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020122 Form 460 Hertz 2020Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE 1. Tyne of Recipient Committee: Alt Comm ppiceaolder, Candidate Controlled Commtttee U State Candidate Macaw Commrttee 0 Racal( ova caapaa PM a [ eneral Purpose Committee Sponsored Smalf Contributor Committee PoIrtcI Pamir/Central Ccrnrntttee mmiftee information ent covers period froin 21122/ through 1131/22 s — Complete Paris Z 3, end 4, Pamtwily Formed Ballot Measure ppmmittee Controtled Sponsared taut aut 23 Primarily Formed Candidate/ Officeholder Committee COMpilk Pad 7; Data oekvton II applicable: (Month, Day, Year) 11/3/2020 Type of fttaMment: Preelection Statement Si semi-annual Statement L Termination Statement (Also file a Form 410 Termination) D Amendment (Explain below) Puna PAGE CAL-IFOI'ZNIA 46 (:) FORIN4 0-108 0 2022 For Official Use Only Quartet( staternem Special Oddcaear Report LD„ NUMBER 1432333 COMMITTEE NAME (OR CANDIDATE'S, NAME IF NO COMMITTEE Anne Hertz for Cypress City Council 2020 STREET ADDRESS tN0 Mo Box) sum zit(' coou rats CA 9063o MAILING AD SG OF DIFFERENT) 4 AND STREET au ao_ BOX CITY FarioNata FAX( E-MAIL ADDRESS arine,hertz@verizon,net 4. Verification STATE ZIP CO ARE, CODE/PHONE ANFA ODE/PHONE Treasureps) NAM TREASURER f esus Mailar chat Croress NAME OF ASSISTANT TREASURER, IF ANY Itla A FZESS ITY OPTIONAL, Fax f E-MAIL AMP ESs naanarivai@yaapaconu &TATE ZIP CODE I have used all reasonable diligence In preparing and reviewing this statement and to the best of rn certify under penalty of perjury under the laws of the State of California that the foregoing is true a Executed on 2/1/22 By Data 2/1/22 Executed or Executed on Executed on Date Dale AREA CODE/PHONE knowledge the information contained herein and in the attached schedules is true and compete. t BY Sfredito or .rom By By r or lard ter o Cs I ate Mewed Ftecottact or R ottsifiu Oftser of and ate, to enteure nopenote abnaiure of ControNeto tothoMett, Candedele, Male Mettonme PlOpa nelt FPPC Farm 460 (Jan/2016)) FPPC Advice: advice IF fppc,ca.gov (866/275.3772) www.fppc.ca.gov Recipient Cormitt Campaign Statement Cover Pogo Part 2 6. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR GAN DIDATE Anne Hertz . . OFFt VCIJOHT OR HELD (INCLUDE LOCATION AND ISTfTICT NUMBER IF APP Cypress City Council RESIDENT)ALMUSINESS ADDRESS (NO, AND STREET) CITY C ress CABLE) STATE ZIP CA 90630 Related Committees Not Included in this Statement: Mr any committees not included in this statement that are c trotted by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME NAME OF TREASURER COMMITTEE ADDRESS STREET ADDRESS CITY LET '4 WLIED CONTROLLED COMMITTEE? El YES NO NOPO BOX) STATE ZIP CO E RE/C0 Nam) NE COMMITTEE NAME NAME OF TREASURER CoMMMTEE ACIDNESS CITY NG NUMBER STROLLED DoMENTY E E YES No STREET ADDRESS (NO PO. BOX) STATE 2IP CODE AREAC DE/PRONE 6. Pdmarily Fo ed Ballot Measure Committee NAME OF BALLOT MEASURE A HT No, CR LETTER JURiSDICTION COHEN PAGE - RANT CALIFORI'.11A 6'0 4 FORM lj SUPPORT OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, it any. NAME OF OFF EINOLDER, CANDIDATE, OR PR oPONENT OFFICE SOUGHT OR HELD (=TRICE' NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed, NAME OF OFFICEHOLDER Of2 CANDIDATE NAME OF FFICEHOLDER OR CANDIDATE NAME OF OFFICEHOLDER CR CANDIDATE NAME OP OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD OFFICE SOUGHT OR HELD ERICH SOUGHT DR HELD PRIGS &WHITT OR Hz Attach continuation sheets if necessary FPPC Advice: advice LJ SUPPORT PPOSE Ej SUPPORT 0 OPPOSE El SUPPORT El DEPOSE SUPPORT OPPOSE FPPCIo (Jan/2016) fppc.ca.gov (866/275-3772) www.fppc.c&gov Campaign Disclosure Statement Summary Page SEE 66STRUCTIONS ON REVERSE NAME SE S1LER Anne Hertz for Cypress City Council 2020 Contributions Received 1. Monetary Coraributione,..„,.„,,_ .....,,. 2. Loans 3, SUBTOTAL CASH CONTRIBUTIONS. Nonmonetary09 5. TOTAL CONTRIBUTIONS RECEIVED Expenditures Made id, SUBTOTAL CASH PAYMENTS ,,„...... --------- 9, Accrued Expenses (thwaid _ 10i Nonmonetary Adjustment 11. TOTAL EXPENDITURES MADE Schedule E Ley 3 Schedule a, Lele Add Lines I + 2 Schedule C, Line 3 __Add Lines 3 + 4 Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SOFSEAluTTISE 0 0 0 Schedule E, Line 4 $ Schedule H, Line 3 ,„ Add Uses 6 s 7 $ ,...Scheeiste F. Line 3 Schpeels C, LOA, 3 Add UM'S 8 d 9 ± 10 $ Current Cash Statement 12, Beginning Cash Mance Preeides smertere Page Line 16 $ 13, Cash Receipts coo= A, Line 3 above 14, Miscellaneous Increases to Cash sairadmir Line 4 'I& Cash Payments, Cohens A, See essays 16, MING CAM BALANCE „bind...L..8dd Limn 12 id 14, then subtract Lens /5 $ if Ws is a termination statement Line le Must be dem 0 0 4958 0 4958 1T. LOAN GUARANTEES RECEIVED., „ Saurus a Cash Equivalents and Outstanding Debts Cash see instructions on MOSSO Add the 2 + Line 9 in Cofume shove 8 0 0 Statement covers period from 7/212021 thro Salaam B cri Ham YEAS' TOTAL TO DATE 0 0 To calculate Column 8, add amounts in Column Ata the corresponding amounts from Column B of your last report. Some amounts in Colurnr A may be negative figures that should be subtracted frorri 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). 1/3112022 SUMMARY PAGE Page 1,D. NUMBER 1432333 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 12 1/1 through 6/30 711 to Date 20, Contributions Received $ 21. Expenditures Made Expenditure Limit Sum $ Candidates $ o or State 22. Cumulative Expenditures Made" or fOtiblect to I/biotite ry E xpenditure Limn Date of Election Total to Date (nm/ddiyy) ;' *Amounts in this section may be different orn am unts remise in Column 9, FPPC Form 460 (Jan/2016)) FPPC ce: aduice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule Monetary Contributions Received SEE 1NSTRJCTIONS ON REVERSE NAME OF MEM' Anne Hertz for Cypress City Council 2020 DATE RECEIVED FULL NAME, STREET ADDRESS ARO MP CODE OF CONTRIBUTOR Off COMMITTEE. K.60 ENTER 1,CL RIMER) Amounts y be rounded to whole dollars, Statement oovers period from 711/2021 through MI31/2022 SCHEDULE A LD, NUMBER 1432333 IF AN INDIVIDUAL, ENTER CONTRIBUTOR I OCCUPATION AND EMPLOYER CODE - SELF-RMPLOYED. ENTER NAME AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN, [EEC, 31) PER ELECTION TO DATE (IE REQUIRED) D COM OTH PTY SCC MID fig com [f] OTH PTY SCC EstlD DOOM OTH PTY SCC [l] COM OTH PTY SCC SUBTOTAL $ Schedule A Summary Amount received this period - Itemized monetary contributions. pridude all Schedule A subtotals.) 2, Amount received this period unitemized monetary contributions of less than $100 _ - .$ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column a, Line 1.)..._.„...___....T(TAL $ *Conti butor zrodes IND m MdiziduM COM -Recipient Committee (other then PTY or SOO) OTH - Other (e.g., tosirmitim entity) PTV - Paq SCC - Small Contributor Committee FPPC Form (Jan/2016)) FPPC Advice: advice@fpoc.ca.gov (6/275-3772) www.fppc.ca.gov Schedule B Part I Loans Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Anne Hertz for Cypress City Council 2020 FULL NAMET STREET ADDRESS AND ZIP CODE OF LENDER coRRAIT TEE, A L SO ENTER ID. NUMBER) Jesus Malian Cypress, CA 90(30 IND 0 COM 0 OTH Anne Hertz Cypress, CA 90630 iND SOO OTH 0 PTY D SCC COM 0 OTH PTV' scc Schedule B Summary Amounts may founded to whole dollars. IF AN INDIVIDUAL, ENTER OCCIJPATI0N AND EMDLOYE,R OF &TIFFIN FuarLTD, ENTER RARE OF BUS SEEM 0$0-01DTIOTE Air Technology Laboratories, Inc, President Boys & Girls Citth of Greater Anaheim and Cypress Statement covers period from 7/ 1/2021 through OUTSTANDING AMOUNT AMOUNT PAID BALANCE RECENED THIS OR FORGNEN BEGINNING "MS PERIOD PE*RIDD ,TztYpISA.IDPERIOD* fri FORGIVEN 45'72 sic E =AID— $ 0 D FORGESEN 12,000 SUBTOTALS $ 0 „tomages • -- 0 RN El POGGIVEN (Total Column SO plus unitemized loans of less than $100„) 2, Loans paid or forgiven this (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule An NET $ Enter the net here and on the Summary Page, Column A, Ude 2„ Dramotinte forgiven or said by another oar& also d required. ust be rethrted DD SuheduIe A, OUTSTANDING BALANCE AT CLO8h OF THIS PERIOD 4,572 $ DATE DUD 000 $ Dr INTEREST PAID THIS PERIOD 0 % RATE DATE DUE 16,572 $ 0 SCHEDULE B PART 1 CALIFORNIA 46(1) FORM P 5 NUMBER 1432.333 ORIGINAL AMOUNT OF LOAN 4 5'72 9/6/20 Ass DATE NDURR ED 12,000 12/17/20 DATE muRRED DAT! R RE D 12 LIMULATIVF ONTRIDUTIONS TO DATE SIDATNENTSR YEAR 4,572 PER PITECTIDEr EAR 12,000 / — pea ehECTION" GALE 11 AR YEAR PER sum& N" ?SG; be a NEED* nuctGE SENN 00 E shoside E., Uss otributor Codes IND — individual LOH — Recipient Committee pcherthan PTV or 4C1Cr OTH * Other (e,g,, bushess eNIN) pay — Polite& Party SCC —Smafl Contributor Committee FPPC Form 41 Oad/2016)) FPPC Adviser advise@fpnema,gov (866/275r3774) www.hnscomson Schedule ContributionsNomads a SEE INSTRUCTIONS REVERSE. NAME. Anne Hertz fear Cy +tees Cater Colleen 2020 GATE RECEIVED F L# AME, STREET AGGRESS AND EHE CODE CSF CON9TR( t TRE (IF COM WEER, ALSO ERIE R6D..NUMBER; Amcovrnt rrsy berrarrdd haRa dolter° BF AN INDR DUAL, ENTER r Cl t1'PAMON AND EMPLOYER RELENEMP TOTED, ENTER NAME' F"EumEs9) `. Stateme through 1 /311 Page N DESCRIPTION OF '"ODS OR SERVICES AMOUNT/ FAIR MARKET VALUE .G NUMBER 1432333 CUMULATIVE TO GATE CALENDAR YEAR MAN 1 H CLEC IN PER ELECTION TO DATE (IF REQUIRED OTH 0 PTY SCC 1 Ej of oTH Lj PSV SCC DINO N] COM OTH PTV Darn Attach additional information o, app prate chedule tt Amount received this period - e lzee r onmot etas con (Include all Schedule C subtotals.).... . Amount received this period a unheralded rTonmonetar Ctatted Ions of lei than E100....., . Total