HomeMy WebLinkAboutSULLIVAN 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