Peter Arellano - Form 460 - 2012/10/01 - 2012/10/20Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 84216.5)
fro
Type or print In ink.
Statement co ers period I Date of election If appll
'C
i I I ('� (Month, Day, Year)
m
IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX / E -MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best
By
Signature of Controting Officeholder, Candidate, State Measure Proponent
By
Signature ofConbdling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05)
FPPC Tofl -Free Helpline: 866/ASK -FPPC (86612753772)
State of California
Recipient Committee Type or print In ink. COVER PAGE - PART 2 Campaign Statement � CALIFORNIA 460
Cover Page — Part 2
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
Peter D. Arellano, M.D.
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Mayor; City of Gilroy
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) 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.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Page I-- of —0
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER I JURISDICTION I ❑ SUPPORT
❑ OPPOSE
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
7. Primarily Formed Candidate /Officeholder Committee List names of
officeholder(s) or candidates) 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 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275-3772)
State of Califomia
Campaign Disclosure Statement Type or print in ink.
Amounts may be rounded
Summary Page to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Peter. D. Arellano, M.D.
SUMMARYPAGE
Statement covers period CALIFORNIA
from i o • -
through �� y, ` (� Page -3 of
I.D. NUMBER
1348325
Expenditures Made
6. Payments Made ........................ ............................... Schedule E, Line 4 $ 2,724.51
7. Loans Made .............................. ............................... Schedule H, Line 3 0
8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 2,724.51
9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0
10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 0
11. TOTAL EXPENDITURES MADE .... ............................Add Lines 8 + 9 + 10 $ 2,724.51
Current Cash Statement
12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 2,269.49
13. Cash Receipts .................... ............................... Column A, Line 3above 0
14. Miscellaneous Increases to Cash ...................... Schedule 1, Line 4 0
15. Cash Payments ................... ............................... Column A, Line 8above 2,724.51
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 455.02
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 B above $
$
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 first report being filed
for this calendar year, only
carry over the 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)
I $
I I $
Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Column A Column B
Calendar Year Summary for Candidates
Contributions Received
TArrACH cTOTALT
Running In Both the State Prima and
Primary
DSCHOD
(FROMATTACHED SCHEDULES) TOTALTODATE
DATE
9
General Elections
1. Monetary Contributions ............ ...............................
Schedule A, Line 3
$ 1 093.00 $
0
1/1 through 6/30 7/1 to Date
2. Loans Received ....................... ...............................
Schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS
Add Lines 1 + 2
$ 1,093.00 $
20. Contributions
.........................
Received $ $
4. Nonmonetary Contributions ..... ...............................
Schedule C, Line 3
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ........................•••
Add Lines 3 + 4
$ 1,093.00 $
Made $ $
Expenditures Made
6. Payments Made ........................ ............................... Schedule E, Line 4 $ 2,724.51
7. Loans Made .............................. ............................... Schedule H, Line 3 0
8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 2,724.51
9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0
10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 0
11. TOTAL EXPENDITURES MADE .... ............................Add Lines 8 + 9 + 10 $ 2,724.51
Current Cash Statement
12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 2,269.49
13. Cash Receipts .................... ............................... Column A, Line 3above 0
14. Miscellaneous Increases to Cash ...................... Schedule 1, Line 4 0
15. Cash Payments ................... ............................... Column A, Line 8above 2,724.51
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 455.02
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 B above $
$
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 first report being filed
for this calendar year, only
carry over the 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)
I $
I I $
Amounts in this section may be different from amounts
reported in Column B.
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Schedule A Type or print In Ink. SCHEDULE A
Amounts may be rounded Statement covers period
Monetary Contributions Received to whole dollars. CALIFORNIA 460
from
j l�l I �� •-
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF FILER I.D. NUMBER
Peter. D. Arellano, M.D. 1348325
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED THIS
CUMULATIVE TO DATE
CALENDAR YEAR
PER ELECTION
TO DATE
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE *
(IF SELF - EMPLOYED, ENTER NAME
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
OF BUSINESS)
❑IND
IBEW Local 332 - FPPC #1298069
[]
10/9/12
2125 Canoas Garden Avenue, Suite 100
❑OTH OTH
$250.00
San Jose, CA 95125
❑ PTY
❑SCC
❑IND
UFCW Local 5 - FPPC #1294035
m
10/9/12
240 South Market Street
❑OTH OTH
$250.00
San Jose, CA 95113
❑ PTY
❑ SCC
IND
❑❑COM
El Grullense Jai Gilroy
10/16/12
2511stStreet
®OTH
$250.00
San Jose, CA 95020
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL $ 750.00°
Schedule A Summary
1. Amount received this period — itemized monetary contributions. 750.00
(Include all Schedule A subtotals.) ......................................................................... ............................... $
2. Amount received this period — unitemized monetary contributions of less than $100 ............................. $ 343.00
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $
1,093.00
'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/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275 -3772)
Tuna nr nrrn4 in Ink
SCHEDULE B - PART 1
Schedule — Part 1 Amounts may be rounded
Statement covers period
Loans Received to whole dollars.
( 1 f l
460
from ► ° 2
• '
through I Z
Page
SEE INSTRUCTIONS ON REVERSE
of
NAME OF FILER
I.D. NUMBER
Peter. D. Arellano, M.D.
1348325
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
OUTSTANDING
BALANCE
b
AMOUNT
(�)
AMOUNTPAID
OUTSTANDING
BALANCEAT
e
INTEREST
ORIGINAL
9
CUMULATIVE
OF LENDER
(IF SELF-EMPLOYED, ENTER
BEGINNING THIS
RECEIVED THIS
OR FORGIVEN
CLOSE OF THIS
PAID THIS
AMOUNTOF
CONTRIBUTIONS
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
NAME OF BUSINESS)
PERIOD
THIS PERIOD`
PERIOD
LOAN
TO DATE
Peter D. Arellano, M.D.
Physician
❑ PAID
CALENDARYEAR
7473 Dornoch Court
$
$ 500.00
%
$ 500.00
$ 500.00
❑ FORGIVEN
PERELECTION-
Gilroy, CA 95020
Kaiser
RATE
500.00
$ 0
TBD
s
$ 500.00
to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
s
$
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
❑ FORGIVEN
PER ELECTION"*
RATE
s
s
s
s
s
DATE DUE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
DATE INCURRED
❑ PAID
CALENDARYEAR
❑ FORGIVEN
PERELECTION—
RATE
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
s
s
E
S
s
DATE DUE
DATE INCURRED
SUBTOTALS $ $ $ 500.00 $�
Schedule B Summary
Loansreceived 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.) ................................ ............................... NET $
Enter the net here and on the Summary Page, Column A, Line 2.
(Enter (e) on
Schedule E, Line 3)
0
tContributor Codes
0
(May be a negative number)
IND—individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
'Amounts forgiven or paid by another party also must be reported on Schedule A.
If required. FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275 -3772)
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
Type or print In ink. Statement cove period CALIFORNIA
from
Amounts may be rounded
to whole dollars. 1 � t i Tb? FORM
through (� ? y Page of
NAME OF FILER I.D. NUMBER
Peter. D. Arellano, M.D. 1348325
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
C1vP
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
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
FND
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
PIRT
print ads
WEB
information technology costs (intemet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Adan Lupercio
Benjamin Lithio
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$
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 $
2,652.09
41.21
0
2,724.51
FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (866/2753772)