HomeMy WebLinkAboutROWLES TERM 410 OH 6/27/01 tat~,ment of Organization
Recipient Committee
Statement Type [] Initial
Not yet qualilied [] or
'l~pe or print In Ink
[] Amendment
Mst I.D. number:.
I_ I, !
Date qualified as committee Date qualified as committee
1. Committee Information
STREETADDRESS (NO RD. BOX)
CITY STATE ZIP CODE AR~ CODeiNE
~LING ~DRESS (IF DIFFEREd)
~ Termination - See Part
List I.D. number:.
# q ol J[,ik
Date of Ten'ninatJon
Date Stamp
LD CITY
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STATEMENT OF ORGANIZATION
Fox OISctaJ Use O~ly
STrEEt ADD~J~SS . ~,
STREET ADORESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS
Ot-3DS- Bq 7
COUN'J~ OF DOMICILE I COUN~WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
K rn
Attach additional informa§on on appropriately labeled con#nuat~n sheets.
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S}, IF APPLICABLE
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 certi[y under penalty of
perjury under the laws of the State of Califomia that the foregoing is true and corral/_.
'7/$1/ ......... RE
Executed O~t ~ SIGNATURE ~ CO~T,~.~ING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
D~T~ By
Execute(~ on SIGNATURE OF CONTROLLING OFFICEHOCDER, CA,flOIDATE, OR STATE MEASURE PROPONENT
~TE By
S~C. NATURE OF cO~rROLUNO OFFIC~HOU~:.R, C.,~O~O^TE, OR STATE MEXSURE PROPONENT
FPPC Form 410 (Jan/01)
FPPC Toll-Free He pllne: 8661ASK-FPPC
St:at'emeht of Organization
Recipient Committee STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
~ -~aat~~ '~tole~ %c C,'~ ~ndil- o~c¢ bbldec Pr¢co~n-F
4, Type of Committee Complete the applicable sections.
I.O. NUMBER
· List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder conlrolled, also list the elective office sought or held, and
district number, if any, and the year of Ihe 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE YEAR OF ELEI
[] Non-Paffisan
· List the financial institution where the campaign bank account is located (controlled 'candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODE/PHONE
CITY
BANK ACCOUNT NUMBER
STATE
CANDIDATE(S) NA~E OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LI~ I I ~:R) CAnDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
INCLUDE DISTRICT N4
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee (contnued)
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 ACTIVITt'
List additional sponsors on an attachment.
NAME OF SPONSOR
STATEMENT OF ORGANIZATION
I.D. NUMBER
q3o503
ADDRESS NO. AND STREET
IINDUSTRY GRO{JP OR AFFILIATION OF SPONSOR
CIT~ STATE ZIP COOE
Date qualified
Check box and provide the date this committee qualified as a small co~tfibutor committee. If the committee qualified as a small
contributor committee on Janua~ 1. 2001, enter 111/01.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or caedidate, olficeholder, or proponent ceftin/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.
-- 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/01)
FPPC Tolt-Free Helpllne: 866/ASK-FPPC