Form 410 Statement of Organization Date Stamp a • .
Recipient Committee CITY C
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Statement Type T Initial ® Amendment ❑ Termination—See Part 5 For Official Use Only
Not yet qualified❑ or List I.D.number- list I.D.number: 2115 SE P 13 P j j 3: 48
# 1379509 #
1 15 115 _✓_�,/
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
NAME OF COMMITTEE NAME OF TREASURER
Gaspar for Supervisor 2016 Nancy Haley
ZIPCODE AREACODE/PHONE
Encinitas CA 92024 (760)632-6942 Encinitas CA 92024 (760)632-3600
MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY
P.O. Box 1042, Ste. B-253, Encinitas, CA 92024 Stephanie Sanchez
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
nhaley @thinkcpa.com kristin @gasparforsupervisor.
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREACODE/PHONE
San Diego San DIego County Encinitas CA 92024 (760)632-3600
NAME OF PRINCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIPCODE AREACODE/PHONE
I have used all reasonable diligence in p parin is t to en an t best my kn wledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the ate o li i t re t d rrect.
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xecuted on gy
`/���/7p 1 ATE 5 ant SIGN A EOFT EAS ER OR ASSISTANT TREASURER
Executed on (\�
DATE SIGNATURE O N FF OLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE 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
MOM
*INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Gaspar for Supervisor 2016 1379509
I.
• All committees must list the financial institution where the campaign bank tcount is located.
NAME OF FINANCIAL INSTITUTION 4ACODE/PHONE BANKACCOUNTNUMBER-
Torrey Pines Bank (760)444-8400 801110968.6
ADDRESS inTy 'STATE ZiPME
2760 Gateway Road _ lCarlsbad CA 92009
• List the name of each controlling officeholder,candidate,or state me sure 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 a j)ated or check"nonpartisan."
• If this committee acts Jointly with another controlled committee,list a name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR WELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
®Nonpartisan
Kristin Gaspar C O unty of SD Supervisor, District 3 2016
Nonpartisan
Gaspar for Mayor 2014 ID#1369449
•I Primarily formed to support or opposo specific candidates or measures in.a single election. List below:
CANDIDATE(S)NAME OR MEASURE($)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)IURISDiCTIpN
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CNECKONE
SUPPORT OPPOSE
a a
_`Li 'In
FPPC Form 410(Dec/2012)
FPPC Advice:adv)ce@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CAUFORNIA
Recipient Committee FORM 410
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Gaspar for Supervisor 2016 1379509
Generol Purpose committee 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
Small Cori triburor Committee
Date qualiBad
• 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(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Additional Comments STATEMENT OF ORGANIZATION
for Form 410 CALIFORNIA i
FORM
INSTRUCTIONS ON REVERSE
4 of 4
COMMITTEE NAME
I.D NUMBER
Gaspar for Supervisor 2016
1379509
Qualification & Additional Mailing Addresses including: 427 C Street, Ste. 220, San Diego, CA 92101
www.netrile.com FPPC Toll-Free Helpline: 8661ASK-FPPC