HomeMy WebLinkAboutHarmon, Heidi - Form 410 - 08-08-2016 - SOSStatement of Organization
Recipient Committee
Statement Type 1Z Initial
IN'Oi yet qualified or
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4D
❑ Amendment
List I.D. number:
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AUG 2 6 2016
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ElTermination —See Parts REC
List I.D. number: in the (
Date qualified as committee Date qualified as committee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
�etp 144-rmun -Puy M"or 201 LP
STRE ETADDRESSINORCI BOX)
Date of Termination
CITY DIAII, ur wuc ...... -yrnc—
SGl h SQC)�'`� t
MAILING ADDRESS (IF DIFFERENT]
FAX /1 -MAIL ADDRESS
COUNTY OF DOMICILE 'FJRISDICTION WHERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately labeled continuation sheets.
I Y ED AND FILED For Official Use Only
ice of the Secretary of SLate
the State of Califomla
AUG 08 2016
f
Treasurer and Other Principal Officers
NAME OF TREASURER
ka+�lie WP,l er-
CITY STATE ZIP CODE AREA CODE/PHONE
5a�n �.0 5 o b; s�o CA �r 3 �f o 5
NAME OF ASSISTANT TREASURER, IF ANY I
H e l b i i a� IM t�1
STREET ADDRESS (NO PO BOX)
}-
CITY STATE ZIP CODE AREA f0DE/PHONE
so'n w1S �65po C 14 C13'401 �� .
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
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 terrify under
penalty of perjury under the laws of the State
PROPONENT
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 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA'
Recipient Committee • -
INSTRUCTIONS ON REVERSE
Page 2
•:AWM.]I::.: NAME I.D. NUMBER
4f/Df SIG-fmu)-, 4;r aDQa
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKACCOUNT NUMBER
14er-(A-a CJaI<S 50,nII005-514L4 --7--72-0c)"OIe-
n�ihc
ADDRESS CITY STATE ZIP CODE
t\"H Horro51- San(.(;(s (�iS�❑ CIA
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 "nonpartisan."
• 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
hrpl01
V
(VNon
parisar
SUPPURE
❑ Nonpartisan
• 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 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPURE
UPPOSE
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA'
Recipient Committee • -
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I I.D. NUMBER
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
51 REET ADDRESS NO.AND STREET CITY STATE ZIP CODE
Date qualified
5, Termination Requirements By SIOUV the verification, the treasurer, asslstaM treasurer and/or candidate, officeholder, or proponent certtfy that aH of the foHewing contfffl s have teed 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 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov