Type or print in ink. Date Stamp 01101/2014. (Month, Day, Year) For Official Use Only. 09/30/ City Clerk. El Termination Statement

Transcription

1 Recipient Committee Campaign Statement Cover Page (Government Code Sections ) from Type or print in ink. Date Stamp Statement covers period Date election if applicable: OCT RECEVED /2014 (Month, Day, Year) For Official Use Only 09/30/ City Clerk SEE NSTRUCTONS ON REVERSE through City Menlo Park ts Office Page 1. Type Recipient Committee: All Committees Complete Parts 1,2,3, and 4.2. Type Statement: o State Candidate Election Committee Committee [J Semiannual Statement o Recall 0 Controlled El Termination Statement (Also complete Part 5) o Sponsored fl [] Special OddYear Report El Supplemental Preelection Q Sponsored (Also file a Form 410 Termination) Statement Attach Form 495 (ALso CompletePwt6) El General Purpose Committee [] o Small Contributor Committee Officeholder Committee o Political Party/Central Committee 3. Commttee nformation COMMTrEE NAME (OR CANDDATE S NAME F NO Kristin Duriseti For City Council 2014 COMMTtEE) Primarily Formed Candidate? Conwlete Part 7) D. NUMBER Treasurer(s) NAME Amendment (Explain below) OF TREASURER Kristin Duriseti MALNG ADDRESS Officeholder, Candidate Controlled Committee El Primarily Formed Ballot Measure ll Preelection Statement Quarterly Statement STREET ADDRESS (NO CTY P.O. BOX) STATE Menlo Park CA MALNG ADDRESS (F DFFERENT) NO. AND STREET OR P.O. ZP CODE AREA CODE/PHONE BOX CTY STATE Menlo Park CA NAME MALNG OF ASSSTANT TREASURER, F ADDRESS ANY ZP CODE AREA CODEPHONE CTY STATE ZP CODE AREA CODE/PHONE CTY STATE ZP CODE AREA CODE/PHONE OPTONAL: FAX / EMAL ADDRESS OPTONAL: FAX / EMAL ADDRESS 4. Verification have used all reasonable diligence in preparing and reviewing this statement and to the best my knowledge the information contained herein and in the attached schedules is true and complete. under penalty perjury under the a the State California that the foregoing is true and correct. / Executed on Executed on 1 0/5/20 14 Date.., // SlsnatureTresoureroristantTreasurer By Date Slsnature Cordrotltng OWeehotder, Candidate, StateMeasure Proponent or ResponsUe OlficerSponsor certify Executed on uaie By Executed on Date By FP Fo 460 FPPC TollFree Helpline: 8661ASKFPPC ( ) State at California

2 Recipient Committee Campaign Statement CoverPagePart2 Type or print in ink. 1Page 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFCEHOLDER OR CANDDATE Kristin Duriseti OFFCE SOUGHT OR HELD (NCLUDE LOCATiON AND DSTRCT NUMBER F APPliCABLE) Menlo Park City Council Member RESDENTAUBUSNESS ADDRESS (NO. AND STREET) CTY STATE ZP Menlo Park, CA Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURSDCTON El SUPPORT El OPPOSE dentify the controlling ficeholder, candidate, or state measure proponent, NAME OF OFFtEHOLDER, CANDDATE, OR PROPONENT if any. Related Committees Not ncluded in this Statement: List any committees not included this statement that are controlled by you or are primarily formed to rece/ve contributions or make expenditures on behalf your candidacy. n OFFCE SOUGHT OR HELD DSTRCT NO. F ANY COMMTtEE NAME.D. NUMBER NAME OF TREASURER CONTROLLED COMMiTtEE? COMMUEEADDRESS STREETADDRESS (NO P.O. BOX> CTY S1X1E ZP CODE AREA CODE/PHONE COMMTTEE NAME.D. NUMBER NAME OF TREASURER CONTROLLED COMMTTEE? COMMTTEEADDRESS STREETADORESS (NO P.O. BOX) El El YES YES Q [j NO NO 7. Primarily Formed CandidatelOfficeholder Committee Ust names or ficeholder(s) or candidate(s) for which this committee is primarily Formed. NAME OF OFFCEHOLDER OR CANDDATE NAME OF OFFCEHOLDER OR CANDDATE NAME OF OFFCEHOLDER OR CANDDATE NAME OF OFFCEHOLDER OR CANDDATE OFFCE SOUGHT OR HELD OFFCE SOUGHT OR HELD OFFCE SOUGHT OR HELD OFFCE SOUGHT OR HELD El SUPPORT El OPPOSE El SUPPORT El OPPOSE El SUPPORT El OPPOSE El SUPPORT El OPPOSE CTY STATE ZP CODE AREA CODE/P HONE Attach continuation sheets if necessary FPPC Form 460 (JanuayJO5) FPPC TollFree Helpline: 8S6ASKFPPC ( ) State California

