HomeMy WebLinkAboutDan Carpenter - Form 410 - Initial - 03-14-2012Statement of organization STATEMENT OF ORGANIZATION
Recipient Committee Type or print in ink Date Stamp -
Statement Type rg initial
Notyetqualified ❑ or
� I 14?O1 Z
Date qualified as committee
❑ Amendment
List I.D, number:
Date qualified as committee
(If applicable)
❑ Termination — See Part 5
List I.D. number:
I I
Date of Termination
RECEIV
MAR 15 2012
SLO CITY
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF SURE�!
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�j Cle V,nA�`�r C I D //f / -NCe I 01 7 STRE DRESS(NO P.O X)
STREET (NO P.O. BOX) U (r ii ��- -iiL%L ii l L•• OC 3 vi `(h
CITY STATE ZIP
ZO 3 0 \ /Co 41 SOn . �u L,I,S C/>< 176s
CITY
STATE ZIP CODE
70
OR
furs Olors
Cm ur-
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
STREETADDRESS (NO P.O. BOX)
AREA
T®se 67
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS(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 California that the foregoing is true and correct.
Executed on By
./D TE IGNAT REASU OR ASSISTANT TREASURER
Executed on T BY
ATE
SIGNATURE 0 C ROLLING LDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE - SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Car /n rJ ^ e2
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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 "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
17,
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fie)/
Non- Partisan
❑ Non - Partisan
. List the financial Institution where the campaign bank account is located (controlled "candidate election" committees only)
W� Its 120 - - 6111 - 0 1 C/, ; 1 7 � y04 ZV
ADDRESS CITY STATE ZIP CODE
6 &s �dwb� �� ��� pus V bispc � A- F 3 yo /
RaWINZINE 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)
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661276.3772)