HomeMy WebLinkAboutForm 410 - Rachel Kertz for Board of Education 2018 InitialStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Q Not yet qualified
or
O Date qualified as committee
❑ Amendment ❑ Termination — See Part 5
Date qualified as committee Date of termination
I.D. Number
(if applicable)
NAME OF COMMITTEE
Ao cGie-1 IerTZ r -p2 13o�2a o F cOuc�ric�✓ o l �
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE
E 15 ACTIVE
Attach additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in preparing this sl
penalty of perjury under the laws of the State of Calife
Executed On f7/ a! ?i // q By
% DATE
Executed on �/ L�/ By
DATE
Executed on By
DATE
Executed on
DATE
OF TREASURER
0
AUG 13 2018
CITY CLERK'S OFFICE
L olze /(i h E/L Z
For Official Use Only
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICE R(S)
n.-+3ckGL �cCfLT i
STREET ADDRESS (NO P.O. BOX)
-
CITY STATE ZIP CODE AREA CODE/PHONE
and to the best of my knowledge the information contained herein is true and com
the fgregoina is true and correct.
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
I certify u
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
Page 2
I.D.NNMBER
• 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." Stating "No party preference" is acceptable.
• 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 YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
rucrenuc
20/5
Nonpartisan
Partisan
(list political party below)
SUPPORT
❑
OPPOSE
❑
Nonpartisan
Partisan
(list political party below)
❑
❑
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
rucrenuc
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
❑
OPPOSE
❑
SUPPORT
❑
OPPOSE
❑
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
••
Statement of Organization
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central 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 AREA CODE/PHONE
Date qualified
• 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 (February/2018)
Clear Pae Print
M_g.. FPPC Advice: advice@fppc.ca.gov (866/2753772)
www.fppc.ca.gov