Mechelle Lawrence Adams Campaign Finance Statement

COVER PAGE
Recipient Committee
Campaign Statement
Cover Page
Date Stamp
CALIFORNIA
FORM
4 60
(Government Code Sections 84200-84216.5)
Statement covers period
SEE INSTRUCTIONS ON REVERSE
1. Type of Recipient Committee:
0
0
State Candidate Election Committee

Recall
(A lso Complete Part 5)
/ . . ,~~
from
01 / 01 /2 016
through
09/ 2 4 / 2 01 6
General Purpose Committee

Sponsored
Small Contributor Committee
Political Party/Central Committee
F'{T) v1
/
""2
of
_
1 _
_-z,j;, _
For Official Use Only
.....
2. Type of Statim~~t:-
Primarily Formed Ballot Measure

Committee
0 Controlled
0 Sponsored
{Also Complete Part 6)
0
0
0
Page
11/08 / 2016
All Committees- Complete Parts 1, 2, 3, and 4.
[Xi Officeholder, Candidate Controlled Committee
Date of election if applicable:

(Month, Day, Year.). _,
00
Preelection Statement
0
0
Semi-annual Statement
0
0
0
Termination Statement
(Also file a Form 410 Termination)
.o
Quarterly Statement
Special Odd-Year Report
Supplemental Preelection
Statement- Attach Form 495
Amendment (Explain below)
Primarily Formed Candidate/

Officeholder Committee
{Also Complete Part 7)
I.D. NUMBER
3. Committee Information
Treasurer(s)
1388598
COMMITTEE NAME (OR CANDIDATE 'S NAME IF NO COMMITTEE)
NAME OF TREASURER
Me c hel le La wrence Adams for San J uan Capi s trano Ci ty Council 20 1 6
Gary Crummitt
MAILING ADDRESS
5 25 E . Seaside Way , #101-C

STREET ADDRESS (NO P.O. BOX)
CITY
2 80 61 Las Bri s as del Mar
Long Beach
CITY
STATE
San Juan Capistrano
CA
ZIP CODE
92675
STATE
ZIP CODE
CA
90802
STATE
ZIP CODE
AREA CODE /PHONE
(5 62 )9 8 3-0815
NAME OF ASSISTANT TREASURER, IF ANY
AREA CODE/PHONE
(56 2 )983- 0815
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
MAILING ADDRESS
525 E. Seaside Way, #101-C

CITY
STATE
Long Beach
CA
ZIP CODE
AREA CODE /PHONE
CITY
AREA CODE/PHONE
9080 2
OPTIONAL: FAX I E-MAIL ADDRESS
OPTIONAL:
FAX I E-MAIL ADDRESS
( 56 2 )983-081 7 I gary@c r ummi ttanda s soci a tes.com
4. Verification
contained herein and in the attached schedules is true and complete. I certify
I have used all reasonable diligence in preparing and reviewing this statement and to the best of m
under penalty of perjury under the laws of the State of California that the foregoing is true and co
Executed on
09/28/2016
Executed on
09/28/2016
Date
Date
{ :=.;;if'
By
b."
U1 v__'=:1( 1 x
~lnmlh :~ .~rftt'.At:.<.ki~~~IIW"
4."0!-:'C
(>;,/ ';r._.. __ . "{\_ "-..,-} _______.._""Lorspoosor
Date
BY------------~~~~~~~~~~~~~~~~~~~-----------
Signature of Controlling Officeholder, Car<tidate, State Measure Proponent
Date
BY------------~~--~~~~~~~~~~~~--~~~-----------
Signature of Controlling Offioeholder. Candidate, State Measure Proponent
Executed on
Executed on
www.netfile.com
By .1 " ~
FPPC Fonn 460 (Jan/2016)

FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
COVER PAGE- PART2
Recipient Committee
Campaign Statement
Cover Page- Part 2
6. Primarily Formed Ballot Measure Committee
5. Officeholder or Candidate Controlled Committee
NAME OF BALLOT MEASURE
NAME OF OFFICEHOLDER OR CANDIDATE
Mechelle Lawrence Adams

JURISDICTION
BALLOT NO. OR LETTER
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
D
D
City Council Member: San Juan Capistrano District 5

RESIDENTIAUBUSINESS ADDRESS
(NO_ AND STREET)
CITY
SfATE
SUPPORT
OPPOSE
ZIP
Identify the controlling officeholder, candidate, or state measure proponent, if any.

San Juan
28061 Las Brisas del Mar
Capist~o
92675
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
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?
DYES
COMMITTEE ADDRESS
CITY
STATE
List names of
officeholdet(s) or candidate(s) for which this committee is primarily formed.
AREA CODE/PHONE
I.D. NUMBER
CONTROLLED COMMITTEE?
NAME OF TREASURER
DYES
CITY
7. Primarily Formed Candidate/Officeholder Committee

ZIP CODE
DISTRICT NO. IF ANY
NO
STREET ADDRESS (NO PO. BOX)
COMMITTEE NAME
COMMITTEE ADDRESS
OFFICE SOUGHT OR HELD
D
D
SUPPORT
OPPOSE
D
D
SUPPORT
OPPOSE
D
D
SUPPORT
OPPOSE
D
D
SUPPORT
OPPOSE
NO
STREET ADDRESS (NO PO BOX)
STATE
ZIP CODE
AREA CODE/PHONE
Attach continuation sheets if necessary
FPPC Form 460 (Jan/2016)

www.fppc.ca.gov
www.netfile.com
SUMMARY PAGE
Campaign Disclosure Statement

Summary Page
Amounts may be rounded

to whole dollars.

from
01/01/2 016
through
09/24/2016
CALIFORNIA
FORM
Page
of
NAME OF FILER
I D NUMBER
Mechelle Lawrence Adams for San Juan Capistrano City Council 2016
1388598
Contributions Received
1.
Monetary Contributions ......... .
2.
Loans Received
3.
SUBTOTAL CASH CONTRIBUTIONS
4.
5.
Schedule A, Line 3
32 , 894.00
32,894.00
32 , 894.00
Schedule C, Line 3
510.00
.. .. .... .... Add Lines 3 + 4
33,404.00
33,404.00
7, 130.28
7,130.28
Expenditures Made
6.
Payments Made
Schedule E, Line 4
7.
Loans Made ...
Schedule H, Line 3
8.
SUBTOTAL CASH PAYMENTS
9.
Accrued Expenses (Unpaid Bills) .......
Add Lines 6 + 7
.. .. .
0.00
7,130.28
7,130.28
2,224.00
10. Nonmonetary Adjustment ... .... .... ........................... .... Schedule c, Line3
510.00
510.00
9,864.28
9 , 864.28
Current Cash Statement

13. Cash Receipts
Previous Summary Page, Une 16
15. Cash Payments ............ .. .... .
0.00
Column A, Line 3 above
32,894.00
Schedule I, Line 4
0.00
Column A, Line 8 above
7 , 130.28
14. Miscellaneous Increases to Cash.
25,763.72
0.00
See instructions on reverse
0.00
Add Line 2 + Line 9 in Column B above
2,224.00
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
19. Outstanding Debts
www.netfile.com
20. Contributions
Received
$ _ _ _ _ __
$ _ __ __
21. Expenditures
Made
$ _ _ _ _ __
$ _ _ _ __
Expenditure Limit Summary for State

Candidates
22. Cumulative Expenditures Made*
2,224.00
12. Beginning Cash Balance .
7/1 to Date
1/1 through 6/30
0.00
Schedule F, Line 3
11. TOTAL EXPENDITURES MADE .. .. ...... ... ................... AddLines 8 + 9 + 10
Calendar Year Summary for Candidates

Running in Both the State Primary and
General Elections
0.00
25
32,894.00
510.00
Nonmonetary Contributions
TOTAL CONTRIBUTIONS RECEIVED
ColumnS
CALENDAR YEAR
TOTAL TO DATE
0.00
Schedule B, Line 3
Add Lines 1 + 2
ColumnA
TOTAL THIS PERIOD
(FROM ATTACH ED SCHEDULES)
460
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).
(If Subject to Voluntary Expenditure Lim It)
Total to Date
Date of Election
(mm/dd/yy)
__
___}_____)
$ _ __
_ _ } _---J.
$_
*Amounts in this section may be different from amounts

reported in Column B.

www.fppc.ca.gov
Schedule A
Monetary Contributions Received

to whole dollars.
SCHEDULE A
from
01/01/2016
CALIFORNIA
FORM
through
09/24/2 016
Page __4
NAME OF FILER
09/01/2016
of ----..1..2
I.D. NUMBER
DATE
RECEIVED
460
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR

(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
JRoMa MCG Partners, LP

6 Venture Ste. 100
Irvine, CA 92618
1388598
I CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPAT ION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 DEC. 31)
510.00
510.00
Attorney
Aitken Airken Cohn
250.00
250.00
Management
Eric Altman
510.00
510.00
Retired
N/A
500.00
500.00
Receptionist
Mission San Juan
Capistrano
100.00
100.00
D IND
D COM
PER ELECTION
TO DATE
(IF REQUIRED)
~ OTH
D PTY
D SCC
08/26/2016
08/31/2016
09 / 17/2016
!Darren Aitken
27906 Goldenridge Road
San Juan Capistrano, CA
~ IND
92675
!Eric Altman
102 Lottle
Irvine, CA 92603
!Gregory Baird
22812 Misty Sea Drive
Laguna Niguel, CA 92677
09/12/2016- --[Marcia Barr

621 Avenida Sevilla Unit N
Laguna Woods, CA 92637
D
D
D
D
COM
OTH
PTY
SCC
(K] INO
D
D
D
D
COM
OTH
PTY
SCC
~IND
DCOM
DOTH
DPTY
DSCC
~ IND
D
D
D
D
COM
OTH
PTY
SCC
SUBTOTAL$
1, 870. ool_- ___
Schedule A Summary
1. Amount received this period- itemized monetary contributions.
(Include all Schedule A subtotals.) ........ ... .. .... ....................................... .. .... .. .. .... .
30 , 159.00
2. Amount received this period- unitemized monetary contributions of less than $1 00 .... ... .. .................... $
2. 735. o o
www.netfile.com
_ __
-~
*Contributor Codes
.... ....... .......... $
3. Total monetary contributions received this period .

