Form 410 Initial 2014 tatement of Organization
ecipient Committee
itement Type Q Initial ❑ Amendment
Nol ye►qudfled® or List I.D.number:
Date qualified as committee Date qualified as committee
(if applkablo)
Committee Information
NAME OF COMMITTEE
i o�LA I'
�
Date Stamp
CALIFORNIA
FORM
❑ Termination—See Part 5
`• 1 t -+` ',' For Official Use On y
List I.D.number;
r(
CITY STATE
MAILING ADDRESS(IF DIFFERENT) -
FAX/E-MAIL ADDRESS"
COUNTY OF DOMICILE JURISDICTION WNERF.COMMITTEE IS ACIIVf
San Diego Encinitas
Ittach additional information on appropriately labeled continuation sheets.
Date of Termination
2. Treasurer and Other Principal
NAME OF TREASURER
Keith Harold
STREET ADDRESS(NO P.O.BOX)
STATE 21P CODE AREACODE/PHONE
Encinitas CA 92024
NAME OF ASSISTANT TREASURER,IF ANY
S'T'REET ADDRESS(NO P.O.BOX)
CITY STATE 211,CODE AREA CODE/PHONE
- -Z_ ___ _ - "Toll'( 6- 'b i
NAME OE)PRINCIPAL.OFFICERIS) -
STREET ADDRESS(NO P.O.BOX)
CIIY STATE 21P CODE AREACODE/PIIONE
Verification
1 have used all reasonable diligence in preparing this statement and to the best of my know
penalty of p�Jun',,25the la s of th State of California that t fo ng is true An)co
Executed � gy
OATH V / S
I?NAT14RE OF TREASL
Executed on By
dATE
Ige the information cont in herein is true and complete. I certify under
OR ASSISTANT TREASURER
OFFICEHOLDER,CANDIDATE,OR
Executed on By '
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on
DATE
gy
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
CITY
ADDRESS
BANK ACCOUNT NUMBER
STATE ZIP CODE
I.D.NUMBER
4.Type of Committee Complete the applicable sections.
I .. I ..
• 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"nonpartisan."
• 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
Primarily Formed Primarily formed to support or oppose specific candidates or measures in a single election. List below:
.-...... t-.....r.r.c 1—r...nc RAI InT Mn nR 1 1:TTFR1
CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
o.rr.. r.Tv no rnl IMTV Ac Am IrARI FI
PARTY
Nonpartisan
Nonpartisan
rHF[K ONE
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
SUPPORT OPPOSE
SUppQgT OPPOSE
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov