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HomeMy WebLinkAboutJan Marx - Form 410 - Termination - 12-31-2008Statement of Organization S OF ORGANIZATION Type or print in ink in the d *e* Pttse Sure Recipient Committee of the State of Cal _ 1 Statement Type ❑ Initial ❑ Amendment 21 Termination — See Part 5 JAS 2 200 For Official Use Only Not yet qualified ❑ or List I.D. number: List I.D. number: # 1307742 DEBRA B'® 4EGE--1VE Secretary of tate FEE � - _ �� 12 / 31 E 2008 Date qualified as committee Date qualified as committee Date of Termination (If applicable) S L0 a--t- r 1. Committee Information 2. Treasurer and Other Principal Officers NAMEOFCOMMITTEE NAME OF TREASURER FRIENDS OF JAN MARX Dominic Perello STREET ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Luis Obispo CA 93405 (805) 543 -9085 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY SAN LUIS OBISPO CA 93401 (805) 541 -2716 Roberta Soules STREET ADDRESSS�� MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX /E -MAIL ADDRESS San LUIS Obispo CA 93401 (805) 544 -0464 (805) 541 -2239 NAME AND POSITION OF OTHER PRINCIPALOFFICER(S), IF APPLICABLE COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT JAN MARX, candidate THAN COUNTY OF DOMICILE MAILING ADDRESS San Luis Obispo CA same CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. San Luis Obispo CA 93405 (805),541-2716 3. Verification I have used all reasonable diligence in preparing this statement and e and complete. I certify under penalty of to the best of my k edge the information PROPONENT Executed on DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA , INSTRUCTIONS ON REVERSE FORM Page 2 COMMITTEE NAME I.D. NUMBER FRIENDS OF JAN MARX 1307742 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 CAN DIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY JAN MARX SAN LUIS OBISPO CITY COUNCIL 2008 ® Non - Partisan 0 Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODEIPHONE BANK ACCOUNT NUMBER FIRST BANK OF SAN LUIS OBISPO 805 541 -6100 ADDRESS CITY STATE ZIP CODE San Luis Obispo CA 93401 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) JAN MARX SAN LUIS OBISPO CITY COUNCIL X ONE OPPOSE FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME I.D. NUMBER FRIENDS OF JAN MARX 11307742 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 OF ORGANIZATION • • • - • List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE ❑ 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 1/1101. 5.Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or propone,-.tcertify 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 (8661275 -3772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or l�1 Date qualified as committee 1. Committee Information NAME OF COMMITTEE FRIENDS OF JAN MARX STREETADDRESS (NO P.O. BOX) Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (It applicable) 0 Termination — See Part 5 List I.D. number: # 1307742 12 t 31 l2008 Date of Termination CITY STATE ZIP CODE AREA CODE/PHONE SAN LUIS OBISPO CA 93401 (805) 541 -2716 MAILING ADDRESS (IF DIFFERENT) P. OPTIONAL: FAX/ E -MAIL ADDRESS ( COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT I THAN COUNTY OF DOMICILE San Luis Obispo CA I same Date RECEIVED I:QN 2 NOS SLO CAN CLERK 2. Treasurer and Other Principal Officers NAME OF TREASURER Dominic Perello STREET ADDRESS CITY STATEMENT OF ORGANIZATION For Official Use Only STATE ZIP CODE AREA CODE/PHONE San Luis Obispo CA 93405 (805) 543 -9085 NAME OF ASSISTANT TREASURER, IF ANY Roberta Soules CITY STATE ZIP CODE AREA CODE/PHONE San Luis Obispo CA 93401 (805) 544 -0464 NAMEAND POSITION OF OTHER PRINCIPALOFFICER(S), IFAPPLICABLE JAN MARX, candidate MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. San Luis Obispo CA 93405 (805) 541 -2716 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my Executed on - BY DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT Executed on BY PATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Januaryl05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE FRIENDS OF JAN MARX 4. Type of Committee Complete the applicable sections. Controlled Committee , STATEMENT OF ORGAN 1307742 • 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 JAN MARX SAN LUIS OBISPO CITY COUNCIL 2008 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 CODElPHONE I BANK ACCOUNT NUMBER FIRST BANK OF SAN LUIS OBISPO ADDRESS 805 541 -6100 CITY STATE ZIP CODE San Luis Obispo CA 93401 • . • . 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) JAN MARX CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) SAN LUIS OBISPO CITY COUNCIL CHECK ONE )RT I OPPOSE x FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275-3772) Statement of Organization Recipient Committee OF ORGANIZATION INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER FRIENDS OF JAN MARX 1307742 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 ❑ STATE Committee PROVIDE BRIEF OESCRIPTION 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 © 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 (8661275-3772)