HomeMy WebLinkAbout2018.11.27_Goldman_Jan_Form 410 TerminationStatement of Organization
Recipient Committee
Statement Type
❑ Initial
0 Not yet qualified
or
Q Date qualification threshold met
1, Committee Information
❑ Amendment
Date quaf4flcallon threshold met
I.D. Number
of applicable) 1 I Q l
Date Stamp
P CEIVeD ANL) Fit.
la Termination — See Paffk III 0ffie@ Of the Socrrilaf]I bf
Af itta €;iAte of CaillnrriiA
Dale of termination
11 13 rla
Lr
NOV 27 2016
2. Treasurer and Other Principal Officers
tote
D
orro .ay
JAN 11 2t19
r'ity Clerk.
NAME OF COMMITTEE
NAME OF TREASURER
Jan Goldman for City Council 2018 John Erwin
STREET ADDRESS (No P.O. COX)
CITY
Morro Bay
STREET ADDRESS (No FRCP 80A)
CITY
Morro Bay
STATE
ZIP CODE AREA COOS PHONE
CA 93442
STATE ZIP CODE AREA COD E/FHONE NAVE OF ASSISTANT TREASURER, IF AID(
CA 93442 805-550-1097
FULL MAILING ADDRESS (iF DIFFERENT)
E-MAI I. ADDRESS REQUIRED)/FAA{OPTIONAL)
•
< C V. - u l -C gorr6 AGE/
Attach additional Information on appropriately labeled continuation sheets.
STREET ADDRESS I.O P.O.60F(
CITY
STALE ZIP CODE AREA CODE/PPIONE
IIA ,!E OF RILL CIFAL OFFICE RCS)
STREET ADDRESS NO P.O. BOA)
CITE STATE 21P 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 th laws of the State of Califo
Executed on /7
At1nf� �1E r1
Executed on I- v F r- U O/ n By
DATE
Executed on
DATE
By
Executed on By
DATE
SSISTANT TREASURER
OR STATE MEASURE PROTON ENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASURE FAOPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
fPPC Advice: advlcet (Fppc.ca,gov (866/275-3772)
www,fppc.Ce.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMIE(NAVE
Jan Goldman for City Council, 2018
• All committees must llst the financial Institution where the campaign bank account Is located.
NAVE Of FINANOAL IN STITUT4ON
Wells Fargo Bank
AMISS
730 Quintana Road
AREA CObr/PISISNE
806.771-8310
or(
Morro Bay
OM.
STATE
CA
LPCOCE
93442
4. Type of Committee Complete the applicable sections,
Controlled Colp{ftjtlee,-';;;;
• 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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATEf0FFICER0L0ER/STATEMEASURE PROPONENT {INCLUDE DISTRICT NUMBER IFAPPLICA8U) ELECTION CHU<WEE
Nonpartisan Partisan (list political party below)
Jan Goldman
Morro Bay City Council
2018
Nonpartisan Partisan
❑ ❑
()1st political party below)
Minority Formed Committee,.;:;
Primarily formed to support or oppose specific candidates or measures In a single election. List below:
CANDIDATE'S} OFFICE SOUGHT OR HELD OR MEASUREISt JURISDICTION
CAND1FATREC RECALL,
OR TE`RECAL. IN FULETOFF iltOF OFFICEHOLDER'S
AOLETTER]{INCLUDE DISTRICTNO, CITYORCOUN1V,ASAPPLICABLE)
1F A RECALL, STATE `RECALL' IN FRONT OF THE OFfICEHOLOER'S NAME.
CHECK ONE
wPfaar oP_PosE
T
FPPC Form 410 {August/2018)
FPPC Advlce, ad vtceePippc,ca.gov (866/275.3772)
www,fppc.ca,gov
Statement of Organization
Recipient Committee
INSTRUCTIONSON REVERSE
COMMITTEE NAME
Jan Goldman for City Council 2018
4. Type of Committee (continued)
General Purpose Committee;_..:.
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee.
List additional sponsors on an attachment.
NAME OF SPONSOR
NDUSTRY GROUP OR AFFIllATION OF SPONSOR
STREET ADDRESS
NO. AND STREET
CITY STATE ZIP CODE AREA COOEIP1ONE
Small Contributor Committee..
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the 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 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov