Form 410 Amendment 02/08/10Statement of Organization 'type or print in ink
Recipient Committee
Statement Type ❑ Initial ® Amendment
Not yet qualified ❑ or List I.D. number:
# 1288623
08 1 10 06
Date qualified as committee Date qualified as committee
(If applicable)
❑ Termination - See Part 5
List I.D. number:
t
Date of Termination
1. Committee Information
NAME OF COMMITTEE
Friends of Teresa Barth for Encinitas City Council 2010
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Cardiff-by-the-Sea CA 92007 760-634-3115
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX/ E-MAILADDRESS
OF UUMIGILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DI
THAN COUNTY OF DOMICILE
San Diego
Attach additional Information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my kn wledge the information contained rein is true and complete. I certify under penalty of
perjury under the laws of the State of California al++n~that the foregoing is true and correct.
Executed on~ (V By
;~_o SIG =EOFTREA~ORR OR ASSISTANT TREASURER
Executed on By
DATE
Executed on
DATE
Executed on
DATE
By
M9NATURF OF CONTROLLING OFFICEHOLDER CANDMATE, OR STATE MEASURE PROPONENT
CITY 0f~Pd(:ir~'f i
CITY
~L' Erg;
ZOIO F'EB -8 AM 10:
STATEMENT OF ORGANIZATION
Of
FFB 10 r„
& PA P'^_
2. Treasurer and Other Principal Officers
Of -
NAME OF TREASURER
Keith B. Harold
STREETADDRESS (NO P.O. BOX)
CITY
Encinitas,
STATE
CA
ZIP CODE
92024
AREA CODE/PHONE
760-942-2572
NAME OF ASSISTANT TREASURER, IF ANY
Don Barth
STREETADDRESS (NO P.O. BOX)
CITY
Cardiff-by-the-Sea
STATE
CA
ZIP CODE
92007
AREA CODE/PHONE
760-634-3115
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/276-5772)
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Friends of Teresa Barth for Encinitas City Council 2010
4. T ype of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
Page 2
1288623
• 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 "non-partisan."
• 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 ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Teresa Barth
City Council Member
2010
®
Non-Partisan
❑ Non-Partisan
• List the financial institution where the campaign bank account Is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
US Bank
ADDRESS
AREA CODE/PHONE
760-753-6489
STATE ZIP CODE
485 Santa Fe Drive Encinitas, CA 92024
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(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
FPPC Form 410 (June/09)
FPPC Toll-Free Helpllne: 866/ASK-FPPC (8661276-3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNIAA
INSTRUCTIONS ON REVERSE
Page 3
Friends of Teresa Barth for Encinitas City Council 2010 11288623
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 BRIEF 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
Co Sinall Contributor
mmittee
❑ ~J~J
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 (June/09)
FPPC Toli-Free Helpline: 8661ASK-FPPC (666/276-3772)