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HomeMy WebLinkAboutJan Marx - Form 410 - Amendment - 07-11-2008Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee Type or print in ink IM Amendment List I.D. number: # 136 7741. bli It 6S Date qualified as committee (If applicable) 40 RECEIVED Elate Stamp AND FILE in the office of the SecretaY4,i of St ❑ Termination — See Part 5 the State of Califon is List I.D. number: JUL 15 2008 # DEBRA BOWEN Date of Termination Se. retary of State 1. Committee Information 2, NAME OF COMMITTEE STREET ADDRESS (NO P.O. BOX) Cffl STATE ZIP CODE AREA COD HONE MAILING ADDRESS (IF DIFFERENT) ! _ r OPTIONAL: FAX /E- MAILADDRE� COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT ��R c ,/'� � f c THAN COUNTY OF DOMICILE l0%J / f90 e^ Attach additional information on appropriately labeled continuation sheets. Treasurer and Other Principal Officers STATEMENT OF ORGANIZATION For Official Use N. MI� OF TREASURER ... P-( xJ (. c, P6:7— p— c� STREET ADDRESS CDW Luis. © b Ii i F70 NAME . SISTANT TREASURER, IF ANY STREET CITY f NAME AND POSITION OF OTHER PM MAILING ADDRESS STATE ZIP CODE AREA CODEIPIHONE ZIP CODE AREA CO P ONE IFAPPLICAB E 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 infm�ntained 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 cot�'et. Executed on By DATE Executed on 1el /'P B DATE y Executed on By DATE Q ��� Executed on DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT JUL 2 9 2008 FPPC Form 410 (January/05) SLO CITY CLERK FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/2753772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE NAiy1E IN ORGANIZATION t ?077YZ 4. Type of Committee Comp!ete 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 �J a t � li✓� "l % `a ✓ ��� Lvl ©�I fP� ��� 6 Non- Partisan ❑ 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 ? G vim► Ij �7 2` J 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 SUPPORT OPPOSE SUPPORT I OPPOSE FPPC Form 410 (January105) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA ' .- INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME e f�`D� —� J (,c rte. /��1� -� jC I_D. NUMBER v -7 7 2 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 F] STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY • • List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE [l `I f Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a Date qualified small 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 certifyt hat 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. FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee Type or print in ink Amendment List I.D. number: # / 3° -7741, b'f I It 1 69 Date qualified as committee (If applicable) ❑ Termination — See Part 5 List I.D. number: 1. Committee Information MIME OF comMi TEE STREET CITY STATE ZIP CODE AREA COD HONE MAILING ADDRESS (IF DIFFERENT) I ,' -j5-) S' zr'i -1 OPTIONAL: FAY I E =MAIL I Date of Termination Date Stamp RECEIVED JUL 11 2008 SLO CITY CLERK STATEMENT OF ORGANIZATION For O;ticial Use Only 2. Treasurer and Other Principal Officers NAME OF TREASURER o O-t ( kJ t+ III PC -= L- b STREET ADDRESS C — STATE ZIP CODE AREA CO ONE STREET CITY yyII�',I�f STATE ZIP CODE AREA COjl���NE ��•� NAME AND lPOSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABI F �f COUNTY CT DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT S r . ,r"� THAN! COUNTY OF € OMICILE !VI L, fpo r- Attach additional information on appropriately labeled continuation sheets. MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the info a ' n ntained 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 rp�t. Executed on DAIS By Executed on -0 By y Executed on DATE By Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK.FPPC (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE C f�j%e'aj, d� S `^ mar x OF ORGANIZATION ?077({Z 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 CANDIDATEIOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY ✓ s�J'� ��li✓� � �Q 1� J �� L�JI � ©�I.�P� � � �-�� 6 Non- Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTMJPON - 603f4- a ADDRESS .f'C' Lit• . AREACODEIPHONE CITY Guy J BANK ACCOUNT NUMBER -Gto / 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 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee ' CALIFORNIA INSTRUCTIONS ON REVERSE FORM COMMITr>;ENAME Page 3 I.D. NUwBER v —7 Z f 4. Type of Committee (Continued) • • - Not forrned 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 • • " • - List additional sponsors on an attachment. NAME OF SPONSOR !, fDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE Zip CODE ❑ _J -J Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a Date qualified small contributor committee on January 1, 2001, enter 111/01. 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. FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612753772)