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Home My WebLink AboutSULLIVAN 410 AMEND 02/11/14Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 0 Amendment List I.D. number: #950347 Date qualified as committee (If applicable) ❑ Termination — See Part 5 List I.D. number: 14 FFP' I ) e # Date of Termination Date Stamp 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER Jacquie Sullivan for City Council 2012 Jacquie Sullivan FAX/ E -MAIL ADDRESS OF DOMICILE COMMITTEE 15 ACTIVE For Official Use Only CITY NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification I have used all reasonable diligence in preparing t ' atement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the Stat I ifornia that the foregoing i rue and correct. Executed on ` / By /DAAT Z TEE SIG RE OF TREASURER OR ASSISTANT TREASURER ! L Executed on gy DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE 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 CALIFORRIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Jacquie Sullivan for City Council 2012 950347 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION ADDRESS 4. Type of Committee Complete the applicable sections: CITY BANK ACCOUNT NUMBER STATE ZIP CODE • 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION (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 SUPPORT OPPOSE FPPC Form 410 (Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER Jacquie Sullivan for City Council 2012 950347 4. Type of Committee (continued) • • Not 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 Sponsored Committee I List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Date qualified S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions have been met: • 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. -- 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 Statement of Organization Recipient Committee When to File 24 -Hour Reporting Who Files: Recipient Committees File this form within 10 days of receiving $1,000 in In addition to the 10 day rule to file an original Persons (including an officeholder or candidate), contributions. Include a $50 payment made payable to Form 410: organizations, groups, or other entities that raise the Secretary of State. Thereafter, the $50 fee is due annually no later than January 15. In addition to the I' $1000 $50 fee, a penalty of $150 may be assessed if payment is late. For early submissions, mark the "not yet qualified" box. The $50 fee is requested at this time but is not legally required until the group qualifies as a committee. The committee's FPPC ID number will be posted at www.sos.ca.gov. Read instructions carefully as a Form 410 will be rejected if all applicable sections are not completed. All committees must now disclose the financial institution and bank account number used by the committee. Where to File All Committees: Original Secretary of State Political Reform Division 150011th Street, Rm 495 Sacramento, CA 95814 County & City Committees: . Also file a copy with local filing officer who will receive the original campaign statements Amendments When information contained in the committee's Statement of Organization changes, file an amendment within 10 days of the change with the Secretary of State and local filing officer (if applicable). During the period 16 days before an election, file an amendment within 24 hours as described below. a recipient committee that qualifies during the 16 days prior to an election in which it must file pre- election statements must file a Form 410 within 24 hours of qualification with the filing officer who will receive the committee's original disclosure statements. a recipient committee that qualifies during the 90 days prior to an election in which the committee makes independent expenditures of $1,000 or more to support or oppose a candidate in that election must file the Form 410 within 24 hours of qualification with the filing officer who will receive the committee's original disclosure statements and with the filing officer(s) for the candidate(s) supported or opposed by the independent expenditure. if, during the 16 days prior to an election when a committee is required to file pre - election statements, a change occurs in the name of the committee, the treasurer or other principal officers, or the controlling candidate, an amendment must be filed with the filing officer receiving the committee's original campaign statements within 24 hours of the change. These filings must be made by fax, guaranteed overnight delivery, personal delivery or online (if online filing is available.) contributions from others tota mg , or more in a calendar year to spend on California elections qualify as a recipient committee. They must register with the Secretary of State and report all receipts and expenditures. "Contributions" include monetary payments, loans and non - monetary goods and services received or made for a political purpose. Existing nonprofit organizations, federal and out -of- state PACs, and other multipurpose organizations that receive contributions from others and make occasional expenditures in California elections must also register as a recipient committee with the Secretary of State. They must report the amount of their expenditures on California candidates or ballot measures and disclose the sources of those funds. (FPPC Reg. 18215.) Candidates: The personal funds of a candidate or officeholder used to seek or hold elective office are contributions and count toward qualifying as a recipient committee. However, personal funds used to pay a candidate filing fee or a fee for the statement of qualifications to appear in the ballot pamphlet do not count toward the $1,000 threshold. This form was prepared by the Fair Political Practices Commission (FPPC). For detailed information on campaign reporting requirements and the Information Practices Act of 1977, see the FPPC Campaign Disclosure Manual. FPPC Form 410(Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov