Recipient Committee Date Stamp Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicable: t (Month, Day, Year) from 01/01/2020 SEEINSTRUCTIONSONREVERSE through 01/18/2020 03/05/2020 1. Type of Recipient Committee: AU Committees - Compete Parts 1,2,3, and 4. 2. Type of Statement: [] Officeholder, Candidate Controlled Committee fl Primarily Formed Ballot Measure Preelection Statement Quarterly Statement o State Candidate Election Committee Committee [J Semi-annual Statement fl Special Odd-Year Report o Recall Q Controlled fl Termination Statement Supplemental Preelection (AIsoCompate Part 5) Q Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495 General Purpose Committee U Amendment (Explain below) o Sponsored U Primarily Formed Candidate! o Small Contributor Committee Officeholder Committee o Political Party!Central Committee 3. Committee Information ID. NUMBER Treasurer(s) 1420822 COMMIHEE NAME (OR CANDIDATES NAME IF NO COMMIHEE) NAME OF TREASURER Lori Greene Gordon-Beverly Hills City Council 2020 David Gould MAILING ADDRESS 249 5. Ocean Blvd. Ste 685 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 9663 Santa Monica Blvd. Ste. 1265 Long Beach CA 90802 (213)489—4792 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Beverly Hills CA 90210 (213)429—4792 Ingrid Orellana MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR RO. BOX MAILING ADDRESS 249 5. Ocean Blvd. Ste. 685 249 5. Ocean Blvd. Ste. 685 CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Long Beach CA 90802 Long Beach CA 90802 (213)489—4792 OPTIONAL. FAX / E-MJL ADDRESS OPTIONAL: FAX I E-MAIL ADDRESS (213)489—4818 / votelori2020gixtail.com 4. VerIfication I have used all reasonable diligence in preparing and reviewing this statementand to the best of my knowledge the information containein and in the attached schedules is true and complete. I certify under penalty of penury under the laws of the State of Califomia that the foregoing is true and correct — — - o — Executed ( Date /} — 1\ l.tcjiaaze otTrAatTreaarer Executed on 1 O W By (U Nk AL Date CaiddateatØ46aaij Ruponentor ResporeNe OMcerof Sponsor Executed on By Date SiattreofConfroBr Officeholder, Cactdate, State Measre Proponent Executed on By SigiattreofContiollwej Otticehokier, Caiddate, State Meaare Proponent FP PC Form 480 (Janf2Ol 6) FPPC Advice: [email protected](86675.3772) www.tppc.ca.gov Page 1 of 12 For Official Use Only Date
12
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(U Nk W 1 - City Of Beverly Hills · 2020. 1. 1. · Enter the net here and on the Summary Page, Column A, Line 2. FPPC Form 460 (Jan12016) FPPC Advice: [email protected] (866/275-3772)
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4. VerIficationI have used all reasonable diligence in preparing and reviewing this statementand to the best of my knowledge the information containein and in the attached schedules is true and complete. I certifyunder penalty of penury under the laws of the State of Califomia that the foregoing is true and correct
— — - o —
Executed( Date /} —
1\ l.tcjiaaze otTrAatTreaarer
Executed on 1 OW By (U Nk ALDate CaiddateatØ46aaij Ruponentor ResporeNe OMcerof Sponsor
Executed on ByDate SiattreofConfroBr Officeholder, Cactdate, State Measre Proponent
Executed on BySigiattreofContiollwej Otticehokier, Caiddate, State Meaare Proponent
Recipient CommitteeCampaign StatementCover Page — Part 2
Page 2 of 12
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
tori Greene Gordon
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
City Council Member Beverly Hills: City of Beverly Hills
RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
9663 Santa Monica Blvd. Ste. 1265 Beverly Hills CA 90210
BALLOT NO. OR LEHER JURISDICTION LI SUPPORT
[1 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: Listany committeesnot included in this statement that are controlled by you or are primarily formed to receivecontributions or make expenditures on behalf of your candidacy.
