Form 410 (2) Date Stamp
Statement of Organization , Y la t:NcINlTAS CALIFORNIA
Recipient Committee CITY f- z�;; •
Statement Type 9 Initial ❑ Amendment ❑ Termination—See Part 5 t For Official use only
Not yet qualified 10 or
Llst I.D.number: List I.D.number: AUG 3 1 1 p PI 4: 46
Date qualified as committee Date qualified as committee Date of Termination
(Napplicable)
NAME OF COMMITTEE NAME OF TREASURER
Gaspar for Supervisor 2016 Nancy Haley
ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
Encinitas CA 92024 (760)632-6942 Encinitas CA 92024 (760)632-3600
MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY
Stephanie Sanchez
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
nhaley @thinkcpa.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE
San Diego 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 ZIP CODE AREACODE/PHONE
I have used all reasonable diligence in repa Wgisstatemen t to the st of my kn wledge the information contained herein is true and compete. I certi fy under
penalty of perjury+ sunder the lawss of th W
t o u correct.
Executed on _ AUG 2:5 2015 gy
DATE ---AGNATUREP ASURER OR ASSISTANT TREASURER
Executed on
—DATE-
SIG N CONTROL NG OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on gy
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
i
_ I
Statement of Organization CALIFORNIA
Recipient Committee FORM,
INSTRUCTIONS ON REVERSE
Pap 2
COMMITTEE NAME I.D.NUMBER
Gaspar for Supervisor 2016
I ,
• All committees must list the financial Institution where the campaign bank ccount is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER-
Torrey Pines Bank (760)444-8400
ADDRESS CITY STATE ZIPCODE
2760 Gateway Road I Carlsbad CA 92009
• List the name of each controlling officeholder,candidate,or state mei 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 affiliated or check"nonpartisan."
I
• If this committee acts jointly with another controlled committee,list ti e 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 PARTY
i
i ® Nonpartisan
Kristin Gaspar County of SD Supervisor, District 3 2016 t
L l Nonpartisan
Gaspar for Mayor 2914 ID#1369449
Primarily Formed Cornmitttx Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) I, CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SU 011
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM 410
INSTRUCTIONS ON REVERSE
rPa`e 3
COMMITTEE NAME 1.0.NUMBER
Gaspar for Supervisor 2016
Purpose I General 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
7--M •- List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIPCODE
Small Contributor Committee
Date quallfied
• 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