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CA Form 460 Recipient Committee Preelection Campaign Statement No. 2 - Susan Brooks - Amendment No. 2 COVER PAGE Recipient Committee Type or print in ink. Date Stamp n Campai Statement CALIFORNIA 460 Campaign FORM Cover Page RECE1"V - (Government Code Sections 84200-84216.5) '`t (OF RANCHO PALOS V _` 9 Statement covers period Date of election if applicable: Page ' of September 20, 2015 (Month, Day, Year) 1 1 201b For Official Use Only from FEB1.. SEE INSTRUCTIONS ON REVERSE October 17, 2015 November 3, 2015 through - ........... . �1 F RD'S _r: ,...,t_ 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 [T Preelection Statement ❑ Quarterly Statement O State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report O Recall 0 ControlledTermination Statement (A1soComplete Part S) ❑ ❑ Supplemental Preelection O Sponsored (Also file a Form 410 Termination) Statement-Attach Form 495 (Also Complete Part 6) ❑ General Purpose Committee ® Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ Revise Schedule A(add a name identified with an Q Small Contributor Committee Officeholder Committee Political Party/Central Committee (Also Complete Part 7) asterisk), Schedule E (Unitemized pymts) and Summary Page. 3. Committee Information 11378646 Treasurer(s) COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Ann Marinovich Susan Brooks for Rancho Palos Verdes City Council 2015 MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Rancho Palos Verdes CA 90275 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Rancho Palos Verdes CA 90275 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 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. -)---/ i / Executed on / By _(/) ' /Date -' Date Signature of Controlling Officeholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Type or print in ink. COVER PAGE-PART 2 Recipient Committee CALIFORNIA 460 Campaign Statement FORM Cover Page— Part 2 Page of 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Susan Brooks OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT El OPPOSE Rancho Palos Verdes City Council RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Rancho Palos Verdes CA 90275 Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT 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 OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER 7. Primarily Formed Candidate/Officeholder Committee List names of NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s)or candidate(s) for which this committee is primarily formed. ❑ YES ❑ NO NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT --- -- -- ❑ OPPOSE COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES [11 NO El SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period CALIFORNIA 4.60 Summary Page to whole dollars. September 20, 2015 FORM from October 17, 2015 --7 of C SEE INSTRUCTIONS ON REVERSE through Page NAME OF FILER I.D. NUMBER Susan Brooks for Rancho Palos Verdes City Council 2015 1378646 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and 11,163 31,898 General Elections 1. Monetary Contributions Schedule A,Line 3 $ $ 0 5,000 1/1 through 6/30 7/1 to Date 2. Loans Received Schedule B,Line 3 11,163 36,898 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ $ 0 0 Received $ $ 4. Nonmonetary Contributions Schedule C.Line 3 21. Expenditures 11,163 36,898 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3+4 $ $ Made $ $ Expenditures Made Expenditure Limit Summary for State 8,286 11,393 6. Payments Made Schedule E.Line 4 $ $ Candidates 0 0 7. Loans Made Schedule H Line 3 8,286 11,393 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ $ (If Subject to Voluntary Expenditure Limit) 0 0 9. Accrued Expenses (Unpaid Bills) Schedule F.Line 3 Date of Election Total to Date 0 0 (mm/dd/yy) 10. Nonmonetary Adjustment Schedule C,Line 3 8,286 11,393 11. TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ $ I I $ Current Cash Statement '/ / $ 22,628 12. Beginning Cash Balance Previous Summary Page.Line 16 $ To calculate Column B,add 11,163 13. Cash Receipts Column A,Line 3 above amounts in Column A to the 0 corresponding amounts "'Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash Schedule I,Line 4 from Column B of your last reported in Column B. 8,286 report. Some amounts in 15. Cash Payments Column A,Line 8 above 25,505 Column A may be negative 16. ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ 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 0 for this calendar year, only 17. LOAN GUARANTEES RECEIVED Schedule B.Part 2 $ carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2, 7, and 9(if 0 any). 18. Cash Equivalents See instructions on reverse $ 0 19. Outstanding Debts Add Line 2+Line 9 in Column B above $ FPPC Form 460(January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded period Monetary Contributions Received to whole dollars. Statement covers pCALIFORNIA 460 September 20, 2015 from FORM October 17, 2015 h Page 1 th rou / of SEE INSTRUCTIONS ON REVERSE 9 NAME OF FILER I.D. NUMBER Susan Brooks for Rancho Palos Verdes City Council 2015 1378646 FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR 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) Josif Borovic, MD, Inc. WIND 9/22/15 RPV CA 90275 ❑coM 100 100 100 GOTH ❑PTY ❑SCC Tony Todora BIND Retired 9/27/15 RPV CA 90275 ElcoM 100 100 100 ❑OTH ❑PTY ❑SCC Anthony Misetich (a IND Owner 9/26/15 , RPV CA 90275 Doom Su ak Consulting200 200 200 00TH 1 ❑PTY ❑SCC Branka Borovic ®IND Registered Nurse 9/22/15 , RPV CA 90275 0 coM St. John's Hospital 100 100 100 ❑OTH ❑PTY ❑SCC Maude Landon ®IND Retired 9/30/15 RPV CA 90275 Ecom 250 250 250 ❑OTH ❑PTY ❑SCC SUBTOTAL$ 750 Schedule A Summary *Contributor Codes 1. Amount received this period—itemized monetary contributions. IND-Individual 10,300 COM-Recipient Committee (Include all Schedule A subtotals.) $ 863 (other than PTY or SCC) 2. Amount received this period—unitemized monetary contributions of less than$100 $ OTH-Other(e.g., business entity) PTY-Political Party 3. Total monetary contributions received this period. scc-Small Contributor Committee 11,163 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA 460 to whole dollars. September 20, 2015 from FORM October 17, 2015 1! through Page of6- _ NAME OF FILER I.D.NUMBER Susan Brooks for Rancho Palos Verdes City Council 2015 1378646 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE.ALSOENTER I D NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IFSELF-EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND 9/21/15 Steve Rachman* ❑COM Salesman 100 100 100 , RPV CA 90275 ❑OTH Revotech ❑PTY ❑SCC El IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 100 *Contributor Codes IND-Individual COM-Recipient Committee (other than PTY or SCC) OTH -Other(e.g.,business entity) PTY-Political Party FPPC Form 460(January/05) SCC-Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) SCHEDULE E Schedule E Type or print in ink. Statement covers period CALIFORNIA Amounts may be rounded 460 Payments Made to whole dollars. September 20, 2015 FORM from October 17, 20156 / SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Susan Brooks for Rancho Palos Verdes City Council 2015 1378646 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 nonrnonetary)* 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 .NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Campaign Literature and Mailings Campaign LA, , Gardena CA 90248 LIT 7,470 Diamond Environmental Svcs. , San Marcos, CA 92069 CMP Facilities 226 LA Newspaper, Woodland Hills, CA 91367 PRT Newspaper Inserts 262 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 7,958 Schedule E Summary 8,220 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 66 2. Unitemized payments made this period of under$100 $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).) $ _ 8,286 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)