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)