Form 410 Amendment 07-21-22Statement of Organization
Date Stamp.
CALIFORNIA
Recipient Committee
CITY OF ENClNIFORM
410
Statement Type El initial [Amendment ❑ Termination — See Part 5
CITY CLERK
For Official Use Only
Q Not yet qualified
2022 JUL 25 PM 1
0
or
ate qualification threshold met Date qualification threshold met
Date of termination
1. Committee• I.D. NumMEMO"
Ifcable)
2. Treasurer and Other PrincipalOfficers
11 a
NAME OF COMMITTEE
'PCC\M e8 4-rll� v Y C t C avl C, l Z�
NAME OF TREASURER
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STREET ADDRESS (NO P.O. BOX)
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STREET ADDRESS (NO P.O. BOX) �/��
STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
t S C � �
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE
ZIP CODE AREA CODE/PHONE
Verification3.
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 California that the foregoing is true and correct.
Executed on r,C ' —3L By
DATES
Executed on ' ` 4 Z By
DATE
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice(@f,opc.ca.eov (866/275-3772)
www.fpoc.ca.Qov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
n
All committees must list the financial institution where the campaign bank account is located.
Page 2
I.D. NUMBER
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BAWACCOUNT NUMBER
0-153
ADDRESS CITY STATE ZIP CODE
CA 9z;10&9
• 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 CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
\*y s\ `
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fopc.cagoz.-- (866/275-3772)
yJ1.VVV.', PPC.CagOVC.cagOV
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
lR
V3': �
General• • 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
SponsoredList additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
Small Contributor Committee
Date
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Page 3
STATE ZIP GUUt HMCH
• 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 (August/2018)
FPPC Advice: adviceMpoc.ca.eov (866/275-3772)
www.fppc.ca.gov