nonmonetaly contributions received this carioca (Add Lines 1 and 2. Eater here and on tete Summary Page, column , Lin 4 and 1 tie,.... asheets. SUBTOTAL Cations. _TOTAL " r til Mtn Cod N Individual Recipient Co Nee Her than Pre or C r T H three . shoes malty} FST` — PEl Party small Contributor Commnmtl FPPC Form 460 [Jami/2016 » FPPC Advice; advice@fppceca.gov (866/275.3174 www.fppc.tag©v Schedule 0 Summary of Expenditures Supporting/Opposing Other Candidates, Measures and 'Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER Anne Hertz for Cypress City Coma 2020 DATE Amounts may roun to whole dollars. soom or s„ Statement covers period 2/1 /2021 ftom _____Eros through 1131 /2422 SCHEDULE D Page sorm_ of 12 1,D. NUMBER— L432333 NAME OF CAM:KATE. OFFICE. AND INSTRICT OR MEASURE NUMBER OR ',ETTER AND JURISOCOON. OR COMMITTEE DESCRIPTVON AMOUNT THIS {IF REQUI IR EC) PERIOD C ontributi on Nontrocetary Contribution, Independent EXpenditure Monetary Contribution Nonmonetam Contribution 0 Independent Exbenditure Monetary ContIbution Nonmonetary Contribution EJ Independent 0 Sumost Oppose Expendltvre CUMULATIVE TO DATE CALENDAR YEAR OAK 1 DEC. 31) PER ESECTION TO OATE RMARED) SUBTOTAL $ Schedule D Summary Itemized contributions and independent expenditures made this period. (Include all Schedule D $ tres_° 2, Linitemized contributions and independent expenditures made this period of under $100_,_ 3, Total contributions end independent expenditures made this period, (Add dines I and 2, Do not enter on the Summary Page.) _____ TOTAL .„ $ ° FPPC Form 460 Nan/2010) FPPC Advice: adviceRforrocoges (866/275-3772) ww,fdpoes „goy Schedule Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FUR Anne Hertz for Caress City Council 2020 CODES: CIAP CNS CEP CVC END iND LEG LIT Amounts may be rounded to whole dollars. if one of the following cedes accurately describes the campaign paraphemaliainriisc. c.ampaign consultants contribution (explain nonmonertaryr civic donations candidate filingleallot fees fLindraising events Independent expenditure supportingiopposing ethers (pit legal defense carinpaign literature and mailings NAME AND ADDRESS OF PAYEE OF COMMUTES, ALSO ENTER TD, NURSERS MBE MEG OF C PET PHO POL POS PRO PRT Se, tement c1v8r3 period 2/1/2021 ham __HA through 1E3182022 payment, you may enter the code, Otherwise, me - cornnunations meetings end appearances Office expenses petition circelating phone banks polling and survey research postage deNvery and messenger servMes professional services (legal, accounting) print ads describe the payment. SCHEDULE a CALFit:$1,r)tf:INIA A At u ILF Page of Le NUMBER RAO radio airtime a70 production costs RFD returned contributienS SAL campaign workers' salaries TEL ty, or cable airtime and oroductlon costs TRC candidate travel, lodging, and mealts TRS staff/spouse travel, lodglng, and meals TSF transfer between committees of the same candidateisbonsor VOT voter registration 11VEB inforrriatlon technology costs (Internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAM a Payment's that are contributions or independent expenditures must also be summarRed on Soh Schedule E Summary le D. SUBTOTAL $ T's 1, itemized payments made this period, (lneiode ail Schedule E subtotals)._ ... A, $ 2, Unitemized payments made this period of under $100, 3, Total interest paid this period on lo,ans. (Enter amount from Schedule B, Part 1, Column $ 4, Total payments made this period. (Add Lines 1, 2, and 3. Enter here and an the Summary Page, Coiumn A, Line TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advicetafpor,ca.gov (866/275-3772) www.fopc.ca.gov Schedule F Accrued Exp n (Unpaid B a) EE INSTRUCTION Ott REVERSE NAME OF MEP Anne e Hrtz for Cypress Clt) CODES: one of he to to tng cedes a dish campaign paraphaernaliarraise, CMS campaign consultants CTE contribution (explain nonmonetaryg CVC civic donations Flt candldete MN/ballot fees Feed fundraising evertrs BED independent expenditure sup ortinglopposing (Ahem LEG legal deems LRT campaign titer.ature and mailings Amougla may be total qwhole d Ilarc urately describe NA lvtF AND ADDRESS 0 OF COMMITTEE. N ROENTE REDIT the MBR MTC OFC PET PHO PCNL press)• POS PRO P RT payment, you niay ente member communications meetings and appearances office expenses petition circulating phone banks palling and survey research postage, delivery and messe professional services (legal, a print ads he cotes (the nae, RAID RFD SAI TEL TRC TRS TSF VCT 3 ersarv'ices urling) r'ik"~E OR ogYSTANDiNO DEFiC RIPTION of PAYMENT BALANCE SECINNiN F THIS PERIOD dee the dame ra1Ro arrtarre and production costs returned contributions campaign workers` salaries cable airtime and production costs candidate travel, lodging, and meals staffispouse travellodging and nrealu transfer between committees of the same can{ voter registration information technologycosts (Internet, e"madt} () MOUNT lNCU tRED THIS PERIOD at AI ICUNE PAID THIS PERIOD LGSTANDING mt=NCEATCLOSE of iHIS PERIOD " Paymetals teat are r tr t uT#a m rune sum rrered ria SctT d D SUBTOTALS $ 0 Schedule F Summary Total accrued expenses incurs id th period, Indeed all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unite tl ed accrued expenses under ON . Total a ued expenses paid this period, (Include all Schedule FE Column (a` subtotals for payments on accrued expenses of 100 arm re, pleas total l shorn ed payments on accrued expenses under MODE„, .stet change this period, (Subtract Life 2 from Lane 1. Enter tete difference here and _INCURRED TOIL PAM TOTALS $ ".ay be a rr �s8rar urs' r PPC Fair zr Jan/ 016 ,PPG Adrike advice f pc,ca4av (866/275-3712) w w. ppc, mgov Schedule G Payments Made by an Agent or independent Contractor (on Behalf of Thin Committee) SEE INSTRUCTIONS qN REVERSE NAME OF FILER Anne Hertz for Cypress City Council 2020 NAME OF AGENT OF INDEPENDENT CONTRACTOR Amounts may rounded to whole dollars, Weeniest Fairs perked — rum 7/1 /2021 through ali3112022 SCHEDULE CALIFOFtN1A 416() FORM page 10 NUMBER 1432333 of 12 CODES: if one of the following codes accurately Pegged s the CMP CNS CTB CVC FIL END IND L EG LIT Parnpeign paraphernalia/misc. wave consurianrs contribution (explain norrnonstarsE sines donallons candidate filinglaglist fees fundraising events independent expendPure supportingicaposing others (explain). legal defense campaign Rterature and regaings MBR MEG OFC FEL RHO POL FOS PRO PRE payment you may enter the code, Othewvise, describe the payment, member communications meetings and appearances office ever ses petition circulating phone banks polfing and survey research postage, delivery and messenger services professional services (legal, accounting) print ads * Payments that are contributions or independent expenditures must also be summarized on Schedule Di HAND AND ADDRESS OF PAYEE OR CREDITOR SF COMMITTEE, ALSO ESTEE LE NUMBER) HAD EFD SAL TEL FRC TES ESE NEST WES radio airtime arid production costs returned contributions campaign iNorkers° salaries t' or cable airtime and production costs candidate traweli lodging, and meals staff/spouse travel, lodging and meals transfer between committees of the same candidate/sponsor voter registration information technology costs tinternet &trait} DEsCraPcION OF PAYMENT AMOUAT PAID Attach additional information on appropriately labeled continuation sheets, Do not transfer to any older schedule Pr to he Su mary Page, Thee total may not aqua/ the amount paid to the agent r independent centractor as reported on Schedule E, TOTAL* $ 0 FM Form 460 Clatif2016)) PPP Advice: edvica@itgpssergov (S66/275-3 772) wwwilipperesigov Schedule le Loans Made to Others* SEE INSTRUCTtONS ON REVERSE NAME OF FISER Anne Hertz for Cypress City Council 2020 Amounts y be round to whole dollars, rdss AAA_ Statement COMM peace m 7/1120,21 through o 131,12022 SCHEDULE H CALIFCIRNIA A FORM -"Ir ISSN MDISIDUAL, ENTER FULL NAME, STREET ADDRESS AND ZU$ C OCCUPATION AND EMPLEGER OF REORIENT - IN SELF-EMPLOYED, ENTER {IT COMMITTEE, ALEN ENTER" La EUESERI NAME OF ELISINESTE - - , OUTSTANDING BEGBITIMIOHIS AMOUNT LOANED TENS PERIOD REPAYMENT OR FORGIVENESS THIS PERIOD* 0 PAID OUTSTANDING BALANCE AT CLOSE OF THIS INTEREST RECEIVED °DISMAL. AMOUNT OF LOAN COMO LAT FEE LOANS TO DATE CALENDAR YEAR 0 FORGIVEN RATE PER ETRE:NOW DATE RUE A PATE RATE INCURRED CALENDAR YEAR PER ELECTION" *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. Schedule H Su ma!), 1. Loans made this _ (Total Column glue unitsmidee loans of less than $10E) 0 ("Total Column (c) plus ungenifized payments of less than MON 3, Net change this period, (Subtract Line 2 from Line .,, „NET $ (Enter the net here age on the Summary Page, Column A„ Line 7.) Met (Cm Schee* One FI Nee be a negethee number) "V Required FPPC m 4$ # (Jan/2016)) FPPC dyke: edvice@fopc.ca,gov (866/275-3772) www.fppc.ea.gov Schedule Miscellaneous increases to Cash SEE INSTRUCTiONS ON REVERSE NAME OF FILER Anne Hertz for Cypress City Council 2020 DATE RECEIVED Amounts may be rounded to wtiol dollara. Statement covers period ?loam 7/1/2021 I/31/2022 through -ry , SCHEDU E Lig NUMBER FULL NAMEAND ADDRESS oF SOURCE ROBB WEB ALSO ENTER NUMBER) IDESCRIRTiON OF REC HET AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. 1. Itemized increases to cash this phod, , Ungemized increases to cash of under $100 this period, ,$ ° 3, Total of ail interest received this period on loans made to others, (Schedule Hi Column (e)i) 4. Total mi -ligneous increases to dash this period, (Add Lines 1, 2, and 3, Enter here and on the Summary Page, Line 14,) _ TOTAL 0 SUBTOTAL 0 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) ww pc.ca.gov