HomeMy WebLinkAboutRUSSO TERM 410 tatement of Organization
Recipient Committee
Statement Type [] Initial
Notyetquali§ed [] or
Type or print In Ink
[] Amendment
List I,D, number:
I.__ I I___
Date qualified as comrnJttee Date qualified as committee
1. Committee Information
NAME OF COMMI~EE
STREET ADDRESS (NO PO. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
~is't Termination - See Part 5
I.D. number:
#
9 .,~...~'/~ ( ,- ',,u~ ,~. ......
Date of Termination
DaleS~mp
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
For O~ficial Use Only
NAME OF TREASURER
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
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: FA~X/E-MAIL ADORE S
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional informafbn on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowlE
perjury under the laws of the State of Califomia that the foregoing is true and correct.
Executed on q'~q' ''~ O~;~] By
Exe~ted on ~ /-~0
!" x,~cuted on By
DATE
/~e-t~ informatiT:ntained herein is true and complete. I certify under penalty of
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MF-ASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpllne: 8661ASK-FPPC
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
4. Type of Committee Complete the applicable sections.
I.D. NUMBER
· 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 politica} party with which each officeholder or candidate is affiliated or check "non-partisan."
· tf this committee acts jointly with another controlled committee, list the name and identification 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
[] Non-Padisan
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE
ADDRESS CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
l~..tr, lliP~ol~.~*i~'.lm*ml~-~m Primarily formed to support or oppose specific candidates or measures in a single election. List below;
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CIT~ OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (Janl01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
S[atement of Organization
Re~:ipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
P~ge3
4. Type of Committee (Collfinued)
'~'- ' o' ' o-- '' Notformedtosupportoropposespecificcandidatesormeasureslnasingleelection. Checkonlyonebox:
[] CITY Committee [] COUNTY Committee [] STATE Committee
LD. NUMBER
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET Cl~r' STATE ZIP CODE
Date qualified
Check box and provide the date this committee qualified as a small contributor committee. If the commitlee qualified as a small
contributor committee on January 1,2001, enter 1/1/01.
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.
-- 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 (Jan/01)
FPPC Toll-Free Helpllne: 8661ASK-FPPC