(Add Lines 1 and 2. Enter here and on the Summary Page , Column A , Line 1.)
__
.. TOTAL$
!NO-Individual
COM- Recipient Committee
(other than PTY or SCC)
OTH- Other (e.g ., business entity)
PTY- Political Party
SCC- Small Contributor Committee
32,894.oo

www.fppc.ca.gov
Schedule A (Continuation Sheet)

SCHEDULE A (CONT.)
to whole dollars.

from
01/0 1/20 16
CALIFORNIA
FORM
through
09/24/2016
Page
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR 1 CONTRIBUTOR

(IF CCMMITTEE. ALSO ENTER I D. NUMBER)
09]12/20l~INicholas
Basakis
27703 Ortega Hwy #29C
09/12/2016
92765
I Matias Belardes
32211 Avenida Los Amigos
San Juan Capistrano, CA 92675
09/12/2016
09/19/2016
!Manuel Bernal
31103 Rancho Viejo Road #2348
I Manuel Bernal
31103 Rancho Viejo Road #2348
Berr~ngton
Propertie~nc.
26755 Verdugo Street, Suite 200

CODE*
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED. ENTER NAME
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC. 31)
IKJIND
DCOM
DOTH
DPTY
DSCC
Attorney
Nicholas Basakis
500.00
500.00
[R] IND
DCOM
DOTH
DPTY
DSCC
Tribal Chief
Achegeman Nation
250.00
250.00
~ IND
Realtor
Sun Belt Realty
125.00
250.00
Realtor
Sun Belt Realty
125.00
250.00
510.00
510.00
D
D
D
D
COM
OTH
PTY
SCC
~IND
DCOM
DOTH
DPTY
DSCC
D IND
D COM
IK] OTH
D PTY
D SCC
SUBTOTAL$
1,510.00
460
of _..e.
PER ELECTION
TO DATE
(IF REQUIRED)
- - - -
*Contributor Codes
!NO-Individual
OTH - Other (e.g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2 016
CALIFORNIA
FORM
through
09/24/2016
Page
NAME OF FILER
I.D. NUMBER
1388598
DATE
RECEIVED

(IF COMMITTEE, ALSO ENTER I,D NUMBER)
09/22726~1Suilana
Brutoco Bianchi
27272 Viewpoint Circle
92675
I CONTRIBUTOR
CODE *
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
Homemaker
N/A
200.00
200.00
Real Estate
Berkshire Hathaway
200.00
200.00
IK] IND
D COM
D OTH
O PTY
D SCC
Partner
Bolar Hirsch and Jennings
500.00
500.00
IK] IND
Retired
N/A
500.00
500.00
250.00
~0.00
IK] IND
D COM
D OTH
D PTY
46 0
of ____3.2.
PER ELECTION
TO DATE
(IF REQUIRED)
o scc
09/22/2016
!Richard Bianchi
27272 Viewpoint Circle
92675
IKJ IND
O COM
D OTH
O PTY
o scc
08/26/2016
09/23/2016
I Deborah
Bolar
407 Emerald Bay
Laguna Beach, CA
92651
!Gary Campbell
27552 Rolling Wood Lane
92675
09
92675
D
D
D
D
COM
OTH
PTY
SCC
IK] IND
D COM
D OTH
D PTY
Italy
o scc
SUBTOTAL$
1' 6 50 . 0 0 ~--
*Contributor Codes
IND-Individual
OTH - other (e.g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
through
09/24/2016
Page
NAME OF FILER
I D NUMBER
1388598
DATE
RECEIVED
08{3072016

(IF COMMITTEE, ALSO ENTER I.D NUMBER)
!Allen Cayir
104 7 Village Drive
Chino Hills, CA 91709
CONTRIBUTOR
CODE*
IK)IND
O COM
DOTH
OF BUSINESS)
Engineer
Transtech Engineering
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC 31)
510.00
510 . 00
510.00
Sl.O.OO
Broker
SRS Real Estate
500.00
500.00
Homemaker
N/A
500.00
500.00
460
of _2?.
PER ELECTION
TO DATE
(IF REQUIRED)
DPTY
DSCC
09/12/2016 -,Cedar Creek Inn Corporation
26660 Ortega Hwy
DIND
D COM
IKJ OTH
0 PTY
o scc
09/21/2016
! Garrett Colburn
2057 Port Bristol Circle
Newport Beach, CA 92660
IX] IND
D COM
D OTH
O PTY
D SCC
09/23/2016
!Michelle Colburn
2057 Port Bristol Circle
IK] IND
D COM
D OTH
D PTY
o scc
Ol..l lilS
Regal Way
Lake Forest, CA
92630
IK)IND
DCOM
DOTH
Homemaker
N/A
.00
DPTY
D SCC
SUBTOTAL$
2,520.001
*Contributor Codes
IND-Individual
OTH - Other (e.g ., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
throu gh
09/24 / 2016
Page
I D NUMBER
1388598
DATE
RE CEIVED
(IF COMMITTEE. ALSO ENTER I D. NUMBER )
09/23/20~1
Scott Collins
21712 Regal Way
Lake Forest, CA
I CONTRIBUTOR
CODE *
IK]IND
OCOM
DOTH
DPTY
92630
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
Facilities Manager
Facility Services Partner
I nc.
500.00
500 .00
Attorney
Fletcher & Hedenkamp, LLC
510 . 00
510.00
250 . 00
250.00
200.00
200.00
1.00.00
100.00
of ____2?.
NAME OF FILER
46 0
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
09 / 0 7/ 2016
I Edmond
09 / 12/2016
I CR
09/08/2016
!William Cvengros
31975 Pe ppertree Bend
M. Connor
30651 Steeplechase Drive
[R] IND
O COM
D OTH
D PTY
o scc
and R Inc.
11292 Western Avenue
Stanton, CA 90680
D IND
O COM
IRJ OTH
D PTY
o scc
92675
IKJ IND
DCOM
D OTH
D PTY
Chairman
National Retirement
Partners
oscc
0
. F . Hogan an~ssoc~aces
31192 Via Cristal
O IND
0 COM
IK] OTH
D PTY
D SCC
SUBTOTAL$
1,560.00
r
-
-- -
--- - - -,
-
- -
*Contributor Codes
!NO-Individual
OTH - other (e .g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2 016
CALIFORNIA
FORM
through
09/24/2016
Page
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED

(IF COMMITTEE, ALSO ENTER I D NUMBER)
I CONTRIBUTOR
CODE*
09/~2/2016
!Raymond Dagher
26581 Sinforosa Drive
Mission Viejo, CA 92691
09/23/2016
!Dana Smith Show Team, Inc.

31441 Avenida de la Vista
OIND
OCOM
IXJOTH
OPTY
DSCC
09/23/2016
I Chris Daniell
900 NW Lovejoy #808
Portland, OR 97209
IX]IND
DCOM
DOTH
DPTY
09/12/2016
IDondee Company, LLC

21 Larkfield Lane
IRJIND
DCOM
DOTH
OPTY
OF BUSINESS)
Owner
Franciscan Plaza
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 DEC. 31)
150.00
150.00
250.00
250.00
500.00
500.00
200.00
200.00
51. o-:oo
510.00
46 0
of~
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
Property Manager
Resolute Asset Management
Inc.
oscc
O IND
O COM
IRJ OTH
O PTY
o scc
1p Group, lnc.
Dr
Santa Ana, CA
92705
OIND
0 COM
IX] OTH
D PTY
o scc
SUBTOTAL$
1,610.001-
*Contributor Codes
!NO-Individual
OTH- other (e .g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2 016
CALIFORNIA
FORM
through
09/24/2016
Page
10
NAME OF FILER
I D. NUMBER
1388598
DATE
RECEIVED

09/12/2016 --,Stacey Fitts

26616 Mission Street
I CONTRIBUTOR
CODE *
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
!K) IND
D COM
D OTH
D PTY
D SCC
Owner
Floral Occasions
250.00
250.00
08/25/2016 !Mary Jane Forster Foley

7 Phillips Circle
!K) IND
0 COM
D OTH
O PTY
D SCC
Retired
N/A
510.00
510.00
08/19/2016 !Laura Freese

26332 Paseo Toscana
IX] INO
OCOM
DOTH
DPTY
Owner
Capistrano SunRooms
250.00
250.00
Retired
N/A
150.00
150.00
Real Estate r nvestor

Brian Garrigan
.sao: llO
00.00
92675
92675
46 0
of _____2?.
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
09/12/2016 I Jane Ga1ligani
24992 Danamaple
Dana Point, CA 92629
IK]I ND
0 COM
D OTH
O PTY
o scc
rJ.an GarrJ.gan
152 Las Fl ores
Aliso Viejo, CA
92656
!K) IND
0 COM
D OTH
D PTY
D SCC
SUBTOTAL$
1,660.001 _ __
*Contributor Codes
IND -Individual
OTH - Other (e .g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
through
09/24/2 016
Page
11
NAME OF FILER
10 NUMBER
1388598
DATE
RECEIVED
09/2 3/2016

(I F COMMITTEE. ALSO ENTER I D, NUMBER)
Tkri stl. Garrigan

152 Las Flor es
Aliso Viejo, CA
CONTRIBUTOR
CODE*
(IF SELF EMPLOYED, ENTER NAME

OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN 1 -DEC. 31)
Homemaker
N/A
500.00
500.00
IK] IND
D COM
D OTH
D PTY
D SCC
Retired
N/A
125.00
125.00
IK] IND
O COM
D OTH
DPTY
Consultant
Discovery Cube LA
510.00
510.00
250.00
250.00
150.00
150.00
IR] IND
O COM
D OTH
0 PTY
92656
460
of~
PER ELECTION
TO DATE
(IF REQUIRED)
o scc
09/12/2016
!Charles Gildea
29802 Monarch Drive
San J uan Capistrano, CA
92675
08/30/2016
!Wendy Jane Greuel

4433 Agnes Avenue
Studio City, CA 91607
09/12 / 2016
I Grif!in Structures, Inc.

2 Technology Dr. Suite 150
I rvine, CA 92618
oscc
ens on
92648
D IND
0COM
IRJ OTH
0 PTY
DSCC
IKJ IND
D COM
D OTH
D PTY
D SCC
tant
SUBTOTAL$
1,535.00
~~J
contributor Codes
IND-Individual
OTH - Other (e.g ., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
o 1/ o 1 /2 o 1 6
CALIFORNIA
FORM
through
09/2 4 /201 6
Page
12
NAME OF FILER
I.D.NUMBER
1388598
DATE
RECEIVED
09 / 12 / 2016

(IF CO MMITTEE, ALSO ENTER I.D. NUMBER)
IGeorgianna Hales
30542 Marbella Vista
92675
09 / 12 / 2015
!Hess-Verdon and Associates

620 Newport Center Dr. Suite 1030
09 / 23 /20 16
I Matt Higgins
48 Rincon Way
Aliso Viejo, CA
I CONTRIBUTOR
CODE
IK] IND
D COM
D OTH
D PTY
D SCC
OF BUSINESS)
Retired
N/A
DIND
DCOM
IK] OTH
DPTY
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1- DEC . 31)
250.00
250. 00
510.00
510.00
510.00
510.00
5 10.00
51 0.00
~0. 0 0
510.00
4 60
of __2_5_
PER ELECTIO N
TO DATE
(IF REQUIRED)
oscc
IX] INO
DCOM
DOTH
DPTY
92656
CEO
Falcon Leadership
oscc
09/07 / 2016
! Hofmann Finn Development Company, Inc.

3188 Airway Ave.
Ste. A
Costa Mesa, CA 92626
Ste C
92675
DIND
DCOM
IK]OTH
DPTY
DSCC
IKJ IND
D COM
D OTH
D PTY
D SCC
Rea l tor
ReMax San Juan Capistrano
SUBTOTAL$
2,29o.oo[ _____ _
*Contributor Codes
INO -Individual
OTH -Other (e.g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
through
09/24/2016
Page
g_ ot_____e
NAME OF FILER
I D. NUMBER
1388598
DATE
RECEI VED

(IF COMMITIEE, ALSO ENTER I,D NUMBER)
08/30/2016- I Ryan Johnson

28382 Paseo Establo
I CONTRIBUTOR
CODE *

OF BUSINESS)
Veterinarian
Boehinger Ingelherson
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN , 1 - DEC. 31)
250.00
250 . 00
200.00
200.00
200.00
200.00
OIND
OCOM
IKJOTH
0PTY
200. 0 0
200.00
O IND
O COM
IK] OTH
O PTY
00.00
200.00
IKJIND
O COM
DOTH
OPTY
92675
460
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
08/20/2016
I Klein
08 / 26/2016
!Mary Langsdorf
28062 Las Brisas Del Mar
09/12/2016
I Law Offices of Lemkin, Barnes and Row,

1 MacArthur Place, Suite 770
Santa Ana, CA 92707
and Wilson
4770 Von Karman Avenue
O IND
O COM
IKJ OTH
O PTY
o scc
IK] IND
O COM
D OTH
O PTY
Consultant
Mary Langsdorf
oscc
Inc.
oscc
Development~LC
30220 Rancho Viejo Road, Ste A

o scc
SUBTOTAL$
1,050.00
---- ------1
*Contributor Codes
IND-Individual
OTH -Other (e.g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01 /0 1 /20 16
CALIFORNIA
FORM
through
09/24/2016
Page
14
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED
I CONTRIBUTOR
CODE *
(IF SELF-EMPLOYED, ENTER NAM E
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
!K]IND
DCOM
DOTH
DPTY
DSCC
Retired
N/ A
3 00. 00
300.00
09/07 / 2016
IK]IND
DCOM
DOTH
DPTY
D SCC
Consultant
Murow CM
100.00
100.00
IK]IND
DCOM
D OTH
DPTY
D SCC
Labor Re l a t ions Part ne r

Re l yonus Medical Group
198 . 00
198.00
~ IND
Homemaker
N/A
510.00
510.00
Ret: lre
N/ A
198.00
09 / 23 / 201 6
I Jim Micha l ski

1120 N. Bel Aire Drive
Burbank, CA 915 04
08/22 / 2016
I Susan Mikos
27551 Rolling Wood Lane
o8T31720l~ l
Man.anne Ml ller
31911 Calle Winona
92675
92675
92 67 5
D
D
D
D
COM
OTH
PTY
SCC
[ID IND
D COM
D OTH
D PTY
D SCC
SUBTOTAL$
1,306.001_
of~
PER ELECTION
TO DATE
(IF REQUIRED)
CUMULATI VE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
09T0 7/20lg-- I Richard L. Linting

830 Temple Hi l ls Dri ve
Laguna Hi ll s, CA 92651
I Timothy Markel
26262 Via Carrizo
460
*Contributor Codes
INO-Individual
OTH - other (e .g., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2 016
CALIFORNIA
FORM
through
09/2"-/2016
Page
NAME OF FILER
I D. NUMBER
13 88598
DATE
RECEIVED
09/07/2016
09/07/2016

(IF COMMITTEE, ALSO ENTER I. D. NUMBER)
!Anthony Moiso
28812 Ortega Hwy
I Melinda
09/23/2016
I Katie
92675
Moiso
92651
Nahigian
329 w. 15th
Newport Beach, CA
CONTRIBUTOR
CODE *
92663
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1 -DEC 31)
Developer/CEO
Rancho Mission Viejo
510.00
510.00
IK] IND
D COM
D OTH
D PTY
D SCC
Homemaker
N/A
510.00
510.00
IK] IND
O COM
D OTH
O PTY
Attorney
Katie Nahigian
500.00
500.00
OIND
OCOM
IKJOTH
DPTY
DSCC
500.00
500.00
D IND
0 COM
IK] OTH
O PTY
D SCC
250.00
250.00
~ IND
154 Emerald Bay
Laguna Beach, CA
D COM
D OTH
DPTY
DSCC
46 0
ot__e.
PER ELECTION
TO DATE
(IF REQUIRED)
o scc
09/12/2016
!O'Connor Laguna Hills Mortuary

25301 Alicia Parkway
Laguna Hills, CA 92653
SUBTOTAL$
2,270.00r
-~
*Contributor Codes
IND -Individual
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01 / 01/2 01 6
CALIFORNIA
FORM
through
09/24/2016
Page
16
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED

(IF COMMITTEE. ALSO ENTER I D, NUMBER)
09/12/2016
! George Peterson
4 Park Plaza, Ste 700
Irvine, CA 92614
09/2 2 /2016
I Sheila
I CONTRIBUTOR
CODE *
!R)IND
DCOM
DOTH
DPTY
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUM ULATIVETO DATE

CALENDAR YEAR
(JAN. 1 - DEC 31)
Owner
The UPS Store
250.00
250.00
Homemaker
510.00
510.00
250.00
250 . 00
100.00
1 00 .00
460
of ____2?.
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
Peterson
32221 Cook Lane
[R] INO
92675
O COM
D OTH
0 PTY
N/A
o scc
09/12/2016
I Plaza
09/17/2016
I Charles
Art Gallery
32382 Del Obispo Ste C-1
Porter
27250 Corte Montecito
oreen c. Porcer
27250 Corte Montecito
92675
92675
D IND
D COM
!R) OTH
D PTY
D SCC
!R) IND
D COM
D OTH
0 PTY
D SCC
[R] INO
DCOM
DOTH
DPTY
Retired
N/A
300.00
Retire
N/A
o scc
SUBTOTAL$
1, 410.00
r --~--~~
*Contributor Codes
!NO-Individual
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
through
09/24/2016
Page
17
NAME OF FILER
I. D. NUMBER
1388598
DATE
RECEIVED
08 / 22 /2016

(IF COMMITIEE, ALSO ENTER I,D NUMBER)
I Elizabeth
Priest
29932 Imperial Drive
92675
I CONTRIBUTOR
CODE *
(IF SELF EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN . 1- DEC. 31)
Owner
Las Golindrinas
198.00
198.00
IKJIND
DCOM
DOTH
DPTY
DSCC
Homemaker
N/A
510.00
510.00
IK] IND
D COM
D OTH
D PTY
D SCC
Developer
Sanderson
500.00
500.00
150.00
150.00
150 . 00
150.00
[R] IND
O COM
D OTH
O PTY
46 0
of __e.
PER ELECTION
TO DATE
(IF REQUIRED)
o scc
09 / 23 / 2016
I Megan
09 / 02 / 2016
I Janet Ray
Ramer-Higgins
48 Rincon Way
Aliso Viejo, CA 92656
15 Bay Island
Newport Beach, CA
09 /1 2 / 2016
92661
!Reindeer Insurance Services

14037 Pioneer Blvd
Norwalk, CA 90650
D IND
D COM
IKJ OTH
O PTY
o scc
0
92660
I!JIND
0 COM
D OTH
O PTY
Homemaker
N/A
o scc
SUBTOTAL$
1,508.00
-l
*Contributor Codes
IND-Individual
OTH- Other (e.g., business entity)
www.fppc.ca.gov
www.netfile.com

SCHEDULE A (CONT.)
to whole dollars.

from
01 /0 1 /2 0 1 6
CALIFORNIA
FORM
through
09/24/2 016
Page
~of~
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED

(IF COMMITTEE, ALSO ENTER I D. NUMBER)
09/07/2016
!Stephen P. Sandland
2049 Port Bristol Cir.
09 / 23 /2016
I Michael
I CONTRIBUTOR
CODE *
IK]IND
0COM
DOTH
DPTY
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
Vice President
Project Dimensions, Inc .
150.00
150.00
Tech Recruiter
Amazon
500.00
500.00
46 0
PER ELECTION
TO DATE
(IF REQUIRED)
oscc
Schembari
47 Jasmine Creek Lane
[R] INO
OCOM
DOTH
DPTY
DSCC
09/23/2016
I MJ Schembari
47 Jasmine Creek Lane
IK] IND
O COM
D OTH
D PTY
D SCC
Marketing Coordinator
SRS Real Estate Partners
500.00
500.00
08 /30/2016
!Dean Schramm
4433 Agnes Avenue
Studio City, CA 91607
IK] IND
0 COM
D OTH
0 PTY
D SCC
Manager/Producer
The Schramm Group
510.00
510.00
En~gneer
500.0
500.00
Newport Beach, CA
92663
[R) IND
0 COM
D OTH
O PTY
Jacobs
o scc
SUBTOTAL$
2,160.00
[-
--------1
-
--- -
*Contributor Codes
!NO-Individual
OTH -Other (e.g ., business entity)
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01 / 2 016
CALIFORNIA
FORM
through
09/24/2016
Page
19
NAME OF FILER
I D NUMBER
1388598
DATE
RECEIVED
09 / 23/2016

(IF COMMITIEE. ALSO ENTER I.D NUMBER)
I Bobby
Shui
2659 Native Avenue
Rowland Heights, CA
09/12/2016
I Janice
91748
Sorensen
26091 Paseo Minero
08/26/2016
92675
I Connie Spenuza
53 Strand Beach Drive
Dana Point, CA 92629
08/29{2016
08729{2_0_16
!Alison Stein
27677 Paseo Alondra
I R~chard
92675
Ste~n
27677 Paseo Alondra
92675
I CONTRIBUTOR
CODE *
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
IR] IND
D COM
D OTH
D PTY
D SCC
Attorney
Bobby Shui
510.00
510.00
~IND
Retired
N/A
100.00
100.00
!K]IND
DCOM
DOTH
D PTY
D SCC
Author and Publisher

Connie Spenuza
510.00
510.00
!K]IND
DCOM
DOTH
DPTY
DSCC
Teacher
Alison Stein
510.00
510.00
IR] IND
D COM
D OTH
D PTY
D SCC
Execucive DlrecLor
Arts OC
510.0
510.00
D COM
DOTH
DPTY
DSCC
SUBTOTAL$
2,140.001
------ --
460
of ____2?.
PER ELECTION
TO DATE
(IF REQUIRED)
*Contributor Codes
IND-Individual
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01 / 01 / 2016
CALIFORNIA
FORM
through
09/24/2016
Page
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED
09/12 / 2016
09 / 12/2016

