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Form 460 07-01-22 to 09-24-22KeCipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from July 1, 2022 through September 24, 2022 1. Type of Recipient Committee: All Committees — complete Parts 1, 2, 3, and 4. ❑ 0fficeholder, Candidate Controlled Committee State Candidate Election Committee ❑ Primarily Formed Ballot Measure 0 Recall Committee ©Controlled (Also Complete Part 5) 0 Sponsored ❑ General Purpose Committee (Also Complete Part 6) Sponsored Small Contributor Committee m Primarily Formed Candidate/ Officeholder Committee Political Party/Central Committee (Alto CONVet,Pad n 3. Committee information 1.0, NUMBER STACIE DAVIS FOR ENCINITAS CITY COUNCIL 2022 TREETADDRESS Encinitas, CA,92024 ( AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT] ND, AND STREET OR P.O. BOX StacieDavis@4Encinitas.com OPTIONAL: FAX/ E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) November,8th,2022 2. Type of Statement: Date Stamp CITY OF ENCINITA CITY CLERK 22 SEP 26 PM 3: 0 QI Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE Page--1--of For Official Use Only m Quarterly Statement ❑ Special Odd -Year Report NAME OF TREA URER STACIE DAVIS MAILING ADDRESS Encinitas, CA,92024 ( CITY STATE ZIP CODE AREA ONE Eh Eli Stern NAME OF ASSISTANT TREASURER, IF ANY Encinitas, CA,92024 ( MAILING ADDRESS StacieDavis@4Encinitas.com 1 OPTIONAL: FAXI E-MAILADDRESS 4. verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowle ge 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 cor�rroct. ^� Executed on 9/26/2022 d"1 0(\ 6 1i \ /t I i A Date Executed on 9/26/2022 Date Executed on ate Executed on Date By By By Signature or Controlling Otfl older, Candidate, State assure roponent By SIgnature of Controlling %G-h lder, Cand am, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: adviceC fppc.ca,gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page -- Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Stacie Davis OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Encinitas City Counil District 4 RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Encinitas, CA,92024 Related Committees Not Included in this Statement: Listany 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. NUMBER 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER COVER PAGE - PART 2 Page 2 of ❑ SUPPORT P OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPQNENT OFFICE SOUGHT OR DISTRICT NO. IF ANY OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily farmed. �. ----- ❑ YES ❑ NO (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER COMMITTEE NAME I.D. NUMBER NAME OF TR COMMITTEE AD NAME OF OFFICEHOLDER OR CANDIDATE YES ❑ NO NAME OF OFFICEHOLDER OR CANDIDATE ❑ CITY STATE ZIP CODE AREA CODEIPHONE OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE ❑ SUPPORT ❑ OPPOSE OFFICE SOUGHT OR HELD' ❑ SUPPORT ❑ OPPOSE 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 Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE AI A i- STACIE DAVIS FOR ENCINITAS CITY COUNCIL DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF RECEIVED CONTRIBUTOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) 9/6/2022 ADAM GOLDSTONE DUETTE, FL. 34219 9/9/2022 ELI STERN ENCINITAS,CA. 92024 9/11/2012 1 FLORENCE ROSS SAN DIEGO, CA. 92130 1/11/2122 E FREDERIC LAGRANGE CARLSBAD, CA. 92009 9/12/2022 1 GRAHAM MABON CI IICAGO, IL. 60641 Amounts may be rounded to whole dollars. CONTRIBUTOR CODE ® IND C7 coM ❑ OTH ❑ PTY ❑ SCC ® IND ❑ Com ❑ OTH ❑ PTY ❑ 5CC ®IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ® IND ❑ COM ❑ OTH ❑ PTY ❑ sec Z IND ❑ COM ❑ OTH ❑ PTY ❑ SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) NONE NONE NONE GLOBAL SALES MANAGER PRESIDIO COMPONENTS NONE Schedule A Summary 1. Amount received this period — itemized monetary contributions. (include all Schedule A subtotals.)............................................................................. SCHEDULE A aiazement covers from JULY 1, 2022 through SI:PT24,2022 pa _ f 9a Of A I.D. NUMBER 1454041 AMOUNT RECEIVED THIS PERIOD 250.00 250.00 100.00 100.00 100.00 SUBTOTAL $ 800.00 1,000.00 2. Amount received this period — unitemized monetary contributions of less than $100 .............. $ 100.00 3. Total monetary contributions received this period. (Acid Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 1,100.00 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 250.00 250.00 100.00 100,00 100.00 I PER ELECTION TO DATE (IF REQUIRED) *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 (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) unts mbe ro Monetary Contributions Received Amotowholedollarsnded STACIE DAVIS FOR ENCINITAS CITY COUNCIL 2022 DATE RECEIVED 9/24/2022 FULL NAME, STREET ADDRESS AND ZIP COQE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) WII LJAM BENNETT 590 $RIGHT, NEW JERSEY 07760 CONTRIBUTOR * CODE ®IND n COM ❑ OTH IF AN INDIVIDUAL, ENTER OCCU PATIONAND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME) OF BUSINESS) ATTORNEY BLANK ROME ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC [-1 