HomeMy WebLinkAbout460 09/28/2016 Recipient Committee Campaign Statement 07/01/2016 - 09/24/2016 Schelly SustarsicRecipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period Date of election if applicabl c q n Page
7/1/16 (Month, Day, Year) SEP 8 8 2016
from
through
9/24/16
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.
0 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
0 State Candidate Election Committee Committee
0 Recall 0 Controlled
(Aao Complete Pans) 0 Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party /Central Committee
3. Committee Information
❑ Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
Friends of Schelly Sustarsic for City Council 2016
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR PO BOX
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX /E -MAIL ADDRESS
Schellys @aol.com
For Official
CFFY CPERI(
11/08/16 Cur f OF SEAL BEACH.
2. Type of Statement:
52 Preelection Statement ❑ Quarterly Statement
❑ Semi - annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
COVER PAGE
of
NAME OF TREASURER
Patricia Campbell
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY
CITY STATE ZIP CODE AREACODE /PHONE
OPTIONAL: FAX /E -MAIL ADDRESS
Campbellpe @aol.com
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. I
certify under penalty of perjury under the la /ws of the State of California that the foregoing is tru nnjd /cyorrrre-c�t.
Executed on ( /T" By'^'�' -�
pate (
,
Date Sionature of Controlling ORiceholtl antlitlate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Data Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on By
Data Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (Jan /2016)
FPPC Advice: advicilPoc.ca.aov (866/275 -3772)
Recipient Committee
Campaign Statement
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Schelly Sustarsic
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESS 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.
CITY STATE ZIP CODE AREA CODE /PHONE
COMMITTEE NAME I I.D. NUMBER
NAME OF TREASURER
❑ YES ❑ NO
CITY STATE ZIP CODE AREA CODE /PHONE
COVER PAGE - PART 2
Page of
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
UIS I K0..I NU. Ir ANT
7. Primarily Formed Candidate /Officeholder Committee Listnames 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(Jan/2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Campaign Disclosure Statement
Amounts may be rounded
0
SUMMARY PAGE
Statement covers period
0 .
Summary Page to whole dollars.
g
To Calculate Column B,
13. Cash Receipts ............................ ............................... Column A, Linea above
5,779
add amounts in Column
7/1/16
D
Ato the corresponding
14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line q
amounts from Column B
from
0.
of your last report. Some
9/24/16
3 8
SEE INSTRUCTIONS ON REVERSE
16. ENDING CASH BALANCE ..................Add Lines 12 * 13 + 14, then subtract Line 15
$
be negative figures that
through
Page of
NAME OF FILER
If this is a termination statement, Line 16 must be zero.
previous period amounts. If
I.D. NUMBER
Schelly Sustarsic
this is the first report being
17. LOAN GUARANTEES RECEIVED . Schedule 6, Part 2
$
0
1388801
Contributions Received
Column A
TOTAL THIS PERIOD
Column B
Calendar Year Summary for Candidates
0
any).
(FROM ATTACHED SCHEDULES)
CALENDAR YEAR
TOTAL TO DATE
Running in Both the State Primary and
2 779
2 779
General Elections
1. Monetary Contributions .................... ...............................
Schedule A, Line 3
$
$
3,000
3,000
v1 through s/3e 7n to Date
2. Loans Received ................................. ...............................
schedule e, Line 3
— — — — — — —
T779-
5,779
20. Contributions
3. SUBTOTAL CASH CONTRIBUTIONS. ...............
.......... Add Lines t F 2
$
$
Received $ $
117
4. Nonmonetary Contributions ............. ...............................
Schedule C, Line 3
21. Expenditures
5,896
5,896
Made $ $
5. TOTAL CONTRIBUTIONS RECEIVED ... .... .... ._ . .. .....
.- ....AddLines3 +q
......_
$
$
Expenditures Made
Expenditure Limit Summary for State
6. Payments Made ............ ....... ............. ......... .......... ............
schedule E, Line q
$
1,082
$ 1,082
Candidates
7. Loans Made ........................................ ...............................
Schedule H, Line 3
0
0
1, 082
1, 082
22. Cumulative Expenditures Made'
8. SUBTOTAL CASH PAYMENTS ........... ...............................
Add Lines 5 +7
$
$
(Ifeubject to Voluntary Expenditure Limit)
9. Accrued Expenses (Unpaid Bills) ., ........................ ................
schedule F Line 3
0
0
Date of Election Total to Date
10. Nonmonetary Adjustment..... ........ ............ ...............................
schedule C, Line 3
117
117
(mm /dd /yy)
11. TOTAL EXPENDITURES MADE ...... ....... ......__.........Add
Lines S.9110
$
1,199
$ 1,199
1 1 $
Current Cash Statement
0
12, Beginning Cash Balance ............................ Previous Summary Page, Line 16
$
To Calculate Column B,
13. Cash Receipts ............................ ............................... Column A, Linea above
5,779
add amounts in Column
D
Ato the corresponding
14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line q
amounts from Column B
15. Cash Payments ........................ ...._ ............... Column A, Line eabove
1,082
of your last report. Some
4,697
amounts in Column A may
16. ENDING CASH BALANCE ..................Add Lines 12 * 13 + 14, then subtract Line 15
$
be negative figures that
should be subtracted from
If this is a termination statement, Line 16 must be zero.
previous period amounts. If
this is the first report being
17. LOAN GUARANTEES RECEIVED . Schedule 6, Part 2
$
0
filed for this calendar year,
...............................
only carry over the amounts
from Lines 2, 7, and 9 (if
Cash Equivalents and Outstanding Debts
0
any).
18. Cash Equivalents ................. ............................... See instructions on reverse
$
0
19. Outstanding Debts .............................. Add Line 2 +Line 9 in Column 8 above
$
$
`Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Schedule A
Amounts may be rounded
SCHEDULE A
Monetary Contributions Received to wno e, oonars.
statement covers period
o _ iI
7/1/16
• a
from
• � i
9124/16
4 8
SEE INSTRUCTIONS ON REVERSE
through
Page Of
NAME OF FILER
I.D. NUMBER
Schelly Sustarsic
1388801
DATE
FULL NAME, STREETADDRESSAND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTFRi O. NUMBER)
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
CUMULATIVE TO DATE
CALENDAR YEAR
PER ELECTION
TO DATE
RECEIVED
,
CODE '*
(IF SELF - EMPLOYED, ENTER NAME
PERIOD
(JAN. 1 -DEC. 31)
(IF REQUIRED)
OF BUSINESS)
Gary Miller
B IND
retired
8/12/16
❑ OTH
❑ PTY
❑ SCC
Bea Kuebler
0 IND
realtor, independent
8/29/16
❑ OTH
❑ PTY
❑ SCC
Sharman Snow
® IND
retired
917/16
❑ OTH
❑ PTY
❑ SCC
Jennifer Hayter
® IND
retired
917/16
E] OTH
❑ PTY
❑ SCC
Mindy Sander
® IND
homemaker
9!7116
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL$ 1,000
Schedule A Summary
1. Amount received this period — itemized monetary contributions.
(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.) .......
2,049
730
TOTAL $ 2,779
IND — Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTV — Political Party
SCC — Small Contributor Committee
FPPC Form 460 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www fnnr ra onv
Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.)
Monetary Contributions Received to whole dollars.
Statement covers period
a
7/1/16
• •
from
9/24116
5 8
through
Page of
NAME OF FILER
I.D. NUMBER
Schelly Sustarsic
1388801
DATE
FULL NAME, STREETADORESS AND ZIP CODE OF CONTRIBUTOR
REET AIDESSANDZICNUMBER)
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
CUMULATIVE TO DATE
CALENDAR YEAR
PER ELECTION
TO DATE
RECEIVED
CODE*
(IF SELF- EMPLOYED. ENTER NAME
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
OF BUSINESS)
Wendi Debie
®IND
investor
9/19/16
El OTH
❑ PTY
❑ SCC
David Feldman
OIND
dentist
9119/16
❑ OTH
❑ PTY
❑ scC
Marc Loopesko
01ND
retired
9/19/16
❑ OTH
❑ PTY
❑ SCC
Patricia Campbell
RIND
retired
9/19/16
El OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
I
SUBTOTAL$ 1,049
g
xN 'A?`(?5
`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 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SCHEDULE B - PART 1
Schedule B — Part 1 to whole dollars.
Statement covers period
° . , I�4
Loans Received
7/1/16
°
from
•
9/24/16
8 8
SEE INSTRUCTIONS ON REVERSE
through
Page of
NAME OF FILER
I.D. NUMBER
Schelly Sustarsic
1388801
FULL NAME, STREET ADDRESS AND ZIP CODE
OCIF AN INDIVIDUAL, ENTER CUPATION AND EMPLOYER
OUTSTANDING
AMOUNT
e
AMOUNT PAID
OUTSTANDING
e
INTEREST
ORIGINAL
g
CUMULATIVE
OFLENDER
pr CWWTTEE,ALSO ENTER I. D. NUMBER)
(IF SELF - EMPLOYED, ENTER
BALANCE
BEGINNING THIS
RECEIVED THIS
PERIOD
GR FGRGIVEN
BALANCEAT
CLOSE OF THIS
PAID THIS
AMOUNTOF
CONTRIBUTIONS
NAME Or BUSINESS)
PERIOD
THIS PERIOD'
PERIOD
PERIOD
LOAN
TO DATE
Schelly Sustarsic
homemaker
❑ PAID
CALENDAR YEAR
4288 Candleberry Avenue
0
$
$ 3,000
3,000
$ 3,000
Seal Beach, CA 90740
_%
$
E] FORGIVEN FORGIVEN
PER ELECTION"
$ 0
$ 3,000
$ 0
$
8/10/16
$
tid IND ❑ COM ❑ OTH ❑ PTY [-I SCC
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
g
$
%
$
3
E] FORGIVEN FORGIVEN
PER ELECTION"
$
$
$
$
S
DATE DUE
DATE INCURRED
tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION"
RATE
$
$
$
$
$
DATE DUE
DATE INCURRED
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
SUBTOTALS $ 3,000 $ $ 3,000 $
„I "'W1 9P;'
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 $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) ....... ...............................
Enter the net here and on the Summary Page, Column A, Line 2.
"Amounts forgiven or paid by another party also must be reported on Schedule A.
"" If required.
. ..............................$ 3.000
...$ 0
...............NET $ 3,000
(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 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Schedule C Amounts may be rounded SCHEDULE C
Nonmonetary Contributions Received VQ� ��
Statement covers period
4.
711/16
a e
from
9/24/16
7 8
SEE INSTRUCTIONS ON REVERSE
through
Page of
NAME OF FILER
I.D. NUMBER
Schelly Sustarsic
1388801
DATE
FULLP NAME,
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
DESCRIPTION OF
AMOUNT/
CUMULATIVE TO
DATE
PER ELECTION
RECEIVED
ZIP CODE
COD OFCO CONTRIBUTOR
CONTRIBUTOR
CODE
CODE •
OCCUPATION (IF SELF. AND EMPLOYER
(IF SELF ENTER
GOODS OR SERVICES
FAIR MARKET
VALUE
CALENDAR YEAR
TO DATE
(IF COMMITTEE. ALSO ENTER LD. NUMBER)
AL
OF
NAME OF BUSINESS)
(JAN 1 -DEC 31)
(IF REQUIRED)
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL g
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.) .......
..................... $
$ $117
........TOTAL $ $117
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 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
Schelly Sustarsic
Amounts may be rounded
to whole dollars.
Statement covers period
7/11/16
from
through 9/24/16 I Page 8 of 8
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment
1388801
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
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
AMOUNTPAID
Minute Man Press
5480 Katella Avenue
LIT
$130
Los Alamitos, CA 90720
campaign LA
15518 S. Broadway Street CMP $710
Gardena, CA 90248
` Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ $840
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.)
$840
$
$242
............................... $
.................. TOTAL $
$1,082
FPPC Form 460 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
E