Form 410 Amendment 10-5-10Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee type or print In Ink Date Stamp ,
Statement Type ❑ Initial
Not yet qualified ❑ or
® Amendment ❑ Termination - See Part 5 r R
List I.D. number: List I.D. number: 201J OCT -5 AN 10- 12
1288623
1 08 t 10 1 06 11
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1. Committee Information
NAME OF COMMITTEE
Friends of Teresa Barth for Encinitas City Council 2010
STREETADDRESS (NO P.O. BOX)
2140-K Orinda Drive
CITY STATE ZIP CODE AREACODE/PHONE
Cardiff-by-the-Sea, CA 92007 760-634-3115
MAILING ADDRESS (IF DIFFERENT)
2033 San Elijo Ave. #211 Cardiff-by-the-Sea, CA 92007
OPTIONAL: FAX/ E-MAIL ADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
San Diego
Attach additional information on appropriately labeled continuation sheets
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Don K. Barth
STREETADDRESS (NO P.O. BOX)
2140-K Orinda Drive
CITY STATE ZIP CODE AREA CODE/PHONE
Cardiff-by-the-Sea, CA 92007 760-634-3115
NAME OF ASSISTANT TREASURER, IF ANY
-None-
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3.
Verification
have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete.
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on ~ ~ V / y By
Executed on ' L1 amo By
DATE
Executed on
DATE
Executed on
DATE
I certify under penalty of
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPCNEN I
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Friends of Teresa Barth for Encinitas City Council 2010
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
Page 2
1288623
• 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 "non-partisan."
• 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
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Teresa Barth
City Council Member
2010
® Non-Partisan
❑ Non-Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
US Bank 760-753-6489 166230274192
ADDRESS CITY STATE ZIP CODE
485 Santa Fe Drive Encinitas, CA 92024
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee _ ORNIA 410
INSTRUCTIONS ON REVERSE
Page 9
Friends of Teresa Barth for Encinitas City Council 2010 ( 1288623
4. Type of Committee (Continued)
• Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
[]CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
GROUP OR AFFILIATION OF SPONSOR
ETADDRESS NO. AND STREET _ZTTY STATE ZIP
13
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions 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 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 (June/08)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/276-3772)