HomeMy WebLinkAboutSMITH 410 AMENDMENTJiaiement oT Vrganizailon
Recipient Committee
Date Stamp
CALIFORNIA
410
. M
Statement Type ❑ Initial ® Amendment
❑Termination —See Part 5
FOtoffidai Use only
0 Not yet qualified
or
22 APR -7
PM 1 :
Q Date qualification threshold met Date qualification threshold met
Date of termination
L t{fl
• • • I.D. Number
o Ucable
•
• • •
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NAMEOF COM MITTEE
NAME OF TREASURER
BOB SMITH FOR CITY COUNCIL 2022
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
AREA CODE/PHONE
CITY STATE ZIP CODE AREACODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO Po, BOX)
E-MAILADDRESS(REQUIRED)/FAX (OPTIONAL)
CITY
STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE
AREA CODE/PHONE
Verification3.
• •� unlrcn— uI N1 cIjal nlg I� ��aLCinOEEL atE U ulc uesL UE my Knowieuge me InTormaaon contalnea nereln Is true and complete. I certity under
penalty of perju and r he I ws of the Stat f Cal( 1 hat ore oin is true and correct.
Executed on By
,[DATE SIG ATUR FTR SURERORASSISTANTTREASURER
Executed on �7 ?61�e By
DATE
SIGNATM OFTONTkOLLIN$KOFFICEMOLDER, 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 420 (August/2018)
FPPC Advice: advice0fppc.ca.sov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee F..
INSTRUCTIONS ON REVERSECOMMITTEE NAME
BOB SMITH FOR CITY COUNCIL 2022
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODE/PHONE
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled,
aISO 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" Stating "No party preference' is acceptable
• 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 YEAR OF PARTY
NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION «�
RC)R SMTTH
RAKFRRFTFT.T) CITY COTTNCTT. WART) 4
Nonpartisan
Or
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHFCK nNF
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME
BOB SMITH FOR CITY COUNCIL 2022 I.D. NUI
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
List additional sponsors on an attachment.
NAMe Ur]rUNSUR
STREET ADDRESS NO. AND STREET
CITY
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee —
❑
Date qualified
Termination5. • •
• 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(August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov