Professional Documents
Culture Documents
Recipient Committee
Campaign Statement
Cover Page
Date Stamp
from
01/01/2016
through
04/23/2016
Page
460
of
06/07/2016
2. Type of Statement:
X
E-Filed
04/29/2016
09:10:54
Filing ID:
160297120
CALIFORNIA
FORM
Preelection Statement
Semi-annual Statement
Termination Statement
(Also file a Form 410 Termination)
Quarterly Statement
Special Odd-Year Report
Supplemental Preelection
Statement - Attach Form 495
I.D. NUMBER
3. Committee Information
Treasurer(s)
1383687
NAME OF TREASURER
Forrest Hurd
MAILING ADDRESS
CITY
Penn Valley
CITY
STATE
Penn Valley
CA
ZIP CODE
94946
STATE
Penn Valley
CA
ZIP CODE
ZIP CODE
CA
95946
STATE
ZIP CODE
CA
95949
AREA CODE/PHONE
(530)933-8009
AREA CODE/PHONE
Patricia Smith
(530)273-7009
CITY
STATE
MAILING ADDRESS
AREA CODE/PHONE
CITY
95946
Grass Valley
AREA CODE/PHONE
(530)270-9273
psmith9491@gmail.com
forrestleemusic@gmail.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 laws of the State of California that the foregoing is true and correct.
Executed on
Executed on
Executed on
Executed on
www.netfile.com
04/29/2016
Date
Date
Date
Date
By
By
By
By
Forrest Hurd
Signature of Treasurer or Assistant Treasurer
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Recipient Committee
Campaign Statement
Cover Page Part 2
CALIFORNIA
FORM
Page
of
460
CITY
STATE
JURISDICTION
SUPPORT
OPPOSE
ZIP
I.D. NUMBER
NAME OF TREASURER
CONTROLLED COMMITTEE?
YES
COMMITTEE ADDRESS
CITY
COMMITTEE NAME
ZIP CODE
AREA CODE/PHONE
CONTROLLED COMMITTEE?
YES
CITY
www.netfile.com
List names of
officeholder(s) or candidate(s) for which this committee is primarily formed.
SUPPORT
OPPOSE
SUPPORT
OPPOSE
I.D. NUMBER
NAME OF TREASURER
COMMITTEE ADDRESS
NO
STATE
NO
SUPPORT
OPPOSE
SUPPORT
OPPOSE
STATE
ZIP CODE
AREA CODE/PHONE
SUMMARY PAGE
01/01/2016
through
04/23/2016
CALIFORNIA
FORM
Page
of
NAME OF FILER
I.D. NUMBER
1383687
Contributions Received
1. Monetary Contributions ...........................................
Schedule A, Line 3
Schedule B, Line 3
Add Lines 1 + 2
Column B
CALENDAR YEAR
TOTAL TO DATE
7,612.00
5,000.00
$
12,612.00
7,612.00
12,612.00
0.00
Schedule E, Line 4
Schedule H, Line 3
7/1 to Date
20. Contributions
Received
$
$
$
12,612.00
12,612.00
21. Expenditures
Made
$
10,454.51
10,454.51
Expenditures Made
6. Payments Made .......................................................
0.00
5,000.00
0.00
Schedule C, Line 3
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
460
0.00
22. Cumulative Expenditures Made*
Add Lines 6 + 7
10,454.51
10,454.51
0.00
0.00
0.00
0.00
10,454.51
0.00
10,454.51
Schedule I, Line 4
0.00
10,454.51
12,612.00
2,157.49
0.00
0.00
5,000.00
Schedule B, Part 2
www.netfile.com
Date of Election
(mm/dd/yy)
Total to Date
Schedule A
Monetary Contributions Received
SCHEDULE A
Statement covers period
from
01/01/2016
CALIFORNIA
FORM
through
04/23/2016
Page
NAME OF FILER
02/16/2016
of
I.D. NUMBER
460
1383687
Patricia Smith
Grass Valley, CA
95949
X IND
COM
OTH
PTY
SCC
03/04/2016
Hometown Hydroponics
Grass Valley, CA 95945
IND
COM
X OTH
PTY
SCC
03/28/2016
Annie Belinger
Penn Valley, CA
X IND
COM
OTH
PTY
SCC
95946
03/28/2016
Hometown Hydroponics
Grass Valley, CA 95945
IND
COM
X OTH
PTY
SCC
03/28/2016
Jane Hsuan
Grass Valley, CA
X IND
COM
OTH
PTY
SCC
95949
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
Activist
Retired
Web Designer
Self
None
Retired
SUBTOTAL $
AMOUNT
RECEIVED THIS
PERIOD
PER ELECTION
TO DATE
(IF REQUIRED)
300.00
300.00 P2016
$300.00
1,500.00
6,500.00 P2016
$6,500.00
500.00
500.00 P2016
$500.00
5,000.00
6,500.00 P2016
$6,500.00
200.00
200.00 P2016
$200.00
7,500.00
Schedule A Summary
*Contributor Codes
7,500.00
2. Amount received this period unitemized monetary contributions of less than $100 ............................. $
112.00
7,612.00
www.netfile.com
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
