Form 410 Initial Statement_Statement of: Organization
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Date Stamp
Recipient Committee
6VED AND gB ,
Statement Type
x Initial
❑
❑ Amendment
❑ Termination
10 the office of the Secretary of
FPor
4,
— See Part 5
of the State of California
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SEP 1 � 20 1 202
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OCT`4 1 H 2: 31
Q Date qualification threshold met
Date qualification threshold met
Date of termination
1, Committee Information °
I.D. Number
2 Treasurer and}Other Principal Officers y
(if applicable)
: }
NAME OF COMMITTEE
Concerned Citizens of Encinitas Committee
STREETADDRESS(NO P.O. BOX)
188 W Glaucus Street
CITY STATE ZIPCODE AREA CODE/PHONE
Encinitas CA 92024 (760)505-3086
FULL MAID NGADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
info@campaign-compliance.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE
San Diego City of Encinitas
Attach additional information on appropriately labeled continuation sheets.
OF TREASURER
Jen Slater
STREET ADDRESS (NO P.O. BOX)
9070 Irvine Center Drive #150
CITY STATE ZIP CODE AREA CODE/PHONE.
Irvine CA 92618 (949)858-7448
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE - AREACODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
Leah Bissonette
STREET ADDRESS (NO P.O. BOX)
188 W Glaucus Street
CITY STATE ZIP CODE AREA CODE/PHONE
Encinitas CA 92024 (760)505-3086
I have used all reasonable di igence in preparing this statement and to the best of my knowledge the
penalty of perjury under th%ws of the State of California that the fo ing is true and correct,
Executed on C I J -- I By
I DATE SIGNATURE OF TREASURER OR ASSIST
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed'on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed ;on By
I DATE 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.gov
nnffi/a nnm
TREASURER
contained herein is true and complete. I certify under
Statement of Organization CALIFORNIA
11
Recipient Committee �
INSTRUCTIONS ON REVERSE
Page 2 of 3
1EOMMITTEE NAME I.D. NUMBER
Concerned Citizens of Encinitas Committee
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
C ITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
4 Typerof Cornmittee Complete the appllcable
_ -- -•_ _..__ .__..
• 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
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
Primarily Formed Committee 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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
PARTY
CHECK ONE
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE.
T I OPPOSE
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
TNSTRUCTIONS ON REVERSE
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Support and oppose candidates in the City of Encinitas.
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Page 3 of 3
STATE ZIP CODE AREA CODE/PHONE
Smaff Contributor Committee
Date qualified
... F..y.._'.y.
5 Termmatton Re uirements: ' By signing -the verification tfig`t�easurer asslstanttreasurer;and or_candldate;:offieefiolder or ro onentrcertt ,thatall'o€.the followln cod
ltlons have been met
This committee has ceased to receive contributions and make expenditures;
• 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 maybe 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)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov