HomeMy WebLinkAboutForm 410 - Eric Holm for City Council 2009 TerminationStatement of Organization Type or pent In Ink
Recipient Committee
Statement Type :] Initial Amendment
Not yet qualltied 0 or List I.D. number:
Date qu Diadsa committee Date qualAWcsa ommittee
(I€ applloahlo-)
1. Committee information
NAME OF colh)fITTEE
ERIC HOLM FOR SAN RAFAEL CITY COUNCIL
STREETADDRESS (NO P.O. BO}()
Eg Termination — See Part 5
List I,D, number:
01320372
92 t 31 ( 11
Dale of Termination
CRT STATE ZIP CODE AREA CODEiPHONE
SAN RAFAEL CA 94901 (
1(AILING ADDRESS (fF D IFFERENT)
PQ BOX 151626, SAN RAFAEL, CA 94995-1626 —
&PTONAL: FAX/E-MAILAODRESS
CCIJNTYOFDOMICILE COUNTY WHERE ITHAN OUNTYOFOCAOCILEEiB
T�
Attach addfOnat /Wfarmatlon on apptroprfa€ely labeled conrinuation sheets.
IF DIFFERENT
2. Treasurer and Other Principal Officers
OF ORGANIZATION
Use Only
NAME OF TREASURER
By
DATE
MICHAEL WHIPPLE
By
Execuled on
DATE
STREET ADDRESS
By
DATE
CITY
STATE
ZIP CODE
AREA CODEIPHONE
SAN RAFAEL
CA
94915
(
NAME OF ASSISTANT TREASURER, IFN1Y
MICHELLE WHIPPLE
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODEiPHONE
SAN RAFAEL
CA
94915
(
NAME AND POSITION OF OTHER PRINCIPALOFOCER(S), IF APPLICABLE
M,4ILING ADDRESS
CITY STATE ZIP CODE AREA CODEPHONE
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
pedury under the laws of the State of Califomia that the foregoing is true and Correct,
Executed on 1/27/12
By
DATE
1/!27112
By
Execuled on
DATE
Executed on
By
DATE
Executed on
DATE
By
s46NATUREOF G5ttrRUING OFRCEROLUER, CANDDDATE;, ORSTATE !MEASURE PROPONENT
FPPC Form 410 (Januar)OS)
FPPC Tail -Free Helpllne; 8661ASK.FPPC (8661275.3772)
Statement of Organization
Recipient Committee
IN57RUCTIONS ON REVERSE
r-Pir. HOLM FOR SAN RAFAEL CITY COUNCIL
4, Type Of COMMittes Complete the applicable SaGllom,
1320372
0310WA'AI
MM
List the name of each controlling officeholder, candidate, or state measure proponent. if candidate or officeholder controlled, also list the elective office soughtor 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 YEAR OF ELECTION PARTY
NAME OF CANDIDATE/OFFiCEHOLDE WSTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER W APPLICABLE) M Non -Partisan
ERIC HOLM SAN RAFAEL CITY COUNCIL 2009
Non -Partisan
* List the financial institution where the campaign bank account is located (co ntrolled"candidate election' committees only)
NAME Cf: FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMUth
PRESI DIO BANK (416) 466-6000 1104001126
CITY STATE ZIP CODE
ADDRESS SAN RAFAEL CA 94901
999 FIFTH AVE, SUITE 300
07117 11�1=1 Pftarly formed to support or oppose specific candidates or measures in a single election, List below:
CANDICATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
CAND JDAM(S) NAME OR MEASURE(S) FULLTITLE {INCLUDE BALLOT NO, OR LETTER) (INCLLVE DISTRICT NO,, CITY OR cOUWY� AS APPLICABLE) CHECKONE
I supmtr I OPF
FPPC Fcrm 410 (January/06)
IFPPC Toll -Free Helpline: 866)ASK-FPPC (8661275-3772)
STATEMENT OF
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE rage j -
I.D. NUMBER
CGMIAITTEE NAME 132D372
ERIC HOLM FOR SAN RAFAEL CITY COUNCIL
4, Type of Committee (Continued)
General P"rpose Coininittee Not formed to support or oppose specific candidates of measures in a single election. Check only one box;
1--- Crry Committee [] COUNTY Committee [] STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored CommitteeList additionai sponsors on an attachment.
NAME OF SPONSOR
ADDRESS No. AND STREET
CITY
NOUSTRY GROUP OR AFFILIATION OF 15PONSUR
Check box and provide the date this committee qualified as a small contributor committee, If the committee qualified as a
Date qualified small contributor committee on January 1, 2001, enter 111/01.
5.Termination Requirements By signIng the verification, the treasurer, assistant tremrer andlor canclKate, ofteholday, or proponent certify that all of the foilowing conditions have been mel:
4 This committee has ceased to receive contributions and make expenditures,,
• This committee does not anticipate receiving contributions or making expenditures h the future;
• This Committee has eliminated or has no intenflon 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.
FP1PC Form 41D (January/051
FPPC Tol Wree Helpline: 866/ASK-FPPC (866175-3772)