RecipientGommittee Campaign Statement CoverPage (Government Code Sections 84200-84216.5) O State Candidate Election Committee Q Recall (Also complets Pad 5) [] General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Cenkal Committee 3. Committee lnformation E NAME (OR CANOIOATE'S NAME IF NO COMMITTEE) SEE INSTRUCTIONS ON REVERSE 1. Type of Recipient Gommitteel All committees - complete Parts 1, 2, 3, and 4. ! Officeholder, Candidate Controlled Committee f] Primarily Formed Ballot Measure COVERPAGE 2. Type of Stateme I Preelection Statement fl Semi-annual Statement I TerminationStatement (Also file a Form 410 Termination) fl Amendment (Explain below) Treasurer(s) NAME OF TREASURER L155 Meridian Avenue, #214 CITY STATE ZIP CODE AREA CODE/PHONE San Jose, CA 95L25 (408) 978-2064 Type or print in ink. Committee Q Controlled Q Sponsored (Nso Cmplete Paft 6) I Primarily Formed Candidate/ Ofiiceholder Committee (Also Complel€ Pad 7) NUMBER tr n n Quarterly Statement Special Odd-Year Report Supplemental Preelection Statement - Attach Form 495 santa clara Countsy Public SafeEy Alliance STREET ADDRESS (NO P.O. BOX) 1155 Meridian Avenue, #214 CITY STATE ZIP CODE AREA COOE/PHONE CITY ZIP CODE 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 under penalty of perjury underthe laws of the State of California that the foregoing is true and correct. Executed on Executsd on Executod on Executed on Off@holder, NAME OF ASSISTANT TREASURER. IF ANY ehri sl-oFhPr Schrrml't MAILING ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS and in the attached schedules is true and complete. lcertify Signature of Cmlrolllng Offi ceholder, Candldate. State Measuro Prcpqent ----- - sign Conlrolling Otreholder, Candidate, State Measure Proponent FPPC Form 460 (Jrnuary/0s) FPPC Toll-Frse Helpline: 866/A5K.FPPC (866/27S3772) Stato of Gallfomla Dato Stamp t\ r tb r: AUG 0 oi1' "il'l't Statement covers perlod from o1l01/2ol"o o6 /30 /20l.0 Date of electlon il (Month, Day, Year) ffiffi-h"
3. Committee lnformationE NAME (OR CANOIOATE'S NAME IF NO COMMITTEE)
SEE INSTRUCTIONS ON REVERSE
1. Type of Recipient Gommitteel All committees - complete Parts 1, 2, 3, and 4.
! Officeholder, Candidate Controlled Committee f] Primarily Formed Ballot Measure
COVERPAGE
2. Type of Stateme
I Preelection Statement
fl Semi-annual Statement
I TerminationStatement(Also file a Form 410 Termination)
fl Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
L155 Meridian Avenue, #214CITY STATE ZIP CODE AREA CODE/PHONE
San Jose, CA 95L25 (408) 978-2064
Type or print in ink.
Committee
Q Controlled
Q Sponsored(Nso Cmplete Paft 6)
I Primarily Formed Candidate/Ofiiceholder Committee(Also Complel€ Pad 7)
NUMBER
trnn
Quarterly Statement
Special Odd-Year Report
Supplemental PreelectionStatement - Attach Form 495
santa clara Countsy Public SafeEy Alliance
STREET ADDRESS (NO P.O. BOX)
1155 Meridian Avenue, #214CITY STATE ZIP CODE AREA COOE/PHONE
CITY ZIP CODE
oPTIONAL: FAX / E-MAIL ADDRESS
VerificationI have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge theunder penalty of perjury underthe laws of the State of California that the foregoing is true and correct.
Executed on
Executsd on
Executod on
Executed on
Off@holder,
NAME OF ASSISTANT TREASURER. IF ANY
ehri sl-oFhPr Schrrml'tMAILING ADDRESS
OPTIONAL: FAX / E-MAIL ADDRESS
and in the attached schedules is true and complete. lcertify
Signature of Cmlrolllng Offi ceholder, Candldate. State Measuro Prcpqent
----- - sign Conlrolling Otreholder, Candidate, State Measure Proponent
FPPC Form 460 (Jrnuary/0s)FPPC Toll-Frse Helpline: 866/A5K.FPPC (866/27S3772)
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET)
Related Gommiftees Not lncluded in this Statement: Ltstanycommnteesnot Included ln this s{atement that are controlled by you or are prlmarlly formed to recelvecontrlbutlons or make expendftures on behalf of your candldacy.
COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX)
ZIP CODE AREA CODE/PHONE
COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE- PART2
6. Primarily Formed Ballot Measure Committee
ldentify the controlling offlceholder, candldate, or stat€ moasure proponont, lf any.
NAME OF OFFICEHOLDER, CANOIDATE, OR PROPONENT
Primarily Formed Candidate/Officeholder Committee LIst names otofficeholder(s) or candldate(s) far whlch thls commlltee ls prlmarlly formed.
Attach continuation sfieets if necessary
Type or print ln ink.
7.
BALLOT NO. OR LETTER
OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E SUPPoRT
I oeeose
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELDfl suPPoRrE oPPosE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD E SUPPoRT
n oPPosE
NAME OF OFFICEHOLDER OR CANDIOATE OFFICE SOUGHT OR HELD N SUPPoRT
n oPPosE
FPPC Form ,160 (Jrnuiry/051FPPC Toll.Froe Helpllnei 866,A5K-FPPC (8661276-3772)
4. Nonmonetary Contributions .............. schedu,a c, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED ..... Add Lines s + 4
Type or print in inkAmounts may be rounded
to whole dollars.
Column ATOTALTHISPERIOD
(FROM ATTACHEO SCHEDULES)
$ r.0,2s0.00
0.00
1"0 250.00
o - 00
$ r.0,250.00
0.00
Column BCALENDARYEAR
TOTALTODATE
10,250.00
L0 250.00
0.00
10,250.00
8,060.00
0.00
060.00
To calculate Column B, addamounts in Column A to theconesponding amountsfrom Column B of your lastreport. Some amounts inColumn A may be negativefigures that should besubtracted from previousperiod amounts. lf this isthe first report being filedfor this calendar year, onlycarry over the amountsfrom Lines 2, 7, and I (ifany).
SUMMARYPAGE
Calendar Year Summary for CandidatesRunning in Both the State Primary andGeneral Elections
1/1 through 6/30 7/1 to Date
20. ContributionsReceived $- $-
21. ExpendituresMade $- $-
Expenditure Limit Summary for StateGandidates
22. Gumulatlve Expendltures Madet(lf Subl.ct to Voluntrry Exp.ndlturo Llmltl
Expenditures Made6. Payments Made............. schedute E, Line 4
7. Loans Made. schedutl H, Lina 3
8. SUBTOTALCASHPAYMENTS AddLines6+7
9. Accrued Expenses (Unpaid Bills) ............................... scheduteE Line 3
10. Nonmonetary Adjustment .................. . schedute c, Line 3
*Amounts in this section may be different from amountsreported in Column B.
FPPC Form 460 {January/O5)FPPC Toll.Free Helpline: 866/A5K-FPPC (866/275-3772)
covers perlod
oL/ o!/2o:-o
06 /30 /20ro
1,890.00
Stat€m6nt covers psriod
Iro. 01 /01/2 010
o6/30/20LO
I.D. NUMBER
12 81451
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(lF COMMITTEE, ALSO ENTER I.D. NUMBER)
IF AN INDIVIDUAL, ENTEROCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER NAMEoF BUSINESS)
CUMULATIVETO DATECALENDAR YEAR(JAN.1-DEC.31)
l0 Almaden Boulevard, Sulte 1250
San .fose, CA 95113
Attorney
self-Employed (Same)
rina Del Pozzo
4344 Thousand Oaks Drlve
San Joae, CA 95136
Paralegal
Law Foundation ofSilicon Valley
250.00
112 Madera Court
Los Gahos, CA 95032
Real EstaEe
SeIf-Employed (Same)
iqnlia, McMahon & Allard LLP
96 North 3rd Street, suite 620
San Jose, CA 95112
3, 000.00 3, 000 .00
ScheduleAMonetary Contri butions Received
SEE INSTRUCTIONS ON REVERSE
Type or print in inkl\mounts may be roundsd
to whole dollars.
SCHEDULE A
PER ELECTIONTODATE
(lF REOUIRED)
*Contributor Codes
IND - lndividualCOM - Recipient Committee
(otherthan PTY or SCC)OTH - Other (e.9., business entity)PTY-Political PartySCC - Small Contributor Commiftee
Santa Clara Countsy Public Safety Alliance
DATERECEIVED
os/rt/2oro
os/L3/20!o
0s/24/20ro
05/26/2OLl
SUBTOTAL$
Schedule A Summary1. Amount received this period - itemized monetary contributions.
(lnclude all Schedule A subtotals.) ........................ $
Amount received this period - unitemized monetary contributions of less than $100 ............................. $
Total monetary contributions received this period.(Add Lines 1 and2. Enter here and on the Summary Page, Column A, Line 1.)....................... TOTAL $
LEG legal defenseLtT campaign literature and mailings
IND independent expenditure supporting/opposing others (explain)- POS postage, delivery and messenger services
Type or print in lnk,Amounts may be rounded
to wholo dollars.
MBR membercommunicationsMTG meetings and appearancesOFC office expensesPEf petitioncirculatingPl-lO phone banksPOL polling and survey research
PRO professional services (legal, accounting)FKf print ads
RAD radio airtime and production costsRFD returned contributionsSAL campaign workers' salariesTEL t.v. or cable airtime and production costsTRC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationVIEB information technology costs (internet, e-mail)
Statement covors porlod
from 0rl0rl2010
through o6/3o/2oLo
CODES: lf one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
NAME AND ADDRESS OF PAYEE(IFCOMMITTEE.ALSO ENTERI.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID
ng egg e
1334 Lincoln AvenueSan Jose, CA 95125
IND Radio ads to supporc Dolores carr for DA 4,000.00
Advert lsrng Busrness consulcanEs
1334 Lincol.n AvenueSan Jose, CA 951,25
IND Radlo ads to supporE Laurie snlth for Sherlff 4, 000.00
* Payments that are contrlbutlons or lndopendont expendltures must also be summarlzed on Schedule D. SUBTOTAL$ 8,000.00
Schedule E Summary
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............... TOTAL $
000 .00
00
0.00
050.00
FPPG Form 460 (January/05)FPPC Toll-Free Helpline: 866/A5K-FPPC (866127 5-377 2l
