HomeMy WebLinkAboutFrancis - Form 410 - 2022-06-06_Amendment No. 1_RedactedStatement of Organization
Date Stamp
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Recipient Committee
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Statement Type E] initial Amendment
❑ Termination —See Part 5
of the State of GOaril a>s
For Official Use Only
0 Not yet qualified
or
MAY 16 2022
0 Date qualification threshold met Date qualification threshold met
Date of termination
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Committee1. Q2.
Treasurer and Other PrincipalOfficers
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NAME OF COMMITTEE
NAMEOFTREASURER
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STREET ADDRESS (NO P.0.804
STREET
CITY STATE
ZIP CODE AREACODE/PHONE
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CITY STATE LIP CODE AREACODEIPHONE
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NAME OF ASStSTANTTREASURER, IF ANY
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FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQU[RED)/FAX (OPTIONAL)
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CITY STATE
CPS
ZIP CODE AREACODE/PHONE
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COUNTY OF OOMICILE
IURfSDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX}
Attach additional information on appropriately labeled continuation sheets.
CITY STATE
ZIP CODE AREA CODE/PHONE
3. Verification
1 nave used all reasonaole ohigence In preparing this statement and to the test 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 S; III 2.
DATE
Executed on J i l I'LZ
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
RECEIVED
JUN 0 6 2022
5 L�TY C
FPPC Form 410 (August/2018)
FPPC Advice: (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
E►Ll,t s SLR G�,� Ca�11 2o7Z
All committees must list the financial Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
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ADDRESS
CITY
Page 2
I.D. NUMBER
i44S
BANK ACCOUNT NUMBER
5-000 7--7,3q
STATE ZIP CODE
CA 93i0l
Controlled corpirlitlef,
• 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)
C i� Ce�uhc,L`
YEAR OF PARTY
ELECTION CHECK ONE
2-0Z
Nonpartisan
Partisan
Pist 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT I OPPOSE
SUPPORT I OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice Lf9Rc--Ca—.F,0—v(866/275-3772)
w_w_w.fpDc.ca.Jgov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
CPA MiTTEE NA, h4 E.
IA. NUMBER
PurposeGeneral 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 OFACTIVITY
SponsoredList additional sponsors on an attachment.
--. yr.KUNJUK
CITY
Smoll Contributor Committee
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE/PHONE
• 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: ady ice ;n�fMc.ca,.zgv-(866/275-3772)
wwmfppc.ca.ray