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Home My WebLink AboutForm 460 - Termination - Committee to Restore Saratoga r Statement of Organization Date5tamp , • . . , Recipient Committee ('`V N"CLr "u'1I .o-Q • . 1 �4-p p l,ic�ri tm c� Statement Type ❑initial ❑ Amendment -termination RECEI EDANL� `14—, For offidalUse Only Not yet qualified❑ or List I.D.number: List I.D.number: in the office of the Secretar of State l 3 ZS, 3 00 of the State of Galifoi nia 31 ZotL- JAN 0 3 2017 Date qualified as committee Date qualified as committee Date of Termination (If applicable) Other:Psi 'ci al?Officers,:k; ur rand. n _ yeas a .._. .... ._ -. 1<,_.Committee,lnfo. anon._,... _.... ,.... . ..�.,,..,In_,...,...�......::.:.::� ,: . . .-: .... . .__..... _..,�.._...., ., __. NAME OF COMMITTEE NAME OF TREASURER --I "-,- C�,Q- STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX) CITY tTATE ZIPCODE AREA CODE/PHONE 1 9 6 2.-7 Q l, ti �m-,rye .'_l-fl 4nt CITY I STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDRESS(IF DIFFERENT STREET ADDRESS(NO P.O.BOX) ])..( FAX/E-MAIL ADDRESS CITY STATE ZIPCODE AREACODE/PHONE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE NAME OF PRINCIPAL OFFICER ) `( STREET AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. I havelused all reasonableJAiigence in preparing this statement and to the best of,my�kn owl eethe information contained herein is true and complete. I certify under penalty of perjury under lthe �laws of the State of California that the foregoing�is true and correct. Executed on ��w�a'�I ( Zo1_66y DATEt n .,,� y�,{„_„�yp�� SIGNATURE OF TREASURER OR SSISTANT TREASURER Executed on By �' lib' fv�^3 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(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA1 Recipient Committee . INSTRUCTIONS ON REVERSE Page 2 - COMMITTEE NAME I.D.NUMBER C. n+ex- 40 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER ADDRESS STATE ZIP CODE r ' ;t 4:4T a of:C :4 ommltte a';e��Co'In lete:the�a °licab c �.Yp r :��°" .. �.,a ... �s.:. .�_..e.,.--.,..n....,:...k,,,........u.;..�..-. _ .vl.._�.w?..,,....-L„,.ta.':i.�a�.:•r.'.;.,..k...�._`�a .�t:.,., • 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." • 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 ❑ Nonpartisan Primarily Formed Committee -- Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S)NAME OR MEASURES)FULLTITLE{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 S UPPORTOPPOSE El FPPC Form 410(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov . - . ^ Statement of Organization CALIFORNIA 410 Recipient Committee FORM INSTRUCTIONS ON REVERSE �Page 3 COMMITTEE NAME j.D.NUMBER General Purpose Committee, Not formed to support or oppose specific candidates or measuresina single election. Check only one box: OCITYCommittee [] COUNTY CommitteeOSTATECommittee , ^\ PROVIDE BRIEF DESCRIPTION o,ACTIVITY ` List additional sponsors ononattachment. NAMEOFSPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO.AND STREET CITY STATE ZIP CODE Small Contributor Committee 6=«=lifled ° 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 v'��-=�� ° 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. RdertoGnvemment Code Section 88S19. — Leftover funds of ballot measure committees maybe used for political,legislative or governmental purposes under Government Code Sections 89SIl-89518,and are subject tn Elections Code Section 1a§OD and Fppc Regulation 1oS21.s. FPPcporm 410(Jan/206) pppc Advice:aumcp@,fppc.co' ( '3772) wwv.fppc.p^.mpv '' Trish Cypher , Committee to Restore Saratoga Saratoga, California Assigned FPPC Committee Identification Number 1328300 Debra Bowen Secretary of State State of California Political Reform Division 1500 11th Street, Room 495 Sacramento, California 95814 December 30, 2016 Dear Ms. Bowen, This letter serves to notify you of the withdrawal of the application made in support of the creation of the legal entity Committee to Restore Saratoga supported by a Statement of Organization (form 410),with the assignment of the above committee identification number by the Fair Political Practices Commission (FPPC) in 2010. This letter also serves as an affidavit that paperwork and funds since the formation and termination of this committee have been properly handled. Fees to Secretary of State have been paid for 2016. The final form 410 is enclosed and final form 460 filed with the City Clerk Please update your records accordingly to reflect the withdrawal of application and termination of any contract,which includes my name and close this account Consent to act on behalf of any legal entity including,but not limited to the "Committee to Restore Saratoga" is hereby withdrawn. y Without prejudice, � rn JAN 0 31011 Trish Cypher C-) Qrr Treasurer; until 12 midnight December 31, 2016 for legal entity Committee to Restore Saratoga dissolved December 31, 201 qRY OF g�P� Enclosure: Final 410, termination of committee