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY "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 aratement covers from JULY 1, 2022 SCHEDULEA (CONT.) through SEPT 24, 2022 Page 9 -. of LD. NUMBER 1454041 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) MOM 200,00 SUBTOTAL $ 200.00 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule B — Part 1 Amounts may be rounded SCHEDULE B - PART 1 to whole dollars. Statement covers period Loans Received a o 1 from JULY 1, 20220 0s : ►t SEE INSTRUCTIONS ON REVERSE STACIE DAVIS FOR ENCINITAS CITY COUNCIL FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER LD. NUMBER) STACIE DAVIS ENCINITAS, CA. 92024 1454041 t ® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC through SEPT 24, 2022 page of I.D. NUMBER 1454041 IF AN INDIVIDUAL, ENTER ) ° OCCUPATION AND EMPLOYER (IF SELF EMPLOYED, ENTER OUTSTANDING BALANCE AMOUNT RECEIVED THIS AMOUNT PAID OR FORGIVEN OUTSTANDING BALANCE AT e INTEREST ORIGINAL CUMULATIVE NAME OF BUSINESS) BEGINNING THIS PERIOD PERIOD THIS PERIOD. CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTION PERIOD TO DATE BUSINESS OWNER ❑ PAID , C L NDA EA HAIR BY STACIE s s 2,000,00 2,000.00 STACIE DAVIS BUSINESS OWNER HAIR BY STACIE ENCINITAS, CA. 92024 1454041 t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Schedule B Summary ❑ FORGIVEN RATE s 2,000.00 2,000.00 PER ELECTION** s s � 11/7/2022 � 9/7/2022 DATEINCURRE7 DATE DUE S ❑ PAID A N A AR S $ 3,000.00 3,000.00 $ 5.000.00 ❑ FORGIVEN RATE 3,000.00 3,000.00 II/7/2022 9123/2022 PER ELECTION" $ S � S $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR S ❑ FORGIVEN RATE PER ELECTION" S 8 S S DATE DUE DATE INCURRED S SUBTOTALS $ 5,000.00 $ $ 5,000.00 $ 1. Loans received this period ............................ 5,000.00 (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ............................. 0 (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 $ 5,000.00 ......................................... Enter the net here and on the Summary Page, Column A, Line 2. (May be a negatW number) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** if required_ on r 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 (866/27S-3772) www.fppc.ca.gov Schedule E Payments Made SEE, INSTRUCTIONS ON REVERSE STACIE DAVIS FOR ENCINITAS CITY COUNCIL DISTRICT 4 Amounts may be rounded to whole dollars. Statement covers period from JULY 1, 2022 through SEPT 24, 2022 SCHEDULE E Page , Lei of 1454041 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS campaign paraphernalia/misc. campaign consultants MBR member communications RAID radio airtime and production costs CTB contribution (explain nonmonetary)* MTG OFC meetings and appearances office expenses RFD returned contributions CVC FIL civic donations candidate filing/ballot fees PET petition circulating SAL TEL campaign workers' salaries t.v. or cable airtime and production costs FND fundraising events RHO POL phone banks polling and survey research TRC TRS candidate travel, lodging, and meals staff/spouse travel, lodging, and meals IND LEG independent expenditure supporting/opposing others (explain)* legal defense POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LIT campaign literature and mailings PRO PRT professional services (legal, accounting) print ads VOT voter registration WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID VISTA PRINT 275 WYMAN STREET WALTHAM, MA. 02451 7121 CMP CAMPAIGN STICKER 127.00 VISTA PRINT 275 WYMAN STREET WALTHAM, MA. 02451 9/8 CMP _ COZY AND TOTE 147.00 x Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 274.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 274.00 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 492.00 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 $ 766.00 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE rvAIAL yr rILEK - STACIE DAVIS FOR ENCINITAS CITY COUNCIL DISTRICT 4 Contributions Received column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions................................................... Schedule A, Linea $ 1,100.00 2. Loans Received................................................................ Schedule B, Line 3 5,000.00 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add lines 1 +2 $ 6,100.00 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ 6,100.00 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, Line 3 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 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 1, 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. $ 766.00 $ 766.00 $ 766.00 6,100.00 766.00 $ 5,334.00 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 8 above $ 5,000.00 Statement covers period from JULY 1, 2022 through SEPT 24, 2022 Column B CALENDAR YEAR TOTAL TO DATE $ 1,100.00 5,000.00 $ 6,100.00 $ 6,100.00 $ 766,00 $ 766.00 $ 766,00 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). SUMMARY PAGE Page —L_ of - J I.D. NUMBER 1454041 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ 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) --/ ------------- --- $ *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