460 Adolph 2014 from 01/01 - 12/01Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
Type or print in Ink.
Statement covers period Date of election if applicable:
from 01/01/2014 (Month, Day, Year)
SEE INSTRUCTIONS ON REVERSE Ithrough 12/1/2014
1. Type of Recipient Committee: All Committees— Complete Parts 1, 2, 3, and 4.
® Officeholder, Candidate Controlled Committee
❑ Ballot Measure Committee
Q State Candidate Election Committee
0 Primarily Formed
Q Recall
0 Controlled
(Also Complete PaHB)
Q Sponsored
E]General Purpose Committee
(Also Canplete Pad6)
Q Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
Q Political Party/Central Committee
(Alan Complete Part 7)
3. Committee Information
I.D.NUMSER
1369461
Committee to Re-elect Mayor Don Adolph 2014
STREET ADDRESS (NO P.O. BOX)
55105 Riviera
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-771-0577
MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
Date
RECEIVED
DEC 18 2014 1 Page 1 of 5
11/04/2014 ¢irry OF LA QUINTA
11 fl'Y CLERK DEPARTMENJ
2. Type of Statement:
❑ Preelection Statement ❑ Quarterly Statement
❑ Semi-annual Statement ❑ Special Odd -Year Report
® Termination Statement ❑ Supplemental Preelection
❑ Amendment (Explain below) Statement - Attach Form 495
Treasurer(s)
NAME OF TREASURER
Diane J. Adolph
MAILING ADDRESS
55105 Riviera
La
MAILING ADDRESS
CA
760-771-0577
CITY STATE ZIP CODE AREA CODE/PHONE
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
'``� ooff perjury under the laws of the State of California that the foregoing is t `e and correct.
Executed on - 1 r'1 LBy
f Date SI tore ofTreesur slstentTreesurer
Executed on `4,[W h4c, By
Executed on By
Oete $IgnaturaolControulrg Ofixandtler, Centlitlata, State MeasureProporrent
Executed on - By
' Date By
olCoribolllrg Oficaholtlar, Centlltlete, State Measure Proponent FPPC Form 460 (June/01)
FPPC Toll -Free Helpline: 868/ASK-FPPC
State of California