COVER PAGE
acipient Committee ampaign Statement
Type or print in ink.
FILE
over Page
wernment Code Sections 84200-84216 5)
a INSTRUCTIONS ON REVERSE
Type of Recipient Committee: All Committees •
from
01/01/2012
Date of election if applicable: (Month, Day, Year)
through
03/17/2012
06/05/2012
Statement covers period
Complete Parts 1, 2, 3, and 4.
Primarily Formed Ballot Measure 0 Committee
Officeholder, Candidate Controlled Committee
O State Candidate Election Committee
Controlled 0 Sponsored
O Recall
(Also Complete Pert 5)
(Nso Complete Part 6)
O General Purpose Committee O Sponsored 0 Small Contributor Committee O Political Party/Central Committee
MAR
2 1 2012
JULIE L RODEWALD COUNTY CLEP
2. Type of Statement:
-90444.4Z L,CYL/ p T
ID Quarterly Statement
2 Preelection Statement Semi-annual Statement 0 Termination Statement (Also file a Form 410 Termination) Amendment (Explain below)
D
D Special Odd-Year Report
0 Supplemental Preelection Statement -Attach Form 495
0
Primarily Formed Candidate/ O ffi ceholder Committee
For Official Use Only
(Also Complete Part 7)
I.D. NUMBER
Committee Information
Treasurer(s)
1294032
COMMITTEE NAME (OR CANDIDATES NAME IF NO COMM!
NAME OF TREASURER
EE)
Sharon A. McMahan
Friends of Adam Hill, County Supervisor 2012
MAILING ADDRESS
765 Mesa View Drive #21 STREET ADDRESS (NO P.O. BOX)
STATE
CITY
Arroyo Grande
260 Sandercock CITY
STATE
ZIP CODE
San Luis Obispo
CA
93401
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR
AREA CODE/PHONE
ZIP
C ODE
CA 93420
AREA CODE/PHONE
(805) 481-0268
NAME OF ASSISTANT TREASURER, IF ANY
(805) 550-7916
RO. BOX
MAILING ADDRESS
P.O. Box 1248
, CITY
STATE
CA
Grover Beach
ZIP CODE
AREA CODE/PHONE
STATE
CITY
ZIP CODE
AREA CODE/PHONE
93483
OPTIONAL: FAX / E-MAIL ADDRESS
OPTIONAL: FAX
/ E-MAIL ADDRESS
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. \ \ V4-,A \n"-- NCYv N Executed on
a (,)
Executed on Executed on Executed on
By
By
Date Date
By By
Signatur7f Tr
Signature o
urer or ssistant Treasurer
holder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Sgnature of Controlling Officeholder, Candidate, State Measure Proponent Signatureof Controlling Officeholder, Candidate, State Mena Proponent
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866/ASK-FPPC (866 1275-3772)
State of California
COVER PAGE - PART 2
Type or print in ink.
tecipient Committee :ampaign Statement :over Page — Part 2
6. Primarily Formed Ballot Measure Committee
Officeholder or Candidate Controlled Committee
NAME OF BALLOT MEASURE
NAME OF OFFICEHOLDER OR CANDIDATE
Adam Hill JURISDICTION
BALLOT NO. OR LETTER
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
0
San Luis Obispo County Supervisor, District 3 RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET)
STATE
CITY
ZI P
San Luis Obispo, CA 93401
260 Sandercock
Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you o are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME
LD.
NAME OF TREASURER
CONTROLLED COMMITTEE? YES 0 NO
COMMITTEE ADDRESS CITY
STREETADDRESS
STATE
COMMITTEE NAME
COMMITTEE ADDRESS CITY
AREA CODE/PHONE
ZIP CODE NUMBER
CONTROLLED COMMITTEE? YES EI NO
NAME OF TREASURER STREETADDRESS
STATE
Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
NUMBER
(NO P.O. BOX)
.D.
SUPPORT OPPOSE
7. Primarily Formed Candidate/Officeholder Committee
List names of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
0
SUPPORT
0
SUPPORT
• OPPOSE • SUPPORT • OPPOSE
• OPPOSE • SUPPORT OPPOSE
0
(NO P.O. BOX) ZIP CODE
AREA CODE/PHONE
Attach continuation sheets if necessary
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 856/ASK-FPPC (8661275-3772) State of California
SUMMARY PAGE
lype or print In Ink. Amounts may be rounded to whole dollars.
