through 10/20/2012 (Month, Day, Year) Clerk s Office ity of Me;ilu Park

Transcription

1 Executed on Recipient Committee Campaign Statement REE1 ED Cover Page Date of Election if applicable Page 1 of 9 from 1o, 01/2012 / OCT COVER PAGE ForOfficialUseOn!y through 10/20/2012 (Month, Day, Year) Clerk s Office ity of Me;ilu Park 1. Type of Recipient Committee 2. Type of Statement Officeholder, Candidate Controlled Committee fl Primarily Formed Ballot Measure Pre-election Statement Q Quarterly Statement State Candidate Election Committee Committee Semi-Annual Statement Special Odd-Year fl Statement o Recall Q Controlled Termination Statement Supplemental J Pre-election General Purpose Committee 0 Sponsored fl Amendment Statement - Attach Form 495 Sponsored i:i Primarily Formed Candidate! Small Contributor Committee Officeholder Committee o Political Party/Central Committee I l.d. Number 3. Committee Information Treasurer(s) COMMITTTEE NAME Vtel NAME OF TREASURER PrkeOTh0mas_Montgomery STREET ADDRESS STREET ADDRESS (NO P0 BOX) CI TYM MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA / ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE ZIP CODE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I ADDRESS 4. Verification OPTIONAL: FAX / ADDRESS / cc@catnbob.com / toin@politicalvisions.biz 1 have used all reasonable diligence in preparing and reviewing this statement and to the be..rmy knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws Executed on fo/.ry/. 2I.2._ By Executed on Executed on t(5/ By By By is true and correct. _=3 SIGNATURE OF TREASURER OR ASSISTANT TREASURER SIGNATUR OF ROLLING OFFICEROER, CANATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDI, STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDI, STATE MEASURE PROPONENT FPPC Form Januarylo5 State of CalifornialSl

2 Recipient Committee Campaign Statement Cover Page-Part 2 COVER PAGE - PART Page 2 of 9 2 through 10/20/ Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDI Ms. Catherine Canton OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE Menlo Park RESIDENTIAL/BUSINESS ADDRESS ( NO. AND STREET) CITY STATE ZIP Menlo Park CA Primaiiy Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. CR LETTER JURISDICTION [] Identify the controlling officeholder, candidate, or state measure proponent. if any. NAME OF OFFICEHOLDER OR CANDI 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 fanned to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME NAME OF TREASURER COMMII1 EE STREE:r ADDRESS NO P.O. BOX) LD. NIJMBER CONTROLLED COMMITTEE? YES LI NO CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME LD. NUMBER 7. OFFICE SOUGHT OR HELD I DISTRICT NO. IF AN.L.. Primarily Formed Candidat&Officeholder Committee List names of officeholder(s)or candidate(s) for which this committee is pn marioy formed. NAME OF OFFICEHOLDER OR CANDI NAME OF OFF1CEHOLDER OR CANDI OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD fl NAME OF TREASURER COMMITTEE STREET ADDRESS ( NO P.O. BOX) CONTROLLED COMMITTEE? YES NO NAME OF OFFICEHOLDER OR CANDI OFFICE SOUGHT OR HELD CITY STATE ZIP CODE ARE.A CODE/PHONE NAME OF OFFICEHOLDER OR CANDI OFFICE SOUGHT OR HELD j [] FPPC Form JanuarylO5 State of california/si

