HomeMy WebLinkAboutdocument (63)4. VerificationI 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 certifyunder penalty of perjury under the laws of the State of California that the foregoing is true and correct.BySignature of Treasurer or Assistant TreasurerBySignature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of SponsorBySignature of Controlling Officeholder, Candidate, State Measure ProponentBySignature of Controlling Officeholder, Candidate, State Measure ProponentExecuted on DateExecuted on DateExecuted on DateExecuted on DateSEE INSTRUCTIONS ON REVERSEDate of election if applicable:(Month, Day, Year)Recipient CommitteeCampaign StatementCover PageFor Official Use OnlyPage of COVER PAGECALIFORNIA FORMDate Stamp3. Committee InformationCOMMITTEE NAME (OR CANDIDATE’S NAME IF NO COMMITTEE)MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOXStatement covers periodfromthrough(Government Code Sections 84200-84216.5)1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4.STREET ADDRESS (NO P.O. BOX)CITY STATE ZIP CODE AREA CODE/PHONETreasurer(s)NAME OF TREASURERNAME OF ASSISTANT TREASURER, IF ANYMAILING ADDRESSCITY STATE ZIP CODE AREA CODE/PHONE460CITY STATE ZIP CODE AREA CODE/PHONEOPTIONAL: FAX / E-MAIL ADDRESSMAILING ADDRESSCITY STATE ZIP CODE AREA CODE/PHONEOPTIONAL: FAX / E-MAIL ADDRESSI.D. NUMBER2. Type of Statement:Preelection StatementSemi-annual StatementTermination Statement(Also file a Form 410 Termination)Amendment (Explain below)Quarterly StatementSpecial Odd-Year ReportSupplemental PreelectionPrimarily Formed Ballot MeasureCommitteeControlledSponsored(Also Complete Part 6)Officeholder, Candidate Controlled Committee State Candidate Election Committee Recall(Also Complete Part 5)Primarily Formed Candidate/Officeholder Committee(Also Complete Part 7)General Purpose CommitteeSponsoredSmall Contributor CommitteePolitical Party/Central CommitteeStatement - Attach Form 495www.netfile.comFPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.govFPPC Form 460 (Jan/2016)1707/01/201512/31/201502/04/2014XX1357926Carey Davis for Mayor 2014San BernardinoCA92404(909)648-5827Santa AnaCA92406lysaray.campaignservices@gmail.comLysa RaySanta AnaCA92705(714)540-229501/12/2016Lysa Ray01/12/2016Carey DavisE-Filed02/01/201613:55:09Filing ID:158484088
Page of COVER PAGE - PART 2CALIFORNIAFORMRecipient CommitteeCampaign StatementCover Page — Part 24605. Officeholder or Candidate Controlled CommitteeNAME OF OFFICEHOLDER OR CANDIDATERelated Committees Not Included in this Statement:List any committeesnot included in this statement that are controlled by you or are primarily formed to receivecontributions or make expenditures on behalf of your candidacy.NAME OF TREASURERCOMMITTEE NAMEYESNOI.D. NUMBERCONTROLLED COMMITTEE?COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)CITY STATE ZIP CODE AREA CODE/PHONEOFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIPNAME OF TREASURERCOMMITTEE NAMEYESNOI.D. NUMBERCONTROLLED COMMITTEE?COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)CITY STATE ZIP CODE AREA CODE/PHONE6. Primarily Formed Ballot Measure CommitteeNAME OF BALLOT MEASUREDISTRICT NO. IF ANYIdentify the controlling officeholder, candidate, or state measure proponent, if any.NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENTOFFICE SOUGHT OR HELDJURISDICTIONSUPPORTOPPOSEBALLOT NO. OR LETTER7. Primarily Formed Candidate/Officeholder Committee List names ofofficeholder(s) or candidate(s) for which this committee is primarily formed.NAME OF OFFICEHOLDER OR CANDIDATENAME OF OFFICEHOLDER OR CANDIDATEOFFICE SOUGHT OR HELDOFFICE SOUGHT OR HELDSUPPORTOPPOSESUPPORTOPPOSENAME OF OFFICEHOLDER OR CANDIDATEOFFICE SOUGHT OR HELDSUPPORTOPPOSEAttach continuation sheets if necessaryNAME OF OFFICEHOLDER OR CANDIDATEOFFICE SOUGHT OR HELDSUPPORTOPPOSEwww.netfile.comFPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.govFPPC Form 460 (Jan/2016)27Richard Carey DavisMayor: San BernardinoSan BernardinoCA92404
