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Form 460 -- 10-17-04 thru 12-31-04
Recipient Committee Campaign Statement (Government Code Sections 84200-84216.5) Type or print in ink. Date Stamp oc r , CINITAS C� 'r CLERK COVER PAGE Statement covers period Date of election if applicabig! JAN 31 F11 '_: '-«3 1 /13 from 10/17/2004 (Month, Day,Year) For Official Use Only SEE INSTRUCTIONS ON REVERSE through 12/31/2004 11/02/2004 1. Type of Recipient Committee:All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement: X1 Officeholder,Candidate Controlled Committee ❑ Ballot Measure Committee ❑ Pre-election Statement ❑ Quarterly Statement Q State Candidate Election Committee Q Primary Formed Q Recall Q Controlled Semi-annual Statement ❑ Special Odd-Year Report (Also Complete Part 5.) Q Sponsored ❑ Termination Statement E] Supplemental Preelection ❑ General Purpose Committee ❑ Amendment(Explain below) Statement-Attach Form 495 Q Sponsored (Also Complete Part 6.) ❑ Primary Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7.) 3. Committee Information 11268244ER Treasurer(s) COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE NAME OF TREASURER Alice Jacobson for City Council Louise Cohen STREET ADDRESS(NO P.O.BOX) MAILING ADDRESS 164 Coop Court 5705 Friars Road Unit 54 CITY STATE Encinitas CA ZIP CODE AREA CODE/PHONE 92024-1437 CITY San Diego STATE ZIP CODE AREA CODE/PHONE CA 92110-1815 619-291-6550 MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX NAME OF ASSISTANT TREASURER,IF ANY CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS OPTIONAL:FAX/E-MAIL ADDRESS CITY STATE ZIP CODE 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 co plete. I certify under penalty of perjury unde r laws laws of the State of California that the foregoing is true and correct. Executed on I 3` 0,S" By DATE/ - / IGNATURE OFT ASURER OR ASSISTANT 1 TREASURER Executed on 3 5 By DATE SIGNATURE OF CONTROLLING OF I EHOLDER,CANDIDATE,STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT Executed on By FPPC Form 460(June/01) DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,STATE MEASURE PROPONENT FPPC Toll-Free Helpline:866/ASK-FPPC State of California Recipient Committee Type or print in ink. COVER PAGE-PART 2 k Campaign Statement ; Cover Page — Part 2 ... ... ;,. 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Alice Jacobson OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Sought: City Council Member City Encinitas RESIDENTIAL/BUSINESS ADDRESS(NO.AND STREET) CITY STATE ZIP 164 Coop Court Encinitas CA 92024-1437 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 to make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑YES ❑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? p YES ❑NO COMMITTEE ADDRESS STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO.OR LETTER JURISDICTION [:] SUPPORT ❑ 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 Committee List names of officeholder(s)or candidate(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(June/01) FPPC Toll-Free Helpline:866/ASK-FPPC State of California Campaign Disclosure Statement Type or print in ink. Summary Page Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from i b - IZ --O4 through 1U--3 j -c)4- NAME OF FILER Alice Jacobson for City Council 43330.48 17709.45 0.00 Contributions Received $ 21130.88 $ Column A Column B 0.00 0.00 TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE 1. Monetary Contributions ............................................. Schedule A, Line 3 $ 4050.00 $ 28196.00 2. Loans Received ......................................................... Schedule B, Line 7 13659-46 14559.45 SUBTOTAL CASH CONTRIBUTIONS............................ Add Lines 1 +2 $ 17709 45 $ 42755 45 4. Nonmonetary Contributions ................................... Schedule C,Line 3 0.00 346.98 5. TOTAL CONTRIBUTIONS RECEIVED........................... Add Lines 3+4 17709.45 $ 43102.43 Expenditures Made 6. Payments Made ........................................................ Schedule E,Line 4 7. Loans Made .............................................................. Schedule H,Line 7 8. SUBTOTAL CASH PAYMENTS................................... Add Lines 6+7 9. Accrued Expenses (Unpaid Bills) ............................. Schedule F,Line 3 10. Nonmonetary Adjustment ......................................... Schedule C,Line 3 11. TOTAL EXPENDITURES MADE............................. Add Lines 8+9+10 f:urrent Cash Statement L. 