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Don Gage - Form 460 - 2015/07/01 - 2015/12/31Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 134216.5) SEE INSTRUCTIONS ON REVERSE from Type or print in ink. Date Stamp DEC 31 2015 Statement covers period Date of election If applicable July 1, 2015 (Month, Day, Year) through December 31, 2015 1. Type of Recipient Committee: All Committees –Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also compete Part 5) Q Sponsored (Also complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q 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 4. Verification 2. Type of Statement: ❑ Preelection Statement Semi - annual Statement ® Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Sara Humphrey -Nino COVER PAGE of 6 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 MAILING ADDRESS NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E -MAIL ADDRESS STATE ZIP CODE AREA CODE /PHONE 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 I� zell a 1� By � Data Executed on Data By Signature oFConlydlirg Olficetrplder ,Candidate, State Measure Proponent Executed on By Gate Signature ofConhd6ngOficr ceder ,Carddate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866IASK -FPPC (866/276 -3772) State of California Recipient Committee Campaign Statement Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee Type or print in ink. NAME OF OFFICEHOLDER OR CANDIDATE Don Gage OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Mayor of Gilroy, California 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 fanned to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO RO. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE -PART 2 Page 2 of 6 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 I DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee List names of oficeholder(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/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) State of Califomia Campaign Disclosure Statement Summary Page Type or print In Ink. Amounts may be rounded to whole dollars. Statement covers period from July 1, 2015 SUMMARY PAGE Expenditures Made through December 31, 2015 page 3 of 6 SEE INSTRUCTIONS ON REVERSE 7. Loans Made .............................. ............................... schedule H, Line 3 0.00 0.00 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ NAME OF FILER $ 2,812.38 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0.00 I.D. NUMBER Don Gage for Mayor 2012 0.00 0.00 11. TOTAL EXPENDITURES MADE . ............................... Add lines 6 + 9 + 10 1346217 2,402.38 $ 2,812.38 ColumnA Column B Calendar Year Summary for Candidates Contributions Received 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 TOTALTHIS PERIOD CALENDARYEAR Running in Both the State Primary and 13. Cash Receipts ................................................... Column A, Line 3 above (FROMATTACHEDSCHEDULES) TOTALTODATE General Elections 1. Monetary Contributions ....................... .................... Schedule A, Line 3 607.70 $ $ 607.70 from Column B of your last 0.00 0.00 111 through 6130 711 to Date 2. Loans Received ............................... ....................... schedule s, Line 3 $ 0.00 figures that should be 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 607.70 $ 607.70 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... Schedule C, Line 3 0.00 0.00 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 607.70 $ 607.70 Made $ $ 0.00 Expenditures Made 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 2,402.38 $ 2,812.38 7. Loans Made .............................. ............................... schedule H, Line 3 0.00 0.00 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 2,402.38 $ 2,812.38 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0.00 0.00 10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 0.00 0.00 11. TOTAL EXPENDITURES MADE . ............................... Add lines 6 + 9 + 10 $ 2,402.38 $ 2,812.38 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 1,794.68 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 607.70 amounts in Column A to the 0.00 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 15. Cash Payments ............................ ..................... Column A, Line 8 above 2,402.38 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0.00 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 a, Pert 2 $ 0.00 for this calendar year, only carry over the amounts any)' m Lines 2, �, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... see instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 91n Column 8 above $ 0.00 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (n Subject to Voluntary Expenditure Omit) Date of Election Total to Date (mm/dd/yy) -� $ 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/06) FPPC Toll -Free Helptine: 8661ASK -FPPC (8661275 -3772) SChottiIIP_ A Type or print In ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded rj/ to whole dollars. Statement covers period —CALIFORNI July 1, 2015 from FORM, ® December 31, 2015 4 6 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Don Gage for Mayor 2012 1346217 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 COMMI TEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑❑COnn 12/21/2015 City of Gilroy 607.70 607.70 7351 Rosanna Street ®OTH Gilroy, CA 95020 ❑ PTY p SCC ❑IND [3Com ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$�� Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals:) ......................................................................... ............................... $ 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.) ....................... TOTAL $ 607.70 ME 607.70 `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 1ASK -FPPC (866/275 -3772) . a 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 July 1, 2015 through December 31, 20fi CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 5 of 6 I.D. NUMBER 1346217 CNP 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 FIND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals 10 independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense FRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT 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 Old City Hall Restaurant Donation 7400 Monterey Street CVC 100.00 Gilroy, CA 95020 The Salvation Army Donation P.O. Box 1059 CVC 100.00 Gilroy, CA 95021 New Hope Community Church Donation 8886 Muraoka Dr. CVC 500.00 Gilroy, CA 95020 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 700.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ........................ $ 2,355.45 ............................................ ............................... 2. Unitemized payments made this period of under $100 46.93 3. Total interest paid this period on loans. (Enter amount from Schedule B Part 1 Column e $ 0.00 4. Total: a ments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 2,402.38 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK -FPPC (8661275 -3772) }Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SCHEDULE E (CONT.) (Continuation Sheet Type or print in Ink. Amounts m Statement covers period I' Payments Made POS to wholedol�arsnded .CALIFORNIA July 1, 2015 •' UUM from through December 31, 20j& 6 6 SEE INSTRUCTIONS ON REVERSE Page of 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 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 PFK) 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 FRO professional services (legal, accounting) VOT voter registration Lrr campaign literature and mailings FRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE OF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID FFA Boosters 2322 Hoya Lane Gilroy, Ca 95020 CVC Donation 675.45 United States Postal Service 100 4th Street Gilroy, CA 95020 POS Postage 980.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1,655.45 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)