HomeMy WebLinkAboutRUDDELL FORM 410 TERMStatement of Organization
Recipient Committee
Statement Type [] Initial
Not yet qualified [] or
Type or print in ink
[] Amendment
List ID numben
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I.__
Date qualUied as committee Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
STREET ADDRESS (NO PO BOX)
CITY
MAILING ADDRESS (IF DIFFERENT)
STATE ZIP CODE AREA CODE/PHONE
rmination - See
.nurnben
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Date of Termination~'
Part 5
Cate Stamp
2. Treasurer and Other Principal Officers
ST,'~'EMENT OF ORGANIZATION
For Official Use Only
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E MAIL ADDRESS
COUNTY OF OMICILE COUNTY W~IERE COMMITTEE IS ACTIVE IF DIFFERENT
(~.~/~ THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained her,eJ, n is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
Executed on
Executed on By
DATE S~OhWURE O~ COmROLU,G OFP~CEHOLDER. C.~aO.'~. OR ST~ M~SU~E PRoeo~rr
Execut~:l on By
FPPC Form 410 (JanJ03)
Statement of Organization
Recipient Committee
INSTR[JCTIONS ON REVERSE
4. Type of Committee Complete the applicable sections
STATEMENT OF ORG.~NIZAT1ON
· List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
· List the political party with which each officeholder or candidate is affiliated or check"non_partisan.-
· If this committee acts jointly with another con ro ed committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDI~EIOFEICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAR T~
[] Non-Partisan
[] Non-Partisan
· List the~nanciaiinstituti~nwherethecam~aignbankacc~untis~~cated(c~ntr~l~ed"candidatee~ecti~n"c~mmittees~n~y)
NAME OF FINANCIAL ~NSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
I~'--~.-~it'a~-,,,~,~x,.mm.-~-.--- Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(B) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(B) OFFICE BOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DIBTRICT NO., CITY OR COUNTY. AS APPLICABLE) CHECK ONE
FPPC Form 410 (Janl03)
FPPC Toll*Free Helpllne: 866/ASK-FPPC
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
COMMITTEE NAME PtJge 3
I.D. NUMBER
4. Type of Committee (Continued)
[] CITYCommittee [] COUNTYComrnittee [] STATEComrnlttee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an atlachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREE] ADDRESS NO ANO STREET CITY STATE ZIPCODE
~l~'~t~/'7}'l(~r~'e[';'"'~i'~'l [] --J___J Check box and provide/he date this committee qualified as a small conldbutor committee. If/he committee qualif'~d as a
Date qualified small contributor committee on January 1, 2001, enter 1/I/01.
5. Termination Requirements By signing the vedficafion, thetreasurer, assistant treasurerand/or candidate, officeho~er, or proponent ce~tifythat allofthe followingcondifions have been met:
c.-'//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
Government Code Section 89519.
FPPC Form 410 (Jan/03)
FPPC Toll-Free Helpline: 866/ASK-FPPC