HomeMy WebLinkAboutPATIENTS FOR COMPASSIONATE USE POLICIES 410 AMEND 7/5/13IF
Statement of Organization
Recipient Committee
Statement Type ❑ Initial .�' Amendment ❑ Termination — See Part 5
Not yet qualified ❑ or List I.D. number: List I.D. number:
# q
Date qualified as committee Date qualified as committee Date of Termination
IN applicable)
Treasurer and
NAME TREASURER
Date Stamp
For Official the Only
STREET DDRESS P.O. X) -
NAME CrASSISTANT TREASURER, A Y
Executed on BY
DATE SIGNATURE OFCONTROLUNG 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 CALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
MMITTEE ME I ` C I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME O FINA AL INSTITUTI
4. Type of Committee Complete the applicable sections.
• 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
_.__a_. � -_ -- �..�._. _ ...__.--- _•____._�,____.__. _-- ___._._-- --- - -- _.
111 Nonpartisan
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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE)
FPPC Form 410 (Dec/2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT -
_ OPPOSE
St4ppa
i
O
[n-
FPPC Form 410 (Dec/2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
I...
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE P°a 3
4. Type
(Continued)
formed to support or oppose specific candidates or measures in a single election. Check only one box:
Committee 13 COUNTY Committee ❑ STATE Committee
: n .,
sponsors on an attachment.
SPONSOR
NAME OF SPONSOR
STREET ADDRESS flu. A..aI —I
ti
t
Date qualRied
By signing the veriftcation, the treasurer, assistant treasurer and /or candidate, otticehoider, or proponent cemty mat an or me rvuvwIng cwwMVIM nave Ueen mec
• 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 maybe 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.ce.gov (866/275 -3772)
www.fppc.ca.gov