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Home My WebLink About2021-06-30 Form 460 - HarnikCOVER PAGE Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 01/1/2021 through 06/30/2021 1. Type of Recipient Committee: All Committees -Complete Parts l,2,a,and 4. m tficeholder, Candidate Controlled Committee 8 El Primarily Formed Ballot Measure State Candidate Election Committee Committee O Recall O Controlled (Also ca„rok>e Pals) O Sponsored (Ako 0oeeh0a Penh) ❑ General Purpose Committee ❑ Sponsored Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee fN Cw kte PaY> 3. Committee Information I.D. NUMBER RE-ELECT TAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE INDIAN WELLS, CA 92210 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE PALM DESERT, CA 92262 OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification Date of election if applicable: 2�21 JUL ' 9 P-1 P 1 of 12 (Month, Day, Year) For Official Use Only 11/06/2018 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Z Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) ELIZABETH LOPEZ MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE INDIO, CA 92203 ( NAME OF ASSISTANT TREASURER, IF ANY CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS f 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 schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is tryg_aY ram_ Executed on 07/16/2021 Date Executed Executed on r^' Date Executed on Date Executed on Date By Signature W Conhoging Officeholtler, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.w.gov (866/275-3772) www.fppc.w.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE JAN HARNIK OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) yrrcK•u cylia.Irrca;tiv"AVLu 1aM RESIDENTIAUBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP INDIAN CA 92210 WELLS, 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. NAME NAME OF TREASURER I.D. NUMBER ❑ YES ❑ NO CITY STATE ZIP CODE AREACODE/PHONE COMMITTEE NAME I I.D. NUMBER [:]YES ❑ NO STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page 2 of 12 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OR DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Llstnames or officeholder(s) or candidates) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppcm.gov (866/275-3772) v W.fppt.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Summary Page to whole dollars. Statement covers period7- from 01/01/2021throw h 06/30/2021 2 SEE INSTRUCTIONS ON REVERSE 9NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 Contributions Received 1. Monetary Contributions................................................... Schedule A, Line 3 2. Loans Received................................................................ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3+4 Expenditures Made 6. Payments Made................................................................ Schedule e, Line 4 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE .................................... Add Lines 8+9+10 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page; Line 16 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A. Line a above 16. ENDING CASH BALANCE ..................Add Lines12+13+14,thensubtmctLine15 If this is a termination statement, Line 16 must be zero. Column A Column B TOTAL THIS PERIOD CALENDARYEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE $ 00.00 00.00 $ 00.00 00.00 $ 00.00 $ 644.52 00.00 $ 644.52 00.00 00.00 $ 644.52 $ 7712.69 00.00 00.00 644.52 $ 7068.17 17. LOAN GUARANTEES RECEIVED ................................ SChedU/eB,Part2 $ 00.00 I Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instrucb'onsonreverse $ 00_00 19. Outstanding Debts .............................. Add Line 2+ Line 9 in Column B above $ 00.00 $ 00.00 00.00 $ 00.00 00.00 $ 00.00 $ 644.52 00.00 $ 644.52 00.00 00.00 $ 644.52 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 far this calendar year, only carryover the amounts from Lines 2, 7, and 9 (if any). Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made• (a Subject to voluntary Expenditure Lima) Date of Election Total to Date (mnVdd/yy) 1 1 $ E 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppcm.gov (866/275-3772) www.fppcca.gov, Schedule A Amounts may be rounded SCHEDULE A to whole dollars. Monetary Contributions Received Statement covers period from 01/01/2021SEE through 06/30/2021 2 r INSTRUCTIONS ON REVERSE NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED. ENTER NAME (IF coMMITTEE,ALso ENTER I.o. NUMBER) OF of BUSINESS) PERIOD (JAN.'I-DEC. 37) (IF REQUIRED) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 00.00 Schedule A Summary *Contributor Codes 1. Amount received this period — itemized monetary contributions. 