Campaign Statements - Carlson

8/8/2019 Campaign Statements - Carlson

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City of Los AltosFPPC CAMPAIGN DISCLOSURE STATEMENT

Name of Committee: Nancy M Carlson

Treasurer: Ted Forsman

DISCLAIMER:

The information contained in these pages is information as submitted by the candidates to the CityClerk as required by the Political Reform Act of 1974 (amended). The City Clerk does not certify thaccuracy of any information contained in these pages.



Recipient CommitteeType or print in ink.

2:

Date Stamp

2010 ocr -I

CITY CL E ~ " ' S I ' i I F

Campaign StatementCover Page(Government Code Sections 84200-84216.5)

Statement covers period

from 07/01/2010

through 09/30/2010EE INSTRUCTIONS ON REVERSE

1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4.

o Officeholder, Candidate Controlled Committee o Primarily Formed Ballot Measure

o State Candidate Election Committee Committeeo Recall o Controlled(AlSO Complere ParT 5) o Sponsored

(AlSO Complete Part 6)

o General Purpose Committee

oSponsored \Zl Primarily Formed Candidate/

o Small Contributor Committee Officeholder CommitteeIAlso Complete Part T}o Political Party/Central Committee

1.0. NUMBER3. Committee Information

1330148COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)

NANCY CARLSON FOR CITY COUNCIL 2010

STREET ADDRESS (NO P.O. BOX)

981 Thatcher Drive

CITY STATE ZIP CODE AREA CODE/PHONE

Los Altos CA 94024 650-255-1435

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

CITY STATE ZIP CODE AREA CODE/PHONE

OPTIONAL: FAX / E-MAIL ADDRESS

nmcarlsonO [email protected]

Date of election if applicable:

(Month, Day, Year)

11/02/2010

2. Type of Statement: I I ".:.., z " ~ ! F C '

I;zI Preelection Statement o Quarterly St

o Semi-annual Statement o Special OddU Termination Statement o Supplemen

(Also file a Form 410 Termination) Statement -

o Amendment (Explain below)

Treasurer(s)

NAME OF TREASURER

Ted Forsman

MAILING ADDRESS

501 San Felicia Way

CITY STATE ZIP CODE

Los Altos CA 94022 NAME OF ASSISTANT TREASURER, IF ANY

Nancy Carlson

MAILING ADDRESS

981 Thatcher Drive

CITY STATE ZIP CODE

Los Altos CA 94024

OPTIONAL: FAX / E-MAIL ADDRESS

[email protected]

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 schedul es is tr

under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

09/27/2010Executed on

DaleBy \1 ~ : A : ~ t ~ T - ~ _ ~ _ ' ~ _ : T ~ _ ~ ~ ~

09/27/2010Executed on By ~ ' __ . Y ~ _ ~ } J . J 9 : ' ¥ ~ ......<; u •••,._nu. _ " , . ~ " __.. 'o __

Date

Executed on

By rtDate Sigture of Controlling Officeholder. Candidate, State Measure Proponent

Execu1ed onDal. By - - - - - - - - - , ; S " . i g . , . , n a : : - ' u - : r e , . . . o 7 . f c ~ o , . , . n " ' t r o " ' l I i . , . , n g : - ; O f f i = c e : - : h , . , . o l ; : ; - d . : c : r . ' C : : - a n " " d : : : l d ; : : a l : : - e , - ; : S " ' t a " ' , e " : ' M : : : e - a s - u r e = p - ' r o - p : C : " " ------

FPPC Toll-Free Helpline:



Type or print in ink.

Recipient CommitteeCampaign StatementCover Page - Part 2

5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee

NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE

Nancy Carlson

BALLOT NO. OR LETTER JURISDICTIONOFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)

City Council Member Los Altos

RESIDENT IAl/BU SINESS ADDRESS (NO. AND STREET) CITY STATE ZIP

981 Thatcher Drive Los Altos, CA 94024Identify the controlling officeholder, candidate, or state me

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.

OFFICE SOUGHT OR HELD DISTRIC

COMMITIEE NAME 1.0. NUMBER

NAME OF TREASURER CONTROLLED COMMITTEE?7. Primarily Formed Candidate/Officeholder Committ

officeholder(s) or candidate(s) for which this committee is primari

DYES o NO

COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)

CITY STArE ZIP CODE AREA CODE/PHONE

COMMITTEE NAME '1.0. NUMBER

NAME OF TREASURER CONTROLLED COMMITTEE?

DYES o NO

COMMITTEE ADDRESS STREET ADDRESS (NO PO. BOX)

NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR




CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessa

FPPC Toll-Free Helpline:



Type or print in ink.Campaign Disclosure StatementAmounts may be rounded

Statement covers periodCAummary Page to whole dollars.

from 07/01/2010

SEE INSTRUCTIONS ON REVE':lSE

NAME OF FILER


I through

133

09/30/2010 IPag

ID.

Contributions ReceivedColumnA

TOTAL THIS PERIOD

(FROM ATTACHED SCHEDULES)

ColumnBCALENDAR YEAR

TOTAl TO DATE

Calendar Year Summary

Running in Both the Sta

1. Monetary Contributions . Schedule A. Line 3 $ 750 $ 750General Elections

2. Loans Received. . . Schedule B. Line 31915.18 1915.18

1/1 through

Add Lines 1 + 2

Schedule C, Line 3

3. SUBTOTAL CASH CONTRIBUTIONS .

4. Nonmonetary Contributions .

$2665.18

o$

2665.18

o

20. ContributionsReceived $

21. Expenditures

5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 + 4 $2665.18

$2665.18 Made $

Add Lines 6 + 7

Schedule E. Line 4

Schedule H, Line 3

8. SUBTOTAL CASH PAYMENTS ..

9. Accrued Expenses (Unpaid Bills) . Schedule F. Line 3

10. Nonmonetary Adjustment SchedufeC.Line3

11. TOTAL EXPENDITURES MADE.. . . . . . Add Lines 8 + 9 + 10

Expenditures Made6. Payments Made.

7. Loans Made . .

o

o

o

1745.79

1745.79

1745.79$

$

$

o

o

o

1745.79

1745.79

1745.79

$

$

$

Date of Election

(mm/dd/yy)

22. Cumulative Ex(If Subject to Volunb

------l--l__

Expenditure Limit Summ

Candidates

F

FPPC Toll-Free Helpline: 86

'Amounts in this section may be

reported in Column B.

. Add Lines 12 + 13 + 14. then subtract Line 15

Column A. Line 8 above

Schedule I Lme 4

Column A, Line 3 above

Previous Summary Page. Lme 16

If this is a termination statement, Line 16 must be zero.

16. ENDING CASH BALANCE ..

Current Cash Statement

12. Beginning Cash Balance ..

13. Cash Receipts .

14. Miscellaneous Increases to Cash __ .

15. Cash Payments ....

o

919.39

o

1745.79

2665.18

$

$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).

Schedule B. Part 27. LOAN GUARANTEES RECEiVED . o$

Cash Equivalents and Outstanding Debts

18. Cash EquivalentsSee

instructions on reverse

Add Line 2 + Line 9 in Column B above9 Outstanding Debts .

o

1915.18

$

$



Schedule A Type or print in ink.

Amounts may be roundedStatement covers periodMonetary Contributions Received to whole dollars. CA

from 07/01/2010

SEE INSTRUCTIONS ON REVERSE

NAME OF FILER


through 09/30/2010 Pa

I.D.

133

MOUNT CUMULATIVE TO DATEF AN INDIVIDUAL. ENTERFULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ICONTRIBUTORDATE ECEIVED THIS CALENDAR YEARCCUPATION AND EMPLOYER(IFCOMMITIEE.ALSOENTER1.D.NUMBER) CODE *RECEIVEDIF SELF·EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31)

OF BUSINESS)

hZllNO

oCOM Retired 508/26/2010 $50DOTH

oPTY

o s e e

~ I N O oeOM Self employed $5050 8/24/2010DOTH NCL AssociatesoPTY

osee

\;ZJ INO

OCOM General Manager 1001008/26/2010DOTH Monumental VenturesoPTY

OSCC

{llINO

oeOM CFO 1001008/30/2010DOTH Coast RVoPTY

osee

blIlNOJohn and Dani Thompson Vice PresidenteO M 100100

DOTH Intero Real EstateOPTY

o s e e

09/14/2010

Schedule A Summary -Cuntribulo

1. Amount received this period - itemized monetary contributions.(Include all Schedule A subtotals.) $

$750_

IND-Indiv

COM - Re(ol

2. Amount received this period - unitemized monetary contributions of ess than $100 $ $0OTH - OtPTY - Pol

3. Total moneta ry contributions received this period. $750 sc e - Sm

(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ _FP




Schedule A (Continuation Sheet) Type or print n ink.

Amounts may be rounded Statement covers periodonetary Contributions ReceivedCAo whole dollars.

from 07/01/2010

through 09/30/2010 Pa

NAME OF FILER I.D

NANCY CARLSON FOR CITY COUNCIL 2010 13

MOUNT CUMULATIVE TO DATF AN INDIVIDUAL, ENTERFULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ICONTRIBUTORDATE ECEIVED THIS CALENDAR YEARCCUPATION AND EMPLOYER(IF COMMITIEE.ALSO ENTER I.D. NUMBERj CODE *RECEIVED (IF SELF·EMPLOYED. ENTER NAME

ERIOD (JAN. 1 • DEC 31)OF BUSINESS)

IllINDWilliam and Maria Lonergan OCOM

09/20/2010DOTH

DPTY

DSCC

IllIND

OCOM09/21/2010

DOTH

DPTY

Dscc

IllIND

DCOM08/3012010

DOTH

DPTY

Dscc

Software Sales100100OfferPal, Media

Product Designer150150Apple, Inc.

Vice President, Sales100100SAP America

OINDDCOM

DOTH

DPTY

Dscc

DiND

DCOM

DOTH

DPTY

oscc

SUBTOTAL$ $350 I

'Contributor Codes

IND -Individual

COM - Recipient Committee

(other than PTY or SCC)

OTH - Other (eg., business entity)PTY - Political Party

FPSCC - Small Contributor Committee




Schedule B - Part 1Loans Received

Type or print in ink.

Amounts may be rounded

to whole dollars.

Statement covers period

from 07/01/2010CAL

SEE INSTRUCTIONS ON REVERSE through09/30/2010 Page

NAME OF FILER I.ID. N

NANCY CARLSON FOR CITY COUNCIL 2010 1330

0'(b)- - -

(d) tel-

(e)OUTSTANDING AMOUNT AMOUNT PAID

OUTSTANDING INTEREST ORBALANCE

RECEIVED THISBALANCE AT PAID THIS AMO

BEGINNING THIS OR FORGIVEN C L O ~ ~ 9 ~ ~ H I SpFRlon

PERIODTHIS PERIOD' P RI

PERIOD L

o PAID

0$

313.58 _0_,, $3

-o FORGIVEN

RATE

0 I 313.58 I 0 0 085

DATE DUE DATE

o PAID

0S

1401.60 _0_% 5 1-

RATE FORGIVEN

0 I 1401.60 I 0 0 08- 5

DATE DUE DATE

o PAID

0S

200.00 _0_% S-RATE

FORGIVEN

0 I 200.00 I 0 - 0 08

IF AN INDIVIDUAL. ENTER

OCCUPATION AND EMPLOYER

(IF SELF-EMPLOYED. ENTER

NAME OF BUSINESS)

RealtorIntero Real Estate



FULL NAME. STREET ADDRESS AND ZIP CODE

OF LENDER

(IF COMMITTEE. AlSO ENTER I D NUMBER)

Nancy Carlson

tlilJ IND 0 COM DOTH 0 PTY 0 SCC

tGll IND 0 COM DOTH 0 PTY 0 SCC

Nancy Carlson

tlilJ IND 0 COM DOTH 0 PTY 0 SCC I I I I I DATE DUE I I DATE

SUBTOTALS $ $ $ $ I'(Enlerle)m

SchedlJIAE.L""3)Schedule 8 Summary

1915.181. Loans received this period .. _ $

(Total Column (b) plus unitemized loans of ess than $100.)

o2. Loans paid or forgiven this period _ $

(Total Column (c) plus loans under $1 00 paid or forgiven.)

(Include loans paid by a third party that are also itemized on Schedule A.)

1915.183. Net change this period. (Subtract Line 2 from Line 1.) NET $

(May be a negative number)

Enter the net here and on the Summary Page, Column A, Line 2.

tContribu

IND -Indi

COM - R(o

OTH - OPTY - PoSCC - Sm

'Amounts forgiven or paid by another party also must be reported on Schedule A.

" tf required. FP




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Campaign Statements - Carlson