HomeMy WebLinkAboutForm 410- Gary Phillips for Mayor 2015 TerminationStatement of Organization
Recipient Committee
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Statement Typefficial
❑ Initial ❑Amendment
Termination —See Pa
For OUse Only
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Q Date qualification threshold met Date qualification threshold met Date of ter nation
W231 ICITY CLERK'S OFFIC
Committee1. I.D. Number ,�,2.
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NAME OF COMM CTTEE
Treasurer and Other PrincipalOfficers
NAME OF TREASURER
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STREETA DRESS (Nb AO, BOX}
STREET ADDRESS(NO P.O. BOX)
CITY STATE ZIP CODE
AREA CODE/PHONE
C STATE ZIPCODE
NAME OF ASSISTANT TREASURER, IF ANY
FULL MAILING ADDRESS (IF DIFFERENT) r
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL)
CITY STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
1V ISOICTI ON V7E COMMITTEEI5ACTIVE
NAME OF PRINCIPALOFFICER(S)
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE
AREA CODE/PHONE
3. Verification
$ nave used all reasonable diligence In preparing
STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
FPPC Advice: advice (cafppc.ca.gov (866/275-3772)
www.faoc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
I s 0\ -51-. G.0011,0— 4 r--I4-qV i
• 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 ORHELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION rucrk nuc
D
J
.. r , 1
Nonpartisan
Partisan
(list political party below)
r
Nonpartisan
Partisan
(list political party below)
Primarily Formed Committ�e 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 SOUGHTOR HELD OR MEASURE(S)JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONTOF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(August/2018)
FPPC Advice: advice0fppc.ca.gov (866/275-3772)
www.fppc.ca.eov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
E
AA.-
General
�y
PurposeNot 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
STREET ADD RESS NO. AND STREET
❑
Date anllRad
CITY
I NDUSTRY GROUP OR AFFILIATION OF SPONSOR
• This committee has ceased to receive contributions and make expenditures;
1/ • This committee does not anticipate receiving contributions or making expenditures in the future;
Page 3
I.D. NUMBER
T
STATE ZIP CODE AREA CODE/PHONE
�• 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
1• 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 (August/2018)
FPPC Advice: advicelu poc.ca.gov (866/275-3772)
www.fppc.ca.gov