Form 410 Initial 08/08/12Statement of Organizatiot;ovl ypeor print inInk
Recipient Committee
Statement Type ❑x Initial
Not yet qualified ❑ or
08/08/2012
_J -J
Date qualified as committee
1. Committee Information
❑ Amendment
List LD number-
Date qualified as committee
(If applicable)
Stamp
CITY OF ENCINIT A S
❑ Termination — See Part 5 I T y r 1° r P r
ListLD number- 2012 A JG 13 PH 5: 09
W
-I_
Date of Termination
NAME OF COMMITTEE
Jerome Stocks for City Council 2012
STREET ADDRESS (NO P.O. BOX)
330 Encinitas Blvd., Ste 101
CITY STATE ZIP CODE AREA CODE /PHONE
Encinitas, CA 92024 760- 635 -0425
MAILING ADDRESS (IF DIFFERENT)
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
Nancy Haley
STREET ADDRESS (NO P.O BOX)
STATEMENT OF ORGANIZATION
For Official Use Only
330 Encinitas Blvd., Ste. 101
CITY STATE ZIP CODE AREA CODE/PHONE
Encinitas, CA 92024 760- 632 -3600
NAME OF ASSISTANTTREASURER, IF ANY
Robin Stephen
STREET ADDRESS (NO P.O. BOX)
330 Encinitas Blvd., Ste. 101
CITY STATE ZIP CODE AREACODE/PHONE
Encinitas, CA 92024 760- 632 -3600
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of e information c in d erei is true and complete. I certify under penalty of
perjury under the la f he tate of California that the foregoing is true and correZ41
Executed on BY
ATE - NW E OF TR SURE 27 TREASURER
Executed on � � 2-- By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on DATE
Executed on
DATE
BY ��
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April/2011)
www.netfile.com FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Jerome Stocks for City Council 2012
4. Type of Committee Complete the applicable sections.
Pending
• 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 CANDIDKE /OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
Torrey Pines Bank 760- 444 -8400 4110548284
ADDRESS CITY STATE ZIP CODE
2760 Gateway Road
Carlsbad CA 92009
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 SOUGHTOR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (ApriU2011)
FPPC Toll -Free Helpline: 666/ASK -FPPC
www.netfi'le.com
City Council Member
❑X Non-Partisan
Jerome Stocks
City of Encinitas
2012
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
Torrey Pines Bank 760- 444 -8400 4110548284
ADDRESS CITY STATE ZIP CODE
2760 Gateway Road
Carlsbad CA 92009
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 SOUGHTOR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (ApriU2011)
FPPC Toll -Free Helpline: 666/ASK -FPPC
www.netfi'le.com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE J or
COMMITTEE NAME I.D. NUMBER
Jerome Stocks for City Council 2012 Pending
4. Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTYCommittee ❑ STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
.. List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO AND STREET CITY STATE ZIP CODE
.. ❑ _1 1
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
www.netFile.com