Campaign Disclosure Statement Summary Page
Statement covers period from through
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
01/01/2012
03/17/20123 Page
19,985.00
Schedule B, Line 3
o
Schedule
C, Line 3
Add Lines 3 + 4
Schedule E, Line 4
7. Loans Made 8. SUBTOTALCASH PAYMENTS 9. Accrued Expenses (Unpaid Bills)
Schedule H, Line 3
la Nonmonetary Adjustment 11. TOTAL EXPENDITURES MADE
Schedule C. Line 3
Add Lines 6 + 7
$
$
Schedule F Line 3
Add Lines 13 + 9 + 10
$
Current Cash Statement
61,770.66 19,985.00 0 14,295.92 67,459.74
Previous Summery Page, Line 18 Column A, Line 3 above
Schedule I, line 0 14. Miscellaneous Increases to Cash Column A, Line 8 above 15. Cash Payments Add Lines 12 + 13 + 14, then subtract Line 15 16. ENDING CASH BALANCE II this is a termination statement, Line 16 must be zero. Schedule s, Part 2
Cash Equivalents and Outstanding Debts See insbuctions on reverse A dd Line 2 + Line 9 in Column B above
14,295.92 0 14,295.92 953.00 638.40 15,887.32
$
67,459.774 5,253.00
1/1 through 6/30
4300.00
7/1 to Date
20.Contributions Received $ 21.Expenditures Made
19,985.00 638.40 20,623.40
Add Lines 1 + 2
Expenditures Made
19. Outstanding Debts
CALENDAR YEAR
Schechae A, Line 3
6. Payments Made
18. Cash Equivalents
19
Calendar Year Summary for Candidates Running in Both the State Primary and General Elections
Column B TOTALTO tan
Column A
TOTALMS PERIM (FIROMATTACHED SCHEDULES)
5. TOTAL CONTRIBUTIONS RECEIVED
17. LOAN GUARANTEES RECEIVED
of
ID. NUMBER
Contributions Received
12. Beginning Cash Balance 13. Cash Receipts
460
1294032
Friends of Adam Hill County Supervisor 2012
Monetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions
CALIFORNIA FORM
Expenditure Limit Summary for State Candidates
$
0 $
22.Cumulative Expenditures Made' Sub}act
953.00
Date of Election (mm/dd/yy)
to voluntary Expenditure
Limiti
Total to Date
$
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 fi rst report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 ( i f any).
'Amounts in this section may be different from amounts reported in Column B.
FPPC Form 480 (January/05) FPPC Toil-Free Helpline: 866/ASK-FPPC (866 1 275-3772)
• hedule
A
metary Contributions Received
Type or print in ink. Amounts may be rounded to whole dollars.
SCHEDULE A Statement covers period
01/01/2012
from
03/17/2012
through
INSTRUCTIONS ON REVERSE IE OF FILER
2ECEIVED
13/12
&
2/6/12
Stella Jenkins 285 Buena Vista San Luis Obispo, CA 93405
2/6/12
Peter Keith 865 Charles Grover Beach, CA 93433
2/6/12
Kurt P. Kupper 8888 Toro Creek Rd. Atascadero, CA 93422
2/6/12
Mike Ritter 120 Highway 28 Crystal Bay, NV 89402
4
of
\ CA
1294032
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE *
Norm Adams 3337 Kiler Canyon Paso Robles, CA 93446
Page
I.D. NUMBER
Friends of Adam Hill, County Supervisor 2012 DATE
460
CALIFORNIA FORM
• DOTH •• •• •• •• •• •• •• •• 0•
IND COM
PTY SCC 12] ND COM OTH PTY SCC gj IND
cm
OTH PTY SCC
IND COM OTH PTY SCC IND
Coro
MAOUNT
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER
RECEIVED THIS PERIOD
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
Retired
150.00
Retired
100.00
Self-Employed, Investor
100.00
Retired
250.00
OTH PTV SCC
2100.00
SUBTOTALS
hedule A Summary \
1l00.00 61%aS.uo
TOTAL $
PER ELECTION TO DATE (IF REQUIRED)
1500.00
Retired
\ mount received this period — itemized monetary contributions. Include all Schedule A subtotals.) 1, mount received this period — unitemized monetary contributions of less than $100 rotal monetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
19,°036,00
*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 (January/06) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
:hedule A (Continuation Sheet) onetary Contributions Received
SCHEDULE A (CONT.)
