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HomeMy WebLinkAboutAndrew Carter - Form 410 - Initial - 07-01-2010Statement of Organization Recipient Committee Statement Type X(nitial Not yet gUallfied ❑ or lul , ©I, 10 Date qualified as committee 1. Committee Information NAME OF COMMITTEE Type or print In ink \\�� ❑ Amendment ❑ Termination — See Part 6 List IA number: List I.D. number; m w � f Date qualified as committee (If applicable) Co V' ke-.0.r C-0-4 l zo STREET ADDRESS (NO P.O, BOX) CITY STATE ZIPCODE AREACODE/PHONE Soav, L"6 Obis po , G Fi 9340 I I i Date of Termination OPTIONAL; FAX /E- MAILADDRESS of the State of Cain! JUL 66 2010 DEBRA B01WEN STATEMENT OF ORGANIZATION lit JUL 14 1010 SLO CITY CLERK STREET ADDRESS (NO P.O. BOX) .. NAME OF PRINCIPAL OFFI STREET ADDRESS (NO P.O. BOX) �v, l... ks 00*16c0 . GA 13401 CITY '--TT—ATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 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, ASSISTANT TREASURER Executed on By GATE..._.... .._.._,,,,.�..., ,.,. _._._...._. _.:.. _..._._._ Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE - SIGNATUREOF CONTROLLING OPFIC8HOLDER, CANDIDATE. O STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 869 /ASK -FPPC (8661275.3772) Statement of Organization STATEMENT OF Recipient Committee INSTRUCTIONS ON REVERSE Page 2 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY AWA •relz I'� _ �..L�1 -+�C vG.Jt.+, ,Jrs�, �; /� _, , 1�' .C_ L\�S Z�,0 Non- Partisan ❑ Non - Partisan • List the financial Institution where the campaign bank account Is located (controlled "candidate election" committees only) - ADDRESS CITY STATE ZIP CODE -- Primarily formed to support or CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE lawCpeclfic candidates or measures in a single election. List below: OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR (INCLUDE DISTRICT NO., CITY OR COU FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275.3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE C4Cl,'%r \� 4:6V C ©w JK o 2-0k c II.U. MUMtltK 4. Type of Committee (Continued) Not formed to support or oppose specific candidates []CITY Committee ❑ COUNTY Commi -#w List additional sponsors on an attachment. bYUNWK IM Mlad MOP El I Date qualifled ��n a single election. Check only one box: STATE Committee OF S. 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 FPPC Regulation 18521.5, FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275.3772)