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HomeMy WebLinkAboutJan Marx - Mayor - Form 410 - Initial - 02-14-14Statement of Organization Recipient Committee Statement Type 0 Initial Not yet qualified % or 1,_J Date qualified as committee 1. Committee Information NAME OF COMMITTEE Type or print in ink \3\P4 REC Amendment Termination — See Pigrft a List I.D. number: List I.D. number: of / -1 Date qualified as committee (If applicable) Date of Termination -�1*11)` A-e2 ,� 0 2 D-0 I STREET ADDRESS (NO P.O. BOX) CITY (( STATE ZIP CODE AREA CODE /PHONE J CC rA % i's 1'0 c) C4 3 V C t 2'7f MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX / E -MAIL ADDRESS SA ev-- ,�VA%/- COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT ,(� THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. 0 STATEMENT OF ORGANIZATION AND FILED WRIM ' Secretary of State of California For Official Use Only B 19 2014 BOWEN f of State 2. Treasurer and Other Principal Officers NAME OF TREASURER STREET ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY STREET ADDIfESS CITY L4 STATE ZIP CODE AREA CODEIPHONE 'n 0� )l -D � 3 o �! � -2-7 NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 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 certifv under Denaltv of perjury under the laws of the State of California that the foregoing is true Executed on 2 " / V / T E� 14-f DA Executed on 2 / E �, DATE Executed on Executed on DATE DATE NUNN UKt Ur UUN I KULLiNU UFFIGFHOLDER, CANDIDATE, OR STATE MEASURE PHOHUNENT FPPC Form 410 (Jan/01) FPPC Tnll -FrPP HPlnlinP- RSS /ASK -FPPC Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA , .- INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME LD NUMBER 4. Type of Committee Complete the applicable sections. • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE imarily 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE OPPOSE FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC Non - Partisan V v [ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE imarily 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE OPPOSE FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE - Page 3 COMMITTEE NAME I.D NUMBER 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 ❑ STATECommittee PROVIDE BRIEF DESCRIPTION OF ACTIVITY NAME OF SPONSOR List additional sponsors on an attachment. Z_ INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO AND STREET CITY STATE ZIP CODE -J I Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small Date qualified contributor committee on January 1, 2001, enter 1/1/01. 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all ofthe 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. -- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan, repayments of loans made to others, or any other receipts. FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC Statement of Organization Recipient Committee Statement Type $ Initial Not yet qualified N1 or 1..J Date qualified as committee 1. Committee Information NAME OF COMMITTEE Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (If applicable) ❑ Termination - See Part 5 List I.D. number: �I Date of Termination STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX / E -MAIL ADDRESS S .,� 1 /-r COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE s� Attach additional information on appropriately labeled continuation sheets. STATEMENT OF ORGANIZATION Date Stamp CALIFORNIA FORM 410 Fear Offirral Use Only FEB 14 2014 2. Treasurer and Other Principal Officers NAME OF TREASURER. -A/w— M 1I { STREET ADDRESS T STATE ZIP CODE AREA CODE/PHONE I f 5"3 (6, NAME OF ASSISTANT TREASURER, IF ANY �� STREET ADDFJESS J CITY NAME AND POSITION OF OTHER MAILING ADDRESS + -+-C,-1 i 3 1NCIPAf OFFICER($), IF APPLICABLE 14 (a 17 CITY STATE ZIP CODE AREA CODE /PHONE 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 ComDlete. I certifv under Denaltv of perjury under the laws of the State of California that the foregoing is true a '- Executed on 2- / V — / V- DAT Executed on r — DATE Executed on Executed on DATE DATE 20TA B SIGNATURE OF GUN I BULLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE U. PROPONENT FPPC Form 410 (Jan/01) FPPC Tnll -Free HPlnline- R66 /ASK -FPPC Statement of Organization STATEMENT OF C7RGANQAn0N Recipient Committee CALIFORNIA , .- INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER TAB AA40,x -Fa� M rrT L)14e_ 4. Type of Committee Complete the applicable sections • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER T_ rte% D e L /✓ Cc T, ADDRESS CITY STATE ZIP CODE 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 OPPOSE FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC . ( Non- Partisan V V © Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER T_ rte% D e L /✓ Cc T, ADDRESS CITY STATE ZIP CODE 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 OPPOSE FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE J-A/ / Mr K 9- �N o a­o 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 ❑ STATECommittee PROVIDE BRIEF DESCRIPTION OF ACTIVITY • • • • List additional sponsors on an attachment. r_ NAME OF SPONSOR Y GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO AND STREET CITY STATE ZIP CODE Page 3 I.D. NUMBER JJ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small Date qualified contributor committee on January 1, 2001, enter 1 /1/01. 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all ofthe 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. -- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan, repayments of loans made to others, or any other receipts. FPPC Form 410 (Jan /01) FPPC Toll -Free Helpline: 866 /ASK -FPPC