HomeMy WebLinkAbout2018.08.15_Goldman_Jan_Form 410Statement of Organization
Recipient Committee
Statement Type
nitial
ick Not yet qualified
or
0 Date qualified as committee
/
/
❑ Amendment ❑ Termination — See Part 5
Date qualified as committee
Date of termination
Date Stamp
RECEIVED
City of Morro Bay
AUG 1 5 2018
Administration
For Official Use Only
1. Committee Information
I.D. Number
(if applicable)
2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
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MAILING ADDRESS (IF DIFFERS )
EMAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE ff
.(LA �-(c C) C-) i Se c.;
JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
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EA CODE PHONE
NAME OF ASSISTANT TREASU R, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/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 St. rect.
Executed on Ae.)6 ?, 2 6 l d By
DATE
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Executed on L �l , j TE� ' / a By
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
ER OR ASSISTANT TREASURER
1OLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
w.fppc.ca.gov
A
tatement of anization
ecipient ormittee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Jan Goldman for City Council j
All committees must list the financial institution where the campaign bank account is located.
I,D, NUMBER
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE
BANK ACCOUNT NUMBER
ADDRESS
4. Type of Com
ee 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
Jan Goldman
Primarily Formed Committee
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
Morro Bay City Council
YEAR OF
ELECTION
2018
CHECK ONE
Nonpartisan
Nonpartisan
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)
PARTY
Partisan
Partisan
(list political party below)
(list political party below)
v
SUPPORT
Esai
SUPPORT
El
CHECK ONE
OPPOSE
OPPOSE
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
+• - 'w.fppc.ca.gov