.:-r CoV\Le>PT' t V \'5 llgl\s 1.\-' "--1 o-h oh? o. s o...o.e. v. (). AMOUNT PAI C\t\\L~\-S\o q~~-i;- I ESCRIPTION OF PAYMENT ~wat \Jo..\\~ I Co-' q?,,('.)lecs Heaven\~ Pv,(\-h~ \VYh radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, ) (xi llw\ 'ock" \ndv-i'to...u.td ~~~'f ~\f{\\ s OR RA RF SAL TEL TRC TRS TSF VOT WEB \-o..>.x, d.cc1. c Y") (_a._ C\ 3o4_S' nr- * Payments that are contributions or independent expenditures must also be summarized on Schedule., 5. C) CV\ -~ \5\i..\SUBTOTAL S \ 1 \..\,?\..\, FPPC Form 46 (Jan/216)
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