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 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. 17. LOAN GUARANTEES RECEIVED........................... Schedule B,Part 2 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse 19. Outstanding Debts ....................... Add Line 2+Line 9 in Column B above $ 21130.88 $ 43330.48 17709.45 0.00 0.00 $ 21130.88 $ 43330.48 from Column B of your last 0.00 0.00 0.00 346.98 $ 21130.88 $ 43677.46 $ 2846.40 To calculate Column B,add 17709.45 amounts in Column A to the corresponding amounts 0.00 from Column B of your last 21130.88 report.Some amounts in Column A may be negative $ -575.03 figures that should be subtracted from previous period amounts.If this is the first report being filed $ 0.00 for this calendar year,only carry over the amounts from Lines 2,7,and 9(if any). $ 0.00 $ 14559.45 SUMMARY PAGE 3/ 13 I.D.NUMBER Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contribution Received $ 0.00 $ 43102.43 21. Expenditures Made $ 0.00 $ 43677.46 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) 11/02/2004 43330.48 $ *Since January 1, 2001.Amounts in this section may be different from amounts reported in Column B. FPPC Form 460(June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A Monetary ontributions Received """"""""'°'""""""°" y to whole dollars. Statement covers period p x COM from 0- (other than PTY or SCC) OTH- Other SEE INSTRUCTIONS ON REVERSE through O 4/ 13 NAME OF FILER I.D Number Alice Jacobson for City Council 1 . 268244 DATE FULL NAME,MAILING ADDRESS CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED AND ZIP CODE OF CONTRIBUTOR CODE' OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IFSELF-EMPLOYED,ENTER NAME OF BUSINESS) PERIOD (JAN.1 -DEC.31) (IF REQUIRED) Rcpt Dt: 10/20/2004 Steven Aceti,J.D. Q IND ❑ COM Attorney/Lobbyist 100.00 100.00 100.00 G 04 1133 Second Street, Suite G ❑ OTH Encinitas CA 92024 ❑ PTY Calcoast ID: ❑ SCC Rcpt Dt: 10/20/2004 Paula Broderick IND ❑ COM Real Estate 250.00 250.00 250.00 G 04 235 Leucadia Boulevard ❑ OTH Encinitas CA 92024-1717 ❑ PTY Self ID: ❑ SCC Rcpt Dt: 10/20/2004 Louise Cohen X❑ IND ❑ COM Accounting 100.00 100.00 100.00 G04 5705 Friars Road ❑ OTH Unit 54 San Diego CA 92110-1815 ED Self ID: ❑ SCC Rcpt Dt: 10/20/2004 Virginia Del Ray 1177 Cornish Drive X❑ IND E] COM Real Estate 250.00 250.00 250.00 G 04 ❑ OTH Encinitas CA 92024-5109 ❑ PTY Self ID: ❑ SCC pt Dt: 10/20/2004 0 IND Realtor 100.00 100.00 100.00 G 04 Portia Metras ❑ COM 1498 Village View Road ❑ OTH Encinitas CA 92024 ❑ PTY Caldwell Banker ID: ❑ SCC SUBTOTAL $ } , e� � � F Schedule A Summary 1. Amount received this period -contributions of$100 or more. (Include all Schedule A subtotals.) ........................................................................................................$ 2.Amount received this period - unitemized contributions of less than $100 ............................................$ 3.Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .................... TOTAL$ 3790.00 260.00 4050.00 *Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH- Other PTY- Political Party SCC- Small Contributor Committee FPPC Form 460(JUNE/01) FPPC Toll-Free Helpline:866/ASK-FPPC CnhcaAl flp A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period �t from 10 5/ 13 through � z �(—©`f SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. Number Alice Jacobson for City Council 1268244 DATE FULL NAME,MAILING ADDRESS CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION AND ZIP CODE OF CONTRIBUTOR CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) PERIOD (JAN.1-DEC.31) (IF REQUIRED) Rcpt Dt: 0 IND Accountant 100.00 100.00 100.00 G 04 10120/2004 Linda Miller ❑ COM 1010 Home Avenue ❑ OTH ❑ PTY Self Carlsbad CA 92008-1831 ❑ SCC ID: Rcpt Dt: X❑ IND Engineer 140.00 239.00 239.00 G 04 10120/2004 Wayne Pasco ❑ COM 535 N Highway 101 Ste A ❑ OTH ❑ PTY Pasco Eng Solana Beach CA 92075 ❑ SCC ID: Rcpt Dt: El IND Land planner 100.00 100.00 100.00 G 04 10/20/2004 Jack Robson ❑ COM 301 Hickoryhill Drive ❑ OTH ❑ PTY Cornerstone Communities Encinitas CA 92024-4021 ❑ SCC ID: Rcpt Dt: [K] IND Motel/Hotel Management 250.00 250.00 250.00 G 04 10/20/2004 Lois Rotsheck ❑ COM 310 Arroyo Drive ❑ OTH ❑ PTY Self Encinitas CA 92024 ❑ SCC ID: Scpt Dt: 7X IND Motel/Hotel Management 250.00 250.00 250.00 G 04 10/20/2004 Paul Rotsheck ❑ COM 310 Arroyo Dr ❑ OTH ❑ PTY Self Encinitas CA 92024 ❑ SCC ID: SUBTOTAL $ Schedule A Summary 1. Amount received this period -contributions of$100 or more. (Include all Schedule A subtotals.) ........................................................................................................