HomeMy WebLinkAboutSMITH 410 AMEND 1/2/131
f Statement of Organization
Recipient Committee
Statement Type ❑ initial
Nd yet waw ❑ or
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Data qualified as committee
1. Committee Information
NAME OF COMMITTEE
Type or print M Mk
LAmendment ❑ Termination See Part b
LD. r m6w.. List I.D. number.
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Date qualified as committee Date of Termination
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106 i PjrL COUNCIL. 014
STREET ADDRESS (NO P.O. BO)O
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 CODEIPHONE
is true and complete. i certify under penalty of
By SIGNATURE OF CONTROWNG OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
By
S13NATURE OF CONTR5MR66TMEHOLOER. CANDIWE, OR STATE MEASURE PROPONENT
FPPC Form 410 (AprM2011)
FPPC Toll -Free Helptine: 866/ASK -FPPC (866/275.7772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
M
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 'non - partisan."
• If this committee ads jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATEIOFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• List the financial institution where the campaign bank account is located (controlled 'candidate election' committees only)
1r'1' ,, -
AREA
ADDRESS
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Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) 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) CHECK ONE
FPPC Forth 410 (AprIV2011)
FPPC Toll-Free Helpline: SWASK -FPPC (86 WS -37n)
A.
Statement of Organization STATEMENT OF
Recipient Committee RON e
INSTRUCTIONS ON REVERSE
4.Type -of Committee (continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY connr we ❑ COUNTY camrittee ❑ STATE committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
• • - • List additional sponsors on an attachment
CITY
GROUP OR AFFILIATION OF SPONSOR
3
Small COWributor Committee
Date quaWd
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the folbvdng 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 (AprIV2011)
FPPC Toll-Free Helpline: 8SWASK -FPPC (866/275 -37 2)