Form 410 Amendment ry
Statement of Organization FDate mP Recipient Committee 01 g p Statemen t Type ❑ gmendment ❑ Termination—See Part 5' ND �' Q� or rficl I Use Only
❑Initial Q Not yet qualified In cetary ui or Callfr��'��S
0�/ 16 /2015 2016
Q Date qualified as committee AUG
Date qualified as committee Date of termination
1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers
(if applicable) 1377657
NAME OF COMMITTEE NAME OF TREASURER
Nancy Haley
North County Neighborhoods Coalition
STREET ADDRESS(NO P.O.BOX)
Encinitas CA 92024 (760)632-3600
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Encinitas CA 92024 (760)632-3600 Danielle Stephen
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE *ZIP CODE AREACODE/PHONE
nhaley@thinkcpa.com Encinitas CA 92024 (760)632-3600
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
San Diego San Diego County Jerome Stocks
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets. Encinitas CA 92024 (760)815-7787
3. Verification
I have used all reasonable diligence in preparing this sta o t est f nowl a the i formation contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of Californja�tat th of r e
Executed on 8/21/2018 By
DATE S AT OFT EASUR OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING FFICEHOLDER,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)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 1
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2 page 2 of 4
COMMITTEE NAME I.D.NUMBER
North County Neighborhoods Coalition 1377657
• 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 8011035915
ADDRESS CITY STATE ZIP CODE
2760 Gateway Road Carlsbad CA 92024
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." 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 OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
Nonpartisan Partisan (list political party below)
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
IF A RECALL,STATE"RECALL"IN FRONT OFTHE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(February/2018)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 410
Recipient Committee FORM
INSTRUCTIONS ON REVERSE Page 3 page 3 of 4
COMMITTEE NAME I.D.NUMBER
North County Neighborhoods Coalition 1377657
4.Type of Committee (Continued)
General Purpose Committee � Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee x❑ COUNTY Committee❑ STATE Committee❑ Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Support/Oppose Local Candidates and Measures
Sponsored Committee — List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO.AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
—Small Contributor ❑
Date qualified
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the 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(February/2018)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Additional Comments ADDITIONAL COMMENTS
For Form 410 CALIFORNIA
• -
Page 4 of 4
COMMITTEE NAME I.D.NUMBER
North County Neighborhoods Coalition 1377657
Amendment to change committee's name.
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