HomeMy WebLinkAboutHarmon, Heidi - Form 410 - 10-14-2016 - amendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
1 1
Date qualified as committee
3. Committee Information
NAME OF COMMITTEE
Heidi Harmon for Mayor 2016
® Amendment
List I.D. number:
#1388334
❑ Termination — See Part 5
List I.D. number:
08 115 12016
Date qualified qualified as committee Date of Termination
(If applicable)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
San Luis Obispo CA 93401 (
MAILING ADDRESS (IF DIFFERENT)
FAX/ E-MAIL ADDRESS
heidiismighty@gmail.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
San Luis Obispo San Luis Obispo
2. Treasurer and 0
NAME OF TREASURER
Nicholas Andre
STREET ADDRESS (NO P.O. BOX)
Date Stamp
RECEIVED
OCT 14 2016
LO CITY CLE
For Official Use Only
CITY
STATE ZIP CODE AREA CODE/PHONE
San Luis Obispo
CA 93405 (
NAME OF ASSISTANT TREASURER, IF ANY
Heidi Harmon
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
San Luis Obispo
CA 93401 (
NAME OF PRINCIPAL OFFICER(S)
Heidi Harmon
STREET ADDRESS (NO P.O. BOX)
CITY
Attach additional information on appropriately labeled continuation sheets.
STATE ZIP CODE AREA CODE/PHONE
San Luis Obispo CA 93401 (
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 10/14/2016 By
DATE
Executed on 10/14/2016 By
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
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
Recipient Committee
CALIFORNIA,
• -
INSTRUCTIONS ON REVERSE
❑ Nonpartisan
Page 2
COMMITTEE NAME
I.D. NUMBER
F-ioirii Wnrmnn fnr AAnu^r9n1R
1388334
• All committees must list the financial Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODEJPHONE BANY, ACCOUNT NUMBER
Union Bank [805}783-5140 �' ��
_ .. ..-..
ADDRESS CITY STATE ZIP CODE
995 Higuera Street San Luis Obispo CA 93401
4. Type of Committee Complete the applicable sections.
l Iw
• 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Heidi Harmon
Mayor, City of San Luis Obispo
2016
❑ Nonpartisan
SOP.^ORT
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
r—rr nuc
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SOP.^ORT
OPPOSE
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
1388334
pe of Corn ntttee (Connnued)
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
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
F
Date qualified
S. Termination Requirements By signing the vertkation, she treasurer, assisrant treasurer and/ar candidate, officeholder, a proponent certify shat aII at the fallowing ccnditions have been imI:
• 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