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Home My WebLink About2016 01-01 thru 06-30 Nichols 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. CITY , CI ry CLERK Statement covers period Date of election if aMiabli 33 AM 7: 55 from Jan 1, 2016 (Month, Day, Year) through June 30, 2016 Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part5) 0 Sponsored ❑ General Purpose Committee (Also Complete Part6) 0 Sponsored ® Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information (I.D^NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Kim Nichols for Orange City Council 2014 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Orange CA 92869 MAILING ADDRESS nF n1rPPRENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE Orange CA 92683 OPTIONAL: FAX / E-MAIL ADDRESS Nov 4, 2014 I 2. Type of Statement: ❑ Preelection Statement ® Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Lynn A Nichols MAn imn Ann RFCC COVER PAGE Page 1 of 6 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 CITY STATE ZIP CODE AREA nnnFrpl-Inw: Orange CA 92869 NAME OF ASSISTANT TREASURER, IF ANY Not applicable MAILING 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 begfaf my knowled the�nf gtion coryi�ined 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 foreg Executed on August 1, 2016 Date Executed on August 1, 2016 Dare � «,ea< Executed on By Date SignatureofContmlingOfliceholder, Candidaite,StateMessureProponent Executed on g Date y Slgnaturs of Controling Officeholder, Candidate, Stale Measure Proponent FPPC Form 480 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612753772) State of California Recipient Committee Type or print In ink. COVER PAGE - PART 2 Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Kimberlee C Nichols OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) CITY COUNCIL MEMBER, ORANGE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Orange, CA 92869 Page 2 of 6 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. 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 OFF contrlbutfons or make expenditures on behalf of your candidacy. I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ YES ❑ NO UUMMII I LE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ YES ❑ NO AUUKE55 STREET ADDRESS (NO P. CITY STATE ZIP CODE AREA CODE/PHONE DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee /s 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 (January/05) FPPC Toll -Free Helpline: 866/ASK•FPPC (866/2753772) State of California Campaign Disclosure Statement Summary Page Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from — Jan 1, 2016 SUMMARY PAGE June 30, 2016 3 6 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NLIMBER Committee to Elect Kim Nichols for Orange City Council 2014 1368342 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHISPERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 2. Loans Received ...................................................... Schedule B, Line 3 0 0 1/1 through 6/30 711 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 0 $ 0 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 0 $ 0 Made $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 348.48 $ 7. Loans Made ............................................................. Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 348.48 $ 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 348.48 $ 348.48 0 348.48 I 0 348.48 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 1,559.64 To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 .01 corresponding amounts from Column B of your last 15. Cash Payments .................................................. Column A, Line 8 above 348.48 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 1,211.17 figures that should be subtracted from previous if this is a termination statement, Line 16 must be zero, period amounts. If this is 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions an reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ — the first report being filed 0 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* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) I*Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) c4cneau|e t5 rart iAmou'ritsLoans -may""be"ro'u'n"cled Statement covers period Received to whole dollars. Jan 1, 2016 a from SEE INSTRUCTIONS ON REVERSE through Page ---I_ of NAME OF FILER I.D. NUMBER Committee to Elect Kim Nichols for Orange City Council 2014 1368342 FULL NAME, STREET ADDRESS AND ZIP CODE OFLENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT BALANCE AMO OUTS'4DING INTEREST ORIGINAL CUMULATIVE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER RECEIVED THIS BEGINNING THIS OR FORGI VEN CLOSE OF THIS PAID THIS AMOUNTOF CONTRIBUTIONS — NAMEOF BUSINESS) PERIOD PERIOD THIS PERIOD* P RIOD PERIOD LOAN TO DATE Steven A Nichols Attorney E] PAID CALENDARYEAR Kimberlee C Nichols Restaurant Manager E] PAID CALENDARYEAR FORGIVEN Orange, CA 92869 RATE PER ELECTION PAID CALENDARYEAR F1 FORGIVEN PER ELECTION RATE ScheduUe B Summary 1. Loans received this period ............ ................................ ....................................................... (Total Column (b)plus undemizodloans ofless than $1O0j 2. Loans paid orforgivonthis period .......................................................................... ............... (Total Column (c)plus loans under $100paid orforgkmn.) (Include loans paid byuthird party that are also itemized onSchedule Aj 3. Net change this period. (Subtract Line 2from Line 1.).................Enter the net here and on the Summary Page, Column A, Line 2. Amounts forgiven or paid by another party also must be reported on Schedule A. If required. ........................................ � Ic O (May be a negative nu;iber) karner (a) on Schedule E, Line a tContributor Codes wo-Individual nom-necipiu^cvmmntee (other than pTvm,onc) orH-Other (e.o.. business entity) pTv-Political Party sco-Small Contributor Committee FPPC Form *60Wwnuarym FppoToll-Free wupnne:oo61asnfppcmno127e-377u Schedule E Payments Made Type or print mInk. Amounts may uvrounded to whole dollars. Statement covers period from - Jan 1.2O1S SEE INSTRUCTIONS ON REVERSE through Page - of NAME OF FILER I.D.NUMBER Committee to Elect Kim Nichols for Orange City Council 2014 1368342 CODES: If one ofthe following codes accurately describes the payment, you may enter the node, Otherwise, describe the payment. CW campaign MBR member communications Rm radio airtime and production costs cws campaign consultants mmo meetings and appearances m*z returned ovmmuuxon, CTB contribution (explainnonmonetary)* OFC office expenses SAL campaign workers' salaries cvu civic donations PET petition circulating TEL txvrcable airtime and production costs rIL candidate filing/ballot fees PHm phone banks TmC candidate travel, lodging, and meals nvo fundraising events poL polling and survey research Tma staff/epousetrave|. |muuino, and meals W independent expenditure supporting/opposing others hmn|omy rma pootaoe, delivery and messenger services TeF transfer between committees of the uomo candidate/sponsor LEG legal defense PRO professional services (|000|.accounting) vor voter registration LIT campaign literature and mailings pnr print ads WEB information technology costs (imomet.e-maiV NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D, NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID UNITED STATES POSTAL SERVICE 1075 N. Tustin Street Orange, CA 92863 POST OFFICE BOX RENTAL 133.00 ^ Payments that are contributions o,Independent expenditures must also uesummarized vn aoxeumo D. SUBTO7AL$ 133.00 Schedule E Summary 1.Itemized payments made this period. (include all Schedule Enubhotois).............................................................................................................. $ 133.00 2.Unbemizedpayments made this period ofunder $10O.......................................................................................................................................... $ 215.48 3.Total interest paid this period onloans. (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 $ 348.48 FPPC Form wmpmnumy/0q ppPunm-pmmxe/pl/me:oomAnu-Fppc(8om2,o-37ru —� — -rounded Miscellaneous Increases to Cash nts maybe to whole dollars. from — Jan 1, 2016 SEE INSTRUCTIONS ON REVERSE through June 30, 2016 Page. 6 Of 6 NAME OF FILER I.D. NUMBER Committee to Elect Kim Nichols for Orange City Council 2014 1368342 DATE FULL NAME AND ADDRESS OF SOURCE AMOUNTOF RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT INCREASETOCASH � Attach additional infomnabonmnappropriately labeled continuation sheets. GU8TOTAL$ O Schedule USummary 1. Itemized increases hocash this period . ---------------------------------------..$ u 2. Unitemizedincreases bocash ofunder $100this period ............................................................................................. * 0'01 3. Total ofall interest received this period onloans made hoothers, (Schedule H.Column (e).)................................. $ « 4. Total miscellaneous increases hocash this period. (Add Unoa 1' 2. and 3. Enter here and onthe FPPC Form wmAanuarym ppPcToll-Free xmpmm:unowmm-FpPo(onmu7n-3r,o) FPPC Form wmAanuarym ppPcToll-Free xmpmm:unowmm-FpPo(onmu7n-3r,o)