HomeMy WebLinkAboutSTAHL 410 tatement of Organization
Recipient Committee
Statement Type ,J~lnitial
Not yet quatified/J~ or
Type or print in ink
[] Amendment
List I.D. number:.
I I I
Date qualified as committee Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
STREET ADDRESS (NO P,O. BOX)
CITY
MAILING ADDRESS (IF DIFFEFIENT)
OPTIONAL: FAX I E~MAIL ADDRESS
cou.w OF DOM,C,LE COU"TY W"ERE COMM,~rEE,S ^CT,VE,. D,.~ERE.T
~<~¢-~ TH^. COU.TY O. ~O~,C,~
Attach additional informa~fon on appropdatsly labeled continuation sheets.
3. Verification
[] Termination - See Part 5
List I.D. number.
#
I
Date of Termination
Dale S~amp
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2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
Fo~ Official Use Only
NAME OF TREASURER
MAIUNG ADDRESS
o2eot ~. ~2cmL P_O.
STATE ZiP CODE
ARF~CODFJPHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODFJPHONE
NAME AND POSITION OF OTHER PRINCIPAl. OFFICER(S), IF APPLICABLE
MAILING ADbRESS
CITY STATE ZIP CODE AREA CODE/PHONE
I have used all reasonable diligence in preparing this statement and to the best of my knowledge lhe information contained herein is true and complete. I certify under penaify of
perjury under the laws of the State of California that the foregoing is true anat. ~
_ ¢ ',.
EXSCU~edon ~y~// ' - (~SIGEYATbRI~I~FCiDNfROLLINGOFFICEHOtDER'CANDIOATE'ORSTATEMEASUREPROcONENT
DAT~ SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 4110 (8/99)
For Technical Asslstsnce: 916/322-5660
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMK~ ~ ~ t:~= NAME
STATEMENT OF ORGANIZATION
Page 2
4. Type of Committee complete the applicable seclions.
I.D. NUMBER
· List the name of each controlling officeholder, candidate, or state measure proponenl. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and lhe year of the election.
· List the political party wilh which each officeholder or candidate is affiliated or check "non-partisan."
· If this committee acts jointly with another controlled committee, list the name and idenlification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
· List lhe financial institution and the disposition of surplus funds (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADOR;=:~ CITY STATE ZIP CODE DISPOSITION OF SURPLUS FUNDS
DATE OPENED
CANDIDATE(S) NAME OR MEASURE(S) FULL TI~.E (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE
.................. ~ CHECK ONE
SUPPORT OPPOSE
SUP~RT OP~SE
FPPC Form 410 (8/99)
For Technical Assistance: 916/322-5660
Statement of Organization STATEMENT OF ORGANI7,ATION
Recipient Committee
INSTRUCTIONS ON REVERSE
I.D. NUMBER
4. Type of Committee (Continued)
'~:;~[=;~.ll:a~llojo~.-r'.~ejtljjtjjt~=[-J Not forn~d to support or oppose specific candidates or measures in a single election. Check only one box:
[] CITY Committee [] COUNTYCommittee [] STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
MAILING ADDRESS NO. AND S/H~ ~ CITY STATE ZiP CODE
[] (For purposes of special election contribution limits)
· This committee has ceased to receive contributions and make expenditures;
· This committee does not anticipate receiving contributions or making expenditures in the future;
· This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
· This committee has no surplus funds; and
· This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
the Information Manual on Camoai(]n Disclosure Provisions of the Political Reform Act. for Elected Officers. Candidates and their Controlled Committee,-~
(Manual A).
-* Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (8/99)
For Technical Assistance: 916/3~2-5660