Form 410 Amendment t
Statement of Organization Date Stamp
Recipient Committee e
Statement Type ❑Initial ® Amendment ❑ Termination—See Part 5 For Official Use Only
List I.D.number: List I.D.number: ^ r !!
Not yet qualified El or ^?/,
1385489 RE EIVED AND FILED
a a in IN office of the Secretary of WK
06 28 2016 of the State of C*bn+w
Date qualified as committee Date qualified as committee Date of Termination `JUL 0 12016
(H applicable)
1 Committee Information: ; 2 Committee -Treasurer and Other Principal Officers,.
NAME OF COMMITTEE NAME OF TREASURER
Phil Graham for Encinitas City Council 2016 C. April Boling
STREET ADDRESS(NO P.O.BOX)
_
STATE ZIP CODE AREA CODE/PHONE
(also PO Box 232578, Encinitas 92023) San Diego CA 92119 (619)713-6888
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Encinitas CA 92023 (760)472-3578
FAX/E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE E JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
San Diego )City of Encinitas
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3 Verl cation
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on �� � �� By <— ----- I
7 -�
DATE SIGNATURE OF TREASURER OR AZISTAa*T ASURER
q r;
Executed on `J By
DAfE GNAT E OF CONTROL G FFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIG4YAE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM i
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Phil Graham for Encinitas City Council 2016 1385489
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
Union Bank (619)265-5737 10063158646
ADDRESS CITY STATE ZIP CODE
5197 Waring Rd San Diego CA 92120
4:Type Of COmmlttee Complete the applicable sections.
Controlled Committee
• 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 CA D!E?ATE10FF!CEHOI DER S!A7E MEASURE PROPO!dOMT ,.��__-U-0-2 S `` � �` A ``AS c�
N' YFAR OF FI FCTION PARTY
❑Nonpartisan
Phil Graham Encinitas City Council 2016
❑ Nonpartisan
Primarily Formed Committee 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 SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
0 ❑
FPPC Form 410(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA t
Recipient Committee • -
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Phil Graham for Encinitas City Council 2016 1385489
4 TType of Cornrnitte e (Con tinuea) u
General 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.AND STREET CITY STATE ZIP CODE
Small Contributor Committee
Date qualified
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7:'1eCfilln�t1011 Kei(UiteCi1�I1$S ,dysignin tne-vermcanon,tne.treasure assistan�treastrer„-ano/or,wnalaate;omcenolaer,orproponen cenlfyu�atai vlLnrIGllowlrl>sColiu�uv�u,ne�����,� �<
• 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(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov