HomeMy WebLinkAbout2022.09.09_Wixom_Form 410 AmendStatement of Organization
• 1
RDate ECEIVED
4 '
Recipient Committee
City of Morro Bay
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• IL
Statement Type r' Initial ® Amendment
ElTermination — See Part 5
For Official Use Only
SEP 9 2022
1 Not yet qualified
or
12) Date qualification threshold met Date qualification threshold met
Date of termination
City Clerk
08 / 30 / 2022 08 / 30 / 2022
/ /
® I.D. Number 1452627
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1 a llcable
NAME OF COMMITTEE
7NAMEOF TREASURER
Carla Wixom For Mayor 2022
ten 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, Morro Bay, CA, 93443
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
carlaformayor2022@gmaii.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
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 certity under
penalty of perjury under the laws of the State of California -that the foregoing is true and correct.
Executed on IDR 6-7 -2.C) L.Z By
DATE / SIGNATURE OF TREASURER OR ASSISTANT TREASURER
f �
Executed on 0 ` 7Z Byr
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATEy OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.Rov