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Form 410 AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified F1 or Date qualified as committee Type or print in ink R Amendment List I.D. number # 1228848 1_ 1 Date qualified as committee (If applicable) ❑ Termination - See Part 5 List I D number Date of Termination 1. Committee Information NAME OF COMMITTEE Encinitas Coalition of Home Owners STREET ADDRESS (NO PO BOX) 1734 South Pacific St CITY STATE ZIP CODE AREA CODE/PHONE Oceanside Ca 92054 760-439-5979 MAILING ADDRESS (IF DIFFERENT) P O Box 448 Oceanside, Ca 92049 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. STATEMENT OF ORGANIZATION 2012 FEB -2 2. Treasurer and Other Principal Officers NAME OF TREASURER Mary Azevedo STREET ADDRESS (NOPO BOX) 1734 South Pacific St. CITY STATE ZIP CODE AREA CODE/PHONE Oceanside CA 92054 760-439-5979 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P 0 BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) Mary Azevedo STREET ADDRESS (NO PO BOX) 1734 South Pacific St. CITY STATE ZIP CODE AREA CODE/PHONE Oceanside Ca 92054 760-439-5979 3. Verification 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 12/31/2011 By DATE SIGN T!! F TREASURER OR ASSISTANT TREASURER 12/31/2011 ~)I I C Executed on DATE Executed on DATE Executed on DATE By ROLLI OR S By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Dale Stamp CIT FPPC Form 410 (April/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE lIulvllvll I I CC IVNIVIL Encinitas Coalition of Home Owners STATEMENT OF ORGANIZATION I.D NUMBER 1228848 4. Type of Committee Complete the applicable sections Controlled Committee • 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 NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT NAME OF FINANCIAL INSTITUTION ADDRESS ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMRFR IF APPI irAal F) YFAR nF F1 FrnrN1 0n IV AREA CODE/PHONE CITY BANKACCOUNT STATE ZIP CODE 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) FPPC Toll-Free Helpline 8661ASK-FPPC (866/275-3772) • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee _i7 INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME ID NUMBER Encinitas Coalition of Home Owners 1228848 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 Monitor and disseminate information to the citizens of Encinitas • . • • . List additional sponsors on an attachment. NAME OF SPONSOR NDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO AND STREET CITY STATE ZIP CODE WY77-71KO =M Mil r-1 I Date qualified 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 (April/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)