IND Individual
COM Recipient Committee
(other than PTY or SCC)
OTH Other (e.g., business entity)
PTY Political Party
SCC Small Contributor Committee
SCHEDULE B - PART 1
Schedule B Part 1
Loans Received
from
01/01/2016
through
04/23/2016
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
NAME OF BUSINESS)
(a)
(b)
OUTSTANDING
AMOUNT
BALANCE
RECEIVED THIS
BEGINNING THIS
PERIOD
PERIOD
(c)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD *
(d)
(e)
(f)
(g)
OUTSTANDING
BALANCE AT
CLOSE OF THIS
PERIOD
INTEREST
PAID THIS
PERIOD
ORIGINAL
AMOUNT OF
LOAN
CUMULATIVE
CONTRIBUTIONS
TO DATE
CALENDAR YEAR
PAID
94946
0.00
5,000.00
0%
X OTH
PTY
0.00
5,000.00
0.00
5,000.00
0.00
DATE DUE
SCC
04/22/2016
OTH
PTY
PER ELECTION **
$
$
DATE DUE
SCC
DATE INCURRED
CALENDAR YEAR
PAID
$
IND
COM
OTH
PTY
SUBTOTALS $
5,000.00 $
0.00 $
DATE INCURRED
5,000.00 $
0.00
(Enter (e) on
Schedule E, Line 3)
5,000.00
0.00
www.netfile.com
Schedule B Summary
3. Net change this period. (Subtract Line 2 from Line 1.) ............................................................... NET $
Enter the net here and on the Summary Page, Column A, Line 2.
$
PER ELECTION **
DATE DUE
SCC
RATE
FORGIVEN
P2016 5,000.00
RATE
FORGIVEN
COM
DATE INCURRED
CALENDAR YEAR
IND
5,000.00
PER ELECTION **
PAID
RATE
FORGIVEN
COM
1383687
IND
of
I.D. NUMBER
Page
NAME OF FILER
460
CALIFORNIA
FORM
Contributor Codes
5,000.00
IND Individual
COM Recipient Committee
(other than PTY or SCC)
OTH Other (e.g., business entity)
PTY Political Party
SCC Small Contributor Committee
SCHEDULE E
Schedule E
Payments Made
from
01/01/2016
CALIFORNIA
FORM
through
04/23/2016
Page
NAME OF FILER
I.D. NUMBER
1383687
of
460
8
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
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 messenger services
professional services (legal, accounting)
print ads
CODE
OR
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
DESCRIPTION OF PAYMENT
AMOUNT PAID
PRT
FND
300.00
Wrist-Band.com
Houston, TX 77058
CMP
238.90
Payments that are contributions or independent expenditures must also be summarized on Schedule D.
SUBTOTAL $
1,600.00
2,138.90
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.) .............................................................................................................. $
10,454.51
0.00
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $
0.00
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $
10,454.51
www.netfile.com
Schedule E
(Continuation Sheet)
Payments Made
SCHEDULE E (CONT.)
Statement covers period
from
01/01/2016
through
04/23/2016
CALIFORNIA
FORM
Page
460
of
I.D. NUMBER
1383687
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
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
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
YubaNet
Nevada City, CA
Event Helper
Grass Valley, CA
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
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
CODE
WEB
OR
DESCRIPTION OF PAYMENT
AMOUNT PAID
WEB Advertising
2,000.00
Event Insurance
104.45
95959
95949
PRT
570.00
LIT
351.41
LIT
Educational Brochures
289.75
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
www.netfile.com
SUBTOTAL $
3,315.61
Schedule E
(Continuation Sheet)
Payments Made
SCHEDULE E (CONT.)
Statement covers period
from
01/01/2016
through
04/23/2016
CALIFORNIA
FORM
Page
460
of
I.D. NUMBER
1383687
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
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
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
CODE
LIT
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
www.netfile.com
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
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
OR
DESCRIPTION OF PAYMENT
AMOUNT PAID
Deposit on mailer
5,000.00
SUBTOTAL $
5,000.00