3 Campaign Disclosure Statement Summary Page from 10/01/2012 through 10/20/2012 Page SUMMARY PAGE 3of9 [111 NAME OF FILER Contributions Received 1. Monetary Contributions SChSdUiS A. Line 3 2. Loans Received Schedule B. Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines Nonmonetary Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED.cWLinest 4 Expenditures Made 6. Payments Made Schedule E. Line 4 7. Loans Made Scheji H. Line 3 8. SUBTOTAL CASH PAYMENTS AddLines Accrued Expenses (Unpaid Bills) chedie F. Line Nonmonetary Adjustment Schedule C Line TOTAL EXPENDITURES MADE Acid Liries8+9+1O Current Cash Statement 12. Beginning Cash Balance PreHous Summer, Page, Line Cash Receipts olumn t, Line 3 above 14. Miscellaneous Increases to Cash scherji.qe I, Line /FR0 Column A Q5L 7,00 7,00 7,00 4, cvc11 YA ACYA1v.YS 5, , , , Column B CY,LANOAR YEAR rotalto OSTA 16, ,00 21, , , , , LI.). NUMBER Calendar Year Summary for Candidates Running in Both the State Primary and General Elections. 20. Contributions Received 21. Expenditures Made Ill through 6/30 7/1 to Date Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made * (If Subject to Voluntary Expenditure Limits) * Amounts in this Section may be different from amounts reported in Column B. S 15. Cash Payments 0/urn,) A. Line 8 above 16. ENDING CASH BALANCE Add Lines , then subtract Line 15 7,00 2, LOAN GUARANTEES RECEIVED checjuieb, Part 2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents 19. Outstanding Debts Addines2+Line9inCalurnnBahove 5,00 FPPC Form 460 Januarylo5 State of CaIiIomiaISI

4 Small Recipient Schedule A Monetary Contributions Received - 1hI SCHEDULE A [1 I çr Wv\I Jr!( c NAME F FILER ID. NUMBER through 10/20/2012 Page 4of9 RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER ID. NUMBER) Preston Butcher Foster City, CA IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Real Estate Broker Legacy Partners Bill Butler Redwood City, CA WL Butler Construction Joel Butler anager Redwood City, CA WL Butler Karisa Chin Homemaker Kristin Choatai Homemaker SUBTOTAL 1,501 I Schedule A Summary 1. Amount received this period - itemized contributions (Includes all Schedule A subtotals) 2. Amount received this period - unitemized 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page. Column A Line 1) 5, TOTAL 5, ( Contributor Codes I IND - Individual COM - Committee (other than PTY or SCC) 0TH - Other I PTY - Politcal Party SCC - Contributor Committee FPPC Form 460(JanIO5) FPPC Toll-Free Helpline: 8661A5K-FPPC

5 Schedule A (Continuation Sheet) Monetary Contributions Received Li SCHEDULE A [j1j through 10/20/2012 Page 5 of 9 NAME OF FILER k i)?o) P NUMBEP IF AN INDIVIDUAL, ENTER FULL NAME, STREET ADDRESS A ND ZIP CODE OF OF CONTRIBUTOR CUMULATIVE TO PER ELECTION CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT RECEIVED CALENDAR YEAR (IF COMMIFFEE, TO ALSO ENTER ID. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED (JAN. 1 - DEC. 31) (IF REQUIRED) Richard Ciardella IND Landscape Architect Self Howard Dallmar IND Realtor Cornish and Carey 10/10 / Sally Falkenhagen IND Retired Atherton, CA Gail Farwell IND Retired Diana Gilbert IND Accountant Mountain View, CA Rose Ryan Contributor Codes: IND - SUBTOTAL Individual COM - Recipient Committee (other than PTY or SCC) 0TH - Other PTY - Political Party SCC - Small Contributor Committee

6 Schedule A (Continuation Sheet) Monetary Contributions Received rom Statement covers Period 10/01/2012 SCHEDULE A [1.J through 10/20/2012 Page 6 of 9 C or (4 Y frj &rk_j/ LAVtC) NAME OF FILER FULL NAME, STREET ADDRESS A ND ZIP CODE OF OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT RECEIVED (IF COMMITTEE, ALSO ENTER ID. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED CUMULATIVE TO PER ELECTION (JAN. 1 - DEC. 31) (IF REQUIRED) 10/10/2 012 Virginia Kiraly urn Director Menlo Park Fire Protection Board Ms. Kimberly LeMieux IND Home Builder Laurel Homes George Liddle IND Retired Lincoln Club of Northern California 0TH 1,00 1,00 Belmont, CA Ed Moritz urn Realtor Alain Pinel [ - Contributor Codes: ND SUBTOTAL 1,550.0( Individual COM - Recipient Committee (other than PTY or SCC) 0TH - Other PTY - Political Party SCC - Small Contributor Committee J

7 Schedule A (Continuation Sheet) Monetary Contributions Received I SCHEDULE A jil [jij NAME FILE 4- VIi4k OZ through 10/20/2012 Page 7 of 9 P IF AN INDIVIDUAL, ENTER FULL NAME, STREET ADDRESS A ND ZIP CODE OF OF CONTRIBUTOR CUMULATIVE TO PER ELECTION CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT RECEIVED (IF COMMITTEE, CALENDAR ALSO YEAR ENTER 1.0. NUMBER) CODE TO (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED (JAN. 1 - DEC. 31) (IF REQUIRED) 10/10/2 012 Charles Munger IND PhysiciSt 1,00 1,00 Palo Alto, CA Stanford Douglas Scott IND Retired Herbert Stickel IND Retired ** Contributor Codes: ND - Individual COM - Redpient Committee (other than PlY or SCC) 0TH - Other PTY - Political Party SCC - Small Contributor Committee

8 Schedule B - Part I Loans Received I from through covers period 10/01/ /20/2012 SCHEDULE B - PART Page 8 of 9 I [imjj,j Ccrf rki+ dzc)) NAME QF FiLER FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER Catherine Canton Park, (a) (c) ID. NUMBER (e) (f) IF INDIVIDUAL, (b) (d) (g) OCCUPATION & EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OIJTSTANDING INTEREST ORIGINAL CUMULATIVE BAlANCE IF COMMITTEE, ID NUMBER RECIEVEDTHIS ORFORGIVEN BAI.ANCEAT PAID AMOUNTOF BEGINNING CONTRIBUTIONS THIS PERIOD THIS PERIOD CLOSE OF THIS PERIOD THIS PERIOD PERIOD LOAN TO CALENDAR YEAR 5,00 5,00 5,00 5,000 Menlo CA QFORGIVEN PER ELECTION** DUE INTEREST RATE INCURRED ContributorCode: IND 11/06/ /15/2012 % SUBTOTALS (b) Cc) (d) (e) 5,00 Schedule B Summary 1. this period (Total Column (b) plus unitemized Loans received loans of less than 100.) 2. Loans paid or forgiven this period (Total Column (c) plus 100 paid or forgiven.) (Include paid by a third party itemized on 3. Net loans change Enter the this period. net on here and loans under (Subtract thatare also Schedule A.) Line 2 from Line 1. ) NET the Summary Page, Column A, Line 2. r Conhibutor COdeS LD.mnd1aI COM-RecientCommtee(otherttanP1 1orS 0TH - Other PW-POIWCaIPa SCC-Smail Contributor Committee FPPC Form 460(January 105-SI)

9 Schedule E Payments Made SCHEDULE E j jr [1 J 11 through 10/20 / Page 9of9 NAME )F FILER Wtc) d/2 ID CODES: If one of the following 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 retumed contributions CTB contribution (explain nonmonetary) OFc office expenses SAL campaign workers salaries CVC civic donations PET petition circulating TEL t.v. or cable production costs FIL candidate filing / ballot fees PHO phone banks TRC candidate travel, lodging and meals FND fundraising expenses POL polling and survey research TRS staff/spouse travel, lodging and meals IND independent expenditures supporting/opposing others POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO poressional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, ) NAME AND ADDRESS OF PAYEE CODE or DESCRIPTION OF PAYMENT AMOUNTPAID City Strategies CNS 7,00 San Francisco, CA Schedule E 1. Itemized payments made this period. (Include all Schedule E subtotals.) Summary SUBTOTAL 7,00 7,00 2. Unitemized payments made this period of under Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) 4. Total payments made this period. (Add Line 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL 7,00 FPPC Form 460(January 105-SI)