Form 410 Initial Statement Statement of Organization P�
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Recipient Committee 0 Clf -,I �..li�:, � O• ' , 0 RM
Statement Type ❑X Initial ❑ Amendment ❑ Termination—See Part 5 n 1 - -- d For Official Use only
Not yet qualified x❑ or
List I.D.number List I.D.number: 2t7 " J�FL e 5 Ff l 5: 21
Date qualified as committee Date qualified as committee DateofTerminaton
(if applicable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Gaspar for Mayor 2016 Nancy Haley
STREET ADDRESS(NO RO.BOX) STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIPCODE AREACODE/PHONE CITY STATE DECODE AREACODE/PHONE
Encinitas CA 92024 (760)632-3600 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 ZIPCODE AREA CODE/PHONE
San Diego City of Encinitas Encinitas CA 92024 (760)632-3600
NAME OF PRINCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuations Teets. STREET ADDRESS(NO P O BOX)
CITY STATE ZIPCODE AREACODE/PHONE
3. Verification
I have used all reasonable diligence in preparing thqstaaery Ptnd to the best owl ge the information contained herein is true and complete. I certify under
penalty of perjury under the ot a e of Cali rnia o i e n r
Executed on A Bi
TE I S N E OFT REASUR ASSISTANT TREASURER
Executed on
DATE SIGNXWE OLLING OFFIC HOLDER,CA DIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGWVURE OF CONTROLLING OFFICEHOLDE DIDATE OR STATE MEASURE PROPONENT
Executed on
DATE � SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE OR STATE MEASURE PROPONENT
FPPC Form 410(Jan12016)
www.netfile.com FPPC Advice:advice @fppc.ca.gov(8661275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
INSTRUCTIONS ON REVERSE
Page 2 of 3
COMMITTEE NAME ID.NUMBER
Gaspar for Mayor 2016
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Torrey Pines Bank (760)444-8400
ADDRESS CITY STATE ZIP CODE
2760 Gateway Road Carlsbad CA 92009
4.Type of Committee Complete the applicable sections.
91 M-,WILTRIIIII-TRUffin
• 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 CAN DID91EJOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Mayor: City of Encinitas (] Nonpartisan
Paul Gaspar 2016
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. Listbelow:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO OR LETTER) CANDIDATES)OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICTNO.,CITY OR COUNTY,ASAPPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(Jan/2016)
www.netFle.com FPPC Advice:advice @fppc.ca.gov(8661275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
INSTRUCTIONS ON REVERSE
Page 3 of 3
COMMITTEE NAME ID.NUMBER
Gaspar for Mayor 2016
4.Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑CITYCommittee ❑ COLINTYCommittee ❑STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Listaddifional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO AND STREET CITY STATE ZIP CODE
❑ _ 1 1.
Date qualified
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all ofthe 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(Jan/2016)
www.netfile.com FPPC Advice:advice@fppc.w.gov(8661275-3772)
www.fppc.ca.gov