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Home My WebLink AboutJan Marx - Form 410 - Initial - 08-09-2008IAD Statement of Organization Recipient Committee Statement Type Ig Initial Not yet qualified 9or Date qualified as committee Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (If appl&c a le) ❑ Termination - See Part 5R List I.D. number: in t Date of Termination 1. Committee Information 2 NAME OF COMMITTEE Fla t o &' d s v`�— _--7—CLn Mq r- x, STREET ADDRESS (NO P.O. BOX), CITY STATE ZIP CODE AREA CODE/PHONE .-f r." L_vl 3 g l i'seo C4 3.f � � PS is MAILING ADDRESS OF DIFFERENT) & �. � t / C4 f3�dk OPTIONAL. FAX J E -MAIL ADDRESS (� - I — 2- 21 COUNTY OF DOMICILE WHERE COMMITTEE IS ACTIVE IF DIFFERENT )UNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. 3. Verification �n Date Stamp CEIVED AND FIL office of the Secretary of of the State of California JUN 13 2008 EBRA BOWEN Treasurer and Other Principal '0712%,17s NAME OF TREASURER fl-1 (14 (IC__ STREET ADDRESS CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY ' STREET ADDRESS :>_�� CITY STATE ZIP CODE AREA CODE/PHONE NAMEAND POSITION OF OTHER PRIM c[PAL OFFICER(S), IFAPPLICABLE ' MAILING ADDRESS CITY ZIP CODE AREA I have used all reasonable diligence in preparing this statement and to the best y knowledge the information C99taineo4eir is true and complete. I certify under penalty of perjury under the laws of hig Stale/of California that the foregoing is true and Executed on Executed on x-00 oAT€ Executed on t DATE Executed on DATE By By 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) 5� :tement of Organization - Recipient Committee INSTRUCTIONS ON REVERSE c svnmc P 0- r STATEMENT OF ORGANIZATION 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 0 t ( C_ eve ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) 4h 410 CJdif�o • List the financial institution where the Campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE frs- Syr - &10 ADDRESS CITY Lf YEAR OF ELECTION PARTY Non - Partisan Non- Partisan �I _,)-D Pr—, BANK ACCOUNT NUMBER STATE ZIP CODE C Iq �3 410 1 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 GPPQSE FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612753772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE NAME 4. Type of Committee (Continued) General Purpose Committee 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 OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR - RCC 1 HUURCJJ NU. HNU JJ I KLL i CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE ENT OF ORGANIZATION Page 3 I.D. NUMBER Small Contributor Committee r—_ ❑ —I - I 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 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.. FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) statement of Organization Recipient Committee Statement Type k'initial Not yet qualified Ar or I I Date qualified as committee Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (If applicable) 1. Committee Information NAME O F COM M ITTE E Fri e ids �-� Tai.• -, �ti� ,� ❑ Termination — See Part 5 List I.D. number: �I I Date of Termination STATEMENT OF ORGANIZATION Date Stamp REG ED For Sc.a CITE' CLERK 2. Treasurer and Other Principal Officers NAME OF TREASURER STREET AREA CODE/PHONE _ C f STATE Zip CODE CITY ..ja -, L��'s 6) 1i's STATE ZIP CODE AREA CODE/PHONE CA 5 3 foS S i- 2-914 NAME OFASSISTANTIREASURER, IF ANY MAILING ADDRESS {IF DIFFi =RENT] � � �}.., f �,� �(S 06_iI b ��+" STREET ADDRESS � � � , � ° ` J'•"''•' "' 4 j �vtv_� � CITY STATE ZIP CODE r� � t 53 � o_ 4l�EACODEIPHONE � �t`f T(® OPTIONAL: FA7{,I E AIL ALJi7RESS " r 2- 2- ° f NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE COUNTY CIF DOMIGiLE COLS.. THANICOUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT OFDOMICILE � MAILING ADDRESS Attach additional information on appropriately labeled continuation sheets. 3. Verification e STATE ZIP CODEIP I have used all reasonable diligence in preparing this statement and to the best y knowledge the information c twine ein is true and complete. I certify under penalty of perjury under the laws of State/6f h . California that the foregoing is true and Executed on (9 By Executed on Executed on Executed on v O ii B DATE y �(i p By Hart 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 STATEMENT OF ORGANIZATION Page 2 1. D. N I r6ER 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 f9 W f Non - Partisan t Non- Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION k D ADDRESS AREA CODE/PHONE oD CITY Jam.-, BANK ACCOUNT NUMBER STATE ZIP CODE c114 :/:, 3 �10 r Formed Primarily 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) ONE OPPOSE FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)