00.00 IND— Individual ......................................................................................................... (Include all Schedule A subtotals.) $ COM — Recipient Committee (other than PTY or SCC) 00.00 OTH — Other (e.g., business entity) 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ PTY — Political Party SCC — Small Contributor Committee 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)... TOTAL $ 00_00 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.m.gov (866/275-3772) www.fppc.ra.gov Arnounts IT— be rounded SCHEDULE B-PART 1 Schedule B — Part 1 "to whole dollars: Statement covers period Loans Received from 01/01/2021 CALIFORNIA • FORM through 06/30/2021 Page 5 of 12 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 FULL NAME, STREET ADDRESS AND ZIP CODE (FAN INDIVIDUAL, ENTER OUTSTANDING (b) AMOUNT e AMOUNT PAID OUTSTANDING e INTEREST ORIGINAL g CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FORGIVEN BALANCEAT PAID THIS AMOUNTOF CONTRIBUTIONS (IF commITTEE, Also ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNINGTHISE PERIOD THIS PERIOD- OF CLOPEROD HIS PERIOD LOAN TO DATE NAME OF BUSINesS) PERIOD I] PAID CALENDARYEAR BRIAN S. HARNIK SELF $ 2798.08 18,000 $RATE ❑ FORGIVEN PER ELECTION $ 2798.08 $ 00.00 $ $ 10/01/10 $ DATE DUE DATE INCURRED 1m IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE T ❑ IND ❑ COM ❑ OTH El El $ S $ $ $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR 8 $ ❑ FORGIVEN PER ELECTION" RATE $ 8 $ 8 $ DATE DUE DATE INCURRED 1❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 00.00 $ 00.00 $ 2798.08 $ 00.00 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 $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.)...................................... Enter the net here and on the Summary Page, Column A, Line 2. 'Amounts forgiven or paid by another party also must be reported on Schedule A. •• If required. 00.00 ..................$ — ..................$ 00.00 00.00 ........................NET $ May be a negati� number) (Enter (e) an Schedule E, Line 3) ?Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Parry SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.w.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received 0 W"0 a uo a`S Statement covers period CALIFORNIA 01/01/2021 from ' • " • 06/30/2021 6 12 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 DATE FULL NAME, STREETADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OC ONAND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR COMMniEE,AL50 ENTER I.D. NUMBER) • CODE IFSELF-EMPLOYED, ENTER ( IF SELF-EMPLOYED. GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF REQUIRED) (IF NAME OF BUSINESS) (JAN 1-DEC 31) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 00.00 it 1 ; ,; ',ii? .: Schedule C Summary *Contributor Codes 1. Amount received this period - itemized nonmonetary contributions. IND- Individual 00.00 COM- Recipient Committee (Include all Schedule C subtotals.)......................................................................................................................$ (other than PTY or SCC) 00 OTH - Other (e.g., business entity) 2. Amount received this period - unitemized nonmonetary contributions of less than$100..................................$ 00 PTY- Political Party SCC - Small Contributor Committee 3. Total nonmonetary contributions received this period. 00 00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) w .fppc.ca.gov Schedule D SCHEDULED bummary or tx enaitures Amounts may ae rounaea Statement covers period71.0NUMBE7R to whole dollars. Supporting/Opposing Other 01/01/2021Candidates, Measures and Committeesfromthrough 06/30/2021 SEE INSTRUCTIONS ON REVERSE NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT CALENDAR YEAR TO DATE OR COMMITTEE (IF REQUIRED) PERIOD (JAN.1-DEC. 31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure l 4 r .I. Af� SUBTOTAL $ 00.00 Elkr ?.� Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 00.00 2. Unitemized contributions and independent expenditures made this period of under$100.................................................................................... $ 00.00 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.).......... TOTAL.. $ 00.00 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppcm.gov (866/275-3772) www.fppcca.gov Schedule E Payments Made Amounts may be rounded to whole dollars. RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 covers from 01/0112021 06/30/2021 I Page 8 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment 1322067 SCHEDULE of 12 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)` POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (ntemet, e-mail) NAMEANDADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.O. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID CITI CARDS WEB (Nationbuilder) 347.35 P.O. BOX 78045 111,.1.T,- �1,11...I a CITI CARDS POST OFFICE BOX RENTAL 226.00 P.O. BOX 78045 TTTI V..\TTV A' OCA,l OAAC Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 573.35 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 573.35 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 71.17 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 00.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)........................... TOTAL $ 644.52 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppcca.gov (866/275-3772) www.fppc.ra.gov SCHEDULE Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. Statement covers period from 01/01/2021 through 06/30/2021 • ' . - g 12 Page of NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers'salades CVC civic donations PET petition circulating TEL Lv. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO ,professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE,ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNTINCURRED THIS PERIOD (D) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD - Payments that are contributions or independent expenditures must also be SUBTOTALS $ 00.00 $ 00.00 $ 00.00 $ 00.00 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 00.00 accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 00.00 accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under$100.).................................. PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 00.00 onthe Summary Page, Column A, Line 9.)................................................................................................................................................................................... NET $ May be a negative number FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppcw.gov (866/275-3772) www.fppc.ca.gov Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) Amounts may be rounded to whole dollars. from 01/01/2021 through 06/30/2021 10 12 Page of_ NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1 1322067 CODES: If one of the following codes accurately describes the CMP campaign paraphernaliatmisc. MBR CNS campaign consultants MTG CTB contribution (explain nonmonetary)' OFC CVC civic donations PET FIL candidate filing/ballot fees PHO FND fundraising events POL IND independent expenditure supportinglopposing others (explain)` POS LEG legal defense PRO LIT campaign literature and mailings PRT payment, you may enter the code. member communications meetings and appearances office expenses petition circulating phone banks polling 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 D. Otherwise, describe the payment. RAD radio airtime and production costs RFD returned contributions SAL campaign workers'salades TEL l.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staf (spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (Internet, e-mail) Attach additional information on appropriately labeled continuation sheets. TOTAL` $ 00.00 Do not transferto any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or FPPC Form 460 (Jan/2016)) independent contractor as reported on Schedule E. FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppcca.gov SCHEDULE Schedule H Amounts may be rounded Statement covers period _ to whole dollars. - ' Loans Made to Others* from 01/01/2021 0 T• FPage11 SEE INSTRUCTIONS ON REVERSE through 06/30/2021 of 12 NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 FULL NAME, STREET ADDRESS AND ZIP CODE FAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (a) OUTSTANDING (b) AMOUNT c REPAYMENTOR e OUTSTANDING V) ORIGINAL g CUMULATIVE OF RECIPIENT (IF COMMITTEE,ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS LOANED THIS FORGIVENESS BALANCEAT INTEREST CLOSE OF THIS RECEIVED AMOUNT OF LOANS NAME OF BUSINESS) PERIOD THIS PERIOD` PFRIOD LOAN TO DATE PAID CALENDAR YEAR E g _% g g ❑ FORGIVEN PER ELECTION" RATE S E S S g DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR E E _% E g ❑ FORGIVEN PER ELECTION* RATE $ $_ S E DATE DUE DATE INCURRED E `Loans that are contributions to another candidate or committee must ' I r ' also be summarized on Schedule D. Loans forgiven must also be h"Mi�i.f I reported on Schedule E. SUBTOTALS $00.00 $ 00.00 $ 00.00 $ 00.00 I�i A .v$�IillU.e (Enter (e)on Schedule I. Line 3) Schedule H Summary 1. Loans made this period............................................................................................................. (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans..................................................................................................... (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.).............................................................. (Enter the net here and on the Summary Page, Column A, Line 7.) 00.00 ...................$ ..........................$ 0000 ...........NET $ 00.00 (May be a negative number) "If Required FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.w.gov (866/275-3772) www.fppc.ca.gov Schedule I Amnuntc may ha rnundad SCHEDULE I Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 01/01/2021 through 06/30/2021 CALIFORNIA ' FORM Page 12 of 12 NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 I.D. NUMBER 1322067 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 00.00 Schedule mmary 1. Itemized increases to cash this period............................................................................................................................$ 00.00 2. Unitemized increases to cash of under $100 this period.................................................................................................$ 00.00 3. Total of all interest received this period on loans made to others. Schedule H, Column (a).) $ 00.00 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the 00.00 SummaryPage, Line 14.)............................................................................................................................. TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov