Form 460 - Recipient Committee Campaign Statement Cover Page
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50COVER PAGE
Recipient Committee
Date Stamp
460
CALIFORNIA
Campaign Statement
FORM
Cover Page
E-Filed
(Government Code Sections 84200-84216.5)
01/27/2017
Statement covers period
Date of election if applicable:
14:12:05
1
50
Page
of
(Month, Day, Year)
07/01/2016
from
Filing ID:
For Official Use Only
162992771
12/31/2016
SEE INSTRUCTIONS ON REVERSE
through
1. Type of Recipient Committee:
2. Type of Statement:
All Committees – Complete Parts 1, 2, 3, and 4.
Officeholder, Candidate Controlled Committee
Preelection Statement
X
Primarily Formed Ballot Measure
Quarterly Statement
State Candidate Election Committee
Committee
Semi-annual Statement
X
Special Odd-Year Report
Recall
Controlled
Termination Statement
Supplemental Preelection
(Also Complete Part 5)
Sponsored
(Also file a Form 410 Termination)
Statement - Attach Form 495
(Also Complete Part 6)
Amendment (Explain below)
General Purpose Committee
Primarily Formed Candidate/
Sponsored
Officeholder Committee
Small Contributor Committee
(Also Complete Part 7)
Political Party/Central Committee
I.D. NUMBER
3. Committee Information
Treasurer(s)
1359658
COMMITTEE NAME (OR CANDIDATE’S NAME IF NO COMMITTEE)
NAME OF TREASURER
Lisa Bartlett for Supervisor 2018
Jen Slater
MAILING ADDRESS
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
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 is true and correct.
01/18/2017
Jen Slater
Executed on
By
Date
Signature of Treasurer or Assistant Treasurer
01/18/2017
Lisa Bartlett
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
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