Form 410 Terminatiion Statement of Organization Date Stamp I CALIFORNIA
Recipient Committee CITY L'-i: i.:fd(^; 1y�,9 FORM 410
Statement Type ❑Initial ❑ Amendment Termination—See Part s `'' i ` ' ( `�� For Official use only
Not yet qualified El or List I.D.number: List I.D.number: 1 J 0 P11 2:
# 1389886 # 1389886
/ 1 1213112016
Date qualified as Committee Date qualified as committee Date of Termination
(lrappllable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Committee Opposed To Encinitas Measure T Bruce Ehlers
Encinitas CA 92024 (760)944-9482
CITY 57ATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Encinitas CA 92024 (760)946-6668 Elizabeth Ehlers
MAILING ADDRESS OF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
FAX/E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE
Info @EncinitasSaveOurCity.com Encinitas CA 92024 (760)944-9482
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OPICERIS)
San Diego City of Encinitas Susan Turney
STREET ADORE55(NO P.O.BOX)
STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
Encinitas CA 92024 (858)382-3705
3. Verification
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 Califor ' the fore i is true and correct.
Executedon 01/29/2017 By
DATE SIGNAT R iTREASUPFft OR ASSISTANTTREASURER
Executedon 01/2912017 By
DATE - SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR TATE 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(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA ,
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
E.g.2
COMMITTEE NAME LD.NUMBER
Committee Opposed To Encinitas Measure T 1389886
• All committees must list the financial Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Chase Bank (760)633-1814 872063271
ADDRESS CITY STATE ZIP CODE
105 N. El Camino Real Encinitas CA 92024
4.Type of Committee Complete the applicable sections.
IF 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
i] Nonpartisan
❑ Nonpartisan
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) CANDIDATES)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
Measure T City of Encinitas ✓
SUPPORT I OPPOSE
0
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(666/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 1
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.O.NUMBER
Committee Opposed To Encinitas Measure T 1389886
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 [] COUNTY Committee❑ STATE Committee
PROVIDE SWEF 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
Date pvallReE
5.Termination Requirements By signingthe verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all ofthefollowing 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)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov