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Home My WebLink About2020-12-31 Form 460 - HarnikCOVER PAGE Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 07/01/2020 through 12/31/2020 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. m eToeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure V State Candidate Election Committee ommittee O Recall Controlled (aho bPal 5) Sponsored (also Campbte Part 6) ❑gneral Purpose Committee Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee (AtsobPal n 3. Committee Information I I. NUMBER 4. MMITTEE NAME (OR CANDIDATE'S NAME RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 STREET ADDRESS (NO P.O. BOX) 45-025 MANITOU DRIVE CITY STATE ZIP CODE AREACODE/PHONE INDIAN WELLS CA 92210 (760) 285-7531 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. BOX 3943 CITY STATE ZIP CODE AREACODE/PHONE PALM DESERT CA 92262 OPTIONAL: FAX / E-MAIL ADDRESS L CALIFORNIA C11 Y CLERK'S OF) { fi. • Date of election if applicapl,�t 1l 4 1 Page 1 of. 7 (Month, Day, Year) " ` r 1 5 f; t L For Official Use Only 11 /06/2018 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement 10 Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER DR. WILLIAM KROONEN MAILING ADDRESS P.O. BOX 3943 CITY STATE ZIP CODE AREACODE/PHONE PALM DESERT CA 92260 (760) 578-3039 NAME OF ASSISTANT TREASURER. IF ANY ELIZABETH LOPEZ MAILING ADDRESS 41621 MICHELLE PLACE CITY STATE ZIP CODE AREACODE/PHONE INDIO CA 92203 (760) 578-3878 OPTIONAL: FAX/E-MAIL ADDRESS Verification I 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. certify under penalty of perjury under the laws of the State of California that the foregoing is Executed on D I 1 13 /�O I By Date _ ngX7re of Treasurer or Assistant4reasurer r Executed on ` ` = :2— 1 By Date Executed on By Date Executed on Date By Signature of Controping Officeholder. Cantlidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.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) CITY COUNCIL - CITY OF PALM DESERT RESIDENTIAUBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP 45-025 MANITOU DRIVE INDIAN VE CA 92210 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. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 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 OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s) or candidate(s) 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@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE to whole dollars. Statement covers period ,summary Page • - , from 07/01/2020 • - M through 9 12/31/2020 Page 3 of. l� INSTRUCTIONS ON REVERSE _SEE PIAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... schedule A, Line 3 $ 00.00 $ 00.00 00.00 00.00 1/1 through 6/30 7/1 to Date 2. Loans Reoelved................................................................ Schedule B, Line 3 00.00 00.00 20, Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. add Lines 1 +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ schedule C, Line 3 00.00 00.00 21. Expenditures I 5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3 + 4 $ 00.00 $ 00.00 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 20.67 7. Loans Made....................................................................... schedule H, Line 3 00.00 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+r $ 20.67 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule l; Line 00.00 10. Nonmonetary Adjustment......................................................... schedule C, Line 3 00.00 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 20.67 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 7733.36 13. Cash Receipts........................................................... Column A, Line 3 above 00.00 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 00.00 15. Cash Payments......................................................... Column A, Line 8 above 20.67 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 7712.69 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part $ 00.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 00.00 19. Outstanding Debts .............................. Add tine 2 +Line gin Column B above $ 00.00 $ 328.34 00.00 $ 328.34 00.00 00.00 $ 328.34 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 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). IExpenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' IN Subject to voluntary Expenditure Limit) Date of Election Total to Date (mmlddtyy) $ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received io whole aoham. Statement covers period a _ , ' 07/01/2020 from ' • 12/31/2020 Page 4 of SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 FULL NAME, STREETADDRESS 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 00.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. 00.00 (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 00.00 3. Total monetary contributions received this period. 00.00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Omnunts maw ho mundrad SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Statement covers periodI111111111111111111111111 Loans Received 07/01/2020 CALIFORNIA FORM 460 from through 12/30//2020 Page 5 of.- 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 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING b AMOUNT c AMOUNT PAID OUTSTANDING INTEREST IN REST ORIGINAL g -� CUMULATI V E OF LENDER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THIS PERIOD. CLOPERIOFDTHIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD ❑ PAID CALENDAR YEAR BRIAN S. HARNIK SELF 2798.08 18,000 f f % f f 45-025 MANITOU DRIVE ROEMER & HARNIK LLP RATE ❑ FORGIVEN PER ELECTION INDIAN WELLS, CA 92210 2798.08 00.00 10/01/10 f f f f f t ® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED PAID CALENDAR YEAR S S % $ S ❑ FORGIVEN RATE PER ELECTION`S 1 ❑ IND ❑ COM ❑ OTH ❑PTY ❑SCC S f $_ S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR f $ % S S ❑ FORGIVEN RATE PER ELECTION" S S S S S DATE INCURRED t❑ IND ❑ COM ❑ OTH [IPTY ❑ SCC DATE DUE SUBTOTALS $ 00.00 $ 00.00 $ 2798.08 $ 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. 