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Home My WebLink AboutD Smullen 460 Semi-annualRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from Oct 23, 2016 through Dec 31, 2016 1. Type of Recipient Committee: All Committees — Complete Pads 1, 2, 3, and 4. • Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Alm Complete Part 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Carp/ere Pads) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) RECEIVED JAN ; 2011 CITY • F SARATOGA Date of election if applicable: (Month, Day, Year) November 8, 2016 COVER PAGE CALIFORNIA 460 FORM Page 1 of 13 For Official Use Only 2. Type of Statement: ❑ Preelection Statement ® Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) ❑ Quarterly Statement ❑ Special Odd -Year Report 3. Committee Information I.D. NUMBER 1387616 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Dede Smullen for Saratoga City Council STREET ADDRESS (NO P.O. BOX) CITY Saratoga STATE ZIP CODE CA 95070 AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Roger Smullen MAILING ADDRESS CITY Saratoga NAME OF ASSISTANT TREASURER, IF ANY Dorothea Smullen STATE ZIP CODE CA 95070 AREA CODE/PHONE MAILING ADDRESS CITY 'Saratoga STATE ZIP CODE CA 95070 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 of perjury under the laws of the State of California that the foregoing'ts-true-ar correct. 1/31/2017 Executed on By Date 1/31/2017 Executed on Executed on Executed on Dale Date Date ra e ofTree By I // SigirrolnAfficeholder, Candidate, State - ure Proponent or Responsible Oficer .0� rant Treasur By By Signature of Controlling Officeholder, Candidate, Slate Measure Proponent Signature of Controlling Officeholder, Candidate, Slate Measure Proponent FPPC Form 460 (fan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 COVER PAGE - PART 2 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE Dede Smullen OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member, City of Saratoga RESIDENTIALJBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Saratoga, CA 95070 Related Committees Not Included in this Statement: List any committees not included In this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 0 YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 0 YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT 0 OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or cand/date(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. Statement covers period From Oct 23, 2016 through Dec 31, 2016 SUMMARY PAGE Page 3 of 13 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 Contributions Received 1. Monetary Contributions Schedule A, Line 3 2. Loans Received Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 +2 4. Nonmonetary Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add lines 3+4 Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1351 $ $ $ 1529.84 0 1351 $ 178.84 Column B CALENDAR YEAR TOTAL TO DATE 2457 18865.00 21322.00 845.19 22167.19 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 20. Contributions Received $ 21. Expenditures Made $ 1/1 through 6/30 7/1 to Date Expenditures Made 6. Payments Made Schedule E, Line 4 $ 7. Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment Schedule C, Linea 11. TOTAL EXPENDITURES MADE Add Lines 8+9+10 $ 6697.23 $ 19560.29 0 6697.23 $ -161.09 178.84 6714.98 $ 0 19560.29 0 845.19 20404,98 Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule I, Line 4 15. Cash Payments Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 12 + 13+ 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 7107.94 1351.00 0 6697.23 1761.71 17. LOAN GUARANTEES RECEIVED Schedule B, Part2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents See instructions on reverse $ 19. Outstanding Debts Add Line 2+Line gin Column B above 0 $ 18865.00 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made° (a Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) $ Total to Date *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received ll, IIVIIVIt1EOiIaro. SEE INSTRUCTIONS ON REVERSE Statement covers period from Oct 23, 2016 CALIFORNIA FORM Page �6 O through Dec 31, 2016 4 of 13 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (If SELF-EMPLOYED. ENTER NAME OF BUSINESS) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 10/24/2016 El IND ❑coM ❑ OTH ❑PTY ❑ SCC Retired School Teachers 750 750 750 10/25/2016 IND ❑❑coM WI OTH ❑ PTY ❑ SCC 500 500 500 ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS Schedule A Summary 1. Amount received this period - itemized monetary contributions. (Include all Schedule A subtotals.) $ 1250 2. Amount received this period - unitemized monetary contributions of less than $100 $ 101 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 1351 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY- Political Party SCC - Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Loans Received SEE INSTRUCTIONS ON REVERSE from through Statement covers period Oct 23, 2016 CALIFORNIA FORM Page 5 TV 460 Dec 31, 2016 of 13 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 FULL NAME, STREETADDRESS AND ZIP CODE (IF COMMITTEE, EF DTER I.D. NUMBER) IF AN INDIVIDUAL, ENTER OCCER FSELFOMPLOY O. ENTER N AND EMPLOYER NAME OF BUSINESS) (a) OUTSTANDING BALANCE BEGINNING THIS PERIOD (b) AMOUNT RECEIVED THIS PERIOD (o) AMOUNT PAID OR FORGIVEN THIS PERIOD' (d) OUTSTANDING C OSEOF TTHIS PERIOD (a) INTEREST PAID THIS PERIOD (t) ORIGINAL AMOUNT OF LOAN (g) CUMULATIVE CONTRIBUTIONS TO DATE 10 IND 0 COM 0 OTH 0 PTY 0 SCC Candidate, Saratoga City Council Chair, Saratoga Planning Commission $ 18865 $ 0$ 0 PAD 0 $ 18.865 0 $ 18865 CALENDAR YEAR $ 18865 $ o FORGIVEN 0 11/7/2018 RATE $ 0 Various PER ELECTION" $ 18865 DATE DUE DATE INCURRED 1. CI IND 0 COM 0 OTH 0 PTY 0 SCC $ S ❑ PAID $ $ % $ CALENDAR YEAR $ ❑ FORGIVEN $ RATE $ PER ELECTION" $ DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC S $ ❑ PAID $ $ -% RATE $ S CALENDAR YEAR $ ❑ FORGIVEN $ PER ELECTION" $ DATE DUE DATE INCURRED SUBTOTALS $ 0 $ 0 $ 18865 $ 0 Schedule B Summary 1. 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 $ 0 Enter the net here and on the Summary Page, Column A, Line 2. 0 0 'Amounts forgiven or paid by another party also must be reported on Schedule A. ' If required. (May be a negative member) (Enter (e) on Schedule E, Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C NonmonetaryContributions Received Tvwnv�eavnara. SEE INSTRUCTIONS ON REVERSE Statement from through covers period Oct 23, 2016 CALIFORNIA 460 FORM Page 6 of 13 Dec 31, 2016 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I. D. NUMBER) CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) DESCRIPTION OF GOODS OR SERVICES AMOUNT/ FAIR MARKET VALUE CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 - DEC 31) PER ELECTION TO DATE (IF REQUIRED) 10/25/17 ca IND ❑ COM 00TH 0 PTY ❑SCC Saratoga City Council Member Small Group Mailing 178.84 341.97 341.97 ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ 0TH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.) 2. Amount received this period — unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) $ 178.84 $ 0 TOTAL $ 178.84 *Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY -Political Party SCC - Small Contributor Committee FPPC Form 460 (Jan/2016 FPPC Advice: advice@fppc.ca.gov (566/275-3772 www.fppc.ca.gov Schedule D SCHEDULE D ouRJrnary Of GRpenaluures /Amounts may oe rounaea Supporting/Opposing Other to whole dollars. Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE Statement covers period from Oct 23, 2016 CALIFORNIA 460 FORM Page 7 of 13 through Dec 31, 2016 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR R. (JA7-DEC. 37) PER ELECTION TO DATE (IF REQUIRED) o Monetary Contribution 0 Nonmonetary Contribution o Independent Expenditure ❑ Support 0 Oppose o Monetary Contribution 0 Nonmonetary Contribution ❑ Independent Expenditure ❑ Support 0 Oppose o Monetary Contribution ❑ Nonmonetary Contribution o Independent Expenditure ❑ Support 0 Oppose SUBTOTAL $ 0 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) $ 2. Unitemized contributions and independent expenditures made this period of under $100 $ 0 0 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) TOTAL $ 0 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Dorothea Smullen Amounts may be rounded to whole dollars. Statement covers period from Oct 23, 2016 through Dec 31, 2016 SCHEDULE E CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID LIT Mailer #2 - Postcard Printing and Mailing 4900.67 CMP Sponsor Banner for Community Carnival 500.00 Facebook WEB Facebook Page Promotions 268.48 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 5669.15 Schedule E Summary 1. 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).) $ 6574.92 122.31 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 6697.23 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Dorothea Smullen Amounts may be rounded to whole dollars. Statement covers period from Oct 23, 2016 through Dec 31, 2016 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)' CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E (CONT.) radio airtime and production costs retumed contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 10. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Flowers for Event Locations 130.80 Food for Election Night Watch Party $240.97 Food For Campaign Head Quarters Get Out the Vote $188.00 Sal Senior Voter Guide PRT Newsletter/Slate Ad $346.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ QOM 77 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Dorothea Smullen Amounts may be rounded to whole dollars. Statement covers period from Oct 23, 2016 through Dec 31, 2016 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads SCHEDULE F RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF CREDITOR (W COMMITTEE. ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT () OUTSTAANDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNT INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD WEB - Facebook Advertising 161.09 107.39 268.48 0 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 161.09 $ 107.39 $ 268.48 $ 0 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) INCURRED TOTALS $ 0 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) PAID TOTALS $ 161.09 NET $ -161.09 Maybe a negative number FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Dorothea Smullen NAME OF AGENT OR INDEPENDENT CONTRACTOR Amounts may be rounded to whole dollars. Statement covers period from Oct 23, 2016 through Dec 31, 2016 SCHEDULE G CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* CVC civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE H Schedule H Amounts may be rounded to whole dollars. Loans Made to Others*from SEE INSTRUCTIONS ON REVERSE through Statement covers period Oct 23, 2016 CALIFORNIA 460 FORM Dec 31, 2016 Page 12 of 13 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 FULL NAME, STREET ADDRESS AND ZIP CODE IENT (IF COMMITTEOE, FASO EPNTER I.E. NUMBER) IF AN INDIVIDUAL, ENTER AND EMPLOYER OCCUPATION NAME OF BUSINESS) (a) OUTSTANDING BALANCE BEGINNING THIS PERIOD N) AMOUNT LOANED THIS PERIOD (o) REPAYMENT OR FORGIVENESS THIS PERIOD- (d) OUTSTANDING CLOS OCF T IS PERIOD lel INTEREST RECEIVED In ORIGINAL AMOUNT OF LOAN (at CUMULATIVE LOANS TO DATE S I ❑ PAID S S -76 RATE S S CALENDAR YEAR S ❑ FORGIVEN S PER ELECTION" S DATE DUE DATE INCURRED S S El PAID s $ N RATE S s CALENDAR YEAR $ ❑ FORGIVEN S PER ELECTION" S DATE DUE DATE INCURRED *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. SUBTOTALS $ $ $ $ Schedule H Summary 1. Loans made this period (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans $ (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.) (Enter the net here and on the Summary Page, Column A, Line 7.) $ (Enter (e) on Schelde I, Una 3) NET $ 0 (May be a negative number) "If Required FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov hedule I SCHEDULE I Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from Oct 23, 2016 CALIFORNIA 460 FORM through Dec 31, 2016 Page 13 of 13 NAME OF FILER Dorothea Smullen I.D. NUMBER 1387616 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 0 Schedule I Summary 1. Itemized increases to cash this period. $ 2. Unitemized increases to cash of under $100 this period. $ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) $ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) TOTAL $ 0 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov