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HomeMy WebLinkAboutSULLIVAN 410 AMEND 07/16/08 Statement of Organization Recipient Committee Statement Type `Initial Not yet qualified© or Date qualified as committee 1. Committee Information Type orprint in ink %3 Amendment List I.D.number. # -25"o3N�%r Date qualified as committee (If applicable) ❑ Termination—See Part 5 List I.D.number: # NAME OF COMMITTEE Jacquie Sullivan STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS(IF DIFFERENT) ( COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Kern Attach additional information on appropriately/abeled continuation sheets. Date of Termination STATEWNr OF ORGANIZATION 2. Treasurer and Other Principal Officers NAME OF TREASURER Tracey Mitchell STREET ADDRESS For Official Use Only NAME OF ASSISTANT TREASURER,IF ANY STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S),IFAPPLICABLE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification I have used all reasonable diligence in preparing this statement 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 State of California that the foregoing is true a Executed on V By DA Executed on DATE Executed on DATE Executed on DATE www.netfie.com BY SIGNMURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT • 9C tT�i�fel3sl;=aIi7.YfZsI�t.Ce?:s79CK�Cs7�i7�ZiL1.f�IITi=sI�i�1_alysF.'iilc7a7c?si���:i4.� FPPC Form 410(Jan/05) FPPC Toll-Free Helpline:866/ASK-FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE M Jacquie Sullivan 950347 4.Type of Committee Complete the applicable sections. Controlled Committee ;I • 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 controlled committee,list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDID/WE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY • List the financial institution where the campaign bank account is located(controlled"candidate election"committees only) NAME OF FINANCIAL INSTITUTION Wells Fargo ADDRESS AREA CODE/PHONE 016-0099925 CITY STATE ZIP CODE Primarily Formed Committee I Primarily formed to support or oppose speck candidates or measures in a single election. List below: CANDIDATE(S)OFFICE SOUGHTOR 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(Jan/05) FPPC Toll-Free Helpline:866/ASK-FPPC www.netfile.com Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D.NUMBER Jacquie Sullivan 950347 4.Type of Committee (Continued) General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑CITY Committee ❑COUNTYCommittee ❑STATECommittee 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 STATE ZIP CODE Small Contributor Committee 1 ❑ I Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small Date qualified contributor committee on January 1,2001,enter 1/1/01. 5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all ofthefollowing 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. -- 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/05) FPPC Toll-Free Helpline:866/ASK-FPPC www.netfile.com