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HomeMy WebLinkAboutJan Marx - Form 410 - Initial - 05-15-2010Statement of Organization Recipient Committee Type or print in ink Statement Type 0 Initial Q Amendment Not yet qualified ❑ or List I.D. number: 05 1 05 t 10 11 Date qualified as committee Date qualified as committee (N applicable) 1. Committee Information NAME OF COMMITTEE Elect Jan Marx Mayor 2010 Q Termination – See Part 5 List I.D. number: —I_ I Date of Termination STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE San Luis Obispo CA 93405 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E- MAILADDRESS janmarx @stanfordalumni.org COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT I THAN COUNTY OF DOMICILE San Luis Obispo I - Attach additional information on appropriately labeled continuation sheets. in th office of the MAY 19 2010 TO t ,. STATEMENT OF ORGANIZATION For Official use 2. Treasurer and Other Principal Officers R E , m \ m n NAME OF TREASURER Gregory T. Griffin JUN 0 3 2010 STREETADDRESS (NO P.O. BOX) SLO CITY CLERK CITY San Luis Obispo STATE CA ZIP CODE 93401 AREACODEIPHONE NAME OF ASSISTANT TREASURER. IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODEIPHONE NAME OF PRINCIPAL OFFICER(S) Jan Howell Marx STREETADDRESS (NO P.O. BOX) CITY San Luis Obispo STATE CA ZIP CODE 93405 AREACODEIPHONE 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 rnrrPrten n a Executed on �J /� / �� By / DATE Executed on S/ �1 ` -a- of By DATE Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER; CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Elect Jan Marx Mayor 2010 4. Type of Committee Complete the applicable sections. STATEMENT OF ORGANIZATION • 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 IFAPPLICABLE) YEAR OF ELECTION PARTY Jan Howell Marx Mayor of San Luis Obispo 2010 ® Non - Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees onh; ) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKACCOUNT NUMBER Founders Community Bank ADDRESS CITE' 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) CHECK ONE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of organization Recipient Committee INSTRUCTIONS ON REVERSE Elect Jan Marx Mayor 2010 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 INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE OF • • • • - ❑ t J Date qualified 5. Term ination 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) ."'i-tclaftement of Organization STATEMENT OF ORGANIZATION Recipient Committee Type or print in ink Date Stamp e i Statement Type R Initial Not yet qualified ❑ or 05 r 05 1 10 Date qualified as committee 1. Committee Information NAME OF COMMITTEE Elect Jan Marx Mayor 2010 STREETADDRESS (NO P.O. BOX) ❑ Amendment List I.D. number. _�— I Date qualified as committee (If applicable) ❑ Termination — See Part 5 List I.D. number: —I .— I Date of Termination CITY STATE ZIP CODE AREA CODEIPHONE San Luis Obispo CA 93405 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX I E- MAILADDRESS janmarx @stanfordalumni.org COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE San Luis Obispo Attach additional information on appropriately labeled continuation sheets. RECEIVED MAY 17 2010 SLO CITY CLERK 2. Treasurer and Other Principal Officers NAME OF TREASURER Gregory T. Griffin STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE San Luis Obispo CA 93401. NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODEPHONE NAME OF PRINCIPAL OFFICER(S) Jan Howell Marx STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE San Luis Obispo CA 93405 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. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true aprl enrract� Executed on SlAr �� ° By DATE Executed on '� %� ;L D B �TT DATE Y Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER; CANDIDATE. OR STATE MEASURE PROPONENT_ By SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT FPPC Farm 410 (June /09) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Elect Jan Marx Mayor 2010 4. Type of Committee Complete the applicable sections. STATEMENT 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. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Jan Howell Marx Mayor of San Luis Obispo 2010 © Non - Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL Founders Community Sank AREA CODEIPHONE 805 543 -6500 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, ASAPPLICABLE) CHECK ONE FPPC Form 410 (June/09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) • Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Elect Jan Marx Mayor 2010 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 Small Contributor Committee ❑ -J -J Date qualified GROUP OR AFFILIATION OF SPONSOR ZIP STATEMENT OF ORGANIZATION 3 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 Helpline: 8661ASK -FPPC (8661275 -3772)