460 Henderson 2012 from 01/01 - 09/30Recipjer Committee
Campaign' Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink. R G F= i V ttate Stamp
2012 GCT 1 FM 3 22
Statement covers period Date of election if ap1/1/12 IF?gle F LA GUI NTA
(Month, Day, Year
from ',`Y C ERr,�, S QFFIGE
through
9/30/12
1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
0 State Candidate Election Committee Committee
0 Recall 0 Controlled
(Also Complete Part 5) 0 Sponsored
(Also Complete Part 6)
❑ General Purpose Committee
0 Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
❑ Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
3. Committee Information I.D. NUMBER
1349748
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Terry Henderson for Mayor 2012
STREET ADDRESS (NO P.O. BOX)
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-564-3044
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE AREA CODE/PHONE
11/6/12
COVER PAGE :
Page —I— of /
0 1
For Official Use Only
2. Type of Statement:
Z Preelection Statement ❑ Quarterly Statement
❑ Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement ❑ Supplemental Preelection
(Also file a Form 410 Termination) Statement -Attach Form 495
❑ Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Richard L. Jandt
MAILING ADDRESS
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/RHONE
La Quinta CA 92253 760-564-3044
NAME OF ASSISTANT TREASURER, IF ANY
None
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
Fax: 760-564-3044 Fax: 760-564-3044 Email: richardjandt@aol.com
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. %
Executed on � / � Z By
to i atureofT asurerorAssistantTreasurer
D
Executed on fi I �� By
Date Sionature ofC Ino Officehnlder Candidata R}eta Meati iro Prnnnnont nr Pcennneihic n firornf Q-
Executed on
Date
By
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