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period from through
01/01/2012 03/17/2012
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR OF COMMITTEE) ALSO ENTER La NUMBER)
CONTRIBUTOR CODE *
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYEO ENTER NAME OF BUSINESS)
Ray Weymann 7610 San Marcos Road Atascadero, CA 93422
•• DPW
Retired
2/16/12
Marion Wolff 3128 Spring Street San Luis Obispo, CA 93401
•• ••
Retired
3/11/12
Robert Vessely 1745 Garden Street San Luis Obispo, CA 93401
2/06/12
Lawrence Vierheilig 950 Waypoint Drive Nipomo, CA 93444
2/15/12
John Carsel 3285 Shearer Avenue Cayucos, CA 93430
2/22/12
5
of
N `I
1294032
of Adam Hill, County Supervisor 2012
DATE
Page
460
I.D. NUMBER
AE OF FILER
r riends
CALIFORNIA FORM
IND COM OTH
E scc q IND
COM OTH PTV SCC
•4 IND
Self-Employed, Structural 485.00 Engineer
r/ IND COM OTH PTY SCC
Retired
OTH PTV SCC
I IND
DCOM
•• El scc OTH PTV
PER ELECTION TO DATE (IF REQUIRED)
100.00
• c0m
•• • •• ••
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
190.00
100.00
Self-Employed, Attorney 300.00 At Law SUBTOTALS
i:ontributor Codes ID — Individual OM —Recipient Committee (other than PTY or SCC) TH — Other (e.g., business entity) TY — Political Party CC —Small Contributor Committee
AMOUNT RECEIVED THIS PERIOD
1175.00
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866 1275-3772)
;hedule A (Continuation Sheet) onetary Contributions Received
SCHEDULE A (CONT.)
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period from through
01/01/2012 03/17/2012
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE *
•• •• • ••
IND COM OTH PTY SCC IND COM IJOTH PTV SCC
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER BF SELF-EMPLOYEET ENTER NAME OF BUSINESS)
Self-Employed, Farmer
3/11/12
Lisen A. Bonnier 6015 Los Osos Valley Rd. San Luis Obispo, CA 93405
2/17/12
Muril Clift 1011 Suffolk Street Cambria, CA 93428
1/06/12
Burke L. Dambly 1201 Longview Avenue Pismo Beach, CA 93449
ZI IND ECOM OTH 0 PTV SCC
Retired
Ed Eby 520 Camino Roble Nipomo, CA 93444
Ir/ IND
•• com n
Retired
Tracy Del Rio 135 Whiteley Street Arroyo Grande, CA 93420
IZ IND
Mediator, SLO County Superior Court
2/14/12
3/6/12
6
of
k c\
1294032
of Adam Hill, County Supervisor 2012
DATE RECEIVED
Page
460
L D. NUMBER
.01E OF FILER r riends
CALIFORNIA FORM
•
Retired
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
PER ELECTION TO DATE (IF REQUIRED)
100.00
300.00
200.00
•
•
Ocom
•• •
340.00
OTH PTY SCC
OTH PTY SCC
SUBTOTAL $ ontributor Codes ID —Individual OM —Recipient Committee (other than PTY or 5CC) TI-1 — Other (e.g., business entity) TY — Political Party CC — Small Contributor Committee
AMOUNT RECEIVED THIS PERIOD
180.00
1120.00
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866 1ASK-FPPC (866/275-3772)
;hedule A (Continuation Sheet) onetary Contributions Received
SCHEDULE A (CONT)
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period
01/01/2012
from through
03/17/2012
'- riends of Adam Hill, County Supervisor 2012
7
of
‘e%
Castlerock Development, A California Corp. 445 Green Gate Rd. San Luis Obispo, CA 93401
2/06/12
Verdin Marketing Ink 689 Tank Farm Rd #210 San Luis Obispo, CA 93401 George Lewis 1852 6th Street Los Osos, CA 93402
ND • COM
AMOUNT RECEIVED THIS PERIOD
IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
PER ELECTION TO DATE (IF REQUIRED)
1...
••
5000.00
OTH PTY 0 SCC 0 IND
ZCOM
•
100.00
OTH 0 PTY SCC
•
q IND
• COM
•
Retired
100.00
OTH 0 PTY SCC
•
3/07/12
Allyn Arnold 777 North Ocean Ave Cayucos, CA 93430
1!A IND 0 COM OTH PTY SCC
2/21/12
Sheila Blake 1320 Longview Avenue Pismo Beach, CA 93449
0 IND COM OTH PTY SCC
•• • •• •
Retired
100.00
Retired
245.00
•
SUBTOTAL S 3ontributor Codes ID —Individual OM — Recipient Committee (other than PTY or SCC) .TH — Other (e.g., business entity) TY — Political Party CC —Small Contributor Committee
1294032
_
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OF COMMITTEE, ALSO ENTER 1.1). NUMBER) CODE *
2/10/12
1/25/12
Page
460
ID. NUMBER
AE OF FILER
DATE RECEIVED
CALIFORNIA FORM
5545.00
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
:hedule A Continuation Sheet . . onetary Contributions Received
SCHEDULE A (CONT.)
.. e or p. rint in ink. Amounts may be rounded to whole dollars.
Statement covers period from through
01/01/2012 03/17/2012
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I a NUMBER) CODE *
3/05/12
Walter Brothers Construction Company, Inc. 3220 S. Higuera Street San Luis Obispo, CA 93401
1/06/12
Lynne Landwehr 2644 Flora Street San Luis Obispo, CA 93401
2/21/12
3/03/12
3/01/12
8
of
\ P'"
1294032
of Adam Hill, County Supervisor 2012
DATE RECEIVED
Page
460
I.D. NUMBER
AE OF FILER
r riends
CALIFORNIA FORM
Dawn Legg 2480 Parkland Terrace San Luis Obispo, CA 93401
• IND COM
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
•• •
OTH PTY SCC !I IND
• COm fj OTH
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
PER ELECTION TO DATE (IF REQUIRED)
250.00
Retired
150.00
•
PTY 0 SCC
vál IND • Com
•• OTH PTY
Assistant Project Manager, First Solar
135.00
• SCC %IND
Pricilla Kiessig 460 Tessa Court Templeton, CA 93465
•com 00TH
Director, Sea Life Center
Jerry Williams 5365 Candelabra San Luis Obispo, CA 93401
•co m
Builder, JW Design Construction, Inc.
••
PTV SCC IN IND
•• •
OTH PTY SCC
&
SUBTOTALS 3ontributor Codes ID —Individual OM — Recipient Committee (other than PTY or SCC) TH — Other (e.g., business entity) TY— Political Party CC —Small Contributor Committee
AMOUNT RECEIVED THIS PERIOD
135.00
500.00
1170.00
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
:hedule A (Continuation Sheet) onetary Contributions Received
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period from through
01/01/2012 03117/2012
Page
9
of
\ c‘
1294032
of Adam Hill, County Supervisor 2012
DATE RECEIVED
460
FORM
ID. NUMBER
AE OF FILER
: riends
SCHEDULE A (CONT.) , CALIFORNIA
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OF COMMITTEE, ALSO ENTER I D. NUMBER) CODE *
IND COM OTH PTY IliSCC IND COM ill OTH
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
2/22/12
David Ogren 1016 Willow Circle San Luis Obispo, CA 93401
•• El
Senior Deputy Public Defender, County of Santa Barbara
2/16/12
Dr. Bradford Parkinson 236 Camino Edna San Luis Obispo, CA 93401
• • Pr(
Retired
rj IND
AMOUNT RECEIVED THIS PERIOD
PER ELECTION TO DATE (IF REQUIRED)
190.00
100.00
0 scc
3/11/12
Kayla Ann Plourde 745 Evans Road San Luis Obispo, CA 93401
El COM
Self-Employed, Book Sales
160.00
1/03/12
Christine Rogers 735 Tank Farm Road #264 San Luis Obispo, CA 93401
.4 IND COM OTH PTV
Program Manager, Economic Vitality Corporation
190.00
21IND
2/06/12
Ernest Roide 88 Bena Vista San Luis Obispo, CA 93405
Owner, Promotions Plus
•• • •• •• scc •• OTH PTY SCC
•
OTH PTY SCC
SUBTOTALS :;ontributor Codes ID — Individual OM — Recipient Committee (other than PTY or SCC) TH — Other (e.g., business entity) TY — Political Party CC —Small Contributor Committee
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
890.00
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866 1ASK-FPPC (8661275-3772)
;hedule A (Continuation Sheet) onetary Contributions Received
SCHEDULE A (corm
Type or print in Ink. Amounts may be rounded to whole dollars.
Statement covers period from through
01/01/2012 03/17/2012
10
of
\ ck
12 032
of Adam Hill, County Supervisor 2012
DATE RECEIVED
Page
460
I.D. NUMBER
AE OF FILER
z riends
CALIFORNIA FORM
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER W. NUMBER)
2/16/12
Charles Senn 178 Broad Street San Luis Obispo, CA 93401
2/23/12
San Luis Obispo Democratic Club 1406 Broad Street San Luis Obispo, CA 93401
CONTRIBUTOR CODE *
IND
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
0 COM
Self-Employed, Sales
•• IND cOm
FPPC 862266
•• OTH PTY • SCC
•ru OTH PTY
#
CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31)
PER ELECTION TO DATE (IF REQUIRED)
100.00
100.00
• SCC
Jennifer Skinner 5420 Huasna Township Road Arroyo Grande, CA 93420
•41 IND
3/11/12
•COm
Owner, Huasna Valley Farms
w4 IND
2/06/12
Mary E. Smith 1111 Vista Del Lago San Luis Obispo, CA 93405
Mom
Retired
rAl I ND
2/06/12
John Spatafore 1303 Garden Street San Luis Obispo, CA 93401
Self-Employed,John A. Spatafore, Attorney At Law
•• OTH PTY • SCC
0 COM 0 OTH PTY •• SCC
170.00
300.00
00TH 0 PTY 0 SCC
SUBTOTALS 3ontributor Codes JD -Individual OM - Recipient Committee (other than PTY or SCC) TH - Other (e.g., business entity) TY - Political Party CC -Small Contributor Committee
AMOUNT RECEIVED THIS PERIOD
250.00
920.00
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866/ASK-FPPC (866/275-3772)
Schedule A Continuation Sheet) Monetary Contributions Received
SCHEDULE A (CONT.)
or print In Ink. Amounts may be rounded to whole dollars.
Statement covers period from
011/2012
through
03/17/2012
NAME OF FILER
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE *
3/11/12
Jenifer Rescola 1323 Balboa Street San Luis Obispo, CA 93401
01/06/12
Teddy Bear Homes 896 Tanis Place Nipomo, CA 93444
Page 1% ID. NUMBER
of
460 \ ek
1294032
Friends of Adam Hill, County Supervisor 2012 DATE RECEIVED
CALIFORNIA FORM
ND
• OM • OTH
•• SCC PTY •rACOM IND • OTH El PTY
IF AN INDIVIDUAL ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYEA ENTER NAME OF BUS INES 51
Psychiatric Technician, Atascadero State Hospital
AMOUNT RECEIVED THIS PERIOD
CUMULATIVE TO DATE CALENDAR YEAR
(JAN. 1 - DEC. 31)
PER ELECTION TO DATE (IF REQUIRED)
140.00
100.00
0 SCC END COM 0 OTH PTY SCC
• •• •• IND COM 00TH PTY 0• SCC
IND •• COM
•
OTH 0 PTY 0 SCC
SUBTOTALS
240.00
*Contributor Codes COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Conhibutor Committee
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866 1ASK-FP PC (866/2754772)
Inn
Schedule B — Part 1 Loans Received
vai
in nit
SCHEDULE B - PART 1
1 el •• 1 n.
Statement covers period 01/01/2012 from
Amounts may be rounded to whole dollars.
Page 12 I.D. NUMBER
03/17/2012
through
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
CALIFORNIA FORM
(IF COMMITTEE ! ALSO ENTER ID. NUMBER)
Adam Hill San Luis Obispo, CA 93401 t o IND
0 COM 0 OTH
0 PTY
IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
(I) (b) OUTSTANDING AMOUNT BALANCE H Is RECEIVED THIS BEGIMItNIAT PERIOD
CandidateSupervisor SLO County District 3
260 Sandercock
0 SCC
5
4300.00
$
0
(ci AMOUNT PAID OR FORGIVEN THIS PERIOD -
0
PAID
s 0
FORGIVEN
OUTSTP,I4DING BALANCEAT
(n
INTE(eREST
ORIGINAL AMOUNT OF LOAN
PAID THIS PERIOD
CLOSE OF THIS
PFRIOD
0
5
4300.00
$
0 t
0
$
k
10,300
$
0 PTY
$
PER ELECTION'.
DATE INCURRED
RATE
PER ELECTION** $
s
S
DATE INCURRED
DATE DUE
0 SCC
CALENDAR YEAR %
$
S
$
COM
0
OTH
0 PTY
$
S
0
0$
4300.00
$
0
(Include loans paid by a third party that are also itemized on Schedule A.)
*Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required.
0
0
Loans received this period (Total Column (b) plus unitemized loans of less than $100.)
Net change this period. (Subtract Line 2 from Line 1.) Enter the net here and on the Summary Page, Column A, Line 2.
$
$
Sthedule E, Lino 3)
2. Loans paid or forgiven this period (Total Column (c) plus loans under $100 paid or forgiven.) 3.
DATE INCURRED
(Enter (et) on
Schedule B Summary 1.
S
PER ELECTION**
5
DATE DUE
O SCC
SUBTOTALS $
5
RATE
C FORGIVEN
0
s
$
%
S
0 PAID
T O IND
$
CALENDAR YEAR
5
0 COM 0 OTH
19)
CUMULATIVE CONTRIBUTIONS TO DATE
RATE
s
DATE DUE
0 FORGNEN
0 IND
\ C\
CALENDAR YEAR
0 PAID
t
of
1294032
Friends of Adam Hill, County Supervisor 2012 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER
460
NET $
0 (May be
•
tConhibutor Codes ND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY —Political Party SCC — Small Contributor Committee
negafiVe nurnbar)
FPPC Form 460 (January/05) FPPC Toll-Free Mainline: 866/ASK-FPPC (866 1275-3772)
Type or print in Ink. Amounts may be rounded to whole dollars.
— — - -- ---- —
Nonmonetary Contributions Received
SCHEDULE C statement covers period
01/01/2012
from through
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
03/17/2012
2/24/12
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 70. NUMBER)
Adam Hill 260 Sandercock San Luis Obispo, CA 93401
Page
13
of
460 19
ID. NUMBER
1294032
Friends of Adam Hill County Supervisor 2012 DATE RECEIVED
CALIFORNIA FORM
CONTRIBUTOR CODE *
IF AN INDIVIDUAL, ENTER OCCUPATIONAND EMPLOYER (IF SELF-EMPLOVED, EN7F_R
DESCRIPTION OF GOODS OR SERVICES
NAME OF BUSINESS)
0% IND 5COM
• OTH Ej Pr(
District 3 Supervisor
Wine Baskets and other items for raffle
AMOUNT/ FAIR MARKET VALUE
CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 - DEC 31)
PER ELECTION TO DATE (IF REQUIRED)
$600.00
•SCC
IND • COM •DOTH 0 PTY • SCC IDIND • COM EIOTH PTY • SCC • • No DCOM 0 OW 0 PTY
5SOO Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL $
600.00
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.)
600.00 38.40 TOTAL $
re 38.40
*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
FP PC Form 460 (January/05) FPPC Toll-Free HelplIne: 866/ASK-FP PC (86612754772)
Schedule E Payments Made
SCHEDULEE
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period
:LEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Page 1 LI of
\
I.D. NUMBER
1294032
Friends of Adam Hill, County Supervisor 2012 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, d escribe the payment. CM째 campaign paraphernata/misc. ChIS campaign consultants 0113 contribution (explain nonmonetary)* OVC civic nonations FL candidate filing/ballot fees Ft fundraising events independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings
RAD RFD SAL TEL 1RC TRS TSF VOT NEB
MBR member communications MTG meetings and appearances OFC o ffi ce expenses PET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) FRT print ads
NAME AND ADDRESS OF PAYEE
ocCOMMITTEE ALSO ENTER 1.1). NUMBER)
CODE
radio airtime and production costs returned contributions campaign workers' salaries Lv. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the sarne candidate/sponsor voter registration information technology costs (*Internet, e-mail)
DESCRIPTION OF PAYMENT
OR
poliARC 286 Aspen Street #220E Arroyo Grande, CA 93420
Web Management
Pismo Beach Chamber of Commerce 581 Do!liver Street Pismo Beach, CA 93449
Dues
Grover Beach Chamber of Commerce 180 Highway One Grover Beach, CA 93433
Installation Dinner
Payments that ore contributions or independent expenditures must also be summarized on Schedule D.
AMOUNT PAID
300.00
71.00
100.00
SUBTOTAL $
Schedule E Summary I. Itemized payments made this period. (Include all Schedule E subtotals.) 2. Uniterni zed payments made this period of under $100 3 Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e) ) t. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)
471.00 14,136.80 159.12
0 TOTAL $
14,295.92
FPPC Form 460 (January/05) FPPC Toll-Free HelplIne: 866/ASK-FPPC (866/276-3772)
Schedule E (Continuation Sheet) Payments Made
SCHEDULE E (CONT.)
Type or print In Ink. Amounts may be rounded to whole dollars.
Statement covers period
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Page
15
of
ID. NUMBER
1294032
Friends of Adam Hill, County Supervisor 2012
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot fees FND fundraising events IC independent expenditure supporting/opposing others (explain)* LEG legal defense UT campaign literature and mailings NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER
to NUMBER)
MBR MTG OFC FET PHO POL POS PRO Ffit
RAD radio airtime and production costs RFD returned contributions SAL campaign workers salaries TEL tv. or cable airtime and production costs ITC candidate travel, lodging, and meals WS 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)
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
AMOUNT PAID
DESCRIPTION OF PAYMENT
Political Data Inc. 1251 Imperial Highway, Suite 200 Norwalk, CA 90650
On-Line Voter File, Software, Bar Code Wand
Pacific Coast Business Times 14 East Carrillo Street #A Santa Barbara, CA 93101
Reprints of article, including high resolution PDF's
Pismo Beach Chamber of Commerce 581 Dolliver Street Pismo Beach, CA 93449
Installation Dinner
Susan Devine 1845 Garden Street San Luis Obispo, CA 93401
Reimburse for Auction items at Grover Beach Installation Dinner
860.00
Susan Devine 1845 Garden Street San Luis Obispo, CA 93401
Reimburse for Auction items at Pismo Beach Installation Dinner
500.00
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D.
476.50
169.00
50.00
SUBTOTAL
2,055.50
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866 12754772)
Schedule E (Continuation Sheet) Payments Made
SCHEDULE E (CONT.)
Type or print in ink. Amounts may be rounded to whole dollars.
Statement covers period
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Page 16 La NUMBER
of \C
1294032
Friends of Adam Hill, County Supervisor 2012 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. QvV campaign paraphernalia/misc.
CNS campaign consultants C1B contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot tees END fundraising events independent expenditure supporting/opposing others (explain)* LEG legal defense Lif campaign literature and mailings NAME AND ADDRESS OF PAYEE BF COMMITTEE.
N-50 ENTER LE NUMBER)
MBR member communications MTG meetings and appearances OFC office expenses FET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) FRT print ads CODE
OR
RAD radio airtime and production costs RFD returned contributions SAL campaign workers salaries ra tv. or cable airtime and production costs 1RC 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) AMOUNT PAID
DESCRIPTION OF PAYMENT
poliARC 296 Aspen Street #220E Arroyo Grande, CA 93420
Web Management, Walk Piece printing
Clint Weirich 380 Saratoga Grover Beach, CA 93433
Campaign worker salary
Political Data Inc. 12501 Imperial Highway, Suite 200 Norwalk, CA 90650
On-Line Voter File, Software, Bar Code Wand
PPS - Public Policy Solutions 979 Osos Street, Suite E San Luis Obispo, CA 93401
Office supplies for precinct walk k ts
San Luis Obispo Chamber of Commerce 1039 Chorro Street San Luis Obispo, CA 93420
State of the State Luncheon
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
1179.65
500.00
476.50
186.16
280.00
SUBTOTAL $
2,622.31
FPPC Fonn 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661276 4772)
Schedule E (Continuation Sheet) Payments Made
SCHEDULE E (CONT.)
