Form 410 Initial Statement Stamp A s '
Statement of Organization Date • ' �
Recipient Committee •
Statement Type Kinitial ❑ Amendment ❑ Termination—SeePart S For Offlaal Use Only
Not yet qualified 0 or List I.D.number: List I.D.number:
# #
If
Date qualified as committee Date qualified as committee Date of Termination
IN.PPlluble)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME Of TREASURER
Tony Brandenburg for Encinitas City Council Kevin K. Forrester
Encinitas CA 92024 760-944-1918
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Encinitas CA 92024 760-944-1918
MAILING ADDRESS IN DIFFERENT)
STREET ADDRESS(NO P.O.BOX)
FAX/EMAIL ADDRESS CITY STATE ZIP CODE AREACODE/PHONE
kforrester @psmkr.us
COUNTY OF DOMICILE IURESDICIAON WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
San Diego County G � GINS Anthony J. Brandenburg
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets. Encinitas CA 92024 760-525-4569
3. Verification
I have used all reasonable diligence in preparing qCal s tement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under a laws of the State f n ia at the foregoing is true and correct.
Executed on ��� By -
C DATE SIGNAT EOFTREASURER OR ASSISTANT TREASURER
Executed on 3a By
0 TE SIGNATURE OF CONTROLLING OFFICEtIPUDER,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(lan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275.3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Pap=
COMMITTEEMAN[ IL NUMBER
Tony Brandenburg for Encinitas City Council 2016
• All committees must list the financial Institution where the campaign bank acrount is located.
NAME Of EINANCUUNSTITUT*N AREA CODVNIONE MNRKYOUNT NUMBER
U.S. Bank 760-632-3620 157507347647
"MESS CITY STATE ZV CODE
131 N El Camino Real Encinitas CA 92024
S� �I{fe_0111111�Ce Complete the a_P.Pllablesections. _- - ;- --_ . _
• 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 CANDI DATE/OFFICEHOLDER/STATE MEASU RE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
0 NMpartiMn
Anthony J. Brandenburg Encinitas City Council Member 2016
❑Nonpartlsan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATEIS)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE($)OFFICE SOUGHT OR HELD OR MEASUREW JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SYPMAT I OPPME
FPPC Form 410(Jan/2016)
FPPC Advice:advice @fppcca.gov(666/2753772)
www.fppc.n.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Raga 3
COMMITTEE NAME I.D.NUMBER
Tony Brandenburg for Encinitas City Council 2016
4 eofFolftjfiltt�e `_ (coaaDaedl
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑CRY Committee []COUNTY Committee❑STATE Committee
PROVIDE BRIEF DESORIPTIONOF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO.AND STREET CITY STATE OF CODE
❑��
Dm RUaMbG
5'T WreFttents -
:.—__�.__ _ By sIgT18�gtheYallflealton,ehet■eaarer,asstitanttTeasumrand/or tandl ;oiflDdTOlder,oY plrEpmlenC.oeFtlfytflat aO T>ftha follpwingmnditlDTS have-tFemme-C'
• 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()an/2016)
FPPC Advice:advice®fppe.ca.gov(866/275-3772)
www.fppc.ca.gov