Lan Greene Gordon-Beverly Fulls City Council 2020 1420822
Column A Column B Calendar Year Summary for CandidatesContributions Received TOTALThIS PERIOD CALENDARYEAR(FROMATTACHEDSCHED4]LES) ToTLToDATe Running in Both the State Primary and
General Elections1. Monetary Contributions ScheduleA, line 3 $ 2, 950.00 $ 2,950.00
1/1 through 6/30 7/1 to Date2. Loans Received ScheduleB,line3 5,000.00 20,550.00
4. Nonmonetary Contributions Schedule C, line 3 0.00 0.0021. Expenditures
5. TOTALCONTRIBUTIONS RECEIVED Addlines3+4 $ 7,950.00 $ 23,600.00 Made $ $
$ 15,852.26 $ 15,852.26
0.00 0.00
$ 15,852.26 $ 15,852.26
—3,378.36 0.00
0.00 0.00
$ 12,473.90 $ 15,852.26
$ 10,669.28
7,950.00
0.00
15, 852.26
$ 2,767,02
17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $ 0.00
To calculate Column B, addamounts in Column A to thecorresponding amountsfrom Column B of your lastreport. Some amounts inColumn A may be negativefigures that should besubtracted from previousperiod amounts. If this isthe first report being filedfor this calendar year, onlycarry over the amountsfrom Lines 2, 7, and 9 (ifany).
01/07/2020 Rochelle Maize jlND Real Estate Wealth Adviso 450.00 450.00514 N. Alta Dr. COM NourmandBeverly Hills, CA 90210 Received through inte ediary:.....0TH erundraising Connecti
E PlY 2831 0 St. Ste. 120Sacramento, CA 90816
LI 5CC01/11/2020 Rose Cheung JlND Bus Executive 450.00 450.00
1545 Carla Ridge Multi PropertiesBeverly Hills, CA 90210 Received through into ediary:
LI 0TH etundraising Connecti is
E] o-ry 2831 G St., Ste. 120Sacramento, CA 95816
LI 5CC01/11/2020 Stave Wong jlND Retired 450.00 450.00
1545 Carla Ridge RetiredBeverly Hills, CA 90210 COM
Received through inte .:ediary:LI 0TH eruodraising Connecti is
LI OTV 2831 G St., Ste. 120Sacramento, CA 95816
LI SCC
SUSTOTAL$ 2 250 001
Schedule A Summary1. Amount received this period — itemized monetary contributions.
(Include all Schedule A subtotals.) $ 2, 950.00
2. Amount received this period — unitemized monetary contributions of less than $100 $ 0.00
3. Total monetary contributions received this period.(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 2,950.00
Schedule AMonetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
Amounts may be roundedto whole dollars.
Statement covers period
from 01/01/2020
through 01/18/2020 Page 4 of 12
*ContribUtor Codes
IND— IndividualCOM — Recipient Committee
(other than PlY or SCC)0TH — Other (e.g., business entity)Ply—Political PartySCC — Small Contributor Committee
FPPC Form 460 fJan12016)FPPC Advice: advicefppc.ca.gov (8661275-3772)
www.fppc.ca.govwww.netfile.com
NAMEOFFILER ID.NUMBER
Lori Greene Gordon-Beverly Hills City Council 2020 1420822
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTORIF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
9FCOMMITTSE.ALSOENTERID NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATERECEIVED CODE *
01/13/2020 Marc Teren lND CEO 250.00 250.00213 South Reeves Drive Divy, Inc.Beverly Hills, CA 90212 LICOM
Received through inte mediary:LI 0TH eFundraising Connecti Os
LI pj-y 2831 G St., Ste. 120Sacramento, CA 95816
LI SCC
01/16/2020 Gavin Polone FJIND Film producer 450.00 450.001975 Carla Ridge
LICOMGavin Polone
Beverly Hills, CA 90210 Received through inte mediary:LI 0TH eFuodzaising Cormecti Os
LI Ply 2831 0 St., Ste. 120Sacramento, CA 95816
LI SCC
LI IND
LI COM
LI 0TH
LI PlYLI 5CC
LI ND
LI COM
LI 0TH
LI PTYLI 5CC
LI ND
LI COM
LI 0TH
LIPTYLI 5CC
FPPC Form 460 (JanI2016)FPPC Advice: advicefppc.ca.gov (8661275-3772)
www.fppc.ca.gov
Monetary Contributions Received Amounts may be roundedto whole dollars.
Schedule A (Continuation Sheet) SCHEDULEA (CONT.)
Statement covers period
frnm 01/01/2020
through 01/18/2020 Page of 12
eContributor Codes
ND— Individual
COM - Recipient Committee
(other than PlY or SCC)0TH — Other (e.g., business entity)
PlY — Political Party
5CC — Small Contributor Committee
SUBTOTALS 700.001
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SCHEDULE B - PART 1
Amounts may be roundedto whole dollars.
Schedule B Summary
1. Loans received this period $(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period $(Total Column (c) plus loans under $100 paid or forgiven.)(Include 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.
FPPC Form 460 (Jan12016)FPPC Advice: [email protected] (866/275-3772)
www.fppc.ca.gov
Schedule B — Part ILoans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Lori Greene Gordon-Beverly Hills City Council 2020
FULL NAME, STREET ADDRESS AND ZIP CODEOF LENDER
(IF COMMIUEE, ALSO ENTER tO, NUMBER)
Statement covers period
from 01/01/2020
through 01/18/2020
r”L;iii
Page 6 of 12
ID. NUMBER
IF AN INDIVIDUAL, ENTEROCCUPATION AND EMPLOYER
(IF SELF.EMPLOYED, ENTERNAME OF BUSINESS)
Lori Greene Gordon Conmerical Real Estate9663 Santa Monica Blvd. Ste. 1265 OwnerBeverly Hills, CA 90210 Lori Greene Gordon
“JXJ IND COM t: 0TH fl Pm’ f SCC
Lori Greene Gordon9663 Santa Monica Blvd. Ste. 1265Beverly Hills, CA 90210
t] IND Q COM Q 0TH Q Pm’ Q SCC
1420822
Lori Greene Gordon9663 Santa Monica Blvd. Ste. 1265Beverly Hills, CA 90210
t1] IND Q COM Q 0TH Q Pm’ Q SCC
(Enter(e) onSchedule E, line 3)
5,000.00
forgiven or paid by another party also must be reported on Schedule A.If required.
0.00
tContributor Codes
ND— IndividualCOM — Recipient Committee
(other than PTY or SCC)0TH — Other (e.g., business entity)PTY — Political PartySCC — Small Contributor Committee5.000. 00
(May be a negauve number)
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SCHEDULE B - PART 1 (CONTJ
Schedule B — Part I (Continuation Sheet)Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Lori Greene Gordon-Beverly Hills City Council 2020
FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER
OF LENDER OCCUPATION AND EMPLOYER(IF SELF-EMPLOYED, ENTER
(iF COMMITTEE. ALSO ENTER CD. NUMBER> NAME OF BUSINESS)
Lan Greene Gordon Commenical Real Estate9663 Sante Monica Blvd. Ste. 1265 OwnerBeverly Hills, CA 90210 Lori Greene Gordon( LOAN)
t] IND fl COM fl 0Th D Pm’ D SCC
Amounts may be roundedto whole dollars.
I.D. NUMBER
tQ IND COM jJ 0TH Q PTY Q SCC
t0 IND Q COM Q 0TH Q PTY fl SCC
Q IND Q COM Q 0TH Q Pm’ Q SCC
FPPC Form 460 (Jan12016)FPPC Advice: advicetfppc.ca.gov (8661275-3772)
www.fppc.ca.gov
Statement covers period
from 01/01/2020
through 01/18/2020 Page 7 of 12
1420822
forgiven or paid by another party also must be reported on Schedule A.If required.
tContnbutor Codes
IND — IndividualCOM — Recipient Committee
(other than PTY or SCC)0TH — Other (e.g., business entity)PTY — Political PartySCC — Small Contributor Committee
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Schedule E Summary
Amounts may be roundedto whole dollars.
1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 15, 852.26
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.) TOTAL $ 15,852.26
FPPC Form 460 (Jan!2016)FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
www.fppc.ca.gov
Schedule EPayments Made
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 01/01/2020
through 01/18/2020 Page 8 of 12
NAME OF FILER ID. NUMBER
Lori Greene Gordon-Beverly Hills City Council 2020 1420822
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs
CNS campaign consultants MTG meetings and appearances RFD returned contributionsCTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers’ salariesCVC civic donations PET petition circulating TEL t.v. or cable airtime and production costsFIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and mealsEND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and mealslF’D independent expenditure supporting/opposing others (explain)* P05 postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsorLEG legal defense PRO professional services (legal, accounting) VOT voter registrationLIT campaign literature and mailings PRT print ads ‘NEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE(tF COMMFTTEE.ALSO ENTER ID, NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
GOULD & ORELLANA, LLC PRO 300.00249 E. Ocean Blvd., Ste.685Long Beach, CA 90802
Dan Siwulec Communications Marketing, Inc. LIT 4,981.1215135 W. Sunset Blvd., Ste. 240Pacific Palisades, CA 90272
eFundraising Connections CMP Credit Card Processing Fee 20.752831 G St., Ste. 120Sacramento, CA 95816
Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,301.87
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FPPC Form 460 (Jan12016)FPPC Toll-Free Helpline: 866IASK-FPPC (86612753772)
www.fppc.ca.gov
Schedule E(Continuation Sheet)Payments Made
SEE INSTRUCTIONS ON REVERSE
Amounts may be roundedto whole dollars.
SCHEDULE E (CONT.)Statement covers period
from 01/01/2020 4L I
through 01/18/2020 Page 9 of 12
NAME OF FILER CD. NUMBER
Lori Greene Gordon-Beverly Hills City Council 2020 1420822
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.avF campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costsCNS campaign consultants MTG meetings and appearances RFD returned contributionsCTB contribution (explain nonmonetary) OFC office expenses SAL campaign workers salariesCVC civic donations FET petition circulating TEL tv. or cable airtime and production costsFIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and mealsFND fundraising events POt. polling and survey research TRS staff/spouse travel, lodging, and mealsND independent expenditure supporting/opposing others fexplain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsorLEG legal defense PRO professional services (legal, accounting) VOT voter registrationLIT campaign literature and mailings PRt print ads WEB information technology costs (internet, e-mail)
(IF RN R)CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
American Express CMP Credit Card Payment 3,378.36P0 Box 0001Los Angeles, CA 90096-8000
Simon’s Catering FND Fundraising Event Catering 4,780.00226 S. Carson Rd.Beverly Hills, CA 90211
eFundraising Connections CMP Credit Card Processing Fee 20.752831 G St., Ste. 120Sacramento, CA 95816
eFundraising Connections CM? Credit Card Processing Fee 20.752831 G St., Ste. 120Sacramento, CA 95816
Educate Your Vote (ID# 1345655) Slate Mailer Payment 420.0016633 Ventura Blvd., Ste. 1008Encino, CA 91436
Payments that are contributions or independent expenditures must also be summarized on ScheduleD. SUBTOTAL $ 8, 619.86
www.neffile.com
FPPC Form 460 (Janl2016)FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
www.fppc.ca.gov
Schedule E SCHEDULE E (CONT.)