'Amounts forgiven or paid by another party also must be reported on Schedule A. If required. 00.00 00.00 00.00 (May be a negative numbe0 (Enter (e) on Schedule E. Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded " i � ii .. SCHEDULE C Nonmonetary Contributions Received ""uw Statement covers period • _ 07/01/2020 from a • " through 12/31/2020 page 6 SEE INSTRUCTIONS ON REVERSE 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 OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED 21P CODE AL CONTRIBUTORSO ENTER I.D. NUMBER) (IF COMMITTEE, AL + CODE (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF REQUIRED) NAME OF BUSINESS) (JAN 1 - DEC 31) ❑ IND ❑ cOM ❑ OTH ❑PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 00.00 Schedule C Summary Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)......................................................................................................................$ 2. Amount received this period — unitemized nonmonetary contributions of less than $100..................................$ 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ 00.00 00.00 00.00 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D SCHEDULE D Summary of Expenditures Amounts may be rounded Statement covers period ' Supporting/Opposing Other to whole dollars. 07/01/2020 • � ! t Candidates, Measures and Committees from through 12/31/2020 Page 7 1� SEE INSTRUCTIONS ON REVERSE of NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 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 (IF REQUIRED) PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (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 SUBTOTAL $ 00.00 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@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Amounts may be rounded y Statement covers period - to whole dollars. • I Payments Made 07/01/2020 • - from through 12/31/2020 Page 8 of SEE INSTRUCTIONS ON REVERSE 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' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filingiballot 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 PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 00.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 00.00 2. Unitemized payments made this period of under$100......................................................................................................................................... $ 20.67 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 $ 20.67 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEnUI 1= F Schedule F Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 CODES: If one of the following codes accurately describes the payment, you may enter the code. CMP campaign paraphernalialmisc. MBR member communications CNS campaign consultants MTG meetings and appearances CTB contribution (explain nonmonetary)' OFC office expenses CVC civic donations PET petition circulating FIL candidate filing/ballot fees PHO phone banks FIND fundraising events POL polling and survey research IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads Statement covers period from 07/01/2020 through 12/30/2020 Page 9 of 4a- I.D. NUMBER 1322067 Otherwise, describe the payment. RAID radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration 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) AMOUNT INCURRED THIS PERIOD W 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 summarized on Schedule D. Schedule F Summary 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 $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under$100.)........................... PAID TOTALS $ 00.00 00.00 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@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule G SCHEDULE G Payments Made by an Agent or Independent Amounts may be rounded Statement covers period I CALIFORNIA I Contractor (on Behalf of This Committee) to whole dollars. from 07/01/2020 FORM • through 12/31/2020 Page 10 .� g of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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' 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 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) ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 00.00 Do not transfer to 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.fppc.ca.gov SCHEDULE H Schedule H Amounts may be rounded statement covers period _ ' to whole dollars. Loans Made to Others* from 07/01/2020 � - through 12/31/2020 Page 11 / � SEE INSTRUCTIONS ON REVERSE of NAME OF FILER I.D. NUMBER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 1322067 FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER ° OUTSTANDING AMOUNT REPAYMENT OR OUTSTANDING e ORIGINAL 9 CUMULATIVE OF RECIPIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS LOANED THIS FORGIVENESS BALANCEAT CLOSE OF THIS INTEREST RECEIVED AMOUNT OF LOAN LOANS TO DATE NAME OF BUSINESS) PERIOD THIS PERIOD' PFRI ❑ PAID CALENDAR YEAR S S ti S S ❑ FORGIVEN RATE PER ELECTION - DATE INCURRED DATE DUE ❑ PAID CALENDAR YEAR S S x S t RATE ❑ FORGIVEN PER ELECTION S S = S S DATE INCURRED DATE DUE *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. SUBTOTALS $ $ $ $ (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.)............................................................................................ NET (Enter the net here and on the Summary Page, Column A, Line 7.) $ 00.00 $ 00.00 $ 00.00 (May be a negative number) **If Required FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SchPrllt>IIP I ... ., SCHEDULE I Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 07/01/2020 through 12/30/2020 CALIFORNIA 6 1 FORM Page 12 of_1 — g NAME OF FILER RE-ELECT JAN HARNIK FOR PALM DESERT CITY COUNCIL 2018 I.D. NUMBER 1322067 DATE RECEIVED FULL NAMEAND 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 I Summary 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 e . $ 00.00 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.)............................................................................................................................. TOTAL $ 00.00 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov