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HomeMy WebLinkAboutMarx Supporting Documents - 2010MAY I 1.18 7 cruy of sAn oBispo Oath of C)fIce I, Jan HoweffNarx, do solemnCy swear that I wiCCsupport and defend the Constitution of the United States and the Constitution of the State of CaCfornia against all enemies foreign and domestic; that I will bear true faith and aCCegiance to the Constitution of the United States and the Constitution of the State of CaCfornia, that I take this obligation freely, without any mentaCreservation orpurpose of evasion; andthatl wdlweCCandfaithfuCCy discharge the duties upon which I am about to enter. Subscribed and sworn to before me, this 1St day of December 2010: Elaina Cano, City Clerk CITY OF SAN LUIS OBISP� FINANCE DEPARTMENT 990 PALM STREET SAN LUIS OBISPO, CA 93401 CASHIER (805)781 -7124 MISCELLANEOUS REVENUE Please mark one: Miscellaneous Revenue ❑ Voucher Refund Complete the information below: Date: -7 2 Issuin g Dept: t: IN Vendor Name: .z VoucTier No.: Date: - r. Description: G. L. Acct: Amount: C� Please prepare a duplicate if you want a receipt. Return to: GROI PS /AR/NHSC. REVENUE VOUCHER xD M x ti k� 0 N V N N W N VULICATERECEIPT CIW OF SAN LUIS OBISFOU RECVD BY: FINANCE CASHIER 01000291741 PAYOR: JAN HOWELL MARX TOD,AY`S DATE: 07/27/10 RESISTER DATE� 07/27/10 TIME: 11:40 �E3CRlPTION AMOUNT 0SIlD;CANDIDATE ST'YT , 13CELILANEGUS REVENUE $410.00 TOTAL DUE: $41G.00 CHECK PAID; $410.09 CHECK NU: 192 TENDERED: $401913 CHANGE: $.00 Required to be given to candt date Option! to be signed and returned CODE OF FAIR CAMPAIGN PRACTICES There are basic principles of decency, honesty, and fair play which every candidate for public office in the State of California has a moral obligation to observe and uphold in order that, after vigorously contested but fairly conducted campaigns, our citizens may exercise their constitutional right to a free and untrammeled choice and the will of the people may be fully and clearly expressed on the issues. THEREFORE: (1) 1 SHALL CONDUCT my campaign openly and publicly, discussing the issues as I see them, presenting my record and policies with sincerity and frankness, and criticizing without fear or favor the record and policies of my opponents or political parties that merit this criticism. (2) 1 SHALL NOT USE OR PERMIT the use of character defamation, whispering campaigns, libel, slander, or scurrilous attacks on any candidate or his or her personal or family life. (3) 1 SHALL NOT USE OR PERMIT any appeal to negative prejudice based on a candidate's actual or perceived race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, age, sexual orientation, sex, including gender identity, or any other characteristic set forth in Section 12940 of the Government Code, or association with another person who has any of the actual or perceived characteristics set forth in Section 12940 of the Government Code. (4) 1 SHALL NOT USE OR PERMIT any dishonest or unethical practice that tends to corrupt or undermine our American system of free elections, or that hampers or prevents the full and free expression of the will of the voters including acts intended to hinder or prevent any eligible person from registering to vote, enrolling to vote, or voting. (5) 1 SHALL NOT coerce election help or campaign contributions for myself or for any other candidate from my employees. (6) 1 SHALL IMMEDIATELY AND PUBLICLY REPUDIATE support deriving from any individual or group that resorts, on behalf of my candidacy or in opposition to that of my opponent, to the methods and tactics that I condemn. I shall accept responsibility to take firm action against any subordinate who violates any provision of this code or the laws governing elections. (7) 1 SHALL DEFEND AND UPHOLD the right of every qualified American voter to full and equal participation in the electoral process. I, the undersigned, candidate for election to public office in the State of California or treasurer or chairperson of a committee making any independent expenditures, hereby voluntarily endorse, subscribe to, and solemnly pledge myself to conduct my campaign in accordance with the above principles and practices. Al Printed Name - Jaaern4e-� a p 10 Date of Election O: \FORMS \Nomination Documents \Code of Fair Campaign Practices.doc 2008 / Revised 2006 D& RECEIVED JUL 1. SLO CTY CLERK MC Elections Required to be given to candidate Optional to be signed and returned CODE OF FAIR CAMPAIGN PRACTICES (Division 20, Chapter 5, Elections Code.) Chapter 5. Fair Campaign Practices Article 1. General Intent 20400. The Legislature hereby declares that the purpose of this chapter is to encourage every candidate for public office in this state to subscribe to the Code of Fair Campaign Practices. It is the ultimate intent of the Legislature that every candidate for public office in this state who subscribes to the Code of Fair Campaign Practices will follow the basic principles of decency, honesty, and fair play in order that, after vigorously contested, but fairly conducted campaigns, the citizens of this state may exercise their constitutional right to vote, free from dishonest and unethical practices which tend to prevent the full and free expression of the will of the voters. The purpose in creating the Code of Fair Campaign Practices is to give voters guidelines in determining fair play and to encourage candidates to discuss issues instead of untruths or distortions. Article 2. Definitions 20420. As used in this Chapter, "Code" means the Code of Fair Campaign Practices. Article 3. Code of Fair Campaign Practices 20440. At the time an individual is issued his or her declaration of candidacy, nomination papers, or any other paper evidencing an intention to be a candidate for public office, the elections official shall give the individual a blank form of the code and a copy of this chapter. The elections official shall inform each candidate for public office that subscription to the code is voluntary. In the case of a committee making an independent expenditure, as defined in Section 82031 of the Government Code, the Secretary of State shall provide a blank form and a copy of this chapter to the individual filing, in accordance with Title 9 (commencing with § 81000) of the Government Code, an initial campaign statement on behalf of the committee. The text of the Code shall read, as follows: (See "CODE OF FAIR CAMPAIGN PRACTICES" on reverse side). 20442. The elections official shall accept, at all times prior to the election, all completed forms which are properly subscribed to by a candidate for public office and shall retain them for public inspection until 30 days after the election. 20443. Every code subscribed to by a candidate for public office pursuant to this chapter is a public record open for public inspection. 20444. In no event shall a candidate for public office be required to subscribe to or endorse the code. OAFORMS \Nomination Documents \Code of Fair Campaign Practices doe 2008 i Revised 2006 MC Elections I city Of SAn Luis OBI spo 990 Palm Street, San Luis Obisno CA 93401-3249 July 27, 2010 Fair Political Practices Commission 428 J Street, Suite 620 Sacramento, CA 95814 Dear Sir or Madam: Pursuant to FPPC requirements, enclosed is the Statement of Economic Interests (Form 700), for the following San Luis Obispo City Council candidate in the November 2, 2010 General Municipal Election: Paul Brown, Candidate for Mayor Jan Howell Marx, Candidate for Mayor Dan Carpenter, Candidate for City Council If you have questions regarding this form, please let me know. Sincerely, Elaina Cano City Clerk Enclosures GA702 -01 ElectionslElection 2010XFPPC Form 700 Transmittal Letter. DOC The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecom munlcaIions Device for the Deaf (805) 781 -7410. NOMINATION PROCESS CHECKLIST Official Nomination Paper: Not less than 20 nor more than 30 registered voters in the City of San Luis Obispo signatures. Candidate's Information (p.3) Declaration of Circulator — Handwritten not typed Affidavit of Nominee — Will complete with City Clerk when turning in documents. Please don't sign before then. -- So r Ballot Designation Worksheet All information filled out, signed and dated. Candidate Statement of Qualification The State ent includes: r A a ne, Age, Occupation of the Candidate brief description (no more than 200 words) of the candidate's education and qualifications expressed by the candidate in his/her own words (first person si gular). 'l Correct spelling, punctuation and grammar The State ent DOES NOT include Warty affiliation Membership or activity in any partisan political organization Oq References to other candidates . Boldface type, bullets, boxes, arrowheads, diamonds, asterisks, all capital letters, or underlining ❑ Deposit of $410 for English or $920 for both English/Spanish V Emailed Electronic version to City Clerk C c, f ❑ No Candidate Statement Submitted Statement of Economic Interest — Form 700 '.Cover Page Schedules (if applicable) Y, Code of Fair Campaign Practices Form Submitted by: >( Candidate I y — a-91 n (Date) Received By: City Clerk (Date) NAME: JAN MARX OCCUPATION: CITY COUNCIL MEMBER I'm running for Mayor at a challenging and promising time. San Luis Obispo needs to respond courageously and creatively by renewing our commitment to economic vitality and excellent stewardship. A resident since 1988, married, with grandchildren, I earned degrees from Stanford and Santa Clara Law School. I`ve served on the City Council from 1998 -2002 and from 2008 to the present, and represent San Luis Obispo on the County Council of Governments and Air Pollution Control District. I've been active in Chamber of Commerce, Rotary, neighborhood, anti - domestic- violence, environmental, and humanitarian organizations. I`ll provide capable, caring leadership, based on my experience in government and as a business owner and community volunteer. I support residents' priorities, including conserving our resources - -human, economic, environmental, cultural, and historical -- preserving open space and safe neighborhoods, improving infrastructure and bike paths, and promoting a vibrant Downtown. I'll conduct the city's business with accountability, fairness, diligence, transparency and civility. I'm a good listener and don't turn my back on anyone. My temperament, education and record of dedication to public service make me the best - qualified candidate. As Mayor, I will work with you toward a resilient and sustainable future. I would appreciate your vote. [Visit janmarx.com, email CANDIDATE'S STATEMENT Ol� .4UALIFICATIONS (Elections Code Sections 13307, 13308, 13309, 13311) Candidate for pf the _ C;, d, at the November 2, 2010 Consolidated General Election Date Statement Received from Candidate original - file with CD or diskette attached copy - candidate �4 x� vY �//CU INSTRUI DNS TO CANDIDATE 1. Carefully read the information below 2. Complete the Name, Age & Occupation portion of this statement. 3. Attach your statement to this form. 4. Return this form, the statement and an electronic version of the statement to the City Clerk's office. The statement must be submitted with your nomination papers, or if none, no later than 88 days before the election. It has been determined that the cost of the statement is the responsibility of the candidate. The estimated cost of printing the statement is: English $ 410 Spanish /English$ 920 NOTICE TO CANDIDATE: This statement may include your age, occupation and a description of your education and qualifications not to exceed 200 words. The statement must be written in the first person singular. All statements will be printed in uniform style and type size. Please type your statement in upper and lower case. Check the statement carefully for errors in spelling, punctuation and grammar before filing as your statement will be printed exactly as submitted by you. p 1 decline to submit a Candidate Statement. Q- I submit the following statement: NAME: N /"thl 2X AGE: Ct 7-Y Optional OCCUPATION: C 0 L/ L L_ Al k-,LA Optional. (Maybe more descriptive than what will appear on ballot) EDUCATION AND QUALIFICATIONS - Statement and word count start here. Statement should be printed on a separate page attached to this form. Statement must also be submitted in electronic format. CANDIDATE: PLEASE READ BELOW BEFORE SIGNING. PURSUANT TO ELECTIONS CODE SECTIONS 13307 & 13308, 1 state that I prepared the attached statement which is to be printed in the Voter's pamphlet and mailed to each registered voter in my district. I understand the deposit amount is only an estimate of the actual cost that may be significantly more or les than the estimate, depending on the number of candidates electing to file statements. Accordingly, the election official will bill me for any additional expense or refund any excess amount paid depending on the final actual cost. 1 further state that I will pay for my prorated cost of the statement at such time as required by the elections official ❑ I am indigent and unable to pay for my prorated costs in advance. Attached is a financial disclosure statement pursuant to Elections Code Section 13309 and a release authorizing you to obtain a copy of my most recent federal tax form. I certify under penalty of perjury under the laws of the State of California that the financial statement is true and correct. CHECK THE APPROPRIATE BOXES FOR PRINTING OPTIONS ❑ SPANISH - San Luis Obispo is not a language requirement county under the Federal Voting Rights Act. If you check this box it indicates that you wish to have your statement translated and printed in Spanish in addition to English. The cost of the Spanish statement is in addition to the cost of the English statement. ❑ WITHDRAWAL OF STATEMENT- If no other candidate has filed for election for the same office as of the close of nominations, I authorize withdrawal of my statement of qualifications. ❑ WITHDRAWAL OF STATEMENT -If no other candidate for the same office has filed a statement of qualifications, I authorize withdrawal of my statement of qualifications. J 1i Alv1 i."\ ' (Print name as signed) /^ ( � i (Date of Signing) NAME: JAN MARX OCCUPATION: CITY COUNCIL MEMBER I'm running for Mayor at a challenging and promising time. San Luis Obispo needs to respond courageously and creatively by renewing our conitment to economic vitality and' excellent ste'W_ a- rdship. D, J -� resident srnce X988 marred, with grandchildren, I earned degrees from Stanford an� Santa Clara Liw School. I`vo�setv'ed on the City Council from 1998 -2002 and from 2008 to thef pre�e'nt, aha re�ksent San Lu'i's Obispo on the County C&incil of Governments and Air Pollution Control District. I've ben active in Chamber of Commerce, Rotary , neighborhood, anni- domegtic- violence, environmental, and humahitarian organizations. I`ll provide capable, caring leadership, based on my experience in government and as a 7 usii ess owner acid community volunteer. i support residents' priorities, including conserving li `, title r 7 F •rte .. Ia3 �? ou resources -- human, economic, environmental, culiural, and historical -- preserving open space a-nd safe neighborhoods, improving infrastructure and bike paths, and promoting a vibrant Downtown. . I'll_ conduct the city's business with accountability, fairness, diligence, transparency an civility. I'm a go6d listener and�d n't turn n�,y back on anyone. I1 y tem ament, education and' record of dedication to public service iQce me the be canfiidate. E As Mayor, I will work with you toward a resilient and sustainable future. I would appreciate your vote. [Visit 3allot Designation Worksheet Name of Candidate. J;` -P-' R Office Sought: 0 k SIN C� i S ® l ?r S Po CA-i r_o"e jV1 q Daytime Telephone Number: Evening, FAX Number: ,,` E -Mail k f I DO NOT WISH A BALLOT DESIGNATION LISTED UNDER MY NAME ON THE BALLOT ❑ C i T�' PROPOSED BALLOT DESIGNATION: C'y ✓�� 1 L /4,1 PM R ,,=_, (If using incumbent, appointed incumbent or the elective office currently held, complete this section only) I WAS ❑ ELECTED ON OR ❑ APPOINTED ON (If using any designation other than incumbent, the information below must be completed) THIS IS MY: ❑ OCCUPATION V, PROFESSION ❑ VOCATION ❑ 1 POSSESS THE LICENSE OR CERTIFICATION REQUIRED OF MY PROFESSION OR OCCUPATION ❑ I DO NOT CURRENTLY HAVE A PRINCIPAL OCCUPATION OR PROFESSION, I HAVE WORKED IN THE PROFESSION OR OCCUPATION IN MY BALLOT DESIGNATION IN THE LAST 12 MONTHS Describe what you do and why you believe you are entitled to use the requested ballot designation. If using the title of an elective office, you may submit a copy of your certificate of election or appointment. l rGS del `%'r _k f' ., s, l -e _ -e _(1 s 061 PO 6� h i y, 2_0o, Your Job Title: r , CO e,, W I /vt _Dates in Position: Name of Employer or Business: G Name and Phone # of Person(s) who can verify this information: (If using retired in the ballot designation, complete information below) ❑ IF I AM ELIGIBLE TO USE RETIRED IN MY DESIGNATION FOR THE FOLLOWING REASONS- see reasons on page 20 of the candidate's manual: (if using community volur..er as the ballot designation, con., ate information below) ❑ My volunteer work is my sole, primary, main or leading professional, vocational or occupational endeavor ❑ 1 am not engaged concurrently in another principal profession, occupation or vocation I volunteer for one of the following: ❑ A charitable, educational or religious organization as defined by the U.S. Internal Revenue Code §501(c)(3) ❑ A government agency. ❑ An educational institution Name of organization: If my ballot designation is determined to be unacceptable, use the following alternative: 1St Alternative: C l _F,-. C 0 vn/C_► L [_/0A�q A) 2nd Alternative: rJ L-vk S : Q►4 COwNC -1 t 1 AI`Oq�v_ ' To the best of my knowledge and belief, the above - requested ballot designation(s) represent my true principal profession(s), vocations(s), and /or occupation(s) that I am entitled to use as my ballot designations pursuant to §13107 of the Elections Code. Signed this day of 20 _L� in r a k o (Location) Candidate's Signature You may attach any docume 4s,,6r exhibits that you believe support your proposed ballot designation. These documents will not be returned to you, so do not submit originals. FOR fJr IAL USE Approved for use Signature Date ❑ Rejected Date Candidate Notified Reason for rejection City of San Luis Obispo - City Council Members http: / /wwl• •i. san - luis- obispo .ca.us /citycouncilmembers.asp city of san luis owspo Choose a Destination... Search conrAcs U% i+Pmo City Council Members Mayor Dave Romero (805) 781 -7415 Council Member Allen Settle (805) 878 -7646 Click mailbox to J? Email the City Council or call 805 - 781 -7114 F ouncil Member n Howell Marx (805) 783 -7752 Vice Mayor Andrew Carter (805) 431 -0844 Council Member John Ashbaugh (805) 783 -7753 NOTE: E -Mail correspondence sent to or from members of the City Council via the City's website are considered public records and may be subject to disclosure and additional distribution pursuant to the Public Records Act and Brown Act. About the City I Visiting SL O I Wit's New I City Government I Employment bids. .& Fro..A.0...s @J5 I EcQoQm0c D v lopm n I EAOs I How are we doina? Q2009. Cltw of San Zuls C)btgIp 1 of 2 7/16/2010 8:30 PM RECEIPT FOR MATERIALS PROVIDED BY THE ELECTIONS OFFICIAL hereby acknowledge receipt and review of nomination documents and e- didate'S packet on behalf myself oi , as a p candidate for yor or Council Me ber in the General Municipal Election to be held in the ity of San Luis Obispo on Tuesday, November 2, 2010. Official Nomination Paper Ballot Designation Worksheet ,�,andidate Statement of Qualification 'Statement of Economic Interest — Form 700 /Code of Fair Campaign Practices Form Office Hours L / � Date Received by: Submitted By: "�Z:) — r—, ::: �— ,- ,— City Clerk TO "d _ldlol x _ OF Sacramento, CA 95814 STATE (916) 653 -6224 (916) 653 -5045 (FAX) May 20, 2010 GREGORY T. GRIFFIN ELECT JAN MARX MAYOR 2010 Dear Committee Treasurer: I U. tsox ion Sacramento, CA 95812 -1467 www ss.ca goo (Web Site) RECEIVED MAY 2 0 20119 SLO CITY CLERK Thank you for filing your Recipient Committee Statement of Organization (Form 410). Your committee identification number is 1327606. This number should be used on all the campaign statements your committee files and given as information to all persons and committees to whom you make contributions. Based on your Statement of Organization, your filing jurisdiction is at the city or county level. (Government Code section 84215) (Note; All subsequent section references are to the Government Code.) Since the Secretary of State is a state level filing officer, you will not ordinarily be required to file campaign disclosure statements with this office. Please refer to the information sheet "Where Campaign Statements Must be Filed by Candidates, Officeholders, and Campaign Committees at the Local Level" (www,sos,ca.gov /prd /campaign info /filing_ requirements /where`to_file_local.htm) in order to determine your appropriate local filing officer(s). You may need to file semi - annual statements (§ 84200.5) on an ongoing basis, even if you have no activity. Your committee may also be required to file several types of pre - election and election - specific statements, late contribution (§ 84203) and late independent expenditure (§ 84204) reports, various types of amendments (§ 81004.5), termination statements (§ 84214), and other special reports required by law. In addition, candidates may be required to file candidate intention statements (§ 85200), statements of economic interests (§ 87201), and other types of reports. please refer to the appropriate Fair Political Practices Commission (FPPC) campaign information manual for your specific filing requirements. Changes may occur in the information contained in your original or currently -filed Statement of Organization. For example, you may change the name of your committee, addresses, or treasurers. You must designate a Statement of Organization as an "amendment" and file an original and one copy with this office within 10 days of any change (§ 84103(a)). In addition, if any information contained in your currently -filed Statement of Organization changes during the 16 days immediately preceding the election in which the committee is required to file a pre - election statement, an amendment must be filed within 24 hours of the change. Keep in mind that a copy of all committee registration statements must also be filed with your appropriate local filing officer (§ 84101(a)). The law prohibits a committee from making or receiving contributions without a treasurer. If you resign as the committee treasurer, your committee cannot make any financial transactions until a new treasurer is appointed and the amendment is filed with this office (§ 84100). When your committee is no longer active, or if it disbands, you must designate a Statement of Organization as a "termination" and file an original and one copy with this office in order to officially terminate your active status. 'Until such a Statement is filed, your committee will be subject to all filing requirements and could be fined for failure to timely file (§ 84214). Appropriate forms and manuals may be obtained from your local filing officer or you may download the latest forms, manuals, and filing schedules from the FPPC website at www,fppc,ca.gov, If you have any questions about your campaign filing requirements, please contact your local filing officer or the Fair Political Practices Commission at (916) 322 -5660. If you have any questions about your Statement of Organization, call Gloria Perez at (916) 653 -8763 or Regina Geremia at (916) 653 -8069. TO /TO'd 62ZZtibSS08 upr Zz:60 0T0E- 8Z -),dW Secretary of State NOTICE OF' REJECTION Statement of Organization (Form 410) Name of The Fair Political Practices Commission requires the Secretary of State to reject Statements of Organization (Form 410) that do not provide all of the information required by 2 Cal. Code of Regulations (CCR) § 18410. Your Form 410 is being 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," "Amendment," 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. # 3 ` The Form 410 (Pale 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 comm_ ittee does not include the name of its sponsor(s). (Government Code § 84102(a) and 2 CCR § 18419(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)) 0 The name of the cand Wate-control led committee formed for the purpose of the candidate's election (election held on or after January 1, 2009) does not include: (1) the last name of the candidate, (2) the office sought, and (3) the year of the election. (2 CCR § 18402(c)(2)) - t4sa•�s'`` C-��r• t��v -��. 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)) 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)) 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)) 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) Secretary of State NOTICE OF REJ TION - Statement of Organization (Fo, 110)~ 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 (Page 1, 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 § 841020 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 § 18410(a)(I 1)) 15. Other: (e.g., not legible) In order to file your statement, you must submit an original and a copy of a correct and complete Form 410 to the Secretary of State. A blank Form 410 can be downloaded from www.sos.ca,g Wprd/fonnsl11 1 O.ndr. Submit the signed original and a copy to the Secretary of State, ALONG WITH A COPY OF THIS "NOTICE OF REJECTION" by mail or in person to: Secretary of State; Political Reform Division; 1500 11`x' Street, Room 495; 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.f c.ca.gov/fol-ilis/1-05foi-iiis/41 0FactSheet509. df, Page 2 SOS /PRD 18410 09/08/2009