SEE INSTRUCTIONS ON REVERSENAME OF FILERCampaign Disclosure StatementSummary PagePage of Amounts may be roundedto whole dollars.I.D. NUMBERCurrent Cash Statement12. Beginning Cash Balance ....................... Previous Summary Page, Line 16$13. Cash Receipts................................................... Column A, Line 3 above14. Miscellaneous Increases to Cash ........................... Schedule I, Line 415. Cash Payments.................................................. Column A, Line 8 above16.ENDING CASH BALANCE..........Add Lines 12 + 13 + 14, then subtract Line 15$If this is a termination statement, Line 16 must be zero.CALIFORNIAFORMSUMMARY PAGEExpenditures Made6. Payments Made....................................................... Schedule E, Line 4$$7. Loans Made............................................................. Schedule H, Line 38. SUBTOTAL CASH PAYMENTS.................................... Add Lines 6 + 7$$9. Accrued Expenses (Unpaid Bills) ...............................Schedule F, Line 310. Nonmonetary Adjustment..........................................Schedule C, Line 311. TOTAL EXPENDITURES MADE................................Add Lines 8 + 9 + 10$$17. LOAN GUARANTEES RECEIVED........................... Schedule B, Part 2$Cash Equivalents and Outstanding Debts18. Cash Equivalents........................................ See instructions on reverse$19. Outstanding Debts......................... Add Line 2 + Line 9 in Column B above$Contributions Received1. Monetary Contributions ........................................... Schedule A, Line 3$$2. Loans Received ...................................................... Schedule B, Line 33. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2$$4. Nonmonetary Contributions.................................... Schedule C, Line 35. TOTAL CONTRIBUTIONS RECEIVED...........................Add Lines 3 + 4$$460Statement covers periodfromthroughColumn BCALENDAR YEARTOTAL TO DATEColumn ATOTAL THIS PERIOD(FROM ATTACHED SCHEDULES)Calendar Year Summary for CandidatesRunning in Both the State Primary andGeneral Elections1/1 through 6/30 7/1 to Date20. ContributionsReceived $ $21. ExpendituresMade $ $Expenditure Limit Summary for StateCandidates*Amounts in this section may be different from amountsreported in Column B.Date of Election(mm/dd/yy)Total to Date22. Cumulative Expenditures Made*(If Subject to Voluntary Expenditure Limit)To calculate Column B, addamounts in Column A to thecorresponding amountsfrom Column B of your lastreport. Some amounts inColumn A may be negativefigures that should besubtracted from previousperiod amounts. If this isthe first report being filedfor this calendar year, onlycarry over the amountsfrom Lines 2, 7, and 9 (ifany).////$$www.netfile.comFPPC Form 460 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov3707/01/201512/31/2015Carey Davis for Mayor 201413579260.000.000.008,014.000.008,014.000.000.000.008,014.00101.00502.000.000.00101.00502.000.002,694.000.000.00101.003,196.0012,753.660.000.00101.0012,652.660.000.0010,708.00
INDCOMOTHPTYSCCStatement covers periodfromthroughI.D. NUMBERSCHEDULE B - PART 1Amounts may be roundedto whole dollars.Schedule B – Part 1Loans ReceivedPage ofSUBTOTALS $SEE INSTRUCTIONS ON REVERSENAME OF FILERCALIFORNIAFORM460$$IF AN INDIVIDUAL, ENTEROCCUPATION AND EMPLOYER(IF SELF-EMPLOYED, ENTERNAME OF BUSINESS)INTERESTPAID THISPERIODCUMULATIVECONTRIBUTIONSTO DATEFULL NAME, STREET ADDRESS AND ZIP CODEOF LENDER(IF COMMITTEE, ALSO ENTER I.D. NUMBER)ORIGINALAMOUNT OFLOANOUTSTANDINGBALANCEBEGINNING THISPERIODAMOUNTRECEIVED THISPERIODAMOUNT PAIDOR FORGIVENTHIS PERIODOUTSTANDINGBALANCE ATCLOSE OF THISPERIOD(b)(c)(e)$DATE INCURRED(Enter (e) onSchedule E, Line 3)CALENDAR YEAR$PER ELECTION$%RATE$*Amounts forgiven or paid by another party also must be reported on Schedule A.** If required.Schedule B Summary1. Loans received this period.................................................................................................................... $(Total Column (b) plus unitemized loans of less than $100.)2. Loans paid or forgiven this period......................................................................................................... $(Total Column (c) plus loans under $100 paid or forgiven.)(Include loans paid by a third party that are also itemized on Schedule A.)3. Net change this period. (Subtract Line 2 from Line 1.)...............................................................NET $Enter the net here and on the Summary Page, Column A, Line 2.(May be a negative number)(a)(d)$$(f)(g) PAID$ FORGIVEN$$DATE DUE$$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$$$ PAID$ FORGIVEN$$DATE DUE$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$$$ PAID$ FORGIVEN$$DATE DUEINDCOMOTHPTYSCCINDCOMOTHPTYSCC*******††††Contributor CodesIND – IndividualCOM – Recipient Committee(other than PTY or SCC)OTH – Other (e.g., business entity)PTY – Political PartySCC – Small Contributor Committeewww.netfile.comFPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.govFPPC Form 460 (Jan/2016)4707/01/201512/31/2015Carey Davis for Mayor 20141357926R Carey DavisSan Bernardino, CA 92404XAccountantHEHR International Inc500.000.000.000.00500.000.00500.0005/11/20130.00G2014 700.00G2013 6,955.65R Carey DavisSan Bernardino, CA 92404XAccountantHEHR International Inc2,314.000.000.000.002,314.000.002,314.0008/05/20130.00G2014 700.00G2013 6,955.65R Carey DavisSan Bernardino, CA 92404XAccountantHEHR International Inc500.000.000.000.00500.000.00500.0008/20/20130.00G2014 700.00G2013 6,955.650.000.003,314.000.000.000.000.00
INDCOMOTHPTYSCCStatement covers periodfromthroughI.D. NUMBERSCHEDULE B - PART 1 (CONT.)Amounts may be roundedto whole dollars.Schedule B – Part 1Loans ReceivedPage ofSUBTOTALS $SEE INSTRUCTIONS ON REVERSENAME OF FILERCALIFORNIAFORM460$$IF AN INDIVIDUAL, ENTEROCCUPATION AND EMPLOYER(IF SELF-EMPLOYED, ENTERNAME OF BUSINESS)INTERESTPAID THISPERIODCUMULATIVECONTRIBUTIONSTO DATEFULL NAME, STREET ADDRESS AND ZIP CODEOF LENDER(IF COMMITTEE, ALSO ENTER I.D. NUMBER)ORIGINALAMOUNT OFLOANOUTSTANDINGBALANCEBEGINNING THISPERIODAMOUNTRECEIVED THISPERIODAMOUNT PAIDOR FORGIVENTHIS PERIODOUTSTANDINGBALANCE ATCLOSE OF THISPERIOD(b)(c)(e)$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$*Amounts forgiven or paid by another party also must be reported on Schedule A.** If required.(a)(d)$$(f)(g) PAID$ FORGIVEN$$DATE DUE$$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$$$ PAID$ FORGIVEN$$DATE DUE$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$$$ PAID$ FORGIVEN$$DATE DUEINDCOMOTHPTYSCCINDCOMOTHPTYSCC*******††††Contributor CodesIND – IndividualCOM – Recipient Committee(other than PTY or SCC)OTH – Other (e.g., business entity)PTY – Political PartySCC – Small Contributor Committeewww.netfile.com$DATE INCURREDCALENDAR YEAR$PER ELECTION$%RATE$$$ PAID$ FORGIVEN$$DATE DUEINDCOMOTHPTYSCC**†(Continuation Sheet)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.govFPPC Form 460 (Jan/2016)5707/01/201512/31/2015Carey Davis for Mayor 20141357926R Carey DavisSan Bernardino, CA 92404XAccountantHEHR International Inc4,000.000.000.000.004,000.000.004,000.0009/05/20130.00G2014 700.00G2013 6,955.65R Carey DavisSan Bernardino, CA 92404XAccountantHEHR International Inc700.000.000.000.00700.000.00700.0001/07/20140.00G2014 700.00G2013 6,955.650.000.004,700.000.00
SEE INSTRUCTIONS ON REVERSENAME OF FILERSchedule EPayments MadePage of CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.CODE OR DESCRIPTION OF PAYMENT AMOUNT PAIDSUBTOTAL $Amounts may be roundedto whole dollars.I.D. NUMBERStatement covers periodfromthroughSCHEDULE ERAD radio airtime and production costsRFD returned contributionsSAL campaign workers’ salariesTEL t.v. or cable airtime and production costsTRC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB information technology costs (internet, e-mail)MBR member communicationsMTG meetings and appearancesOFC office expensesPET petition circulatingPHO phone banksPOL polling and survey researchPOS postage, delivery and messenger servicesPRO professional services (legal, accounting)PRT print adsSchedule E Summary1. 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 $CMP campaign paraphernalia/misc.CNS campaign consultantsCTB contribution (explain nonmonetary)*CVC civic donationsFIL candidate filing/ballot feesFND fundraising eventsIND independent expenditure supporting/opposing others (explain)*LEG legal defenseLIT campaign literature and mailingsNAME AND ADDRESS OF PAYEE(IF COMMITTEE, ALSO ENTER I.D. NUMBER)CALIFORNIAFORM460* Payments that are contributions or independent expenditures must also be summarized on Schedule D.FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)www.netfile.comwww.fppc.ca.govFPPC Form 460 (Jan/2016)6707/01/201512/31/2015Carey Davis for Mayor 20141357926Lysa Ray Campaign ServicesSanta Ana, CA 92705PRO95.0095.0095.006.000.00101.00
Statement covers periodfromthroughI.D. NUMBERSCHEDULE FSchedule F Summary1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals foraccrued expenses of $100 or more, plus total unitemized accrued expenses under $100.)............................................INCURRED TOTALS $2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments onaccrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) .................................PAID TOTALS $3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here andon the Summary Page, Column A, Line 9.) ................................................................................................................................................NET $Amounts may be roundedto whole dollars.Page ofSchedule FAccrued Expenses (Unpaid Bills)SEE INSTRUCTIONS ON REVERSENAME OF FILERNAME AND ADDRESS OF CREDITOR(IF COMMITTEE, ALSO ENTER I.D. NUMBER)May be a negative number$CODE ORDESCRIPTION OF PAYMENT(a)OUTSTANDINGBALANCE BEGINNINGOF THIS PERIOD(b)AMOUNT INCURREDTHIS PERIOD(c)AMOUNT PAIDTHIS PERIOD(ALSO REPORT ON E)(d)OUTSTANDINGBALANCE AT CLOSEOF THIS PERIODSUBTOTALS $$$CALIFORNIAFORM460CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.*Payments that are contributions or independent expenditures must also besummarized on Schedule D.RAD radio airtime and production costsRFD returned contributionsSAL campaign workers’ salariesTEL t.v. or cable airtime and production costsTRC candidate travel, lodging, and mealsTRS staff/spouse travel, lodging, and mealsTSF transfer between committees of the same candidate/sponsorVOT voter registrationWEB information technology costs (internet, e-mail)MBR member communicationsMTG meetings and appearancesOFC office expensesPET petition circulatingPHO phone banksPOL polling and survey researchPOS postage, delivery and messenger servicesPRO professional services (legal, accounting)PRT print adsCMP campaign paraphernalia/misc.CNS campaign consultantsCTB contribution (explain nonmonetary)*CVC civic donationsFIL candidate filing/ballot feesFND fundraising eventsIND independent expenditure supporting/opposing others (explain)*LEG legal defenseLIT campaign literature and mailingsFPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)www.netfile.comwww.fppc.ca.govFPPC Form 460 (Jan/2016)7707/01/201512/31/2015Carey Davis for Mayor 20141357926R Carey DavisSan Bernardino, CA 92404FIL2,694.000.000.002,694.002,694.000.000.002,694.000.000.000.00