(IFCOMMITTEE, ALSOENTERI D. NUMBER)
[ Bruce Tatarian
31592 Via Dulcinea
San J uan Capistrano, CA
92675
I Kathleen
Timlay
31386 Don Juan Avenue
92675
I CONTRIBUTOR
CODE*
IK] JND
D COM
D OTH
D PTY
D SCC
IK)IND
OCOM
DOTH
DPTY
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
Teacher
Capistrano Unifi e d School
District
250.00
250.00
Retired
200.00
200.0 0
510.00
510.00
200.00
200.00
100.00
100--:DO
46 0
of----.2?.
PER ELECTION
TO DATE
(IF REQUIRED)
N/A
oscc
09 / 16 / 2016
I Erma J ean Tracy
IK] IND
O COM
D OTH
D PTY
D SCC
10 Breakers Is l e
Dana Point , CA 92629
09/12/2016
[Anna-Carin Uren
30952 Calle San Felipe
Vasquez
31891 Los Rios St
~IND
92675
Br~an
92675
OCOM
DOTH
DPTY
DSCC
Ret ired
N/ A
Presentation Manager
Mission San Juan
Capistrano
IKJ IND
0 COM
D OTH
OPTY
o scc
I
SUBTOTAL$
1,260.001
- --- - --- -
-j
*Contributor Codes
IND-Individual
www.netfile.com

www.fppc.ca.gov

SCHEDULE A (CONT.)
to whole dollars.

from
01/01/2016
CALIFORNIA
FORM
through
09/24/2016
Page
~of~
NAME OF FILER
I.D NUMBER
1388598
DATE
RECEIVED

(IFCOMMITTEE,ALSOENTERI.D NUMBER)
I Jay Witzling
100 Capeberry
Irvine, CA 92603
09/23/2016
OF BUSINESS)
08/23/2016--fHarry Witt
3700 Hartford Street
St. Louis, MO 63116
06/23/2016
I CONTRIBUTOR
CODE*
I Connie
Yu
502 N. Chapel Avenue Apt F
Alhambra, CA 91801
IK] IND
D COM
D OTH
D PTY
D SCC
Retired
IK] IND
D COM
D OTH
D PTY
D SCC
Retired
IX) IND
O COM
D OTH
O PTY
Real Estate
Resolute Asset Management,
Inc.
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVETODATE
CALENDAR YEAR
(JAN" 1 DEC 31)
100.00
100.00
250.00
250.00
500.00
500.00
460
PER ELECTION
TO DATE
(IF REQUIRED)
N/A
N/A
o scc
D
D
D
D
D
IND
COM
OTH
PTY
SCC
DI ND
D COM
D OTH
O PTY
D SCC
SUBTOTAL$
850.00
--~
*Contributor Codes
IND-Individual
www.netfile.com

www.fppc.ca.gov
ScheduleC
Nonmonetary Contributions Received
SCHEDULE C

to whole dollars.

01/01/2016
CALIFORNIA
FORM
through
09/24/2 016
Page ___2_2__ of ___

2_5__

NAME OF FILER
I D NUMBER
Mechelle Lawrence Adams for San Juan Capistrano Cicy Council 2016
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND

ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
CODE *
92675
1388598
(IF SELF-EMPLOYED, ENTER
NAME OF BUSINESS)
(IF COMMITTEE, ALSO ENTER 1.0 NUMBER)
09/08/2016 !Sun Dried Tomato

31781 Camino Capistrano
460
from
DIND
DCOM r
IR]OTH
DPTY
DSCC
DESCRIPTION OF
GOODS OR SERVICES
Food/beverages for
kick off event
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN 1 -DEC 31)
AMOUNT/
FAIR MARKET
VALUE
510.00
PER ELECTION
TO DATE
(IF REQUIRED)
510.00
--
DIND
DCOM
DOTH
DPTY
DSCC
--
DIND
OCOM
DOTH
DPTY
DSCC
--
DIND
DCOM
DOTH
DPTY
DSCC
Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL$
510.00
Schedule C Summary
1. Amount received this period- itemized nonmonetary contributions.
(Include all Schedule C subtotals.) .................... .. ............................................ .. .... .
2. Amount received this period- unitemized nonmonetary contributions ofless 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.)
www.netfile.com
*Contributor Codes
.. ....... $
510.00
...... .. .. $
0. 00
TOTAL $
51o. oo
!NO-Individual
OTH -other (e.g ., business entity)

www.fppc.ca.gov
SCHEDULE E
ScheduleE
Payments Made

to whole dollars.

NAME OF FILER
from
01/01/2016
CALIFORNIA
FORM
through
09/24/2 016
Page _2_3_ _
46 0
of _ _2_5_
I.D. NUMBER
1388598
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
eNS
campaign paraphernalia/misc.
campaign consultants
eTB contribution (explain nonmonetary)*
eve civic donations
RL
candidate filing/ballot fees
FND fundraising events
IND
independent expenditure supporting/opposing others (explain)*
LEG legal defense
UT
campaign literature and mailings
MBR
MfG
OFe
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
NAME AND ADDRESS OF PAYEE

CODE
OR
RAD
RFD
SAL
TEL
TRe
TRS
TSF
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
VOT voter registration
WEB information technology costs (internet, e-mail)
DESCRIPTION OF PAYMENT
AMOUNT PAID
COGS South Signs

3309 s. Main Street
Santa Ana, CA 92707
CMP
1,224.00
Crummitt and Associates

525 E. Seaside Way #101-C
Long Beach, CA 90802
PRO
750.00
Klein and Klein

27405 Puerta Real, Ste 130
Mission Viejo, CA 92691
LIT
1,235.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
SUBTOTAL$
3,209.00
Schedule E Summary
...... ........ .. . $
7,080.28
........ .......... .... .................. ... ...... $
50.00
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 $
7 , 1 30 2 8
1. Itemized payments made this period. (Include all Schedule E subtotals.) ...... .
2. Unitemized payments made this period ofunder$1 00 ..................................... ..

FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
www.fppc.ca.gov
www.netfile.com
SCHEDULE E (CONT.)
Schedule E
(Continuation Sheet)
Payments Made

to whole dollars.
from
01/01/2016
through
09/24 /20 16

NAME OF FILER
CALIFORNIA
FORM
Page __2_4_
460
of __2_5_
I.D. NUMBER
1388598
CODES: If one of the following codes accurately describes the payment, yeu may enter the code. Otherwise, describe the payment.
MBR member communications
CMP campaign paraphernalia/misc.
RAD radio airtime and production costs
CNS
CTB
eve
FIL
FND
IND
LEG
ur
contribution (explain nonmonetary)*
civic donations
candidate filing /ballot fees
fundraising events
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
MTG
OFC
PET
PHO
POL
POS
PRO
PRT

office expenses
phone banks
print ads
CODE
Political Data Inc .

PO Box 59570
Norwalk, CA 90650
Ryan Press
6400 Da l e St.
Buena Park, CA
OR
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 (internet, e-mail)
RFD
SAL
AMOUNT PAID
Walk List
2 01.65
LIT
1,051 .9 2
Samuel Lippke Studios

7014 E. Mezzanine Way
Long Beach, CA 90808
LIT
2,500.00
George Urch
2521 E. Vista Point Drive
Orange, CA 92867
LI T
117.71
90621
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
www.netfile.com
SUBTOTAL$
3,871.28

www.fppc.ca.gov
SCHEDULE F
Schedule F
Accrued Expenses (Unpaid Bills)

to whole dollars.
from
01/01/2016
through
09/24/2 016
CALIFORNIA
FORM
Page_2_5_

NAME OF FILER
460
of _2_5_
I.D. NUMBER
1388598
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.
CTB contribution (explain nonmonetary)*
CVC civic donations
RL
candidate filing /ballot fees
FND fundraising events
IND
LEG legal defense
ur campaign literature and mailings
NAME AND ADDRESS OF CREDITOR
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
office expenses
phone banks
print ads
CODE OR
(a)
OUTSTANDING
BALANCE BEGINNING
OF THIS PERIOD
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
radio airtime and production costs

t.v. or cable airtime and production costs
candidate travel, lodg ing, and meals
staff/spouse travel, lodging , and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet, e-mail)
(b)
AMOUNT INCURRED
THIS PERIOD
(c)
AMOUNT PAID
THIS PERIOD
(d)
OUTSTANDING
BALANCE AT CLOSE
OF THIS PERIOD
(ALSO REPORT ON E)
COGS South Signs

3309 S. Main Street
Santa Ana, CA 92707
CMP
0.00
1,224.00
0.00
1,224.00
Mechelle Lawrence Adams

28062 Las Brisas del Mar
FIL
0.00
1,000.00
0.00
1,000.00
0 . 00$
2,224.00$
o.oo$
--~~
* Payments that are contributions or independent expenditures must also be

summarized on Schedule 0.
SUBTOTALS$
2,224.00
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 $1 00.) ................ ............... ..... ...... ... INCURRED TOTALS$
2, 224 oo
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 $1 00 .) .... ........... ...... .. ... ....... PAID TOTALS$
o oo
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and
on the Summary Page, Column A, Line 9.) .. ..... .................... ... .. .. ... .. .. .. .. ...... .... ........... .
www.netfile.com
NET$
2,224.oo
May De a negatiVe number

www.fppc.ca.gov

Mechelle Lawrence Adams Campaign Finance Statement

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Mechelle Lawrence Adams Campaign Finance Statement

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COVER PAGE

(Government Code Sections 84200-84216.5)

Statement covers period

SEE INSTRUCTIONS ON REVERSE

1. Type of Recipient Committee:

State Candidate Election Committee

(A lso Complete Part 5)

General Purpose Committee

For Official Use Only

Primarily Formed Ballot Measure

All Committees- Complete Parts 1, 2, 3, and 4.

[Xi Officeholder, Candidate Controlled Committee

Date of election if applicable:

Amendment (Explain below)

Primarily Formed Candidate/

COMMITTEE NAME (OR CANDIDATE 'S NAME IF NO COMMITTEE)

Me c hel le La wrence Adams for San J uan Capi s trano Ci ty Council 20 1 6

5 25 E . Seaside Way , #101-C

2 80 61 Las Bri s as del Mar

San Juan Capistrano

AREA CODE /PHONE

NAME OF ASSISTANT TREASURER, IF ANY

(56 2 )983- 0815

MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX

525 E. Seaside Way, #101-C

AREA CODE /PHONE

OPTIONAL: FAX I E-MAIL ADDRESS

FAX I E-MAIL ADDRESS

( 56 2 )983-081 7 I gary@c r ummi ttanda s soci a tes.com

(>;,/ ';r._.. __ . "{\_ "-..,-} _______.._""Lorspoosor

FPPC Fonn 460 (Jan/2016)

COVER PAGE- PART2

6. Primarily Formed Ballot Measure Committee

5. Officeholder or Candidate Controlled Committee

NAME OF BALLOT MEASURE

NAME OF OFFICEHOLDER OR CANDIDATE