HomeMy WebLinkAboutTAKII 410 tatement of Organization
Recipient Committee
Statement Type [] Initial
Not yet qualified [] or
1. Committee Information
Type or print in (nk
[] Amendment
List LD. number:
__J_ /__
Date qualified as committee
(If appl~.e hie )
NAME OF COMMITTEE
STREET ADDRESS (NO PO BOX)
~TY SLATE fZIP"~OOE ~ ~REA CODE/PHONE
~IN G ADDRESS (iF D~FF ERENT) / /
OPTIONAL: FAXIE-MA~LADDRESS
A~ach additional info~afion on app~pfiately labeled continuafion sheEts.
L. TDermination - See Part 5
. number:
#
Date of Termination
Date Stamp
lug -9
,-,~. CITY CLERK
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
For Official Use Only
NAME OF TREASURER
CITY STATE ZIP CODE
NAME OF ASSISTANT TREAEU RE~R, IF ANY -
STREET ADDRESS
CITY STATE ZIP CODE AREA CODF~'PHONE
NAME ANDPOSITIONOFOTHERPRINCIFALOFFICER(S) IF APPLICABLE
,¢'#£// Z.
CI c,~E ZIP CODE
3. Verification
[ have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contalned herein is true and complete. [ certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
DATE
Exe=tE O. 8 -- - 0
DATE
Executed on
DATE
Executed on
DATE
A~URER OR ASSISTANT TREASURER
FPPC Form 410 (Jan/01)
Statement of Organization
Recipient Committee
INsTRucTiONS ON REVERSE
4. Type of Committee C~mpletetheappllcabiesections.
Page 2
LD, NUMBER
· Ust 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
distdct number, if any, and the year of the election.
· Mst the political party with which each officeholder or candidate is affiliated or check "non-partisan."
· If this committee acts jointly with another controlled commit(aa, list the name and identification number ofthe other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDR'EIOFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE} YEAR OF ELECTION PAR Ti'
· List the financial institution where the campaign bank account Is (dca(ed (con(roiled "candidate election" committees only)
BANK ACCOUNT NUMSER
.................... .iTl.,.,,.,,,o.,,,,_ pflmadlyformedtosuppo~toropposespeDlflccandidatesormeasureslnaslnglee~"tion. Lis(below:
CAND IDATE(B) OFFICE SOUGHT OR HELD OR MEASURE(Si JURiSDICTiON
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LE'/TER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE}
CHECK ONE
FPPC Form 410 (Janl01)
FPPC Toll-Frae HelpNne: 8661ASK-FPPC
Statement of Organization STATEMENT OF ORGANIZATK)N
Recipient Committee
[NSTRUCTIONS ON REVERSE
DNUMBER
4, Type of Committee (continue~)
[] CITY Committee [] COUNT? Committee [] STATE Corn mitred
List additional spo'~sers On an attachment.
NAME OF SPONSOR
S~EET ADDRESS NO. ANO STREET
iNDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZiP CODE
--'~ate qualified contrbutor committee o~ Janua~' 1,2001, enter 1/1/01.
5. mermination Requirements Bys~Jning~everi~cati~n~thetreasurer~assistanttre~surerand/~rcandidate~f~ceh~der~rpr~p~nentcer~Eythatai~f~ef~Ibw~c~ndi~nshave~enmet:
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 incu~Ted if, after terminating, t~e 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 (Janl01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
Sara L. Takii
August 8, 2002
City Clerk,
I was unable to file my forms 410 and 460 on 7/31.
I was out of town and did not open the mail in a timely manner.
When I finally realized that this filing was due, I had to locate
my treasurer to sign the appropriate paperwork.
I would like to request that the late fees be waived.
I thank you for your consideration into this matter. Please do not
hesitate to contact me if you have any questions.