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Don Gage - Form 460 - 2012/10/21 - 2012/12/31Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if applicable: from October 21, 2012 (Month, Day, Year) through December 31, 2012 I November 6, 2012 Date Stamp COVER PAGE 1 of 8 For Official Use Only 1. Type of Recipient Committee: All Committees - complete Parts 1, 2, 3, and 4. 2. Type of Statement: - ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee [Z Semi - annual Statement ❑ Special Odd -Year Report 0 Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) Q Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495 (Also Complete Part 6) [J Amendment (Explain below) r-1 General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee 0 Political Party /Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1346217 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Don Gage for Mayor 2012 STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS Treasurer(s) NAME OF TREASURER Sara Humphrey Nino MAILING ADDRESS NAME OF ASSISTANT TREASURER, 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 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 -_2 By Date )� nvlleOfficerofSponsor Executed on Date By Signature ofControlling Officeholder, Candidate, State Measure Proponent Executed on By Dye Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/OS) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Don Gage OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Mayor of Gilroy, Ca RESIDENTIAUBUSINESS 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 COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page 2 of 8 BALLOT NO. OR LETTER JURISDICTION ❑ 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 candidate(s) 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 CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661276 -3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Statement covers period CALIFORNIA . ' Amounts may be rounded Summary Page to whole dollars. October 21, 2012 • - from through December 31, 2012 Page 3 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD SCHEDULES) CALENDARYEAR TOTALTO DATE g Primary Running in Both the State Prima and (FROM ATTACHED General Elections 1. Monetary Contributions ............ ............................... schedule A, Line 3 $ 2500.00 - $ 38309.00 0.00 0,00 1/1 through 6/30 7/1 to Date 2. Loans Received ....................... ............................... schedule e, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add lines 1 +z $ 2500. 00 $ 38309.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 2500.00 $ 38309.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 11688.56 $ 27226.04, Candidates 7. Loans Made .............................. ............................... schedule H, Line 3 0.00 0.00 11688.56 27226.04 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 +7 $ $ (if Sub jectto Voluntary Expenditure Urnit) 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 0.00 0.00 (mm/dd /yy) 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 +9 +10 $ 11688.56 $ 27226.04 ) $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 20271.52- To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 2500.00 amounts in Column A to the 0.00 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule t, Line 4 from Column B of your last reported in Column B. 15. Cash Payments ................... ............................... column A, Line a above 11688. 56 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 11082.96" figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... schedule e, Part z $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts y 18. Cash Equivalents ......... ............................... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column a above $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule A Type or print in ink. SCHEDULE Monetary Contributions Received Amounts may be rounded Statement covers period - to whole dollars. October 21, 2012 ' - • from -DcLI},6,F 31, 2012 Page 4 SEE INSTRUCTIONS ON REVERSE through of NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR E DE O RALSAND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVETO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED COMMITTEE, I.D. NUMBER) CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) 21ND 10/25/12 Michelle Rango ❑COM Marketer. 100.00 100.00 131 Via Lucia ❑OTH "Ctibte - = < ®v- Alamo, Ca 94507 ❑PTY ❑ Scc ❑ IND 10/25/12 CAA Tri- County ❑COM Business 250,00 250.00 980 Ninth Street, Ste 200 20TH Sacramento, Ca 95814 F-1 PTY ❑ Scc ❑ IND 10/25/12 Bonfante Nurseries, Inc OCOM Business 200.00 200.00 3675 Hecker Pass Hwy 2OTH Gilroy, Ca 95020 El PTY ❑ SCC 21ND 10/25/12 Joel Goldsmith ❑COM Retired 250.00 250.00 8321 Peppergrass Ct ❑OTH Gilroy, Ca 95020 F-1 PTY ❑ SCC Peter C Filice Exempt. Trust FBO Candace ❑IND ❑ Trust 25/12 7888 Wrent Ave Ste D143 TH 2 OTH 250.00 250.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC SUBTOTAL $ 1050.00} Schedule A Summary *Contributor Codes 1. Amount received this period — itemized monetary contributions. IND — Individuai (Include all Schedule A subtotals.) .................. ....... ............................... $ 2500.00 COM — Recipient Committee ..... ............................... • • � � � � (other than PTY or SCC) 2. Amount received this period — unitemized monetary contributions of less than $100 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... ....................... $ 1 11 OTH — Other (e.g., business entity) PTY— Political Party SCC — Small Contributor Committee ...... TOTAL $ 2500.00 FPPC Form 460 (January/( FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -37'. Schedule A (Continuation Sheet Type or print in ink. SCHEDULER (CON Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. October 21, 2012 I ' FORM • from 31, 2012 5 through' page of� .. NAME 0F FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR TTEE, ALSO ENTER I.D. NUMBER) (IF COMMI CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND David Li VCOM Self Employed- Physician 10/25/12 10185 Jean Ellen Ct ❑ OTH '0C.— l•l M 250.00 250.00 Gilroy, Ca 95020 ❑ PTY leG1U1c� f ❑ SCC William Reimal ®COD Self Employed- Real 10/25/12 7551 Kentwood Ct ❑ OTH Estate Broker 50.00 50.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC Jim Mingus ®IND E] Self Employed - Mingus 10/25/12 7840 Westwood Dr CO Pest Control 100.00 100.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC Joanne Cunningham ®IND Retired 12 10(25/12 20 Corwin Dr F] 100.00 100.00 Alamo, Ca 94507 ❑ PTY ❑ SCC Peter C Filice Exemption Trust FBO Craig �COM Trust 10/25/12 7888 Wren Ave Ste D143 VOTH 250.00 250.00 Gilroy, Ca 95020 171 PTY []SCC '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 SUBTOTAL $ 750.001 } FPPC Form 460 (January/0 FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -377 Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (COP Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. October 21, 2012 I I FORM from through �c' a'�31, 2012 Page 6 of NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 DATE E 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 COMMITTEE, ALSND I.D. NUMBER) CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Gloria P Millen ❑COM Retired 10/25/12 18364 Oak Dr L] OTH 250.00 250.00 Monte Sereno, Ca 95030 ❑ PTY ❑ SCC Richard Freedman ®IND ❑ COM Real Estate - Intero 10/25/12 8675 Del Rey Court ❑OTHc� 100.00 100.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC Brandt Bastow Trust ❑❑COD Trust 10/25/12 7888 `/�/ren Ave, Ste D143 V1 OTH 100.00 100.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC Greenwaste Recovery, Inc ❑ IND COM Business 10/25(12 1500 Berger Drive 0OTH 250.00 250.00 San Jose, Ca 95112 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Contributor Codes IND — Individual COM — Recipient Committee (other than PTY cr SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee SUBTOTAL $ 700.00 FPPC Form 460 (Januaryh FPPC Toll -Free Helpline: 866 /ASK -FPPC (866(275 -37' Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Don Gage for Mayor 2012 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from October 21, 2012 through December 31,2012 page 7 of 8 I.D. NUMBER 1346217 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment CNP campaign paraphernalia /misc. MBR member communications RAID 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 PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Sanford Consulting, LLC Campaign Consultant 1492 Quail Walk Drive CNS 4000.00 Gilroy, Ca 95020 Sanford Consulting, LLC Design for Campaign Literature LIT 1492 Quail Walk Drive 750.00 Gilroy, Ca 95020 First Class Mailing, Inc 10556 Cobie Road PMB 6485 LIT 3098.56 Auburn, Ca 95602 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 7848.56 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ... ............................... $ 11688.56 2. Unitemized payments made this period of under $100 ........................................................................................................... ............................... $ 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 $ 11688.56 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON NAME OF FILER Don Gage for Mayor 2012 Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers period CALIFORNIA I from October 21, 2012 FORM through December 31, 2% Page 8 of 8 I.D. NUMBER 1346217 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD SAL returned contributions campaign workers' salaries CTB contribution (explain nonmonetary)* OFC PET office expenses petition circulating TEL t.v. or cable airtime and production costs CVC FIL civic donations candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS TSF staff /spouse travel, lodging, and meals transfer between committees of the same candidate /sponsor IUD independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services 1500.00 7351 Rosanna Street LEG legal defense PRO professional services (legal, accounting) VOT WEB voter registration information technology costs (internet, e-mail) i rr cam nainn literature and mailinnS PRT print ads 300.00 13608 First Street * o-ante that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3840.00 FPPC Form 450 (.lanuarylub) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Seledon, Vanni, Humphrey, & Kawafuchi 2000.00 7937 Hanna Street PRO Gilroy, Ca 95020 Vilma Pinheiro Donation 40.00 Caravelle Travel CBT 190 1st Street, Gilroy, Ca 95020 City of Gilroy OFC 1500.00 7351 Rosanna Street Gilroy, Ca 95020 Mama Mia's Restaurant TRC 300.00 13608 First Street Gilroy, CA 95020 * o-ante that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3840.00 FPPC Form 450 (.lanuarylub) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)