CA Form 460 Recipient Committee Termination Campaign Statement - George Lewis (2024) COVER PAGE
Recipient Committee Date Stamp CALIFORNIA 460
Campaign Statement RECEIV: FORM
Cover Page CIITY OF RANCHO PALS Y -
i; ub
Statement covers period Date of election if applicable: Page of
1 U/LU/24 (Month,Day,Year) JA N 3 1 2025 For Official Use Only
from
1L/�1/L4 1"IlU51L4
SEE INSTRUCTIONS ON REVERSE through �� CLERK'S OFFIF_____________
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 ❑ Preelection Statement ❑ Quarterly Statement
State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report
_j Recall Controlled 71 Termination Statement
(Also Complete Pal 5) H Sponsored (Also file a Form 410 Termination)
' (Also Complete Pe 6) ❑ Amendment(Explain below)
General Purpose Committee
Sponsored ❑ Primarily Formed Candidate/ - - -
Small Contributor Committee Officeholder Committee
Political Party/Central Committee (Also Complete Pert
3. Committee Information I.D.NUMBER Treasurer(s)
14/44b5
COMMITTEE NAME(OR CANDIDAT L'S NAME IF NO COMMITTEE) NAME OF TREASURER
t veorgegewis
Lewislorf PVVitycouncilZO24 MAILING ADDRESS
b4b5ylapenzar
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
b4by lagf e]}'lnzar Kancnoiraiosyeraes CA 9UL I b /U t i/b 1 UL4
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Kancnoi aiosyeraes CA VUL/o /U/iki/ WUL4
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 I E-MAIL ADDRESS OPTIONAL: FAX I 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 ntained herein and in the attached schedules is true and complete. I
certify under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct.
U1/.31/Lb
Executed on By
Date Signature r sur: • Asyt Treasurer
U1/n/L5
Executed on Date k3 y Signature of Controlling Officeholder,Sandi e,State •e 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(Jan/2016))
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
COVER PAGE-PART 2
Recipient Committee CALIFORNIA 460
Campaign Statement FORM
Cover Page — Part 2
Page UL of Ub
5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee
NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE
George4ewis
OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT
Cityf ouncilklember ❑ OPPOSE
RESIDENTIAL/BUSINESS ADDRESS (NO_AND STREET) CITY STATE ZIP
64651/iatjteiNnzar Rancho P ab 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 -
COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
❑ SUPPORT
LI 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
[_] SUPPORT
❑ YES ❑ NO
❑ OPPOSE
COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) _
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary
FPPC Form 460(Jan/2016)
FPPC Advice:advice€fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE
to whole dollars.
Summary Page Statement covers period CALIFORNIA 460
g 1 U/LU/24
from FORM
1 Z/61/Z4 Page US of Ub
SEE INSTRUCTIONS ON REVERSE through g
NAME OF FILER I.D.NUMBER
LewistiorIRPVCityfouncilT024 1474465
Column A Column B Calendar Year Summary for Candidates
Contributions Received TOTAL THIS PERIOD CALENDAR YEAR
(FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and
General Elections
tou.uu zvuu.uu
1. Monetary Contributions Schedule A,Line 3 $ $
1/1 through 6/30 7/1 to Date
2. Loans Received Schedule B,Line 3 (815.37) 3131.36
20. Contributions
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1+2 $ (65.37) $ 6031.36Received $ $
4. Nonmonetary Contributions Schedule C,Line 3 21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED .Add Lines 3+4 $ (65.37) $ 6031.36 Made $ $
Expenditures Made Expenditure Limit Summary for State
6. Payments Made Schedule E,Line 4 $ bt$4.bs $ bUs1.4[ Candidates
7. Loans Made Schedule H,Line 3
bt54.b bUs1.4Z 22. Cumulative Expenditures Made"
8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ $ (If Subject to Voluntary Expenditure Limit)
9. Accrued Expenses(Unpaid Bills) Schedule F,Line 3 Date of Election Total to Date
10. Nonmonetary Adjustment Schedule C,Line 3 (mm/dd/yy)
11. TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ bi54.b3 $ bUs1.4'L
Current Cash Statement J I $
tOu.UU
12. Beginning Cash Balance Previous Summary Page,Line 16 $ To calculate Column B,
13.Cash Receipts Column A,Line 3 above (65.37) add amounts in Column
A to the corresponding *Amounts in this section may be different from amounts
14.Miscellaneous Increases to Cash Schedule I,line 4 amounts from Column B reported in Column B.
15.Cash Payments Column A,Line 8 above 684.63 of your last report. Some
amounts in Column A may
16.ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ u.0U be negative figures that
should be subtracted from
If this is a termination statement,Line 16 must be zero. previous period amounts. If
i this is the first report being
17. LOAN GUARANTEES RECEIVED Schedule B,Part 2 $ filed for this calendar year,
only carry over the amounts
Cash Equivalents and Outstanding Debts from Lines 2,7,and 9(if
any).
18. Cash Equivalents See instructions on reverse $
19. Outstanding Debts Add Line 2+Line 9 in Column B above $ FPPC Form 460(Jan/2016))
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Schedule A (Continuation Sheet) Amounts may be rounded
SCHEDULE A (CON T_)
Monetary Contributions Received to whole dollars. Statement covers period
CALIFORNIA 460
from 1U/LU/L4 FORM
through 1 Z/31/Z4 g U4 Ub
9 Pa a of
NAME OF FILER — I.D.NUMBER
LewisfprilkPVCityCouncilt024 1474465
FULL NAME,STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
DATE CONTRIBUTOR OCCUPATION AND EMPLOYER
CONTRIBUTOR * RECEIVED THIS CAI ENDAR YEAR TO DATE
RECEIVED CODE (IF SELF-EMPLOYED,ENTER NAME)
(IF COMMITTEE,ALSO ENTER I.D.NUMBER) OF BUSINESS) PERIOD (JAN.1-DEC.31) (IF REQUIRED)
t HIND 500.00 500.00
10/30/24 Ben Allen for Senate 2022 IZ COM
1700 Tribute Road,Suite 201 ❑OTH
Sacramento,CA 95815 ❑PTY
O_ SCC
t Z IND Self employed(ronsultant 250.00 250.00
10/30/24 ❑COM
Raquel Brown ❑OTH
1010 Estrella Del Mar ❑PTY
D ❑scc
❑IND
❑COM
OTH
❑PTY
❑SCC
❑IND
❑COM
Q OTH
❑PTY
❑SCC -
❑IND
❑COM
❑OTH
❑PTY
�D SCC —
SUBTOTAL$ 750.00 � . K '�kY "Yxs
*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(Jan/2016))
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Amounts may be rounded SCHEDULE B PART 1
Schedule B — Part 1 to whole dollars. Statement covers period CALIFORNIA 460
Loans Received from 1 UTZU/24 FORM
'i2./51/24 Ub Utti
SEE INSTRUCTIONS ON REVERSE
through Page of
NAME OF FILER I.D.NUMBER
LewisliorFPVCityCouncilt024 1474465
IF AN INDIVIDUAL ENTER, tail (b) (c� (d) (e) �} (g)
FULL NAME,STREET ADDRESS AND ZIP CODE OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE
OF LENDER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS
(IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER BEGINNING THIS PERIOD THIS PERIOD. CLOSE OF THIS PERIOD LOAN TO DATE
NAME OF BUSINESS) PERIOD PERIOD-
1I PAID CALENDAR YEAR
George Lewis AMC1 s 815.37 $ % s 3946.79 s
6465 Via de Anzar CFO RATE
❑FORGIVEN PER ELECTION
RPV,CA 90275 3946.79 09/25/24
s s _ s s $
t Z IND [1 COM ❑ OTH ❑ PTY ri SCC DATE DUE DATE INCURRED
a
t_i PAID CALENDAR YEAR
$ S __ % S $
RATF
❑FORGIVEN PER ELECTION**
$ $— - $
t ElIND ❑ COM ❑ OTH ❑ PTY ❑ SCC S $ DATE DUE DATE INCURRED
- ❑PAID CALENDAR YEAR
$ $ % $ $
RATE
❑FORGIVEN PER ELECTION.'
S $ $__._-_ $ S
t❑ IND ❑ COM 0 OTH ❑ PTY ❑ SCC DATE DUE - DATE INCURRED
SUBTOTALS $ $ 3946.79 $ $
1R, .4
(Enter(a)on Schedule E,Line 3)
Schedule B Summary
1. Loans received this period $
(Total Column (b)plus unitemized loans of less than $100.) 815.37 tContributor Codes
2. Loans paid or forgiven this period $ IND-Individual
(Total Column (c)plus loans under$100 paid or forgiven.) COM-Recipient Committee
(Include loans paid by a third party that are also itemized on Schedule A.) (other than PTY or SCC)
3. Net change this period. (Subtract Line 2 from Line 1.) NET $ (815.37) OTH-Other(e.g.,business entity)
Enter the net here and on the Summary Page, Column A, Line 2. PTY-Political Party
SCC—Small Contributor Committee
(May be a negative number)
*Amounts forgiven or paid by another party also must be reported on Schedule A.
"If required. FPPC Form 460(Jan/2016))
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
_ SCHEDULE E
Schedule E Amounts may be rounded Statement covers period
to whole dollars. CALIFORNIA 460
Payments Made 1 U/LU/L4 FORM
from _
1 L/61/Z4 Ub Ub
through__ Page of
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER l.D.NUMBER
LewisfprifkliVfityCouncil024 1474465
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
Fit 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 I SF 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(intemet,e-mail)
NAME AND ADDRESS OF PAYEE
CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
(IF COMMITTEE,ALSO ENTER 1.D.NUMBER)
WEB Websitetevelopment$ervices 684.63
TWB Associates
22209 South Vermont Avenue#15
rr w nn c n, 0
*Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 684.63
Schedule E Summary
684.53
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 $ 684.63b3
FPPC Form 460(Jan/2016))
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov