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460 Pena 2017 from 01/01 to 06/30Recipient Committee Campaign Statement Cover Page COVER PAGE RECEIVED Statement covers period Date of election if appiicabl J U L 2 8 2017 lage _ �— of C from 1/11/2017 (Month, Day, Year) For Official Use Only SEE INSTRUCTIONS ON REVERSE 1 through 6/30/2017 1. Type of Recipient Committee: All committees - complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee Q Recall O Controlled (Also Complete Pod 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee InformationI I.D. NUMBER 1370057 ;0MMITTEE NAME (OR CAND!DATE'S NAME IF NO COMMITTEE) COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2014 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE LA QUINTA CA 92253 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX /E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of certify under penalty of perjury under the laws of the State of California that the forego! g'+�S tru Executed on r By 1 I3al❑ Executed on - By C.,te !:inn nwra of CITY OF LA QUINTA Y CLERK DEPARTMI 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement 2 Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER CHRIS McCULLOUGH MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 NAME OF ASSISTANT TREASURER, IF ANY PAULA HELD CITY STATE ZIP CODE AREACODE/PHONE LA QUINTA CA 92253 OPTIONAL: FAX/E-MAIL ADDRESS the Info rmadorp contained herein and in the a5aekletd schedules is true and complete. I or Executed on By Y Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, Stale Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE JOHN PENA OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) COUNCILMEMBER, CITY OF LA QUINTA RES IDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP LA QUINTA, CA 92253 Related Committees Not Included in this Statement: Llstanycommittees not included In this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMP.VTTEe'' ❑ YES ❑ NO COMMITTEE ADDRESS STREET AD DRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 17, of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE 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 DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of aRYceholder(s) or candidates) for which this committee Is primartfy 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 1/1/2017 SUMMARY PAGE Expenditures Made through 6/30/2017 Page of SEE INSTRUCTIONS ON REVERSE 615 $ 615 7. Loans Made .......... :....... :......... ...:..:.................. .................. schedule H, Line 3 0 NAME OF FILER 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 615 I.D. NUMBER JOHN PENA schedule F Line 3 0 0 1370057 schedule c, Line 3 Column A Column B Calendar Year Summary for Candidates Contributions Received $ TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary (FROM ATTACHED SCHEDULES) TOTAL TO DATE and $ 1087 To calculate Column B, 13. Cash Receipts .................................... ........... ........ . General Elections 0 0 0 1. Monetary Contributions ........................ :.......................... schedule A, Line 3 $ $ 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 0 0 1l1 through 6/30 711 to Date 2. Loans Received................................................................ Schedule e, Line 3 of your last report. Some 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 0 0 4. Nonmonetary Contributions ............................................ schedule c, Line 3 previous period amounts. If 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ............ ........................ Add Lines 3+4 $ 0 $ 0 Made $ $ Expenditures Made 6. Payments Made..............:,:.......;.:. ....:..... . ..:_....,...... w...... schedule E, Line 4 $ 615 $ 615 7. Loans Made .......... :....... :......... ...:..:.................. .................. schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 615 $ 615 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F Line 3 0 0 10, Nonmonetary Adjustment........................................................ schedule c, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 6 + 9 + 10 $ 615 $ 615 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summery Page, Line 16 $ 1087 To calculate Column B, 13. Cash Receipts .................................... ........... ........ . Column A, Line 3above 0 add amounts in Column 0 A to the corresponding 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 amounts from Column B 15. Cash Payments ................ ........... ......:..:.::...:............ column A, Line 6 above 615 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 472 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED ................................ schedule A 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 $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) 'Amounts in this section may be different from amounts reported in Column B. 19. Outstanding Debts.......... .................... Add Line 2+Line 9 in Column B above $ I FPPC Form 460 (Jan/2016) i FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER JOHN PENA Amounts may be rounded to whole dollars. Statement covers period from 1/1/2017 through 6/30/2017 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E I Page of I.D. NUMBER 1370057 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 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 D. NUMBER) LVI 45025 Manitou Dr. SUITE 3, Indian Wells, CA 92210 CA SEC OF STATE SACRAMENTO, CA CODE OR DESCRIPTION OF PAYMENT TRC FIL * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary SUBTOTAL$ 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 $ AMOUNT PAID 475 50 525 615 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov