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HomeMy WebLinkAboutBERTRAM 410 AMENDMENT 9/23/10e Statement of Organization Recipient Committee stat ~le 5 [p ~ t► 4 Not yet qualified ❑ or I v Type or print in ink _JI Date qualified as committee R ® Amendment IT Mi flat@(III P_ 0 rt 5 in t. List I.D. number. List I.D. number: 09 1 07 f 2010 Date qualified as committee (If applicable) 1. Committee Information NAME OF COMMITTEE Martin Bertram for City Council 2010 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E-MAIL ADDRESS COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Kern Attach additional information on appropriately labeled continuation sheets cs Ctary olf State Treasurer and Other Principal Officers 7 STATEMENT OF I TION-k For Official Use Only 2111 OCT -4 PM 13: 14 NAME OF TREASURER Tom Nelson STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREETADDRESS (NO P.O. BOX) 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 and correct. Executed on Q - ~ 3 ` .2, V/ U By DBE __~~SIGNATUR E OF TREASURER OR ASSISTANT TREASURER Executed on - ')`o lo By DATE - IM Executed on DATE Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT FPPc Form 410 (June/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661276-3772) Date SEP 2 9 i jo R Date of Termination n By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Martin Bertram for City Council 2010 4. Type of Committee Complete the applicable sections. STATEMENT OF ORGANIZATION Page 2 • 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Martin Bertram City Council 2010 © Non-Partisan ❑ Non-Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION /il f ADDRESS AREA CODE/PHONE CITY BANKACCOUNTNUMBER STATE ZIP C( Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) OFFICE SOUGHT OR 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 (June/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION Page 3 I.D. NU Martin Bertram for City Council 2010 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 List additional sponsors on an attachment. NAME OF SPONSOR GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE Date qualified 5. 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 (June/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)