Seybert 10-18-2009 thru 12-31-2009 Semi-Annual 460

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Schedule B—Part 1 Type or print in ink. Statement covers period SCHEDULER-PART1 Amounts may be rounded p CALIFORNIA 460 Loans Received to whole dollars. from 10/18/09 FORM SEE INSTRUCTIONS ON REVERSE through 12/31/09 Page of 1 NAME OF FILER I.D. NUMBER JOHN SEYBERT 1313963 IF AN INDIVIDUAL, ENTER (a) (b) (c) (d) (e) (f) (g) FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OCCUPATION AND EMPLOYER BALANCE BALANCEAT OF LENDER (IF SELF-EMPLOYED,ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) PERIOD * PERIOD LOAN TO DATE PERIOD THIS PERIOD PERIOD JOHN SEYBERT CHURCH ADMIN. PCC ❑PAID CALENDAR YEAR $ 0 $ 1,000 0 % $ 1,000 $ 0 REDWOOD CITY, CA 94061 ❑FORGIVEN RATE PER ELECTION*` $ 1,000 $ 0 $ 0 NA $ 0 12/3/08 $ 1,000 tt IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR $ $ % $ $ ❑FORGIVEN RATE PER ELECTION** $ $ $ . $ $ to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑PAID CALENDAR YEAR $ $ % $ $ ❑FORGIVEN RATE PER ELECTION** $ $ $ $ $ to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ if o - 5,, e Schedule B Summary (Enter ) Schedulle e E E,,Line 3 1. Loans received this period $ 0 (Total Column(b)plus unitemized loans of less than$100.) tContributor Codes 2. Loans paid orfor forgiven this period IND—Individual P 9 P $ 0 COM—Recipient Committee (Total Column(c)plus loans under$100 paid or forgiven.) (other than PTY or SCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g.,business entity) PTY—Political Party 3. Net change this period. (Subtract Line 2 from Line 1.) NET $ 0 SCC—Small Contributor Committee Enter the net here and on the Summary Page,Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. **If required. FPPC Form 460(January/05) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)