HomeMy WebLinkAbout2022.08.19_Wixom_Form 410Statement of Organization
Recipient Committee
Statement Type ® Initial ❑ Amendment
0 Not yet qualified
or
Q Date qualification threshold met Date qualification threshold met
NAME OF COMMITTEE
Carla Wixom For Mayor 2022
CITY
Morro Bay
FULL MAILING ADDRESS (IF DIFFERENT)
EMAIL ADDRESS (REQUIRED)/FAX (OP710NALI
carlaformayor@gmail.com
COUNTY OF DOMICILE
San Luis Obispo
T.D. Number
STATE 21P CODE
CA 93442
Morro Bay, CA
IS
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets,
Termination —See Part 5
Date of termination
NAME OF TREASURER
Kristen Headland
STREET ADDRESS (NO P.O. DO%)
CITY
Morro Bay
NAME OF ASSISTANT TREASURER, IF ANY
Barry Branin
STREET ADDRESS (NO P.O. BOX)
CITY
Morro Bay
NAME OF PRINCIPAL OFFICER(S)
Carla Wixom
STREET ADDRESS (NO P,O. BOX)
CITY
Morro Bay
I nave used ail reasonable diligence in preparing this statement and to the best of my knowledge
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on gy�
DATE
DATE SIGNATURE IOF CONTROLLING OFFICEHOLDER, CAM
Executed on
LIVE
DATE
on
Date staMrmutz1vED
Ciry of Morro
�1UG 19 20
City Ulu
STATE
CA
STATE
CA
STATE
CA
ned herein is true
J:737:i7•I•I.TyZi)
PRO
PONENI
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
For Offlclal Use Only
ZIP CODE AREA CODE/PHO
93442
ZIP CODE AREA CODE/PM10
93442
ZIP CODE AREA CODE/PHONE
93442
complete. I certify under
FDP[' Fnrm G10 fAueust/2018)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Carla Wixom For Mayor 2022
I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Pending
AREA CODE/PHONE
BANK ACCOUNT NUMBER
ADDRESS 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
ELECTIVE OFFICE SOUGHT
OR HELD
YEAR OF
PARTY
(INCLUDE pISTRICT NUMBER IF
APPLICABLE)
ELECTION
CHECK ONE
Carla Wixom
Mayor
2022
Nonpartisan
Partisan
(list 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:
CANDIDATE(S)
NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO, OR LETTER)
IF A RECALL, STATE RECALLIN FRONT OF THE OFFICEHOLDER'S NAME.
""
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)1URISDICTIO
N
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (AugustJ2018)
FPPC Advice: (866/275-3772)