HomeMy WebLinkAboutCARSON 410 07/02 tatement ef Organization
Recipient Committee
Statement Type [] Initial
Notyetqualified [] or
Type or print In Ink
I~ Amendment
list I.D. numbec
I
Date qualified as committee Date qualified as ~omm~ee
1. Committee Information
[] Termination - See Part 5
List I.D. numbec
I I
Date of TemflnaUon
~,'~ ~== ~ AD~ (NO p.O. BOX)
IOIC
CITY
MAILING ADDRESS (IF DIFFERENT)
02 JUL 31 P~!
~. E, ~rt CiTY CLER~
~TATEMENT OF ORGANIZATION
2. Treasurer and Other Principal Officers
NAME OF T~EASURER
STATE ZIP CODE o AP. BA CODFJPHONE
/ ~:~ ADDRESS
OP~OH~L: FAX I E-~MAIL ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
Attach ad~Uonal information on approp6ately labeted con~nuation sheets.
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND ~SmON OF OWI~ PRINCIPAL OFFICER(S), IF APPUCABLE
3. Verification
I have used ali reasonable diligence in preparing this statement and to the best of my knowledge the n[onnation contained he~_ar~J complete. I certify under penalty of
pmjury under the Iaws of th~rState ~f California that Ihe foregoing is true and correOx /? /y /2~/~ //'? /~f /(
By
FPPC Fomt 4t0
Statement of Organization
· Recipient Committee
STATEMENT OF ORGANIZATION
;'ag. 2
4. Type of Committee Complete the applicable sections.
!.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 political pa~y with which each officeholder or candidate is affiliated or check "non-partisan."
· 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
[] Non-Partisan
· List the financial institution where the campaign bank account is located (controlled -candidate election, committaes only)
NAME OF FINANCIAL INSTITUTION
14//,k /-f /, N TD Af /Y o' TC,/ /-- N I/-
CANDIDATE(S) NAME OR MEASURE(S) FULL TITI_E (INCLUDE BALLOT NO. OR L~ I I t:R) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURI-~DICTIOR
(INCLUDE DIS~RIC'I' N(
FPPC Form 410 (Jan/01)
FPPC Toil-Fro Halpl~e: 8~/ASK4=Ppc
St~tt~ment of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
Page3
?-o 6A6oT'
4. Type of Committee (Continued)
ler-m'~ma"' 'z'~"~'-u'm'""m ~':i'J N_..ot f/,,ormed to support or oppose specific candidetes or measuras in a single election.
L~rcITY Committee [] COUNTY Committee [] STATE Committee
Ch~ck only one box:
I.D. 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 CITY STAT ZIP CODE
[] I I Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a srnall
Date qualified contributor committee on January 1,2001, enter 1/1/01.
5. Termination Requirements Bysigningthever~cati~n~thetreasurer~assistanttreesurerand/orcandidate~iceh~der~rpr~p~nentcer~i~ythata~fthef~wingc~nditi~nshavebeenmet:
· 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 othem, or any other regeipts.
FPPC Fonn 410 (Jan/01)
FPPC Toll-Free Hell)line: 86~/ASK4:PPC