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Recipient Committee Campaign Statement

Cover Page CA
460
FORM
(Government Code Sections 84200-84216.5)
NAME OF FILER I.D. NUMBER Election Date: Statement Period
Carl J. Petersen for LAUSD School Board 2017 1384794 (Month/Day/Year) from 01/01/2017
03/07/2017
to 01/21/2017
Cover Page

1. Type of Recipient Committee


Officeholder, Candidate Controlled Committee
2. Type of Statement
Pre-Election Statement (Amendment #1)
3. Committee Information
Committee Name : Carl J. Petersen for LAUSD School Board 2017 - 1384794
Committee Address : address redacted
Los Angeles, CA 90063
(818) 869--030
Mailing Address (if different) : address redacted
Los Angeles, CA 90063
Fax Number :
E-Mail Address : ChangeTheLAUSD@gmail.com
Treasurer Name : Cynthia Petersen
Treasurer Address and Phone Number : address redacted
Lake Elsinore, CA 92530
(951) 471-2520
Assistant Treasurer Name :
Assistant Treasurer Address and Phone Number :
Treasurer Fax Number : None
Treasurer E-Mail Address : None
4. Verification
I have used all reasonable diligence and to the best of my know ledge the treasurer has used all reasonable diligence in preparing this statement. I have review ed
the statement and to the best of my know ledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of
perjury under the law s of the State of California that the foregoing is true and correct.
27-Jan-17 Carl Petersen (e-signed)
Executed On: (Date) By: (Signature of Candidate / Officeholder)
27-Jan-17 Cynthia Petersen (e-signed)
Executed On: (Date) By: (Signature of Treasurer)

FPPC Form 460(January/05)


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FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Recipient Committee Campaign Statement
Summary Page CA
460
FORM
(Government Code Sections 84200-84216.5)
NAME OF FILER I.D. NUMBER Election Date: Statement Period
Carl J. Petersen for LAUSD School Board 2017 1384794 (Month/Day/Year) from 01/01/2017
03/07/2017
to 01/21/2017
Sum m ary Page

Contributions Received Column A Column B


(This Period) (Calendar YTD)
1. Monetary Contributions Sched. A, Line 3 $100.00 $100.00
2. Loans Received Sched. B, Line 3 $0.00 $815.00
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $100.00 $915.00
4. Non-Monetary Contributions Sched. C, Line 3 $0.00 $0.00
5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 + 4 $100.00 $915.00
Expenditures Made Column A Column B
6. Cash Payments Sched. E, Line 4 $99.80 $99.80
7. Loans Made Sched. H, Line 3 $0.00 $0.00
8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7 $99.80 $99.80
9. Accrued Expenses (Unpaid Bills) Sched. F, Line 3 $0.00 $0.00
10. Non-Monetary Adjustment Sched. C, Line 3 $0.00 $0.00
11. TOTAL EXPENDITURES MADE Add Lines 8 + 9 + 10 $99.80 $99.80
Current Cash Statement
12. Beginning Cash Balance Prev. Summary, Line 16 $423.89
13. Cash Receipts Col. A, Line 3 $100.00
14. Miscellaneous Increases to Cash Sched. I, Line 4 $0.00
15. Cash Payments Col. A, Line 8 $99.80
16. Ending Cash Balance Lines (12 + 13 + 14) - 15 $424.09
Loan Guarantees Received
17. Loan Guarantees Received Sched. B, Part II $0.00
Cash Equivalents and Outstanding Debts
18. Cash Equivalents $0.00
19. Outstanding Debts Col. B, Lines 2 + 9 $815.00

FPPC Form 460(January/05)


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FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Recipient Committee Campaign Statement
Schedule A CA
FORM
460
Monetary Contributions Received
(Government Code Sections 84200-84216.5)
NAME OF FILER I.D. NUMBER Election Date: Statement Period
Carl J. Petersen for LAUSD School Board 2017 1384794 (Month/Day/Year) from 01/01/2017
03/07/2017
to 01/21/2017
Schedul e A

Schedule A Summary
1. Amount received this period - contributions of $100 or more:
(include all schedule A subtotals) $100.00
2. Amount received this period - unitemized contributions of less than $100: $0.00
3. Total monetary contributions received this period :
(add lines 1 and 2. enter here and on summary page, column A, line 1) $100.00

Schedule A Detail (1 Record)


Date Received Contributor Contributor Occupation and Employer Amount Cumulative Per Election
Code Received this Calendar Y ear To Date
Period (Jan 1 - Dec
31)
01/02/17 Sheridan, Mr. Timothy J Individual Attorney-NFR/AC $100.00 $100.00 $100.00
address redacted NTEU
Lake ELsinore , CA 92532

FPPC Form 460(January/05)


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FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Recipient Committee Campaign Statement
Schedule E CA
FORM
460
Payments Made
(Government Code Sections 84200-84216.5)
NAME OF FILER I.D. NUMBER Election Date: Statement Period
Carl J. Petersen for LAUSD School Board 2017 1384794 (Month/Day/Year) from 01/01/2017
03/07/2017
to 01/21/2017
Schedul e E

Schedule E Summary
1. Itemized payments made this period:(include all Schedule E subtotals) $99.80
2. Unitemized payments made this period of under $100: $0.00
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.) $99.80

Schedule E Detail (3 Records)


Name and Address of Payee Type of Payment Description Amount Paid
(if required)
Litle & Co. Fundraising Events Collection fees $33.80
address redacted
Low ell , MA 01851
Bank of America Office Expenses Monthly bank fees $16.00
address redacted
Northridge , CA 91324
Secretary of State Candidate Filing/Ballot Fees Filing fee $50.00
address redacted
Los A , CA 90013

FPPC Form 460(January/05)


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FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)

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