Form 410 Termination 12/05/12 3 -7
Statement of Organization r print inink
Recipient Committee PIC
C;01
Statement Type E] Amendment
State yp ❑ Initial
List I.D.number:
Not yet qualified El or
#
08/08/2012 -J-J
Dat�ified sa committee Date qualified as committee
(If applicable)
1. Committee Information
❑x Termination-See Part 5
List I.D.number:
# 1349761
_J
12/04/2012
Date of Termination
NAME OF COMMITTEE
Jerome Stocks for City Council
01
CITY STATE ZIP CODE AREA CODE/PHONE
Encinitas, CA 425
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 appropriatelylabeled continuation sheets.
Date Stamp
RECEIVED AND A
1 the office of the Secretary(
of the State of C9f lfop
DEC 11 2012
156RAbOWE
Secretary of Sta
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Nancy Haley
STREET ADDRESS(NO P.O.
01
STATEMENT OF ORGANIZATION
For Official Use Only
CITY STATE ZIP CODE AREACODE/PHONE
Encinitas, CA 600
NAME OF ASSISTANTTREASURER,IF ANY
Robin
01
CITY STATE ZIP CODE AREA CODE/PHONE
Encinitas, CA 600
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 lAy knowledge the informati 0 ' ed rein is true and complete. I certify under penalty of
perjury under the laws of the e f California that the foregoing is true and Corr Ct.
Executed on RV
DATE IGNMU E OF TREASURER O SISTANT TREASURER
Executed on
DATE 9IGNMU OF CONTROLLING OFFICEHOLDER,CANDIDME,OR STATE MEASURE PROPONENT
Executed on DATE SIGN/PURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By DATE F CONTROLLING OFFICEHOLDER, ANDID R STATE MEASURE PROPONENT
FPPC Form 410(April/2011)
www.netFiile.com FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
[Kai
Jerome Stocks for City Council 2012
1349761
4.Type of Committee Complete the applicable sections.
• 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
KIAKAr nG rAmn1n1TF1nFFIr:EH0LDER1STATE 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
Torrey Pines Bank
ADDRESS
2760 Gateway Road
AREA
760-444-8400
CITY
Carlsbad
4110548284
STATE ZIP CODE
CA 92009
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER)
CANDIDATE(S)OFFICE SOUGHT IT HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S) (INCLUDE DISTRICTNO.,CITYOR COUNTY,ASAPPLICABLE) CHECK-
_ ¢I 33NOT noc
OPPOSE
FPPC Form 410(April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC
www.netFile.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
Torrey Pines Bank
ADDRESS
2760 Gateway Road
AREA
760-444-8400
CITY
Carlsbad
4110548284
STATE ZIP CODE
CA 92009
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER)
CANDIDATE(S)OFFICE SOUGHT IT HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S) (INCLUDE DISTRICTNO.,CITYOR COUNTY,ASAPPLICABLE) CHECK-
_ ¢I 33NOT noc
OPPOSE
FPPC Form 410(April/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC
www.netFile.com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Jerome Stocks for City Council 2012
4.Type of Committee (Continued)
Purpose General • 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
STREET ADDRESS NO.AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
us
1349761
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:8661ASK-FPPC
www.netfle.com