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HomeMy WebLinkAbout2018.06.04_Addis_Dawn_Form 410Statement of Organization Recipient Committee Statement Type $1 Initial Not yet qualified or ❑ Amendment ❑ Termination — See Part 5 0 Date qualified as committee / / Date qualified as committee Date of termination Date Stamp RECEIVED City of Morro Bay JUN 4 2018 City Clerk CALIFORNIA 410 FORM For Official Use Only 1. Committee Information I.D. Number (if applicable) NAME OF COMMITTEE Lin CITY STREET ADDRESS 0 P.O. BOX) ak 'ova) Ctl 7.01g CA 205 STATE ZIP CODE AREA CODFJ MAILING ADDRESS (IF DIFFER T) dauwciAvi oreAtu o un p,c. \ra)cAwabl,mc J E-MAIL ADDRESS (REQUIRED) FAX (OPTIONAL) COUNTY OFDOMI LE i_ an ) JURISD CTION WHERE COMMITTEE IS ACTIVE '!'rro Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and Other Principal Officers NAME OF TREASURER (.15.14.. 1I . 444- f t4 v STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CO NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY -Dam m Ci`2 NAME OF PRINCIPAL OFFICER(S) STREE ADDRESS (NO P CITY y STATE ZIP CODE (-A q STATE AREA CODE/PHONE 2, AODEin 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 perjurr' under the laws of the State of California that the f j Executed on W 1 i / c E U E By DATE i t Executed on " ` ■DA E� By T TREASURER R STATE MEASURE PROPONENT Executed on By DATE Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 INSTRUCTIONS ON REVERSE COMMITTEE NAME 4 1, G• f 2 • • Al( committees must list the financial institution where the campaign bank account is located. 1S2 1.D. NUMBER NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER • ADDRESS 4. Type. v --Com .thee .Complete the applicable sections,: Controlled Committee CITY STATE ZIP CODE • 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 Primarily Formed Committee 4 ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION CHECK ONE N onpartisan N onpartisan 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 SUPPORT i PARTY Partisan (list political party below) Partisan (list political party below CHECK ONE OPPOSE 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 COMMITTEE NAME eatid � 4.Type ofcop)-mittee (continued) General Purpose Committee , PROVIDE BRIEF DESCRIPTION OF ACTIVITY Sponsored Committee NAME OF SPONSOR STREET ADDRESS r () 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 List additional sponsors on an attachment. NO. AND STREET Small Contributor committee ; / Date qualified INDUSTRY GROUP OR AFFILIATION OF SPONSOR CITY STATE ZIP CODE I.D. NUMBER AREA CODE/PHONE 5. Termination Requirements By signing the verification,, the treasurer, assistant treasurer and or candidate officeholder- or proponent certify that all of the following con ditions have been met. a • • This committee has ceased to receive contributions and make expenditures; This committee does not anticipate receiving contributionsor 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. • Print FPPC Form 410 (February/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov