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Home My WebLink About460 Recipient Committee Campaign Statement 10/23/2016 - 12/22/2016 Termination - Schelly SustarsicRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period 10/23/16 from through 12/22/16 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. V Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Alm Complete Pad 5) 0 Sponsored (Also Corripf re Pmt 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party /Central Committee (Nso canisters Part 7) 3. Committee Information Friends of Schelly Sustarsic for City Council 2016 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE OPTIONAL: FAX/ E -MAIL ADDRESS 4. Verification Date of election if applh (Month, Day, Year) HIECIEWEDD DEC 882016 COVER PAGE Page of— For Official Use Only 11/8/16 I CITY CLERK II CITY OF SEAL BEACH 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi - annual Statement ❑ Special Odd -Year Report Ira Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Patricia Campbell CITY STATE ZIP CODE AREA CODE /PHONE Seal Beach CA 90740 562 - 598 -3941 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE /PHONE OPTIONAL: FAX /E -MAIL ADDRESS 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 laws of the State of California that the foregoing is true Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Cantlitlale, Stale Measure Proponent Executed on By Dale Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (tan /2016) FPPC Advice: adviceClp. fooc.ca.eov (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) Seal Beach City Council, District 4 RESIDENTIALIBUSINESS ADDRESS (NO.ANDSTREET) 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 ❑ YES ❑ NO CITY STATE ZIP CODE AREACODE /PHONE COVER PAGE - PART 2 Page 2 of 7 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 NLLU DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee Listnames of officeholder fs) 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 rounded to whole dollars. lars. Summary Page from Statement covers period 10/23/16 SUMMARY PAGE 12/22/16 Page � 3 7 through of_ AN RF\ /FRRF _ - - I.D. NUMBER NAME OF FILER Schelly Sustarsic 1388801 Expenditures Made A Column B Calendar Year Summary for Candidates Contributions Received Loans Made ........................................ ............................... TOColumn TALTHIS PERIOD CALENDAR YEAR Running in Both the State Primary and Add Lines 6 +7 $ 9. (FROM ATTACHED SCHEDULES) TOTAL TO DATE 10. Nonmonetary Adjustment .... .__...._..._.. .... ... .......... .... ..Schedule C Line 3 370 4265 General Elections 1. Monetary Contributions .............. Schedule A, Line 3 $ (2,984) $ 1,503 through 6/30 7/1 to Date 16 2. Loans Received ................................. .. ............ ................. Schedule 6, Line 3 2,614 T 4,281 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines l +2 $ $ Received $ $ 17. LOAN GUARANTEES RECEIVED . ............................... Schedule B. Part 2 $ 80 437 4. Nonmonetary Contributions ............. ............................... Schedule C, Linea $ 21. Expenditures $ (2,534) 4,718 d $ $ 5. TOTAL CONTRIBUTIONS RECEIVED .......... ............. __ _ ....AddLines3 +4 $ $ Expenditures Made 6. Payments Made.. ...... -- .................................................. Schedule e, Linea $ 7. Loans Made ........................................ ............................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS....._ .... ............................... Add Lines 6 +7 $ 9. Accrued Expenses (Unpaid Bills) ............................... __.....ScheduleF Linea 10. Nonmonetary Adjustment .... .__...._..._.. .... ... .......... .... ..Schedule C Line 3 11. TOTAL EXPENDITURES MADE. ........ ........ ...... .. ... ... Add Lines 8 + 9 + 10 $ 1,503 $ 0 1,503 $ 0 80 1,583 $ Current Cash Statement 4,117 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ (2,614) 13. Cash RBCBIptS ............................ ............................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash ... ............................... Schedule I, Line 4 1,503 15. Cash Payments .......................... ............................... Column A, Line 8above 0 16. ENDING 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 RECEIVED . ............................... Schedule B. Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................. ............................... See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 6 above $ 4,281 0 4,281 0 437 4,718 To calculate Column B, add amounts in Column Ato 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 oVert e 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) 3 '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) W W WJPPC.ca.gov Schedule A Amounts may be rounded SCHEDULE A ro wools aouers. Monetary Contributions Received Statement covers period p � o - 10/23/16 from ^i 0 � 12/22/16 4 7 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D, NUMBER Schelly Sustarsic 1388801 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENrearo. NUVBEa1 CODE OCCUPATIONANDEMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE Ilr SELF-EMPLOYED, ENTER NAME PERIOD (JAN.1 -DEC. 31) (IF REQUIRED) OF BUSINESS) OF BUSINESS) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ Schedule A Summary *Contributor Codes 1. Amount received this period - itemized monetary contributions. IND - Individual (Include all Schedule A subtotals.) ........................................................................... ..............................$ COM — Recipient Committee than PTY or SCC) 370 2. Amount received this period - unitemized monetary contributions of less than $100 ...........................$ ((other OTH — Other ( business entity) PTY — Political l P Pa arty 3. Total monetary contributions received this SCC — Small Contributor Committee period. a7n Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1. TOTAL $ - FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) ,v,v,u fnnr ra unw SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Statement covers period e _ ' Loans Received 10/23/16 Y from u 12/22/16 5 7 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER 1388801 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING AMOUNT c AMOUNT PAID OUTSTANDING a INTEREST ORIGINAL CUMULATIVE OFLENDER '(IF (IF SELF - EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS COMMITTEE ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE Schelly Sustarsic Homemaker la PAID CALENDARYEAR 4288 Candleberry Avenue 2,984 $ $ 16 3,000 $ 3,000 Seal Beach, CA 90740 % $ F] FORGIVEN FATE PER ELECTION` 3,000 $ $ $ $ $ DATE DUE DATE INCURRED t � IND ❑ COM [:1 OTH ❑ PTY ❑ SCC PAID CALENDAR YEAR $ $ % $ s El FORGIVEN FORGIVEN PER ELECTIONv� $ $ $ 8 5 DATE DUE DATE INCURRED 1❑ IND I] COM ❑ OTH I] PTY ❑ SCC I] PAID CALENDAR YEAR $ $ % S $ El FORGIVEN FORGIVEN PER ELECTION " $ $ $ $ $ DATE DUE DATE INCURRED ❑ ❑ tEl IND COM ❑ OTH PTY ❑SCC SUBTOTALS $ $ 2,984 $ gi 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 $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............... Enter the net here and on the Summary Page, Column A, Line 2. `Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. ............................$ ........$ 2,984 NET $ (2,984) (May be a negative number) (erner(a)on Smeoule 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()an/2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule C Amounts may be rounded [ In I d II SCHEDULE C Nonmonetary Contributions Received ow ee o ars. Statement covers period a _ 10/23/16 • . • from ,±I 12/22/16 6 7 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Schelly Sustarsic 1388801 DATE FULL NAME, CONTRIBUTOR )FAN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR COD OFCO CONTRIBUTOR COD 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 311 (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 $�� Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.) ........................................................................................ ..............................$ 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.) .....................TOTAL $ M1 lZ 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. CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment CMP campaign paraphernalialmisc. 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) NAMEANDADDRESS OF PAYEE (IR COMMITEE, ALSO ENTER i.o. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Seal Beach Sun 216 Main Street PRT 960 Seal Beach, CA 90740 Minuteman Press 5480 Katella Avenue LIT 338 Los Alamitos, CA 90720 Seal Beach Sun 216 Main Street PRT 205 Seal Beach, CA 90740 ` Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1,503 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 $ 1,503 1,503 FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov