Form 410 Termination 7/25/11Statement of Organization
Recipient Committee Type or print in ink STATEMENT OF ORGANIZATION
Statement Type E] Initial
Not yet qualified ❑ or
Date qualified as committee
# 1246028
1. Committee Information
NAME OF COMMITTEE
DAN DALAGER FOR CITY COUNCIL
STREETADDRESS (NO P.O. BOX)
554 HERMES AVE
CITY
STATE ZIP CODE AREA CODE/PHONE
ENCINITAS CA 92024
MAILING ADDRESS (IF DIFFERENT) 760-753-5709
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.
3. Vprifir-oti,,.,
❑ Amendment
List I.D. number:
Date qualified as committee
(It applicable)
Use
® Termination - See Part 5
List I.D. number:
06 r 30 t 11
Date of Termination
241 JUL 27 Nil 3: 30
2. Treasurer and Other Principal Officers
NAME OF TREASURER
CALVIN ELLISOR
STREETADDRESS (NO 'P
.o. BOX)
207 WEST D STREET
clrY
STATE ZIP CODE AREA CODE/PHONE
ENCINITAS CA 92024 760-436-9044
NAME OF ASSISTANT TREASURER, IF ANY
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
have used all reasonable diligence in preparing this statement and to the best of my k
perjury under the law of the ~Ihte of California that the foregoing is true a:M"
Executed on Jj 7- t( By ~ J)
Executed on / L
_ T r J I/
DATE By
oL~
Executed on
DATE
Executed on
DATE
the information contained herein is true and complete. I certify under penalty of
(9
By _ 1 -
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
GNATURE OF CONTROLL NG OFFICE OLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (April/2011)
FPPC Toil-Free Helpline: 8 6 A K FPPC (661275'3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAUF
DAN DALGER FOR CITY COUNCIL
type of Committee Complete the applicable sections.
Controlled Committee
STATEMENT OF ORGANIZATION
I.D. NUMBER
1246028
List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sou
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." ght or held, and
• 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
PARTY
DAN DALAGER
ENCINITAS CITY COUNCIL Non-Partisan
2010
❑ Non-Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIALINSTITIMr)M
UNION BANK
ADDRFS,¢
200 WEST D ST
760-753-5517
ENCINITAS
K
0210048324
STATE ZIP CODE
CA 92024
• • 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
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
_ CHECK ONE
FPPC Form 410 (April/2011) Toll-Free Helpline: 866/AKFPPC (6/75-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
Page 3
DAN DALGER FOR CITY COUNCIL LD. N4. Type of Committee (Continued) 2EMUMIFOrM.- ' = 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
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.ANDSTREET CITY
STATE ZIP CODE
❑
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or pro onent ce i
• This committee has ceased to receive contributions and make expenditures; p rt fY that all of the following conditions have been met:
• 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.
Government Code Section 89519.
Refer to
Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
89511
FPPC Form 410 -
FPPC Toll-Free Helpline: 866/ASK FPPC ( 66/275-3772)