HomeMy WebLinkAboutKAUSAR Form 410 TerminateStatement of Organization Date Stamp CALIFORNIA 41 0
FORM Recipient Committee EIVED AND FILE
Statement Type D Initia l D Amendment Ill Termination -See Part m hf office of the Secretary of Stat
I
For Official Use Only
0 . .of the State of California Not yet quahfied
or
0 Date qualification threshold met I Date qualification threshold met
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1402171
NAME OF COMMITTEE
Anjali Kausar for Saratoga C ity Council 2018
STREET ADDRESS (NO P.O. BOX)
19731 Yuba Ct
CITY
Saratoga
FULL MAILING ADDRESS (IF DI FFERENT)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPT IONAL)
anjali@anjalikausar.com
COUNTY OF DOMICILE
STATE ZIP CODE AREA CODE/PHONE
CA 95070 408-838-0502
Cltcviv
Attach additional information on appropriately labeled continuation sheets.
Date of termination
12 31 20
NAME OF TREASURER
Sameer Kausar
STREET ADDRESS (NO P.O. BO X)
19731 Yuba Ct
CITY
Saratoga
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BO X)
CITY
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O . BOX)
CITY
FEB 04 2021
STATE
CA
STATE
STATE
ZIP CODE
95070
ZIP CODE
ZIP CODE
I have used all reasonable diligence in preparing this statement and to the best of myknowlecfge the information contained herein is true and complete.
penalty of perjury under t h e laws of the State of California that the fQL_egoin?.iis true and correct.
1/29/2021
Executed on By
SIGNATURE OF TREASURER OR ASSISTANT TREASURER DATE
1/29/2021
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
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
AREA CODE/PHONE
408-506-8125
AREA CODE/PHONE
AREA CODE/PHONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fpp c.ca.gov