460 Henderson 2012 from 10/01 - 10/20Recipient Cmmittee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
REC`�VE D
Type or print in ink.
2012 OCT 23 FM 1 95
Statement covPxVXra8 LA ,�fl�Hection if applicable:
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OF NjT�, Day, Year)
from
Date Stamp
COVERPAGE
Page of 7
For Official Use Only
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
Treasurer(s)
NAME OF TREASURER
Richard L. Jandt
MAILING ADDRESS
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-564-3044
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
Fax 760-564-1625 FAX 760-564-1625
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 /d Aj %t Z By
l{ry D to A�igofTre surer or Assistant Treasurer
Executed on / Y , l By
Date Sianature ofConfr&llina Officeholder. Candidate. State Measure Proponent orResconsible Officer of Sponsor
Executed on
Date
By
Signature ofControllingOfficeholder,Candidate, State Measure Proponent
Executed on By
Date SignatureofControllingOfficeholder,Candidate,StateMeasureProponent FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
State of California
10/20/12
11/6/12
SEE INSTRUCTIONS ON REVERSE.'
through
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
2. Type of Statement:
Z Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
iZ Preelection Statement
❑ Quarterly Statement
Q State Candidate Election Committee
Committee
❑ Semi-annual Statement
❑ Special Odd -Year Report
Q Recall
Q Controlled
❑ Termination Statement
❑ Supplemental Preelection
(Also Complete Part 5)
Q Sponsored
(Also file a Form 410 Termination)
Statement -Attach Form 495
❑ General Purpose Committee
(Also Complete Part 6)
❑ Amendment (Explain below)
Q Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
Q Political Party/Central 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
Treasurer(s)
NAME OF TREASURER
Richard L. Jandt
MAILING ADDRESS
54711 Eisenhower Dr.
CITY STATE ZIP CODE AREA CODE/PHONE
La Quinta CA 92253 760-564-3044
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS
Fax 760-564-1625 FAX 760-564-1625
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 /d Aj %t Z By
l{ry D to A�igofTre surer or Assistant Treasurer
Executed on / Y , l By
Date Sianature ofConfr&llina Officeholder. Candidate. State Measure Proponent orResconsible Officer of Sponsor
Executed on
Date
By
Signature ofControllingOfficeholder,Candidate, State Measure Proponent
Executed on By
Date SignatureofControllingOfficeholder,Candidate,StateMeasureProponent FPPC Form 460 (January/05)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
State of California