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2016/01/01 - 2016/06/30 - AFSCME - Form 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200- 64216.5) 1091686 Statement covers period from 01/01/2016 Date of election H appll (Month, Day, Year) AUG 31 "16 COVERPAGE 1 of 6 For Official Use Only SEE INSTRUCTIONS ON REVERSE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS robynzej®gmail.com 4. Verification 1 have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the inFortrratim contained herein and in the attached schedules is true and complete. I certify under pare" otpequry order the laws of the State of California that the foregoing is true and correct. Executed on 08/01/2016 Dab Executed on Executed on ode Executed on Data W W W Ir0/IfM. MT By By Sw� dOx4raffmomodwide, ,coaleb,sbeema pmpvi PAP W"eo vaSpo BY ,Car6m0e.SdoMwsre ROpaeel By Sign0" 0aaaerg OewhoMer, CmdWeb. Slob Memue Rapwenr FPPC Form 160 (Jan/2016) FPPC Advice: adviee@fppc.ea.gov (8561275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page —Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE S. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO OR LETTER RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE LP Related Committees Not Included in this Statement: ustanycommltmes not included In ova smernent Mel are controlled by you or are primarily formed to met" conbibu9mm or make expenditures on behaN of your candidacy. CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME 11.0. NUMBER NAMEOFTREASURER STREETADDRESS (NO P.O. BOX) ❑ YES ❑ NO CITY STATE LP CODE AREA CODEIPHONE wont ndf le room COVERPAGE -PART2 Page 2 of 6 ❑ SUPPORT ❑ OPPOSE IdentNy the controlling olNceholder, candidate, or state measure proponent, N any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee ust names of WNeeholderis) or cmrd ieWs) for which pm commhfee is pdman7y burred. 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 Aftsch contlnuaeon sheets N necessary FPPC Form 460 (Jen12016) FPPC Advice: advice@tppc.c&gov (8861276.3772) wane lippc.cagov Camptaign0sclosure Statement Amounts may be rounded Statement corers period Summary Page to whole dollars. from 01/01/2016 SEE INSTRUCTIONS ON REVERSE through 06/30/2016 page 3 of 6 NAME OF FILER I D. NUMBER APSCNE LOCAL 101 PAC 821697 Contributions Received 1. Monetary Contributions ........... ............................... Smedure a, Line 3 2. Loans Received ...................... .......:....................... Sderade e, Law 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add lines l +2 4. Nonmonetary Contributions.. .......... ..................... Sdmdule C. Lme3 5. TOTAL CONTRIBUTIONS RECEIVED ...................... ... Add tmea3 +4 Expenditures Made $ 6. Payments Made ........................ ............................... sd,edrae E, Lie 4 7. Loans Made ............................ ........:...................... Sdre&A H. LAW 3 8. SUBTOTAL CASH PAYMENTS . ............................... Add tams 6 +7 9 Accrued Expenses (Unpaid Bills) ............................... SdmckAbF, line 3 10. Nonmonetary Adjustment .......... ............................... Schedt* c, use 3 11. TOTAL EXPENDITURES MADE .............. .................. Add Lbm a +9+10 Current Cash Statement 12. Beginning Cash Balance ....................... Ph%wusSurnnwyPage, Line 16 13. Cash Receipts ................... ............................... CobmmA We 3above 14. Miscellaneous Increases to Cash .......................... Sdwd*1,, Lire 15. Cash Payments ................... ............................... CohsmlA. Lim 8ebo 16. ENDINGCASHBALANCE ......... Acutines 12 + 13 + 14, thm subtract line 15 H tlrfs, is a termination &!element Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED CohmnnA ColumnB Calendar Year Summary for Candidates T BPr�n00 GLENMRYFan tnlaenaAFleTACH arnESr roteiroo+le Running in Both the State Primary and General Elections $ 8,246.43 $ 8,246.43 0.00 0.00 $ 8,246.43 0.00 $ 8,246.43 $ 8,246.43 $ 8,246.43 $ 4,000.00 $ 4,000.00 0.00 0.00 $ 4,000.00 $ 4,000.00 0.00 0.00 0.00 0.00 $ 4,000.00 $ 4,000.00 $ 354.52 8,246.43 0.00 4,000.00 $ 4,600.95 SdreUule S. Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........ ..................:............ Swint ctosonrev $ 0.00 19. Outstanding Debts ......................... AddLhe2 +Lvw9ir Cotxm Babow S 0.00 w nn/lifa �m 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 trom previous period amounts. If this is the first report being filed for this plantar year, only cony over the amounts from Unes 2, 7, and 9 (d any). 111 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' Nsvgwmvehue ry eqwndftue Oma) Date of Election Total to Date (mmlddlyy) E: •Amourds in this section may be d8lerent from amounts reported in Column B. FPPC Form 460 (Jar02016) FPPC Advice. advfce@qW-ca.gov (8681175-3772) www.rppc.ca gov Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE Amounts may be rounded element covers period to whole dollars. 01/01/2016 from AFSCMg LOCAL 101 PAC DATE FULL NAME, STREET ADDRESS AND LP CODE OF CONTRIBUTOR OF,�insot r LD WAISER) CONTRIBUTOR CODE • RECEIVED 03/09/2016 Local 101 AFSCNH Does Trust 1150 N First St 101 ❑IND ❑COM San .rose, CA 95112 QOTH ❑ PTY []BCC 04/26/2016 Local 101 AFSCME Dues Trust 1150 N First St 101 San Jose, CA 95112 ❑IND ❑COM MOTH ❑ PTY ❑SCC Local 101 AFSC48 Dues Trust 1150 N First St 101 ❑IND ❑COM 05/27/2016 San Jose, CA 95112 MOTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑SCC ❑IND ❑COM ❑0TH []PTY ❑SCC Schedule A Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER QFSF1F-B4 oD .ENTERN �SUSWSS) A through 06/30/2016 I pegs - 4 of 6 I.D. NUMBER 821697 AMOUNT GUMULATIVETO DATE RECEIVED THIS CALENDAR YEAR PERIOD (JAN.1 -DEC. 31) 8.246.4 8, 8,000.001 8.246. SUBTOTAL$ 8,246 1. Amount received this period— itemized monetary contributions. ............. $ 8,246.43 2 (Include all Schedule A subtotals.) ................... .............. I....... .. ............................... . Amount received this period — unitemized monetary contributions of less than $100 .................... I........ $ 0.00 3. Total monetary contributions received this period. 8, 246.43 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A Line 1.) ....................... TOTAL S PER ELECTION TO DATE (IF REQUIRED) -Comahutor Codes IND — Individual COM —Rer pientCommifim (other than PTY or SCC) OTH — Cther.(e.g., business aridity) PTY — Political Party SCC —Small Comnbutor Committee FPPC Form 490 (Jan12016) FPPC Advice. advh o.ca.gov (99 VS -3772) www.fppc.ca.gov Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers Period from 01/01/2016 SEE INSTRUCTIONS ON REVERSE through 06/30/2016 Page 5 of _6 NAME OF FILER I.D. NUMBER AFSCMB LOCAL 101 PAC 821697 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemaiialmisc. N®R memberooaur6mikations RAD radio airtime and production costs CNS campaign consultants MM meetings and appearances RFD returned contribution C 13 contribution (explain nonmonretary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL Lv. or cede air me and production costs Fll- candidate 6fng/ballot fees PFD phone banks TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS staff/spmbe travel, lodging, and meats I D independent expenditure supporirglopposing others (explain)' PCS 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 Lrr campaign literature and mailings PRT print ads WEB Information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE JWC0labnrEE,P 50B 10 NU4xC9i) South Bay Labor Council COPEFPPC $744711 2102 Almaden Rd 114 San Jose, CA 95125 Josh Baroness San Jose, CA 95135 San Jose, CA 95126 CODE OR DESCRIPTION OF PAYMENT CTB CTB AMOUNT PAID 2,500.00 500.00 ' Payments that are contributions or lodepanderd expenditures must also be summarized on Schedule D. SUBTOTALS 3,500-00 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.) . Nm.w.. n. fNAM Men 000.00 ............... $ 0000 $ 0.00 ... TOTAL $ 4,000.00 FPPC Form 460 [Jan(2016) FPPC T014Free Heipline: 8681ASK+PPC (666177641772) www.fppc.ra.gov Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Sergio Jimenez San Jose, CA 95123 CTS 500.00 PsymentlIthelare contributions or lndopendentexpenditures mustalso be summarized on Schedule D. SUBTOTAL$ 500.00 FPPC Form 460 (Jard201e) FPPC Toll-Free Helpline: 8881ASK -FPPC (868127&9772)