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Home My WebLink AboutShoresman - Form 410 - 2022-03-23_RedactedStatement of Organization Date Stamp Recipient Committee StatementType ~l!ll-ln-it-ia-l-------------~1--------------.-1--------------th~I D Amendment D Termination -See Part RECE IVED 0 Not yet qualified or O Date qualification threshold met I Date qualification threshold met ---I /--------,,----.!-- IJJ.J .. 41fJ.J.UP.4J.,]._Lt _JJ _& I.D. Numb~r _ (ifaapll_cabl•} NAME Of COMMITTH Vote Michelle Shoresman for SLO City Council 2022 STREET ADDRESS (NO P.O . BOX) CITY San Luis Obispo FULL MAILING ADDRESS (IF DIFFERENT) E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) michelleshoresman@gmail.com STATE ZIP CODE CA 93401 COUNTY OF DOMICILE JUR ISDICTION WHERE COMMITTEE IS ACTIVE San Luis Obispo City of San Luis Obispo AREA CODE/PHONE 805 -550-2795 Attach additional information on appropriately labeled continuation sheets. MAR 2 3 2022 Date of termination S LO CITY CLERK NAME Of TREASURER Keith Dunlop STREET ADDRESS (NO P.O . eoxJ CITY STATE San Luis Obispo CA NAME OF ASSISTANT TREASURER, IF ANY NIA STREET ADDRESS (NO P.O BOX/ CITY STATE NAME Of PRINCIPAL OFFICER(S) Michelle Shoresman STREET ADDRESS (NO P.O BOX) CITY STATE San Luis Obispo CA CALIFORNIA 41 0 FORM For Official Use Only ZIP CODE AREA CODE/PHONE 93401 805-320-1127 ZIP CODE AREA CODE/PHONE. ZIP CODE AREA CODE/PHONE 93401 805-550-2795 I h ave used all reasonable diligence i n preparing this statement and t ned herein ls true and complete . penalty of perjury ynder 1he laws of the State of California that the f ,,Z ,:Z. By Executed on Executed on Executed on DATE Executed on DATE _ --........ ,,.__ ... ----............. __ _ By ' ~OFCOTROLllN G OFFICEH OLDER, CANDIDATE, OR STATE MEASURE PROPONENT BY ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ By====~===--== SIGNATURE OF CONTROLLING OFFICEHOLDER, CAND IDATE , OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OF FICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: adv ice@fppc.ca.gov (866/275-3772) W W~,f.e..,.[Q_\l Statement of Organization Recipient Committee CALIFORNIA 410 FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Vote Michelle Shoresman for SLO City Council 2022 All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE Controlled Committee 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. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY CHECK ONE Michelle Shoresman SLO City Council Member 2022 Nonpartisan ./ Nonpartisan Primanly Formed Committee 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) Partisan Partisan ilfst political party belowj (list political party below) CHECK ONE I I I '""°"' J """ I SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc..ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Vote Michelle Shoresman for SLO City Council 2022 CALIFORNIA 41 0 FORM General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: D CITY Committee D COUNTY Committee D STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GRO UP OR AFFILIATION Of SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE Small Contributor Committee D I /·-- Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent 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 (August/2018) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.f ppc.ca.gov