HomeMy WebLinkAboutForm 410 - HMillerStatement of Organization
Recipient Committee
Statement Type ® initial
Not yet qualified ❑ or
07 19 12
1_J
Date qualified as committee
1. Committee Information
Type or print in ink
❑ Amendment
List I.D. number:
Date qualified as committee
(If applicable)
❑ Termination — See Part 5
List I.D. number:
— I
Date of Termination
NAME OF COMMITTEE
Committee to Elect Howard Miller to Saratoga City Council 2012
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREACODE /PHONE
Saratoga
CA 95070
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E- MAILADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Santa Clara
Attach additional information on appropriately labeled continuation sheets
Date Stamp
M 1009 TOd�r
JUL 232012 Ip
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Sandy Miller
STATEMENT OF ORGANIZATION
For Official Use Only
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE
NAME OF ASSISTANT TREASURER, IF ANY
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE /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.
7 -19 -2012
Executed on By
DATE
7 -19 -2012
Executed on By
DATE
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Committee to Elect Howard Miller to Saratoga City Council 2012
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
I.D. NUMBER
• 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 "non- partisan."
• 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
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Howard Miller
Saratoga City Council
2012
❑ Non- Partisan
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
Comerica Bank
AREA CODE /PHONE
408 - 867 -6829
BANKACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
13000 Saratoga Sunnyvale Road Saratoga CA 95070
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
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
Committee to Elect Howard Miller to Saratoga City Council 2012
4. Type of Committee (Continued)
Purpose General 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
, . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all ofthe 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 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)