HomeMy WebLinkAbout2022.08.31_Wixom_Form 410 AmendStatement of Organization
Recinient Committee
Date Stamp
I '
RFrFNt=n • � l f
Statement Type
City of Morro Bay
For Official Use Only
F Initial
® Amendment
❑ Termination — See Part 5
I Not yet qualified
AUG 31 2022
or
10 Date qualification threshold met
Date qualification threshold met
Date of termination
08 / 30 / 2022
08 / 30 / 2022
/ /
City Clerk
Committee1. I.D. Number 14526272.
Treasurer and Other
PrincipalOfficers
(fjo pllcab/eJ
NAME OF COMMITTEE
NAME OF TREASURER
Carla Wixom For Mayor 2022
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
Barry Branin
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
PO BOX 2023 • 'VV% D (,c'D Zpr `{ _'G ,A , °( 3.4 43
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
carlaformayor@gmail.com
Morro Bay
CA
93442
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
San Luis Obispo
Morro Bay, CA
Carla Wixom
STREETADDRESS (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 �"3�-•Z�gy
DATE
Executed on Q v 36 eZ0 Z?--By
DATE
Executed on I By
DATE 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.eov (866/275-3772)
www.fooc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Carla Wixom For Mayor 2022
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Mechanics Bank 805-772-1252
ADDRESS CITY STATE ZIP CODE
251 Harbor Street, Morro Bay CA 93442
Page 2
I.D. NUMBER
1452627
• 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT 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) FULLTITLE (INCLUDE BALLOT NO, OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE -RECALL' IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fooc.ca.gov (866/275-3772)
www.fppc.ca.eov