HomeMy WebLinkAbout2022.01.18_CAL_Form 410 AmendStatement oil Organization
Date
Stamp
CALIFORNIA
Recipient Committee
RECEIVED
FORM
Statement Type ❑ Initial ® Amendment ❑
Termination — See Part 5
City of
Morro Bay
For Official Use Only
0 Not yet qualified
JAN
18 2022
or
0 Date qualification threshold met Date qualification threshold met
Date of termination
Administration
Committee1.
•
• - Officers
PER
1 a llca6le
NAME OF COMMITTEE
NAME OF TREASURER
Citizens For Affordable Living
Kristen Headland
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE AREA CODE/PHONE
Morro Bay
CA
93442
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Morro Bay CA 93442
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
same
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
CITY
STATE
ZIP CODE AREA CODE/PHONE
- COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
San Luis Obispo
Morro Bay
Dan Sedley and Betty Winholtz
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE
ZIP CODE AREA CODE/PHONE
Morro Bay
CA
93442
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.
Executed on �24!15Z -.By
DATE
Executed on , �� By
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275=3772)
www.fopc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Citizens For Affordable Living
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Pacific Premier Bank
ADDRESS
PO Box 25171
Controlled Committee
AREA CODE/PHONE
805=369=5079
clry
Santa Ana
BANK ACCOUNT NUMBER
STATE
C�L1
ZIP CODE
25171
• 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.
Page 2
I.D. NUMBER
1396018
• 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 OFCANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT
OR HELD
YEAR OF
PARTY
(INCLUDE DISTRICT NUMBER IF
APPLICABLE)
ELECTION
cHECKONE
1
Nonpartisan
Partisan
(Ilst political party below)
Nonpartisan
Partisan
(list political party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT N0. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/2753772)
www.fpoc.ca.gov