3 Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. from Statement covers period 01/ SEE NSTRUCTONS ON REVERSE NAME OF FLER Contributions Received 1. Monetary Contributions Schedule A, TOTALTHSPEROO AT1ACHEDSCHE!YJLES) Line 3 $ 4, $ LENDAR TOTALTODATE 09/30/2014 through Page 4, Loans Received Schedule 8, line 3 4, , SUBTOTAL CASH CONTRBUTONS Add Lines + 2 $ 8, $ 4. Nonmonetary Contributions Schedule 5. TOTAL CONTRBUTONS RECEVED Add Lines 3+4 $ 8, $ C, Line 3 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 8, Contributions 1/1 through 6/30 Received $ $ 21. Expendtures 8, Made $ LD. NUMBER $ 711 to Date Expenditures Made 6. Payments Made Schedule E, line 7. Loans Made Schedule H, 4 Line 3 $ 4, $ 8. SUBTOTALCASH PAYMENTS AddLines6+7 $ 4, $ 9. Accrued Expenses (Unpaid Bills) Schedule 10. Nonmonetary Adjustment Schedule F, C, Line 3 Line TOTALEXPENDTURESMADE AddLines8+9+1O $ $ 4, Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* ( Subjectto Voluntary Expenditure Umit) Date Election Total to Date (mm/dd/yy) $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, line Cash Receipts ColumnA, Line3above 14. Miscellaneous ncreases to Cash Schedule 15. Cash Payments Column 16. END# GCASHBA..ANCE Add Lines , if this is a termination statement, Line 16 must be zero. A,, line 4 Line 8 above then subtract Line LOAN GUARANTEES RECEVED Schedule Cash Equivalents and Outstanding Debts B, $ $ Part 2 $ 18. Cash Equivalents See instructions on reverse 19. Outstanding Debts AddLino 2 +Ljne gin Column B above $ $ 0 8, , , To calculate Column B, add amounts in Column A to the corresponding amounts from Column B your last report Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. f this is the first report being filed for this calendar year, only carry over the amounts from lines 2, 7, and 9 (if any). $ Amounts in this section may be different from amounts reported in Column B FPPC Form 460 (January/06) FPPC TollFree Helpline: 866/ASKFPPC (866/ )

4 Schedule A Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 01/ SCHEDULE A SEE NSTRUCTONS ON NAME OF FLER REVERSE through 09/ Page 1.0. NUMBER Kristin DurisetiFor City Council DATE FULL NAME, STREET ADDRESS AND ZP CODE OF CONTRBUTOR F AN NDMDUAL, ENTER AMOUNT CONTRBUTOR CUMULATVETO DATE PER ELECTON (FCOMMTrER, ALSO RECEVED ENTER NUMBER) OCCUPATON AND EMPLOYER RECEVED THS CODE * CALENDAR YEAR TO DATE (FSELF PLOYED, ENTER NAME PEROD (JAN. 1 DEC. 31) (F REQURED) OFEUSNESS) See Attachment (page lfl ) ENO ECOM L Pm ESCC LuND LCOM QPTY 05CC DND L COM 0 Pm LJSCC LuND OCOM OPTY 08CC DND OCOM 0 Pm 05CC SUBTOTAL $ Schedule A Summary 1. Amount received this period itemized monetary contributions. (nclude all Schedule A subtotals.) $ 2. Amount received this period unitemizeci monetary contributions less than $100$ 3. Total monetary contributions received this period. 4,89.00 (Add Lines and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 4, *Contributor Codes ND ndmdual COM Recipient Committee 0TH Pm SCC (other than Pm or SCC) Other (e.g., business entity) Political Party Small Contributor Committee FPPC Form 460 (JanuarylO5) FPPC TollFree Helpline: 8661ASKFPPC ( )

5 Schedule B Part Loans Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 01/01/2014 SCHEDULES PART SEE NSTRUCTONS ON REVERSE NAME OF FLER Kristin Duriseti For City Council through 09/ Page.D. NUMBER FULL NAME, STREET ADDRESS AND ZP CODE OF LENDER (FCQMMTT ALSO ENTSR ll NUMBER( Kristin Duriseti Menlo Park,CA t ND Q COM [J 0TH Q PV( Q SCC tq ND Q COM Q 0TH Q PTY Q 5CC tq ND Q COM Q 0TH Q PTY Q SCC SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period $ (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period $ (Total Column (c) plus loans under $100 paid orforgiven.) (nclude 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 $ Enter the net here and on the Summary Page, Column A, Line 2. 4, , (May be a negatlea numberj enter (a) on Schedule S Line 3) tcontributor Codes ND lndmdual COM Recipient Committee 0TH (other than PTY or SCC) Other (e.g., business entity) PTV Political Party 5CC Small Contributor Committee [*r1f forgiven or paid by another party also must be reported on Schedule A. ** f required. FPPC Form 460 (JanuarylD5) FPPC TollFree Helpline: 8661ASKFPPC ( )

6 Schedule C Nonmonetary Contributions Received SEE NSTRUcTONS ON REVERSE NAME OF FLER Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period 01/01/2014 from 09/30/2014 through Page 6 LD. NUMBER Kristin Duriseti For City Council ( DATE RECEVED FULL NAME, AMOUNT CUMULATVE STREET ADDRESS TO AND F AN CONTRBUTOR NDVDUAL, ENTER DESCRPTON OF ZP CODE OF CONTRBUTOR CODE * OCCUPATON AND EMPLOYER FAR MARKET DATE GOODS OR SERViCES (F COMMTTEE ALSO ENTER D. NUMBER) (F SaFERPLOVED, ENTER VALUE CALENDAR (EAR NAMEOF BUSNESS) (JAN 1 DEC 31) PER ELECTON TO DATE (F REQURED) 8/21/2014 lld rene Searles Photography rene Searles, Donation, 00Th Photographer, rene hour for taking Menlo Park,CA94025 Searles Photography Photos ESCC 00M EJND QC0M EJOTh LJPTY 08CC QND QCOM QOTH U PTY nscc LuND OCOM EJPTY 0sCc Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ f Schedule C Summary 1. Amount received this period itemized nonmonetary contributions. (nclude au Schedule C subtotals.) $ 2. Amount received this period unitemized nonmonetary contributions less than $100 $ 3. Total nonmonetary contributions received this period. (Add Lines and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) TOTAL $ *Contributor Codes ND lndmdual COM Recipient Committee (other than Ply or 8CC) 0TH Other (e.g., business entity) PTY Political Party SCC Small Contributor Committee FPPC Form 460 (Januarylo5) FPPC TollFree Helpline: 8661ASKFPPC ( )

7 Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars Statement covers period from 01/ SEE NSTRUCTONS ON REVERSE NAME OF FLER through 09/30/2014 Page 1.0. NUMBER Kristin Duriseti For City Council CODES: f one the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. campaign paraphernalia/misc. campaign consultants CM MBR CNS MTG RFD CTB contribution (explain nonmonetary)* OFC fice SAL CVC civic PET petition circulating TEL FL. filing/ballot P10 TRC FND POL polling TRS RD (explain)* delivery TSP LEG legal PRO (legal, VOT LT literature WEB donations candidate fundraising events fees independent expenditure supporting/opposing others campaign defense member communicationsrad radio airtime meetings and appearances returned expenses phone banks P05 postage, and mailingsfrt print and survey research pressional services ads and messenger services accounting) campaign lv. or and production contributions workers airtime production travel, lodging, travel, lodging, cable candidate salaries costs costs and and meals and meals transfer between committees staff/spouse voter registration information technology costs the same candidate/sponsor (internet, ) NAMEANDADORESS OF PAYEE (FCOMMTT ALSO ENTST 1O.NUMBS) CODE OR DESCRPTON OF PAYMENT AMOUNT PAD See Attachment 2 (p ) for Schedule E details Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS Schedule E Summary 1. temized payments made this period. (nclude all Schedule E subtotals.) $ 2. Unitemized payments made this period under $100 $ 3. Total interest paid this period on loans. (Enter amount from Schedule 4. Total payments made this period. (Add Lines 1, B, Part 1, Column (e).) $ 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) TOTAL $ 4, ,97530 FPPC TollFree Helpline: FPPC Form /ASKFPPC (January/05) ( )

8 Kristin Duriseti Campaign 01/01/2014 to 09/30/2014, Schedule A Attachment Date First Name Received Last Name 16Sep Jack 17Sep Kelly 15Sep James 14Sep Brielle 8Sep Steve 14SepJoseph 14Sep Mary 14Sep Kathleen 14Sep Joanna 14Sep James 10Sep Victoria Morris Ferguson Masterson 9Sep 9Sep 7Sep 9Sep 8Sep 8Sep 15Sep 13Sep 18Sep 22Sep 22Sep 22Sep 30Sep 30Sep 30Sep 19Aug 30Sep 20Aug 26Aug John Susan Diane Patricia Amy Scott George Catherine Margaret James Allen Elza Kathryn Charlie Dan Mitchel Heyward Barbara paul Andrew Johnck Schmidt Carcione Kenney Armel Mountain Madison Tregoning Fox Lewis Hart Klein Marshall Fisher Wilson Spak Steck Weiner Keet Henkens Bourne Finlay Slomiak Robinson Kitchen Kuntz Combs Address Page City, State Zip Code Employer Occupation Los Altos Hills, CA ND Civil Engineer Sequim, WA n/a NDJELF ND Palo Alto V.A ND ND n/a ND SELF ND SELF ND Stanford ND 23andMe ND SELF ND SELF M.D Real estate agent Domestic Manager Researcher Scientist Lawyer Therapist n/a Amount Received this Period L ND Stanford Physicist ND n/a ND n/a ND n/a ND Marshall Construction General Contractor ND SELF Attorney ND Frank Piro, MD R.N ND SELF Management Consultant ND Kaiser Physician ND Stanford University Pressor J..!ND n/a ND n/a ND n/a ND SELF General Contractor ND SELF Consulting CFO Scientist ND ND Boeing Engineer ND SELF Journalist ND ioö.äo [ J 2 2 SR n/a so.oo

9 Kristin Duriseti Campaign 01/01/2014 to 09/30/2014, Schedule A Attachment Date First Name Received 26Aug 27Aug 3Sep 8Sep 11Sep 14Sep 18Sep 2 3Sep 30Sep 19Sep Carolyn Gail Lucile lily N Cynthia Lynore Lydia Craig Camille evite Last Name Address Clarke Slocum Spurlock lee DuselBacon Banch f 7 Lewis Townshend Evite Error credited Page City, State Zip Code Employer Occupation Pa1o Alto, CA Menlo_Park, CA, ND Accountant Lawyer Physical Scientist scientist Free lance writer Executive Lawyer Teaching Assistant SELF ND PG&E ND ND ND ND ND JND ND n/a USEPA USGS n/a SELF Clean Coalition Stanford University Amount Received this Period ) Subtotal 30Sep Anonymous (unitemized monetary contribution less than $25) 29Aug Kristin Duriseti ND Stanford University Editor Subtotal LOAN 4, , , TOTAL 8,918.00

10 J, 10/ Kristin Duraseti for City Council for 01/01)2014 through 09/30/2014 Columni Column2 date recipient 8/19/20141 Fedex fice 8/20/2014 USPS 8/21/2014 Fedex fice 8/29/2014 Secretary state 8/21/20141 rene Searles Photography 9/1/2014 Nation Builder 9/1/20141 Fedex fice 9/4/2014 Google 9/4/20141 Copymat 9/3/2014 Menlo Press 9/9/20141 Fedex fice 9/6/2014 Fedex fice 9/6/2014 USPS 9/6/2014 USPS 9)6/2O14jUSPS 9/6/2014 USPS 9/6/20141 JSPS 9/6/2014 USPS 9/7/2014Fedex fice 9/9/2014 COGS (Fred Hummel) 9/9/20141 Fedex fice 9/15/2014 Staples 9/11/2014 Copy Factory Palo Alto 9/15/2014 Walgreens 9/16/20141 Fedex fice 9/18/2014 Copy Factory Palo Alto 9/18/2014 USPS 9/22/2014 Sierra Club 9/22/2014 Copy Factory Palo Alto 9/22/2014 Safeway 9/24/2014 Fedex fice 9/26/2014 Copy Factory Palo Alto 9/29/2014 Copy Factory Palo Alto. Page e Schedule E Attachment Column3 vendor address 1194 El Camino Real, Menlo Park, CA Oak Grove Ave Menlo Park CA El Camirio Real, Menlo Park, CA th Street Sacramento CA Menlo Park, CA S. Hill St. Suite 200, los Angeles, CA Oak Grove Aye, Menlo Park, CA Amphitheatre Parkway Mountain View, CA El Camino Real, Redwood City, CA Oak Grove, Menlo Park, CA Bayshore, Palo Alto, CA E Bayshore Palo Alto CA E Bayshore Palo Alto CA Bayshore, Palo Alto, CA E Bayshore, Palo Alto, CA E Bayshore Palo Alto CA East Orangeburg Aye, Suite 675, Modesto, CA El Camino Real #120, Menlo Park CA El Camino Real, Palo Alto, CA Santa Cruz Menlo Park CA El Camino Real, Palo Alto, CA Oak Grove Aye, Menlo Park, CA E Bayshore Rd. Ste 204 Palo Alto, CA El Camino Real, Palo Alto, CA Middle Avenue, Menlo Park, CA El Camino Real, Palo Alto, CA El Camino Real, Palo Alto, CA Column4 Code or Description j P0 BOX Filing fee Photographies Web Site Domain name for website Envelopes J ] r _ printing Signs Supplies Supplies labels Food ColumnS amount $25.72 $44 00 $59.59 $5000 $4 $19.OQj $38.70 $12.00 $ $ $0.65 $ $24.50 $24 50 $24 50 $24 50 $24.50 $24 50 $64.32 $1, $66.65 $19 19 $ $13 05 $93.89 $ $19.60 $27 15 $ $23 96 $ $ $ f j

11 Kristin Duraseti for City Council for 01 /01/2014 through 09/30/2014 Schedule E Attachment Page date recipient vendor address Code or Description amount 9/30/2014 Fedex fice $ /30/2014 Fedex fice 1194 El Carnino Real, Menlo Park, CA $ /9/2014 Evite 8800 W Sunset Blvd. West Hollywood, CA, Evite Debit Error $ /30/2014 Paypal Fees 2211 North First Street San Jose, CA, Online Payment Fees $ TOTAL 4,975.30