Type or print in Ink. Amounts may be rounded to whole dollars.
Statement covers period
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Page 17
of
\
ID. NUMBER
Friends of Adam Hill, County Supervisor 2012
1294032
CODES: if one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CM° 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 pefition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PI-10 phone banks TRC candidate travel, lodging, and meals FWD fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals BID 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 UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PMEE
(IF COMMITTEE, ALSO ENTER ID.NUMBER)
CODE
OR
DESCRIPTION OF PAYMENT
San Luis Obispo County Clerk 1055 Monterey Street San LuisObispo, CA 93401
Filing Fee
Pismo Beach Chamber of Commerce 581 Dolliver Street Pismo Beach, CA 93449
Mailing List
Political Data Inc. 12501 Imperial Highway, Suite 200 Norwalk, CA 90650
Precinct Map
AMOUNT PAID
820.14
35.00
81.56
•
PPS - Public Policy Solutions 979 Osos Street, Suite E San Luis Obispo, CA 93401
Campaign Consultant, Voter List
San Luis Obispo Chamber of Commerce 1039 Chorro Street San Luis Obispo, CA 93420
Mailing List
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
2555.00
175.00
SUBTOTAL $
3,666.70
FPPC Form 460 (January(05) FPPC Toll-Free Helpline: 866/ASK-FPPC (86612754772)
Schedule E (Continuation Sheet) Payments Made
SCHEDULE E (CONT.)
Type or print In Ink. Amounts may be rounded to whole dollars.
Statement covers period
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Page 18
of
I.D. NUMBER
Friends of Adam Hill, County Supervisor 2012
1294032
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. cm, campaign paraphernalia/misc.
campaign consultants CTB contribution (explain nonmonetary) CVC civic donations FIL candidate fi ling/ballot fees fundraising events nu independent expenditure supporting/opposing others (explain)* LEG legal defense UT campaign literature and mailings NAME AND ADDRESS OF PAYEE
(IF coMMITTEE, ALS0 ENTER 1.1) NUMBER)
MBR MTG OFC PET PHO POL POS PRO PRT
member communications meetings and appearances office expenses petition circulafing phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE
OR
RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries Ta ty. or cable airtime and production costs NC 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 ( i nternet, e-mail) DESCRIPTION OF PAYMENT
San Luis Obispo County Clerk 1055 Monterey Street San LuisObispo, CA 93401
Spanish Ballot
Grover Beach Chamber of Commerce 180 Highway One Grover Beach, CA 93433
Membership and Mailing List
poliARC 296 Aspen Street #220E Arroyo Grande, CA 93420
Campaign Literature and Mailings
Patricia Harris 218 Via La Paz San Luis Obispo, CA 93401
Campaign Management
San Luis Obispo Chamber of Commerce 1039 Chorro Street San Luis Obispo, CA 93420
Good Morning SLO Breakfast
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D.
AMOUNT PAID
970.00
200.50
2805.53
500.00
148.00
SUBTOTAL $
4,624.03
FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8664275-3772)
•
Schedule E (Continuation Sheet) Payments Made
SCHEDULE E (CONT.)
Type or print in Ink. Amounts may be rounded to whole dollars.
Statement covers period
SEE INSTRUCTIONS ON REVERSE NAME OF FILER
from
011/2012
through
03/17/2012
Friends of Adam Hill, County Supervisor 2012 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. GIP campaign paraphernalia/misc. campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings NAME AND ADDRESS OF PAYEE
SE COMMITTEE, ALSO ENTER LO. NUMBER/
MBR member communications MTG meetings and appearances OFC office expenses petition circulabng PHO phone banks POL polling and survey research FOS postage, delivery and messenger services PRO professional services (legal, accounfing) FRT print ads CODE
OR
RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and producbon 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 NEB information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT
AMOUNT PAID
Denis Degher 8650 Centra Road Paso Robles, CA 93446
Music for Cayucos Fund Raiser
Patricia Harris 218 Via LaPaz San Luis Obispo, CA 93401
Reimburse for food, tables & chairs for Cayucos Fund Raiser
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
175.00
SUBTOTAL $
522.26
697.26
FPPC Form 460 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/2754712)