HomeMy WebLinkAbout2023.03.13_Wixom_Form 410 AmendStatement of Organization
Date Stamp
,
.. ,
Recipient Committee
RECEIVED
AND FIL
Statement Type [] Initial ® Amendment ❑ Termination -- See Part 5
the office of the Secretary of St
of the State of California
ForOHicial Use Only
0 Not yet qualified
or
FEB 2'7 2023
MAR 13 2023
0 Date qualification threshold met Date qualification threshold met
Date of termination
City Clerk
I.D. Number 1452627
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 CODEIPHONE
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. n0X)
Morro Bay, CA, 93442
E-MAIL ADD RE55 (REQUIRED) /FAX (OPT ZONAL)
CITY STATE
ZIP CODE
ARBACODE/PHONE
carlalormayor2022@gmall.com
Morro Bay CA
93442
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE 15 ACTIVE
NAME OF PRINCIPAL OFFICERS)
San Luis Obispo
Morro Bay, CA
Carla Wixom
STREET ADDRESS (NO RO, Box)
Attach additional Information on appropriately labeled continuation sheets,
CITY STATE
ZIP CODE
AREACODE/PHONE
Morro Bay CA
93442
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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 6 Z - 27 _ 7 -76ZBy l�
SIGNATURE
Executed an By
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fIN c.ca,4py..(866/275-3772)
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Statement of Organization
Recipient Committee •
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Carla Wixom For Mayor 2022 1452627
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
Mechanics Bank 1-805.772-1252
ADDRESS CITY STATE ZIP CODE
251 Harbor Street Morro Bay CA 93442
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.
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• 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 controlledicommittee, 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 CHECKONE
Carla Wixom
Mayor
2022
Nonpartisan
Partisan
(list politicalpartybelow)
i
Nonpartisan
Partisan
(list political party below)
E �
Primarily formed to support or oppose specific candidates or measures In a single election. List below:
CANDIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT N0, OR LETTER) CANDIDATES) 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 I OPPOSE
FPPC Form 410 (August/2018)
FPPCAdvice: .civirea.w(866/275-3772)
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