$ 2. Amount received this period - unitemized contributions of less than $100 ............................................$ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .................... TOTAL$ *Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH-Other PTY-Political Parry SCC-Small Contributor Committee FPPC Form 460(JUNE/01) FPPC Toll-Free Helpline:866/ASK-FPPC Schedule A Type or print in ink. Amounts may be rounded SCHEDULE A Monetary Contributions Received Statement to whole dollars. covers period fromT[L` ma SEE INSTRUCTIONS ON REVERSE through 6/ 13 NAME OF FILER Alice Jacobson for City Council I.D. Number 1268244 DATE FULL NAME,MAILING ADDRESS IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION * RECEIVED AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD OF BUSINESS) (JAN.1-DEC.31) (IF REQUIRED) cpt Dtt004 Bill Sommer ❑ IND F-1 COM Rest Home Owner 100.00 100.00 100.00 G 04 795 Poinsettia Park S ❑ OTH Encinitas CA 92024-2757 ❑ PTY Self ID: SCC Rcpt 10/20//22 004 California Real Estate Political Action Committee/130131 ❑ IND Ao COM 250.00 250.00 250.00 G 04 525 S Virgil Avenue [K] OTH Los Angeles CA 90020-1403 Ej PTY ❑ SCC Rcpt 10/20/2/2 004 Lee Andrew Specialties ❑ IND ❑ COM 250.00 250.00 250.00 G 04 310 Arroyo Drive M OTH Encinitas CA 92024-2618 ❑ PTY ID: ❑ SCC Rcpt Dt: 10/20/2004 O'Connor Family Trust ❑ IND ❑ COM 100.00 100.00 100.00 G 04 449 Sheffield Avenue x❑ OTH Cardiff By The Sea CA 92007-1639 ❑ PTY ID: ❑ SCC pt Dt: 1 0/20/2004 R.e.l.s., Inc. ❑ IND ❑ COM 250.00 250.00 250.00 G 04 PO Box 230816 FX1 OTH Encinitas CA 92023-0816 ❑ PTY ID: ❑ SCC SUBTOTAL$ V � Schedule A Summary 1.Amount received this period - contributions of$100 or more. (Include all Schedule A subtotals.) ........................................................................................................$ 2.Amount received this period - unitemized contributions of less than $100 ............................................$ 3.Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .................... TOTAL $ *Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH-Other PTY-Political Party SCC-Small Contributor Committee FPPC Form 460(JUNE/01) FPPC Toll-Free Helpline:866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A .,.ay �`..U.1°" Monetary Contributions Received to whole dollars. St tement covers eriod p " from SEE INSTRUCTIONS ON REVERSE through 3 —U 7/ 13 NAME OF FILER Alice Jacobson for City Council I.D.Number 1268244 DATE FULL NAME,MAILING ADDRESS CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED AND ZIP CODE OF CONTRIBUTOR CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) PERIOD (JAN.1-DEC.31) (IF REQUIRED) Rcpt Dt: 10/20/2004 Rancho Pacific Management ❑ IND ❑ COM 250.00 250.00 250.00 G 04 636 N Coast Highway 101 Q OTH Encinitas CA 92024-2044 ❑ PTY ID: ❑ SCC Rcpt Dt: 10/20/2004 Rancho Pacific Realty ❑ IND ❑ COM 250.00 250.00 250.00 G 04 636 N Coast Highway 101 0 OTH Encinitas CA 92024-2044 ❑ PTY ID: ❑ SCC Rcpt Dt: 10/22/2004 David Hlavac 0 IND ❑ COM 250.00 250.00 250.00 G 04 291 Melba ❑ OTH Encinitas CA 92024 ❑ PTY Self ID: ❑ SCC Rcpt Dt: 11105/2004 Gary Piro X❑ IND ❑ COM Civil Engineer 125.00 125.00 125.00 G 04 930 Boardwalk#D ❑ OTH San Marcos CA 92069 ❑ PTY Piro Engineering ID: ❑ SCC (cpt Dt: 11/05/2004 X❑ IND Gardener 200.00 200.00 200.00 G 04 Ryan Rotsheck El COM 310 Arroyo Drive ❑ OTH Encinitas CA 92024-2618 ❑ PTY Self ID: ❑ SCC SUBTOTAL Schedule A Summary 1. Amount received this period - contributions of$100 or more. (Include all Schedule A subtotals.) ................................................... ......................................$ 2. Amount received this period - unitemized contributions of less than $100 ................ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .....................$ .... TOTAL$ "Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH-Other PTY-Political Party SCC-Small Contributor Committee FPPC Form 460(JUNE/01) FPPC Toll-Free Helpline:866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received f+moums may oe rounaeo to whole dollars. Statement covers eriod P l d from -7 —0 y through Z —O I 8/ 13 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. Number Alice Jacobson for City Council 1268244 DATE FULL NAME,MAILING ADDRESS CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED AND ZIP CODE OF CONTRIBUTOR CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) PERIOD (JAN.1 -DEC.31) (IF REQUIRED) Rcpt Dt: x❑ IND Land Use Planner 125.00 125.00 125.00 G 04 11/05/2004 Lee Vance ❑ COM 224 Seeman Drive ❑ OTH ❑ PTY Self Encinitas CA 92024-2838 ❑ SCC ID: Schedule A Summary 1.Amount received this period -contributions of$100 or more. (Include all Schedule A subtotals.) .................................................................... 2.Amount received this period - unitemized contributions of less than $100 ........ 3.Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) SUBTOTAL$ 3790.00 ..........................$ ............................$ ................... TOTAL $ *Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH-Other PTY-Political Party SCC-Small Contributor Committee FPPC Form 460(JUNE/01) FPPC Toll-Free Helpline:866/ASK-FPPC SCHEDULE B-PART 1 Schedule B - Part 1 'r"`"' ~" n Amounts may be rounded statement covers period � Loans Received to whole dollars. from 9/ 13 through 12- SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Alice Jacobson for City Council 1268244 (a) (b) (c) (d) (e) (B (g) FULL NAME,STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL,ENTER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTION£ (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER BEGINNING THIS THIS PERIOD THIS PERIOD' CLOSE OF THIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD PERIOD Western Financial Plannin- ❑PAID CALENDAR YEAR V i Jacobson g � $ 900.00 0.00 % � 900.00 � 3900.00 Coop Court ❑FORGIVEN PER ELECTION- g er Manager RATE Encinitas CA 92024-143 3900.00 G 04 ID: $ 900.00 0.00 $ 0.00 10/15/2004 DATE DUE DATE INCURRED MIND ❑COM❑OTH ❑PTY ❑SCC Western Financial Plannin- ❑PAID CALENDAR YEAR Alice Jacobson g � $ 3000.00 0.00 00 $ 3000.00 � 3900.00 164 Coop Court ❑FORGIVEN Manager RATE PER ELECTION" G 04 Encinitas CA 92024-143 3900.00 ID: $ 0.00 3000.00 $ 0.00 10/22/2004 DATE DUE DATE INCURRED ❑X IND ❑COM❑OTH ❑PTY ❑SCC Western Financial Plannin- ❑PAID CALENDAR YEAR g Corp. Alice Jacobson � $ 9500.00 0.00 � $ 9500.00 $ 10659.45 164 Coop Court ❑FORGIVEN PER ELECTION" Manager RATE I iitas CA 92024-1437 10659.45 G 04 ID. $ 0.00 $ 9500.00 $ $ 0.00 11/05/2004 DATE DUE DATE INCURRED n IND ❑COM❑OTH ❑PTY ❑SCC SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period. (Total Column (b) plus unitemized loans 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.) Enter the net here and on the Summary Page, Column A, Line 2. $ 13659.45 $ 0.00 Net$ 13659.45 (may be a negative number) (Enter(e)on Schedule E,Line 3) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. I*Contributor Codes I FPPC Form 460(June/01) IND-Individual COM-Recipient Committee(other than PTY or SCC) OTH-Other PTY-Political Party SCC-Small Contributor Committee FPPC Toll-Free Helpline:866/ASK-FPPC �+..4.i..J..1.. C2 n--& i Tvne nr nrint in ink_ SCHEDULE B-PART 1 *7GIICUU1111V o — rCLI L 1 -,— -- I- ----------- Amounts may be rounded Statement covers period 3 - Loans Received to whole dollars. from f ( _ « —� SEE INSTRUCTIONS ON REVERSE through 'Z � )_ 10/13 NAME OF FILER I.D.NUMBER Alice Jacobson for City Council 1268244 FULL NAME,STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL,ENTER (a) OUTSTANDING (b) AMOUNT (a) AMOUNT PAID (d) OUTSTANDING (e) INTEREST (f) ORIGINAL (g) CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTION; (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER BEGINNING THIS THIS PERIOD THIS PERIOD* CLOSE OF THIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD PERIOD Western Financial Plannin- ❑PAID CALENDAR YEAR Alice Jacobson g Corp. i4 Coop Court $ 500.00 0.00 % $ 500.00 $ 10659.45 ❑FORGIVEN PER ELECTION- Manager RATE Encinitas CA 92024-14 10659.45 G 04 ID: $ 0.00 $ 500.00 $ 0.00 11/19/2004 IND ❑COM❑OTH ❑PTY ❑SCC DATE DUE DATE INCURRED Western Financial Plannin- ❑PAID CALENDAR YEAR Alice Jacobson g Corp. 164 Coop Court 659.45 0.00 % $ 659.45 $ 10659.45 FORGIVEN PER ELECTION" Manager RATE Encinitas CA 92024-14 10659.45 G 04 ID: $ 0.00 $ 659.45 $ $ 0.00 12/31/2004 ❑X IND ❑COM❑OTH ❑PTY ❑SCC DATE DUE DATE INCURRED SUBTOTALS $ 13659.45 $ 0.00 $ 14559.45 $ 0.00 Schedule B Summary 1. Loans received this period. $ (Total Column (b) plus unitemized loans 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) *Contributor Codes IND-Individual COM-Recipient Committee(other than PTY or SCC) OTH-Other PTY-Political Party SCC-Small Contributor Committee (Enter(e)on Schedule E,Line 3) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. FPPC Form 460(June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Amounts may be rounded to whole dollars. from_Lo—I through �'—� —� 11 / 13 NAME OF FILER I I.U.NUMBEK Alice Jacobson for City Council 1268244 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 ^TB contribution(explain nonmonetary)* civic donations rIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others(explain)* LEG legal defense MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage,delivery and messenger services PRO professional services (legal,accounting) noT . .,A- 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 WFR infnrmntinn tarhnnlnnv nnsts(internet.email) LI I Vp111)JUI 11 IllGi gllllG Q -- NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBER) OFC 300.00 Complete Campaigns ID: 610 Gateway Center Way Suite K San Dopgo CA 99102-4,948 POS Distribution 760.00 The Walking Man Inc. ID: 801 E 6th Street Los Angpips CA 90OPl-1015 CMP Signs 1125.99 COGS South ID: 3309 S Main Street Qnntn Ana CA A97n7-4406 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of$100 or more. (Include all Schedule E subtotals.) $ 21100.88 2. Unitemized payments made this period of under$100. $ 30.00 .............................. 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) $ 0.00 4. Total payments made this period. (Add lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.).......................... TOTAL$ 21130.88 FPPC Form 460(June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Type or print in ink. Statement covers period =' Payments Made Amounts may be rounded to whole dollars. from 10 - 1 -7- 01 through Z 3( — / 12/13 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Alice Jacobson for City Council 1268244 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 -TB contribution(explain nonmonetary)* IC 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 NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NORTH COUNTY TIMES 374 N Coast Highway 101 Suite P Western Graphics Western Graphics MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage,delivery and messenger services PRO professional services(legal,accounting) PRT Drint ads RAID 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 technologv costs(internet,email) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID ID: PRT Advertising 163.03 ID: I LIT I Mailers I 6558.24 ID: I LIT I Mailers I 10468.62 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary SUBTOTAL$ 1. Payments made this period of$100 or more. (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$ FPPC Form 460(June/01) FPPC Toll-Free Helpline:866/ASK-FPPC Schedule E Type or print in ink. Statement covers eriod Amounts may be rounded p Payments Made to whole dollars. from a SEE INSTRUCTIONS ON REVERSE through ( 2- 13/13 NAME OF FILER I.D.NUMBER Alice Jacobson for City Council 1268244 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)* 'C civic donations �L candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others(explain)* LEG legal defense I IT rmmnninn liforntwo nnrl mnilinn¢ MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage,delivery and messenger services PRO professional services(legal,accounting) PRT nrint arcs RAID 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 WFR information technoloov costs(internet.email) NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID C NS Design 1725.00 Anne W. Kearns ID: 7701 Knightwing Circle Fort Mvers FL 39912-7231 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary SUBTOTAL$ 21100.88 1. Payments made this period of$100 or more. (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$ FPPC Form 460(June/01) FPPC Toll-Free Helpline:866/ASK-FPPC