HomeMy WebLinkAboutForm 410 - Termination - Mary-Lynne Bernald -2015Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified 0 or
Date qualified as committee
Type or print in ink
❑ Amendment
List I.D. number:
® Termination — See Part 5
List I.D. number:
# 1365458
03 r 09 r 2015
Date qualified as committee Date of Termination
(If applicable)
Date Stamp
RECEIVED AND FILE
in tie office of the Secretary of Stat
of the State of California
STATEMENT OF ORGANIZATION
MAR 162015
For Official Use Only
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
Mary -Lynne Bernald for Council 2014
STREET ADDRESS (NO P.O. BOX)
CITY
Saratoga
STATE ZIP CODE AREA CODE/PHONE
CA 95070
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE
Santa Clara
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Judy L Johnstone
STREET ADDRESS
CITY
Saratoga
STATE ZIP CODE AREA CODE/PHONE
CA 95070
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY
STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY
STATE ZIP CODE AREA CODE/PHONE
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
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on ,g -CD By
DAJrE I 1 )SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on 3 19 a(115 By
DATE
/ 1 SIG"
•
URE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Mary -Lynne Bernald for Council 2014
4. Type of Committee Complete the applicable sections.
ntrolled Committee
STATEMENT OF ORGANIZATION
• 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.
• Listthe 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF ELECTION
PARTY
Mary -Lynne Bernald
Saratoga City Council
2014
Non -Partisan
• Non -Partisan
• Listthe financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
VVells Fargo Bank
AREA CODE/PHONE
BANK ACCOUNT NUMBER
ADDRESS
CITY
Saratoga
STATE
CA
ZIP CODE
95070
P irnarily Forrned Committee
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 SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 666/ASK-FPPC (866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Mary -Lynne Bernald for Council 2014
STATEMENT OF ORGANIZATION
Page 3
I.D. NUMBER
1365458
4. Type of Committee (Continued)
eral Purpose Com►nittee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
® CITY Committee 0 COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
raising money to support candidate
nsored Committee
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET
CITY
STATE ZIP CODE
�= II Contributor Committee
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 1/1/01.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following 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.
FPPC Form 410 (January/D5)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)