(Continuation Sheet) Amounts may be roundedStatement covers period ij •.jieY [jij
Payments Made towholedollars.from 01/01/2020 II
SEEINSTRUCTIONSONREVERSEthrough 01/18/2020 Page 10 of 12
NAME OF FILER I.D.NUMBER
Lori Greene Gordon-Beverly Hills City Council 2020 1420822
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.OvP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costsCNS campaign consultants MTG meetings and appearances RFD returned contributionsCTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers’ salariesCVC civic donations FEt petition circulating TEL t.v. or cable airtime and production costsFIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and mealsFND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and mealsIND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsorLEG legal defense PRO professional services (legal, accounting) VOT voter registrationLIT campaign literature and mailings PRt print ads VvEB information technology costs (internet, e-mail)
(lFcoMMrrrEE,ALS0ENTERID NUMBER)CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
eFundraising Connections CMP Credit Card Processing Fee 53.252831 G SC., Ste. 120Sacramento, CA 95816
COGS South Signs LIT 1,220.283309 S. Main St.Santa Ana, CA 92707
Budget Watchdogs fID# 1345115) Slate Mailer Payment 657.0022410 Hawthorne Blvd., Suite 5Torrance, CA 90505
Payments that are contributions or independent expenditures must also be summarized on Schedule D SUBTOTAL $ 1, 930 .53
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SCHEDULE F
Schedule FAccrued Expenses (Unpaid Bills)
NAME OF FILER
OwCNSCTBCvCFILFNDNJLEGLir
(a) fb) (c) (d)NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING
(IF COMMITTEE. ALSO ENTER ID NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSEOF THIS PERIOD (ALSO REPORT ONE) OF THIS PERIOD
* Payments that are contributions or independent expenditures must also beSUBTOTALS $ 3, 378 .3 6$ 0 .00 $ 3, 378 . 36$ 0 00summarized on Schedule 0.
Schedule F Summary1. 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 $100.) INCURRED TOTALS $ 0.00
2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments onaccrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) PAID TOTALS $ 3,378.36
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here andon the Summary Page Column A, Line 9.) NET $ 3,378.36
May be a negative number
FPPC Form 460 (Jan12016)FPPC Toll-Free Helpline: 866!ASK-FPPC (8661275-3772)
www.fppc.ca.gov
SEE INSTRUCTIONS ON REVERSE
Amounts may be roundedto whole dollars.
Lori Greene Gordon-Beverly Hills City Council 2020
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.campaign paraphernalia/misc.campaign consultantscontribution (explain nonmonetary)cMc donationscandidate filing/ballot feesfundraising eventsindependent expenditure supporting/opposing others (explain)*legal defensecampaign literature and mailings
MBR
OFCPETPoPOLPOSPPOPRT
member communicationsmeetings and appearancesoffice expensespetition circulatingphone bankspolling and survey researchpostage, delivery and messenger servicesprofessional services (legal, accounting)print ads
RADRFDSALTELTRCTRSTSFvolWEB
radio airtime and production costsretumed contributionscampaign workers’ salariestv. or cable airtime and production costscandidate travel, lodging, and mealsstaff/spouse travel, lodging, and mealstransfer between committees of the same candidate/sponsorvoter registrationinformation technology costs (internet, e-mail)
Payments Made by an Agent or Independent Amounts may be rounded Statement covers period
Contractor (on Behalf of This Committee)to whole dollars. from 01/01/2020 [ji]
SEEINSTRUCTIONSONREVERSEthrough 01/18/2020
Page 12 of 12
NAME OF FILER ID. NUMBER
Lori Greene Gordon-Beverly Hills City Council 2020 1420822
NAME OF AGENT OR INDEPENDENT CONTRACTOR
Dan Siwulec Communications Marketing, Inc.
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.QvF campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costsCNS campaign consultants MTG meetings and appearances RFD returned contributionsCTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers’ salariesCVC civic donations PET petition circulating TEL tv. or cable airtime and production costsFIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and mealsFND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and mealsIF’JJ independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsorLEG legal defense PRO professional services (legal, accounting) VOT voter registrationLIT campaign literature and mailings P print ads WEB information technology costs (internet, e-mail)
Payments that are contributions or independent expenditures must also be summarized on ScheduleD.
NAMEAND ADDRESS OF PA’EE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
US Postal Service POS 1,810.967001 S. Central Ave.Los Angeles, CA 90052
Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 1,810.96
* Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent orindependent contractor as reported on Schedule E.
FPPC Form 460 (Jan/2016)FPPC Advice: advicefppc.ca.gov (866/275-3772)