HomeMy WebLinkAboutJan Marx - Mayor - Form 410 - Termination - 12-18-14Statement of Organization Date Stamp CALIFORNIA
Recipient Committee FORM 410
Statement Type ❑ Initial ❑ Amendment
® Termination —See Part 5 For Official Use Only
Not yet qualified ❑ or List I.D. number: List I.D. number:
# 1364038 RECEIV'EO
12 /18 /2014 DEC 18 2014
Date qualified as committee Date qualified as committee Date of Termination
(If app!ic b!e) -
1.
NAME OF COMMITTEE
Jan Marx for Mayor 2014
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
San Luis Obispo CA 93405 (
MAILING ADDRESS (IF DIFFERENT)
same
FAX / E -MAIL ADDRESS
COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE
San Luis Obispo same
Attach additional information on appropriately labeled continuation sheets.
2. Treasurer and Other Principal Officers -
NAME OF TREASURER
Gregory Ty Griffin
STREET ADDRESS (NO P.O BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
San Luis Obispo CA 93401 (
NAME OF ASSISTANT TREASURER, IF ANY
Jan Marx
STREET ADDRESS (NO P.O. BOX)
C -TY STATE ZIP CODE AREA CODWHONE
San Luis Obispo CA 93405 (
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 certify under
penalty of perjury under the laws of the State of lifornia th he fa ing is true and correct.
Executed on -Z — l G� ( By
j DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on ` k-` I" y By
DAT E f' SiGNATU ¢OF CO i]LLING FICEHOLDER, CANUIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE.
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov