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Home My WebLink AboutBernald -Form 410Statement of Organization Recipient Committee Statement Type 0111nitiai Not yet qualified or Q Date qualified as committee Date Stamp OEIV E 0 ' MANMEWS OFFICE. ❑ Amendment ❑ Termination — See Part 5 2013 Bi 14 Pik 4: 11 Date qualified as committee Date of termination SARATOGA. CA Ctilltri►"#rl�mtselifiri I.D. (dumber (if applicable) 141'.,_ s NAME OF COMMITTEE Ka" - [--j cnc.. �� n cM -�'(o r- 6o« �� e k I -Q Q f �8 STREET ADDRESS (NO P.O. BOX) CITY (`/� /� jS'TATT�E ZIPCODE �AkEA°�CODE/PHONE %[ MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Attach additional information on appropriately labeled continuation sheets. �. '1'i�a��urer �rtcC 1'�ther �n�i NAME OF TREASURER JUL J© Vwls- -o rie STREET ADDRESS {NO P.O. BOX) I + r For official Use Only on CITY ®9 STATE ZIPCODE AREA CODE/PHONE CPQ q50 --VG NAME OF ASSISTANT TREASUREP, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY - STATE ZIPCODE AREACDDE/PHONE *: I have used all reasonable diligence in preparing this statementan d to the best of my knowledge the information contained herein is true and complete. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on r �� I ( D gy P DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER � Executed on J Q 51 1 8gy -DATE SIGNATURE 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 (February/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee U INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I: tnoLry -- LL3mmP,�-r na Id dor CcQnct 1 201 S • All committees must list the financial institution where the campaign bank account Is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER (�,�e�15 largo �4C ADDRESS, CITY STATE ZIP CODE - CA Qso� • 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 CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE ly Qrl -Lynne i� r na Id r�i�/� /'. j� , '��Ct' ZQ i • 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 IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE 1 vl lel t VI SUPPORT ❑ Nonpartisan Partisan El (list political party below) SUPPORT OPPOSE Nonpartisan El 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) FULL TITLE (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) CHECK ONE 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 INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER M.ar"Y- L ane tier nC►Id �Or CC) UYA61 24 t$ 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 STREETADDRESS NO.ANDSTREET ❑ --✓-1 Date qualified CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE AREA -- 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 gov (866 275-377 ) Clear Pa e: Print FPPC Advice: advlce�Dfppc.ca.gov (866/275-3772) www.fppc.ca.gov