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HomeMy WebLinkAboutDEAN 410 AMEND 10/10/12Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or * Amendment List I.D. number: # 13 5281© ❑ Termination — See Part 5 List I.D. number: Date Stamp 13 FEB -5 AM 9: 37 For Official Use Only STREET ADDRESS (NO P.O. BOX) STREET CITY STATE ZIP CODE AREA CODE /PHONE CITY MAI COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE f2 r7 Attach additional information on appropriately labeled continuation sheets. ASSISTANT TREASURER, IF STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) V I, I j STREET ADDRESS (NO P.O. BOX) S (�, v --� CITY STATE ZIP CODE AREA CODE /PHONE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee • INSTRUCTIONS ON REVERSE COMMITTEE NAME A /, • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER ADDRESS Page 2 I.D. NUMBER 13 52, $Cv • 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 "nonpartisan" • If 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 V14 A `V 10 w QJCv Z U Nonpartisan SULi ❑ Nonpartisan Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410(Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT ❑ OPPOSE ❑ SULi C FPPC Form 410(Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORiltha Recipient Committee FORMI INSTRUCTIONS ON REVERSE / /�'�o} / Coo':'- Page V`/ 1 �' �k�•D _ �` iov� 17 I.D.�NUjER O COMMITTEE NAME 1IVL/'' '7J {7^ N t formed to support or oppose specific candidates or measures in a single election. Check only one box: CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY l �� ��p r � List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR Date qualified • This committee has ceased to receive contributions and make expenditures; STATE ZIP CODE • 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. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec /2012) FPPC Advice: advice@fppc.ca.gov (866 /275 -3772) www.fppc.ca.gov