HomeMy WebLinkAbout410 - 08/24/2022_ Redacted (TJH)Statement of Organization
Date Stamp .
Recipient Committee
RECEIVED
Statement Type El Initial ❑ Amendment ❑ Termination — See Part 5
For Official Use Only
0 Not yet qualified
AUG 2 4 2022
or
1k Date qualification threshold met Date qualification threshold met
Date of termination
0 C2 .t�
CITY OF ARCADE
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TY CLERK
1. Committee Information
2. Treasurer and
Other PrincipalOfficers
i a licable
NAME OF COMMI Ti{E
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NAME OF IRFASURER
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STREETADDRESS(NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
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CITY
Te�r l� ;
STATE ZIP CODE AREA CODE/PHONE
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CITY STATE ZIP CODE AREA CODE/PHONE
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NAME OF ASSISTANT TREASURER, ANY
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
CITY
STATE ZIP CODE AREA CODE/PHONE
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COUNTY OF DO LE `
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JURISDICTfON WHERE COMMITTEE IS ACTIVE
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NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY
STATE ZIP CODE AREA CODE/PHONE
3. Verification
I have use a reasonable diligence in preparing this statement and to
penalty of perju under he laws of the Sta alifornia that the r
Executed on �` By
D
Executed on By `
ATE
Executed on
DATE
Executed on
DATE
By
best of my knowledge the information contained herein is true ana complete. I certify under
ng is true and correct.
SIGNATURE OF TREASURER OR ASSISTANT TREASURER
LLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.eov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
L
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
y-an 1 -HZI1(o70�A
ADDRESS CITY STATE ZIP CODE
12.00 5. Saldwicx Ave, Nccc8 o, CP\ gIOU�:F
• 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
• 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 CHECKONE
a Ergen H (a
- \a CiC.ouyn ;l 2-
2022
Nonpa 'san
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
FormedPrimarily Committee 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) 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) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Gommi+f -ems 'f -,Ten:5&n 4an4-D Nrc a, %a C(-i Couyx%J, 2ozz
PROVIDE BRIEF DESCRIPTION
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
List additional sponsors on an attachment.
a.ncc i nu✓nc» NV. ANu 51 NEE7
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Page 3
I.D. NUI
STATE ZIP CODE AREA CODE/PHONE
Date aualffied
S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have been met:
ceasedThis committee has to receive contributions
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
— There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519.
— Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511-
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (August/2018)
FPPCAdvice: adviceCafoac.ca.gov (866/2753772)
vrvvw.fooc.ca.eov