Recipient Committee Campaign Statement Cover Page ate of election Ul&WJ>l14i~e (Month, a)t;~rµl. I 2 le it 12 COVER PAGE ~IL.IF@R~I~ ;~salll F@Rl\l'I 91111 Page of For Official Use Only Nov.8,2016 1. Type of Recipient Committee: Ail Committees-Complete Parts 1, 2, 3, and 4. 2. Type of Statement: GZl Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Perl 5) General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Pait 6) Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) GZl Preelection Statement Semi-annual Statement Termination Statement (Also file a Form 410 Termination) Amendment (Explain below) Quarterly Statement Special Odd-Year Report 3. Committee Information COMMITTEE NAME (OR CANIATE'S NAME IF NO COMMITTEE) STREET ARESS (NO P.O. BOX) 1920 West Hemlock Street Oxnard CA ZIP COE 93035 MAILING ARESS (IF IFFERENT) NO. AN STREET OR P.O. BOX AREA COE/PHONE 805-741-8202 Treas1.1rer(s) NAME OF TREASURER Gloria E Zavala MAILING ARESS 2021 Pericles Place Oxnard NAME OF ASSISTANT TREASURER, IF ANY MAILING ARESS CA ZIP COE 93033 AREA COE/PHONE 805-814-2066 ZIP COE AREA COE/PHONE ZIP COE AREA COE/PHONE OPTIONAL: FAX I E-MAIL ARESS chavezforoxnard@outlook.com 4. Verification OPTIONAL: FAX I E-MAIL ARESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge Ifie information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correcy. 10/23/2016 ate 10/23/2016 ate By ------r? By c-;,.........r;,...... u;... ~,..,,..,.,,..,...~,...1,..j,...,.; or Responsible Officer of Sponsor ate By Signature of Controlling Officeholder, Candidate, State Measure Proponent ate By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Recipient Committee Campaign Statement Cover Page - Part 2 COVER PAGE - PART 2 5. Officeholder or Candidate Contmiled Committee NAME OF OFFICEHOLER OR CANIATE aniel Chavez Jr. OFFICE SOUGHT OR HEL (INCLUE LOCATION AN ISTRICT NUMBER IF APPLICABLE) City of Oxnard, Councilmember RESIENTIAUBUSINESS ARESS (NO. AN STREET) ZIP 1920 W Hemlock St 6. Primarily Formed Ballot Measme 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 NAME OF TREASURER CONTROLLE COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. COMMITTEE ARESS YES STREET ARESS (NO P.O. BOX) NO NAME OF OFFICEHOLER OR CANIATE OFFICE SOUGHT OR HEL SUPPORT OPPOSE ZIP COE AREA COE/PHONE COMMITTEE NAME NAME OF OFFICEHOLER OR CANIATE NAME OF OFFICEHOLER OR CANIATE OFFICE SOUGHT OR HEL OFFICE SOUGHT OR HEL SUPPORT OPPOSE SUPPORT OPPOSE NAME OF TREASURER COMMITTEE ARESS CONTROLLE COMMITTEE? YES NO STREET ARESS (NO P.O. BOX) NAME OF OFFICEHOLER OR CANIATE OFFICE SOUGHT OR HEL SUPPORT OPPOSE ZIP COE AREA COE/PHONE Attach continuation sheets if necessary FPPC Advice: advice@fppc.ca.gov {866/275-3772)
Campaign isclosure Statement Summary Page 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 RECEIVE Lines 3 + 4 Column A TOTAL THIS PERIO (FROM ATTACHE SCHEULES) 944.00 944.00 42 1,364.00 Column B CALENAR YEAR TOTAL TO ATE ~lili!fi' RNI~ SUMMARY PAGE IB0Bll FS@RM ~-- Page 3 of 7 _ 2,324.00 1,00 3,324.00 932.00 4,206.00 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to ate 20. Contributions Received 21. Expenditures Made Expenditures Made 6. Payments Made... Schedule E, Line 4 7. Loans Made... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS... Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment......... Schedule c, Line 3 11. TOTAL EXPENITURES MAE... AddLines8+9+1o 2,947.00 2,947.00 2,947.00 Expenditure limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) ate of Election (mm/dd/yy) } } Total to ate Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule I, Line 4 15. Cash Payments Column A, Line 8 above 16. ENING CASH BALANCE... Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVE Schedule B, 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 15 944.00 41 787.00 0.0 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!his calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). J j _ *Amounts in this section may be different from amounts reported in Column B. FPPC Advice: advice@fppc.ca.gov {866/275-3772)
Schedule A Monetary Contributions Received 4 m SCHEULE A ~LIFORNI~ FBOIR.M 1111 Page 4 of 7 ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE, ALSO ENTER ) 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) 10/02/2016 r. Ruby urias 1710 Ambrose Ave. ll]in scc Retired - Educator 10 10 10/13/2016 Oxnard Police Officers Association 251 S. C St Oxnard, CA 93030 INO llj OTH scc 50 50 10/17/2016 Laura Y Gallardo 3131 Isle Way ~IN com scc Retired - Educator 15 15 INO oscc INO scc SUBTOTAL Schedule A Summary *Contributor Codes IN - Individual 1. Amount received this period - itemized monetary contributions. COM Recipient Committee (Include all Schedule A subtotals.) '" 75 (other than PTY or SCC) 2. Amount received this period - unitemized monetary contributions of less than 100... 194.00 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)... TOTAL 944.00 OTH - Other (e.g., business entity) PTY - Political Party SCC Small Contributor Committee FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule C Nonmonetary Contributions Received ~All!flE: RISJIA E: RM SCHEULE C 4aa Page 5_ of 7_ ATE RECEIVE FULL NAME, STREET ARESS AN ZIP COE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER ) IF AN INIVIUAL, ENTER CONTRIBUTOR I OCCUPATION AN EMPLOYER COE * (IF SELF-EMPLOYE, ENTER NAME OF BUSINESS) I ESCRIPTION OF GOOS OR SERVICES AMOUNT/ FAIR MARKET VALUE CUMULATIVE TO ATE CALENAR YEAR (JAN 1 - EC 31) PER ELECTION TO ATE (IF REQUIRE) 09/30/16 10/01/16 Rocio Lemus 1920 W Hemlock St. Salomon Lemus 1920 W Hemlock St l;zj IN SCC l;zj IN SCC INO SCC INO OTH SCC Seasonal Worker Retired Attach additional information on appropriately labeled continuation sheets. Business Cards, Information Flyers and Stickers. "Chavez 2016" T-Shirts SUBTOTAL 18 24 42 Schedule C Summary 1. Amount received this period - itemized nonmonetary contributions. (include ail Schedule C subtotals,)...... 2. Amount received this period - unitemized non monetary contributions of less than 100... 42 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 42 0 *Contributor Codes IN - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Advice: advice@fppc.ca.gov (866/275-3712)
Schedule E Payments Made C~lillllm@RfYJI~ Et@~M " )Bill SCHEULE E ftu Page _6 of _7 COES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB eve FIL FN IN LEG UT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense 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 mesenger services professional services (legal, accounting) print ads RA radio airtime and production costs RF returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) NAME AN ARESS OF PAYEE (IF COMMITTEE. ALSO ENTER ) COE OR ESCRIPTION OF PAYMENT AMOUNT PAI Knights of Columbus 750 632 S. Street FN Oxnard, CA 93030 Woodland Hills Printing 21602 Ventura Blvd. CMP Woodland Hills, CA 91364 Woodland Hills Printing 21602 Ventura Blvd. CMP Woodland Hills, CA 91364 Annual Civic Night info Flyers info Flyers 145.00 164.00 283.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule. SUBTOTAL 592.00 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 592.00 125.00 FPPC Form 460 (.lan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule I Miscellaneous Increases to Cash ~llrn Rtsll~ rn R11\11 : 1 11 SCHEULE I BB Page _7_ of _7 ATE RECEIVE FULL NAME AN ARESS OF SOURCE (IF COMMITTEE, ALSO ENTER 1.. NUMBER) ESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH 09/30/16 24Hour Wristbands.com 14550 Beechnut St Houston, Texas 77083 Refund 41 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL 41 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 Summary Page, Line 14.)... 41..... TOTAL 41 FPPC Advice: advice@fppc.ca.gov {866/275-3772)