HomeMy WebLinkAbout10-5-2018 - Preserve Saratoga Form 410 AmendedDate Stamp
Statement of Organization
Recipient Committee
Statement Type
❑ Initial
O Not yet qualified
or
O Date qualification threshold met
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II Amendment
Date qualification threshold met
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❑ Termination — See Part 5
Date of termination
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1. Committee Information
I.D. Number FPfe /1Fz Z3 2
(if applicable
NAME OF COMMITTEE
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STREET ADDRESS (NO P.O. BOX)
►
STATE ZIP CODE
RECEIVE
OCT 0C 2L 8
CITY OF SARAT03A
For Official Use Only
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STREET ADDRESS (NO P.O. BOX)
CITY
S
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STATE ZIP CODE
AREA CODE/PHONE o77
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OF ASSISTANT ANY e 15070
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AREA CODE/PHONE NAME ,
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FULL MAILING ADORES DIFFERENT) STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
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Attach additional information on appropriately labeled continuation sheets.
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. 1 certify under
penalty of perjury under the laws of the State of Califo9n• that the fore• .ing i• rue and cor;
CITY
STATE ZIP CODE AREA CODE/PHONE
Executed on Oct- 5 2c> frg By
DATE /
Executed on By
DATE
Executed on By
DATE
Executed on By
DATE
NAME OF PRINCIPAL OFFICERS)
TG flew 4- �v1 b-
STREET ADDRESS (NO P.O. B )
CITY'
STATE ZIP CODE AREACOOE/PHONE
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SIGNATURE OF'E SURER OR ASSISTANT TREASURER
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/225-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
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• All committees must list the financial institution where the campaign bank account Is located.
NAME OF FINANCIAL INSTITUTION
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ADDRESS
1730 $
Type of Committee acApiete the applicable sections.
Controlled CbmmiEee
AREA CODE/PHONE
/o12370
BANK ACCOUNT NUMBER
/j/
ZIP CODE
a - Ss'/z7
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
Primarily Formed CbmmiEee
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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
_.
SUPPORT
V
OPPOSE
n
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
qxnsored CbmmiZee
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
p rzc3c , c,1-
4. Type of Committee (continued)
Lateral Purpose O miEee
Not 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
Stpfv/ff' Rector' Aft,i9Jiifft17.9 15.50075 /90P ctIw.Ids /AI 5/ EJ I4j Gib
List additional sponsors on an attachment.
NAME OF SPONSOR
NDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS
NO. AND STREET
CITY STATE ZIP CODE AREA CODE/PHONE
Snail tbntributor cbmmiEee.
Dace qualified
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.
-- 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: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov