Form 410 Initial Statement of Orpnization CIT y Of E?1'CTJ'rT-f T A S CALIFORNIA
Recipient Committee CITY CLERK FORM 410
Statement Type .®Initial ❑ Amendment ❑ Termination—See PartAlB., —
1UG 8 p1l.2: For Offl.dail Use Only
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0 Pate qualified as committee
Date qualified as committee Date of termination
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NAME OF COMMITTEE NAME OF TREASURER
Tony Brandenburg for Encinitas City Council 2016 Kevin K. Forrester
STATE ZIP CODE AREA CODE/PHONE
STATE ZIP CODE. AREACODEIPHONE NAME OF ASSISTANT TREASURERJF ANY
Encinitas CA 92024 760-932-0999
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE -ZIP CODE AREA CODE/PHONE
kevin@?forrestertrust.co
COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
San Diego County City of Encinitas Anthony J. Brandenburg
STREET ADDRESS(NO P.O.BOX)
648 Lomas de Oro
CITY STATE ZIP CODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheets. Encinitas CA 92024 760-,525-4569
gj�ificanon-
I have used all reasonable diligence In preparing this staterne to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury unP!r the laws of the State of California, a t foregoing is true and correct.
Executed on O , By
SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on
BY
ATE SIGNA?VRE OF CONTROLLING OfEICEH=ER,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_(February/2018)
FOC Advice:advlce@fppc.ca-gov(866/275-3772)
y'1ww.fPPC.ca.SOv
Statement of Organization CAUFORNIA �,
Recipient Committee •
INSTRUCT16NS ON REVERSE
Page Z
COMMITTEE NAME I.D.NUMBER
Tony Brandenburg for Encinitas City Council 2018
e All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
U.S. Bank 760-632-3620
ADDRESS. CITY STATE ZIP CODE
131 N El Camino Real Encinitas CA 92024
4 :Type'of Committee Complete the applicable sections (
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• 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:' Stating"No party preference"is acceptable.
• If this committee acts jointly with another controlled committee,list the name and Identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT ORHELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE{MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
Anthony J.Brandenburg Encinitas City Council Member 2018 ❑� E
Nonpartisan Partisan (list political party below)
EJ
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(i)OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION
IF A RECALL,STATE-RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,.CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT. OPPOSE
SUPPORT OPPOSE
FPPC Form 410(February/2018)
FP.PC Advice:advice @fppc,ca.gov(866/275-3772)
www.fppc.ca.gov
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Statement of Organization CALIFORNIA 410
Recipient Committee FORM
INSTRUMONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Tony Brandenburg for Encinitas City Council 2018
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box�.
0 CITY Committee 0 COUNTY Committee 0 STATE committee[] Political Party/Central Committee
P89VIDE,BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors onan attachment.
NAME OF SPONSOR [NDUSTRYGROUPr OR AFFILIATION OF SPONSOR
STREETADDRESS NO.AND STREET CITY STATE ZIP CODE AREACODE/PHONE
Date qualified
[]
° This committee has ceased to receive contributions and make expenditures;
• This committee does not ant:lcipate 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 nu surplus funds;and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
—
There are restrictions onthe disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. nefertoGovomment
Code Section 895z9..
—
Leftover funds of ballot measure committees may be used for*political,legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject tn Elections Code Section.1osuo and rppc Regulation imszz.s.
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