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HomeMy WebLinkAboutJan Marx - Form 410 - Initial - 05-05-2010Statement of Organization Recipient (Committee Statement Type Initial Not yet qualified ❑ or Type or print in ink ❑ Amendment List I.D. number: 5- 1 5- 1 to 1 —1 Date qualified as committee Date qualified as committee (If applicable) 1. Committee Information NAME OF COMMITTEE STREETADDRESS (NO P.O. BOX) ❑ Termination — See Part 5 List I.D. number: I 1 Date of Termination CITY STATE ZIP CODE �5 A REACODE/PHONE s�� S �h s D� A- 3 MAILINGADDRESS (IF DIFFERENT) / 0 P, maKX 0 -%,-J�t0 ?zV-W, l yM0 r o v V- COUN OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIEFERENT THAN COUNTY OF DOMICILE 2. Treasurer and Other NAME�TREASURER Date Stamp RECEIVED SLO CITY CLERK ,incipal Officers STREETAEFR-ESS (NO P,O. BOX) STATEMENT OF ORGANIZATION For Official Use Only CITY STATE ZIP CODE AREA CODE/PHONE S L--, D) �I Ire CA- NAME OF ASSISTANT TREASURER, IFANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) .Ja h H-O Vie q Ma ,,-x STREETADDRESS (NO P.O. BOX) -� CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. _ f / j , r� l�� )j 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 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on -6-161 0 By UAI E MEASURE PROPONENT Executed on By ` 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 (June/09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA INSTRUCTIONS ON REVERSE Page 2 UVNIMII 1 Ct IV{iNIC F-yel-eiri4s o4-_ Tczk--� A-1a r� 4. Type of Committee Complete the applicable sections. Controlled Committee • 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 i ADDRESS —CITE' 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 SUPPORT IOPPOSE OPPOSE FPPC Form 410 (June/09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIA 41 f INSTRUCTIONS ON REVERSE l , e`ids C� 'T"_1 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 ADDRESS OF SPONSOR STATE ZIP CODE Page 3 Small Contributor Committee ❑ Date qualife 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 (866/275 -3772) Statement of Organization Recipient Committee Statement Type 1. '$ Initial Notyetqualified ❑ or Date qualified as committee ' Type or print in ink ❑ Amendment; List I.D. number: —I I Date qualified as committee (fl applicable) ❑ Termination — See Part 5 List I.D. number: —I I Date of Termination Jai /qa vX /111or- STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE MAILING ADDRESS (IF DIFFERENT) DOMICILE J'/'fV? /ZV- -wJ/lJM h I',, D COUNTY WHERE COMMITTEE IS ACTIVE IF DIEE 2. Treasurer and Other REC in the a DEBRA BO Secretary of Officers STREETA TRESS (NO PO. BOX) " \ CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE teak, f{-o 1/ �e t'.{a -,,X THAN COUNTY OF DOMICILE Z44-1r' f � � STREETADDRESS (NO P.O. BOX) �^ f � f'7!S /r>~a- CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 3. Verification i have used all reasonable diligence in preparing this statement and to the best of my knowle a 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. Executed on _ / C By DATE TREASURER OR ASSISTANT TREASURER Executed on / °/ © By ATE MEASURE PROPONENT Executed on By s. 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 (June/09) FPPC Tolt -Free Helpline: 866/ASK -FPPC (8661276 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 �/V�v�Wfl� 7GC tVFIWlC J.U. eY ylvloGR Y�< 4. Type of Committee Complete the applicable sections. OF • 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 �� H��w M � ✓x o r Sav, � Qc�►` o 1 Non - Partisan ❑ Non- Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election' committees only) NAME OF FINANCIAL INSTITUTION EAC DE/PHONE BANK ACCOUNT NUMBER �v.► �t y-s rl m U71.r 1 , .� -( _ 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 FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866/ASK -FPPC (866/276 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE 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 DESCRIPTION OF ACTIVITY .. . -. . List additional sponsors on an attachment. NAME OF SPONSOR STREETADDRESS NO. AND STREET CITY OFSPONSOR STATEMENT OF Date qualffred 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. — 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 Helpiine: 866/ASK -FPPC (866/275-3772), Name of Filer: <11-� The Fair Political Practices Commission requires the Secretary of State to reject Statements of Organization (Form 410) Ghat do not provide all of the, information required by 2 Cal: Code of Regulations (CCR) § 18410. Your Form 410. is beil' returned for the reason(s) circled below: 1. , The'Form 410 (Page 1) does not indicate a "Statement Type," Please indicate. whether it is an "Initial," "Amondnient," or "Termination" filing by checking the appropriate box. Also: a. If Initial - Indicate if the committee has "Not yet qualified" OR, if it has qualified as a committee, the date of qualification. (2 CCR § 18410(a)(1)) b. If Amendment — Indicate the name and ID number of the committee. (2 CCR § 18410(a)(2) and (c)) c. If Termination — Indicate the ID number of the committee and the date of termination. (2 CCR § 18410(a) and (c)) 2. The proposed name of the committee conflicts with the name of another committee. (2 CCR § 18402(b)) The conflict is with: I.D. # 0 The Form 410 (Page 1, Section 1) does not include the full name of the committee: (2 CCR § 18410(a)(3)) a. A full name, not an acronym, is required. (2 CCR §18410(a)(3)) b. The name of the committee does not include the name, of its sponsor(s). (Government Code § 84102(a) and 2 CCR §1841,9(b)(1)) c. The name of the committee does not include the number or letter of the applicable ballot measure and support /oppose position. (Government Code §84107 and 2 CCR §§ 18410(a)(3), 18402(c)(4)(E)) d. The name of the candidate- controlled committee does not indicate the last name of the controlling candidate(s). (2 CCR § 18402(c)(1)) txolled conimitt a formedt fury the purposef the caudidate's election' (elect�ou lilt iii n a xanua�ry 1, 2009) floes not include (1) the last name of the candidate, ( tYie ofce:souht, and tp.J'epl n£ the election. (2 CCR § 184Q2(�)(')) f. The name of the noncandidate- controlled committee primarily formed to support or oppose one or more candidates does not include the last name(s) of the candidate(s), the office(s) sought, the year of the election, and whether the committee supports or opposes the candidate(s). (2 CCR § 18402(c)(3)) g. The name of the state "officeholder" committee does not include the last name of the controlling officeholder, the office held, the year the officeholder was elected to the current term of office, and the words "Officeholder Account," (2 CCR § 18531.62(c)(2)) h. The name of the legal defense fund committee does not include the candidate's or officer's last name and the words "Legal Defense Fund." (2 CCR §§ 18530.4(b) and 18530.45(c)) i. The name of the committee controlled by the target of a recall does not include the words "Recall" and the name of the elected official who is the target of the proposed recall. (2 CCR § 18531.5(c)(1)) j. The name of the committee primarily formed to support or oppose the recall of an elected officer does not include the name of the elected officer proposed to be recalled and whether the committee is in support of or in opposition to the proposed recall. (2 CCR § 18531.5(c)(3)) (OVER) �4. The Form 410 (Page 1, Section 1) does not include the full street address and telephone number of the committee. (A post office box number is not acceptable.) (Government Code § 84102(a) and 2 CCR § 18410(a)(3)) 5. The Form 410 (Pagel, Section 2) does not include the full name, street address, and telephone number of the treasurer and /or assistant treasurer. (Government Code § 84102(c) and 2 CCR § 18410(a)(4)) 6. The Form 410 (Pages 2 -3, Section 4) does not indicate the type of committee because one of the following sections has not been completed: controlled committee, primarily formed committee, or general purpose committee. (2 CCR § 18410(a)(5)) 7. The Form 410 (Page 2, Section 4) does not indicate the full name and office sought by the candidate, including the district number, if applicable. (Applies when the committee is a candidate - controlled committee for the candidate's election.) (2 CCR § 18410(a)(6)) 8. The Form 410 (Page 2, Section 4) does not indicate the name and address of the financial institution where the campaign bank account is located and the account number. (Applies when the committee has qualified AND is a candidate- controlled committee for the candidate's election.) (Government Code § 84102(f) and 2 CCR § 18410(a)(6)) 9. The Form 410 (Page 1, Section 2) does not include the name of each principal officer. (Applies when the committee is a noncandidate- controlled committee.) (Government Code § 84102(c) and 2 CCR §§ 18402.1 and 18410(a)(7)) 10. The Form 410 (Page 2, Section 4) does not include the name of the candidates or the number, letter, or full title of the ballot measure, the jurisdiction, and whether the committee is formed to support or oppose the candidate or measure. (Applies when the committee is primarily formed to support or oppose specific candidates or measures in a single election.) (2 CCR § 18410(a)(8)) 11. The Form 410 (Page 3, Section 4) fails to indicate whether the committee is a city, county, or state committee. (Applies when the committee is a general purpose committee.) (2 CCR § 18410(a)(9)) 12. The Form 410 (Page 3, Section 4) fails to provide a brief description of its activity. (Applies when the committee is a general purpose committee.) (Government Code § 84102(d) and 2 CCR § 18410(a)(9)) 13. The Form 410 (Page 3, Section 4) does not include the full name, street address, and telephone number of each sponsor and the industry group or affiliation of each sponsor. (Applies when the committee is a sponsored committee.) (2 CCR §§ 18410(a)(10) and 18419(b)(2)) 14. The Form 410 (Page 1, Section 3) does not include an originally signed verification of the statement, including the date, by the treasurer or assistant treasurer AND the controlling officeholder, candidate, or state measure proponent, if applicable. (Government Code § 81004 and 2 CCR § 184 1 0(a)(1 1)) 15. Other: (e.g., not legible) spa�pltent „you must submit an original and a, copy of a correct and complete Form 410 to the Secretary of State. can be,downll ded from www.sos.ca,gov/pr(�i/`­forins/41 O.pdf. or Sacramento, CA 95814 If you have any questions, call (916) 653 -6224 or fax (916) 653 -5045. See also the Fair Political Practices Commission's "Form 410 Fact Sheet” at www.fppc.ca.gov/ forms /1- 05forins /41 OFactSheet5O9.1)df. Page 2 SOS /PRD 18410 09/08/2009