Form 410 Termination Statement of Organization Of
Recipient Committee Dale Stamp _
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Statement Type
E] Initial E] Amendment Termination—See Part 5 (, j ( For Official Use Omy
Not yet qualified❑ or List I.D.number. List I.D.number. 2017 iillll ' 7 �-
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# # 1387663 a
. 1 1 311 2016
Date qualified as committee Date qualified as committee DateofTerminafion
It applinae)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Gaspar for Mayor 2016 Nancy Haley
STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIPCODE AREACODEfPHONE CITY STATE ZIP CODE AREACODE/PHONE
Encinitas CA 92024 (760)632-3600 Encinitas CA 92024 (760)632-3600
MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANTTREASURER,IF ANY
Stephanie Sanchez
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
nhaleyethinkcpa.com
STATE ZIP CODE AREACODE/PHONE
San Diego City of Encinitas Encinitas CA 92024 (760)632-3600
NAME OF PRINCIPAL OFFICER(S)
Attach additional information On appropriately labeled continuation SlleefS. STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIPCODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing INS st t nd t t e of the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of C iforn r i g i
Executed on 1/4/2017
DATE NATURE OF Tft RER OR ASSISTANT TREASURER
Executed on 1/4/2017
DATE IGNATU CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on -
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(Jan/2016)
www.neM/e.com FPPC Advice:advice@fppe.ca.gov(8661275.3772)
www.fppe.ca.gov
Statement of Organization
Recipient Committee CALIFORNIA
FORM 4101
INSTRUCTIONS ON REVERSE
Page 2 of 3
COMMITTEE NAME I.D.NUMBER
Gaspar for Mayor 2016 1387663
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
Torrey Pines Bank (760)444-8400 8011707018
ADDRESS CITY STATE ZIP CODE
2760 Gateway Road Carlsbad CA 92009
4.Type of Committee Complete the applicable sections.
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT LECTIVE OFFICE SOUGHT OR HELD YEAR OF ELECTION PARTY
(INC(INCLUDE DISTRICT NUMBER IF APPLICABLE)
Mayor: City of Encinitas Nonpartisan
Paul Gaspar 2016
❑ Nonpartisan
• . Primarily formed to support oroppose specific Candidates or measures in a single election. Listbelow:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICTNO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT I OPPOSE
SUPPORT OPPOSE
www.netfi/e.com FPPC Form 410(Jan/2016)
FPPC Advice:advice&ppc.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 I.D.NUMBER
Gaspar for Mayor 2016 1387663
4.Type of Committee (Continued)
•• Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑CITY Committee ❑COUNTYCommittee ❑STATECommittee
PROVIDE BRIEF DESCRIPTION OFACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIKION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
❑ ��
Date qualified
5.Termination Requirements By signing the verificatim,the treasurer,assistant treasurerandforcandidate,officeholder,orproponent cerfifythat 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.netrle.com FPPC Advice:advice@fppc.ca.gov(6661275-3772)
wvnvJppc.ca.gov