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HomeMy WebLinkAboutCarter Form 410 Termination 01.31.13_Redacted (restored from website)Statement of Organization Recipient Committee If Statement Type ❑ Initial Not yet qualified ❑ or Type or print in ink STATEMENT OF ORGANIZATION 410 For Official Use Only RECEIVED JAN T 0 -2013 SLO CITY Cl_ER 1, Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER ❑ Amendment List I.D, number: Date qualified as committee Date qualified as committee (If appiicabre) Carter for Mayor 2012 ® Termination — See Part 5 List I.D, number: 12 r 28 r 12 Date of Termination STREET ADDRESS (NO P.O. BOX) CITY STATE - —ZIP CODE AREA CODE/PHONE San Luis Obispo CA 93401 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E-MAIL ADDRESS ancarter@aol.com COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE 1S ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE San Luis Obispo ,Attach additional information on appropriately labeled continuation sheets. Andrew Carter s G EH t-Esll"M il,e i) R the ofticia o the Secretary of State os Calif©rn JAN 0 3 2013 DEBRA 60WE SeCretairy of Sta San Luis Obispo CA 93401 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE NAME OF PRINCIPALOFFICER(S) Andrew Carter CITY STATE ZIP CODE AREA CODEIPHONE San Luis Obispo CA 93401 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 California that the foregoing is true and correct. Executed on 12/28/12 DATE Executed on 12/28/12 DATE Executed on DATE Executed on DATE By By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Apri112011) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Statement of Organization 'Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Carter for Mayor 2012 4. Type of Corm mittee Complete the applicable sections. Controlled Committee STATEMENT OF ORGANIZATION Page 2 • 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. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATElOFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) YEAR OF ELECTION PARTY 0 Non -Partisan Andrew Carter Mayor, City of San Luis Obispo 2012 ❑ Non -Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER Heritage Oaks Bank ADDRESS CITY STATE ZIP CODE San Luis Obispo CA 93401 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 (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (AprI112011) FPPC Toil -Free Helpline: 866IASK-FPPC (866I275-3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Carter for Mayor 2012 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 Sponsored List additional sponsors on an attachment. NAME: OfSPONSOR ❑ � f.-- I Date qualified U11Y GROUP OR AFFILIATION OF SPONSOR STATEMENT OF ORGANIZATION Page 3 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 1=PPC Regulation 18521.5, FPPC Form 410 (April/2011) FPPC Toll -Free Helpline. 866/ASK-FPPC (86612754772)