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Don Gage - Form 460 - 2012/11/01 - 2012/12/31 - AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) m SEE INSTRUCTIONS ON REVERSE fro Type or print in ink. Statement covers period I Date of election if applicable: November 1, 2012 (Month, Day, Year) through December 31, 2012 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee Q State Candidate Election Committee O Recall (Also Complete Part 5) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party /Central Committee ❑ Primarily Formed Ballot Measure Committee Q Controlled Q Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1346217 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 4. Don Gage for Mayor 2012 STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY OPTIONAL: FAX / E -MAIL ADDRESS STATE ZIP CODE AREA CODE /PHONE Datet§ tamp l ERR 2013 �, . F_ November 6, 2012 2. Type of Statement: ❑ Preelection Statement ® Semi- annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ® Amendment (Explain below) Corrected Date Range COVERPAGE Page 1 of 5 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Sara Humphrey Nino MAILING ADDRESS NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E -MAIL ADDRESS STATE ZIP CODE AREA CODE /PHONE 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 thhej laws of the State of California that the foregoing is true and correct. Executed on 3 4� t% By Responsible Officer of Sponsor Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Fort 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612763772) State of California 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, California Type or print in ink. 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. COMMITTEENAME 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 COVER PAGE - PART 2 IPage 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I F-1 SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD I 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 Attach continuation sheets if necessary FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -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. November 1, 2012 FORM from through December 31, 2012 page 3 of 5 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 Column Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR Primary Running in Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTO DATE 7 General Elections 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 0.0 $ 38309.00 1/1 through 6/30 711 to Date 0.0 0.0 2. Loans Received ....................... ............................... Schedule s, Line 3 0.0 $ 38309.00 20. Contributions 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ Received $ $ 0.0 0.0 4. Nonmonetary Contributions ..... ............................... Schedule c, Line 3 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ••• .... ...............•••••AddLines3 +4 $ 0.0 $ 38309.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 3990.00 $ 27226.04 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 0.0 0.0 22. Cumulative Expenditures Made* 8. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 +7 $ 3990.00 $ 27226.04 (if Subjectto Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0.0 0.0 Date of Election Total to Date 0.0 0.0 (mm /dd /yy) 10. Nonmonetary Adjustment ........... ............................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE . ............................... Add Lines 6 + 9 + 10 $ 3990.00 $ 27226.04 J $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 15072.96 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 0.0 amounts in Column A to the 0.0 corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last reported in Column B. 3990.00 report. Some amounts in 15. Cash Payments ................... ............................... Column A, Line s above 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 2 $ 0.0 for this calendar year, only carry over the amounts any) Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... See instructions on reverse $ 0.0 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 0.0 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772) E Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from November 1, 2012 SEE INSTRUCTIONS ON REVERSE through December 31, 206 Page 4 of 5 NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 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 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 FIND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals W 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 AMOUNT PAID Sanford Consulting, LLC Design For Campaign Literature 1492 Quail Walk Drive LIT 150.00 Gilroy, Ca 95020 Seledon, Vanni, Humphrey, & Kawafuchi 7937 Hanna Street PRO 2000.00 Gilroy, Ca 95020 Vilma Pinheiro CA-01 Donation Caravelle Travel CBT 40.00 190 1st Street, Gilroy, Ca 95020 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2190.00 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 $ 3990.00 N/A 0.00 3990.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON R Don Gage for Mayor 2012 Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers period from November 1, 2012 through December 31, 201& Page 5 1. D. NUMBER 1346217 of 5 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 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 AMOUNT PAID City of Gilroy 7351 Rosanna Street Gilroy, Ca 95020 OFC 1500.00 Mama Mia's Restaurant 360B First Street Gilroy, Ca 95020 TRC 300.00 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1800.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)