SEIU 521 - Form 465 - 2012/10/01 - 2012/10/20Supplemental Independent
Expenditure Report
(Government Code Section 84203.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded to
whole dollars.
❑ Amendment (Explain Below)
I.D. NUMBER (If recipient committee)
1. Committee /Filer Information 1297707
COMMITTEE /FILER'S NAME
Service Employees International Union Local 521 Independent
Expenditure Committee
STREET ADDRESS (NO P.O. BOX)
2302 Zenker Road
CITY STATE ZIP CODE AREACODE/PHONE
San Jose CA, 95131 (408) 678 -3300
OPTIONAL: FAX /E -MAIL ADDRESS
Report covers period
from 01/01/2012
through 10/20/2012
Date of election if applicable:
(Month, Day, Year)
11/06/2012
SUPPLEMENTAL INDEPENDENT EXPENDITURE
Date Stamp
CALIFORNIA •- •
9C� 2012
r 1 3
Page of
For Official Use Only
Treasurer (If recipient committee)
NAME OF TREASURER
Kristina M. Sermersheim
MAILING ADDRESS
2302 Zanker Road
CITY STATE ZIP CODE AREACODE/PHONE
San Jose CA, 95131 (408) 954 -8715
OPTIONAL: FAX /E -MAIL ADDRESS
2. Name of Candidate or Measure Supported or Opposed CHECK ONE
NAME OF CANDIDATE
Rebecca Armendariz (I)
OFFICE SOUGHT OR HELD AND DISTRICT, IF APPLICABLE
City Council Member City of Gilroy
SUPPORT
X
OPPOSE
NAME OF BALLOT MEASURE
BALLOT NO. /LETTER
JURISDICTION
SUPPORT
OPPOSE
3. Independent Expenditures Made Attach additional information on appropriatelylabeled continuation sheets.
CUMULATIVE TO DATE
DATE
NAME ANDADDRESS OF PAYEE
DESCRIPTION OF EXPENDITURE
AMOUNT
JAN. 1 - DEC. 31
Lester Connect Inc.
250.00
Mailer
10/17/2012
5758 Geary Blvd., #210
5,000.00
San Francisco, CA 94121
Lester Connect Inc.
4,750.00
Mailer
10/20/2012
5758 Geary Blvd., #210
5,000.00
San Francisco, CA 94121
Pacific Print Resources
1,587.80
Mailer
MEMO
10/20/2012
1259 Park Avenue
Subpayment made
through:
Lester Connect
Inc.
Emeryville, CA 94608
FPPC Form 465 (Junel09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Supplemental Independent Type or print in ink.
Report covers period
Expenditure Report Amounts may be rounded
P p
Mnnvun 1
to whole dollars.
from 01/01/2012
SEE INSTRUCTIONS ON REVERSE
through 10/20/2012
r
For use by an officeholder, candidate, or committee making independent expenditures totaling $500 or
Date of election if applicable:
more in a calendar year to support or oppose a single candidate or a single measure. This form must
be filed at the same times and places as the campaign statements filed by the candidate supported or
(Month, Day, Year)
opposed or by a committee primarily formed to support or oppose the measure. A separate form must
be filed for each candidate or measure being supported or opposed. This form is filed in addition to
11/06/2012
anv other required campaign statements.
Subpayment made
IV Independent Expenditures Made Attach additional information on appropriatelylabeled continuation sheets.
SUPPLEMENTAL INDEPENDENTEXPENDffURE
Page 2 of 3
For Official Use Only
CUMULATIVE TO DATE
CALENDAR YEAR
DATE
NAME AND ADDRESS OF PAYEE
DESCRIPTION ION OF EXPENDITURE URE
Mnnvun 1
(JAN. 1 - DEC. 31)
10/20/2012
Lizard Press
Mailer
500.00
MEMO
1067 Market Street #1026
Subpayment made
through:
San Francisco, CA 94103
Lester Connect
Inc.
10/20/2012
US Postmaster
Postage
1,800.00
2700 Campus Drive
MEMO
Subpayment made
through:
San Mateo, CA 94497
Lester Connect
Inc.
Supplemental Independent Type or print in ink.
Amounts may be rounded
Expenditure Report to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Service Employees International Union Local 521 Independent Expenditure Committee
.1994MUM11iTi1�17� »�I7 ��i�3 »►1�]11�1:»
Report covers period CALIFORNIA
from
01/01/2012 FORM
through 10/20/2012
Page 3 of 3
D. NUMBER (If recipient corn.)
1297707
4. Summary
S, 000.00
1. Total independent expenditures of $100 or more made this period. (Part 3.) ............................................................ ............................... $
2. Total independent expenditures under $100 made this period. Not itemized. $ 0.00
3. Total independent expenditures made this period Add Lines 1 + 2. TOTAL $ s, 000.00
5. Filing Officers Enter the name and address of each filing officer with whom the filer's most recent campaign statements (Form 450, 460 or 461) have been filed.
1) NAME OF FILING OFFICER 3) NAME OF FILING OFFICER
Secretary of State
ADDRESS (NO. AND STREET) ADDRESS (NO. AND STREET)
Political Reform Division
1500 11th Street
CITY STATE ZIP CODE CITY STATE ZIP CODE
Sacramento, CA 95814
2) NAME OF FILING OFFICER
ADDRESS
(NO. AND STREET)
4) NAME OF FILING OFFICER
ADDRESS (NO. AND STREET)
STATE ZIP CODE CITY STATE ZIP CODE
6. Verification
I certify that the" independent expenditure(s)" disclosed in this statemeaisue "e at the behest of" the c ndidate or committee that benefitted from the expenditure(s)
as those terms are defined in Government Code Section 82031 and FP225.7. 1 have used all asonable diligence in prepan and reviewing this
statement and to the best of my knowledge the information contained homp) te. I certify unde penalty of perjury under the I s of the State of California that - ' � the foregoing is true and correct. /
Executed on (- 0/Z51i2— By 1 4 A
DATE IG ATURE O 1 ,TREASURER O AS TANT TREASURER -'
Executed on w/� 57// 2— BY
DATE SIGMA E F N ING FI HOLDE AN AT STATE M PROPONENT, OR RESPONSIBLE 6FFICER OF SPONSOR
Executed on
DATE
Executed on
DATE
i
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
FPPC Form 465 (June/09)
FPPC Toll -Free Helpiine: 866 /ASK -FPPC (866/275 -5772)