HomeMy WebLinkAboutForm 410 - Greg Brockbank for City Council 2013 TerminationStatement of Organization
Recipient Committee
Statement Type ❑ Initial
❑ Amendment
Not yet qualified ❑ or List I.D. number:
Date qualified as committee
1. Committee Info
NAME OF COMMITTEE
Date qualified as committee
(If applicable)
G(ZoCh0AN1'_ C-0- CT -TI mc>`3c%' 2.0 l3
Termination -See Part 5
List I.D. number:
# 1-35-0125
Date of Termination
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
5'A (—tS I cA �y�t�j
MAILING ADDRESS (IF DIFFERENT)
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
MQT'r) hav-.n
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
For Official Use Only
2. Treasurerland`Other;P..rincipal-Officers
NAME OF TREASURER .�
Gre iSrocY�r>r,_
STREET A�RESS (NO P.O. BOX)
-
CITY STATE ZIP CODE AREA CODE/PHONE
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NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS IND PO. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (No P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and comp
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on -4/k/2-016_ B �,� U rpt/ 1
ATE y �� SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on _ _ i^� 1,-01 b By
DATE �1 SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
I certify
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
2ocIc.3Ar�h Fe �L C� r�( cowa cZC 2c, (3 i 35 o" -lei
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
GM I, -.-rr Inv, ('�
4(5-- �I .z-�i5� C3 323`7d�
ADDRESS CITY STATE ZIP CODE
I-04GO (r VJc)a6 Hoy SQ, Rag, CA I-)go3
4'
pe of COmmittee Complete the applicable,sections.
L�....1L.1:..2 _..----.-............
Controlled Committee
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
GT Q5 �iro� (tank
Cow.c� I����S' Ci ry �]' carts 150.t��
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Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
IINrI Imp nISTRIrT Nn rITV nR rnuMTV Ac A— trAvi r%
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
1-11
SUPPORT
❑
—
OPPOSE
❑
SUPPORT
C[n
FPPC Form 410 (Jan/2016)
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
I.D. NUMBER
►3 f�O C �S3>4N I� Ftl fZ CTT M i,N C 1, L 9-613
4. Tyke of Committee (Continued)General Purpose 1
CommitteeNot 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 INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
Small Contributor Committee ' 11
Date qualified
S.TerminationRequirements�t, By signing thefveii0cation, the treasurer, assistant treasurer and/or candldat�, officeholder, onpropohentcerdfythatallofthefollow(ngconditionshavebeen met: �u j
• 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 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
wwwJppc.ca.gov