SHORT FORM
Recipient Committee
Type
or
print in ink
D
Statement Short Form
Campaign
SEE INSTRUCTIONS ON REVERSE
Statement
j
by recipient committees that have notreceived a
contribution or other receipt that must be itemized have not
For
use
received
or
made
loans and have
no
outstanding
Type
Recipient
FFQ
Date of election if
applicable
Month Day Year
30
9
2008
from
0
2
Committee
2
Type
3
For Official Use Only
of Statement
General Purpose Committee
election Statement
Pre
Q Primarily Formed
Q Controlled
Q Sponsored
Q Small Contributor Committee
annual Statement
Semi
Quarterly Statement
Special Odd
year Report
Termination Statement
Supplemental Pre
election
Statement
Formed Candidate
Amendment
Officeholder Committee
Attach Form 495
Explain
Also check type of statement you
are
amending
D NUMBER
I
Committee Information
s
Treasurer
1312619
COMMITTEE NAME
NAME OF
Atascadero Professional
of
CITY Cl F R K S OFFIC
Q Sponsored
3
t
OF ATASCADER
08
5
11
Ballot Measure Committee
Primarily
page
U
09
2
through
of
period
accrued
expenses
1
covers
Firefighters
L3600
TREASURER
Matt Vierra
MAILING ADDRESS
6005 Lewis Avenue
STREET ADDRESS
NO PO
BOX
CITY
6005 Lewis Avenue
STATE
Atascadero
CITY
STATE
Atascadero
CA
MAILING ADDRESS IF DIFFERENT
NO
AND STREET
ZIP
CODE
AREA CODE
PHONE
93422
NAME OF ASSISTANT
Bill
OR PO BOX
CA
White
TREASURER
ZIP
CODE
AREA CODE
PHONE
93422
IF ANY
President
MAILING ADDRESS
6005 Lewis Avenue
CITY
STATE
ZIP CODE
AREA CODE
PHONE
CITY
STATE
Atascadero
OPTIONAL
FAX
MAIL ADDRESS
E
OPTIONAL
FAX
CA
ZIP CODE
AREA CODE
PHONE
93422
MAIL ADDRESS
E
4 Verification
I have used all reasonable
diligence in preparing and reviewing this statement and to the best of my knowled
under penalty of perjury under the laws of the State of California that the foregoing is true and corr ct
Executed
on
09
2
SIr3 NATl1RF
SIGNATURE OF CONTROLLING OFFICEHOLDER
co
ain d herein is true and complete
I
certify
F
C
TRFASI IRFR C
R ASSICTANT TRFACI IRFR
CANDIDATE
STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR
By
on
DATE
Executed
n
By
on
DATE
Executed
informati
By
DATE
Executed
a
SIGNATURE OF CONTROLLING
OFFICEHOLDER CANDIDATE
STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING
OFFICEHOLDER CANDIDATE
STATE MEASURE PROPONENT
By
on
DATE
FPPC Form 450
FPPC Toll
Free
Helpline
FPPC
ASK
866
05
January
866
3772
275
Recipient Committee
Campaign Statement
Summary Page
Type or print in
SHORT FORM
ink
statement covers
Amounts may be rounded
to whole dollars
period
30
9
2008
from
through
09
2
Page
NAME OF COMMITTEE
D NUMBER
I
Atascadero Professional Firefighters L3600
Expenditures
Expenditures
of 100
2
Expenditures
under
3
SUBTOTAL EXPENDITURES MADE THIS PERIOD
4
Nonmonetary Adjustment
5
Total
6
1312619
Made
1
If
of
expenditures
or more
100
2500 00
made this period
made this
period Not
itemized
Add Lines 1
2
From Line 8 Below
made from
previous
statement
Previous
this is the first statement for the calendar year enter zero
TOTAL EXPENDITURES MADE TO DATE
Summary Page
Add Lines 3
Zero
Line 6
4
5
2500 00
Contributions Received
7
Monetary
8
monetary contributions
Non
9
Total contributions received from
Ifthis
contributions received this
period
received this
previous
period
statement
Previous
is the first statement for the calendar year enter zero
10 TOTAL CONTRIBUTIONS RECEIVED TO DATE
Summary Page
Add Lines 7
Line 10
g
g
Current Cash Statement
11
Beginning
12 Cash
cash balance
Previous
receipts this period
Summary Page
Line 15
506 00
Line 7 above
13 Miscellaneous increases to cash
14 Cash
expenditures this period
15 ENDING CASH BALANCE THIS PERIOD
Line 3 above
Add Lines 11
12
13 then subtract Line
14
506 00
FPPC Form 450
05
January
FPPC Toll
Free Helpline 866
FPPC 866
ASK
3772
275
Recipient Committee
Campaign Statement Short Form
Type or print in
ink
Statement
covers
period
Amounts may be rounded
to whole
dollars
30
9
2008
from
09
2
through
SEE INSTRUCTIONS ON REVERSE
NAME OF COMMITTEE
D
I
Atascadero Professional Firefighters L3600
S
iP1
1
tetltS Made
DATE
lf
more
space is needed
NAME AND ADDRESS OF
IF COMMITTEE
ALSO
of
Page
3
NUMBER
1312619
use
additional
copies
PAYEE
of this page for continuation
sheets
DESCRIPTION OF PAYMENT
ENTER I
DNUMBER
NAME OF CANDIDATE AND OFFICE OR
NAME OF BALLOT MEASURE AND
BALLOT NUMBER OR LETTER
AMOUNT
THIS PERIOD
CUMULATIVE
AMOUNTS TO
DATE
AND JURISDICTION
Atascadero Professional
Calendar Year
Firefighters
L3600
30
9
08
Payment was for design
and mailing of a
No on Measure D
08
brochure that was
Elect Roberta Fonzi
Elect Jerry
Re
Clay
2000 00
otner
mailed to
registered
voters in Atascadero
The
by
Atascadero Professional
Firefighters
L3600
08
31
10
funding
the three
Payment
was
divided
topics
made toward
Support
oppose
Contribution
Ind
Elect Jerry
Re
Atascadero News The
Elect Roberta Fonzi
was
the three
divided
Calendar Year
No on Measure D
08
newspaper ad run in the
funding
Exp
Clay
500 00
otner
by
topics
Support
Oppose
Contribution
Ind Ex
p
Calendar Year
Other
Support
Oppose
Contribution
Ind
2500 00
Exp
SUBTOTAL
Required only for payments
which are contributions or
2500 00
independent expenditures
FPPC Form 450
FPPC Toll
Free
Helpline
FPPC
ASK
866
05
January
866
3772
275