HomeMy WebLinkAboutJan Marx - Form 410 - Termination - 12-17-2012Statement of Organization STATEMENT OF ORGANIZATION
Type or print in ink Date Stamp
Recipient Committee . - M f
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
❑ Amendment ® Termination — See Part 5��E�
List I.D. number. List I.D. number:
# # 1347247 DEC 17 2012
' l / 2-1 1 7, 2c t Q QTY CLE
Date qualified as committee Date of Termination
(If applicable)
NAME OF COMMITTEE
Jan Marx for Mayor 2012
STREET ADDRESS (NO P.O BOX)
265 Albert Drive
CITY STATE ZIPCODE AREACODE/PHONE
San Luis Obispo CA 93405 805 541 -2716
MAILING ADDRESS (IF DIFFERENT)
same
OPTIONAL: FAX /E -MAIL ADDRESS
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Gregory Ty Griffin
STREETADDRESS (NO P.O BOX)
2075 Hutton
For Official Use Only
CITY
STATE
ZIP CODE
AREA CODE /PHONE
San Luis Obispo
CA
93401
805 543 -2679
NAME OF ASSISTANT TREASURER, IF ANY
Jan Marx
STREETADDRESS (NO P.O BOX)
265 Albert Drive
CITY
STATE
ZIP CODE
AREACODE /PHONE
San Luis Obispo
CA
93405
805 541 -2716
janmarx @janmarx.com NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT Jan Marx
THAN COUNTY OF DOMICILE STREETADDRESS (NO P.O. BOX)
San Luis Obispo same 265 Albert Drive
CITY STATE ZIP CODE AREACODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
San Luis Obispo CA 93405 805 541 -2716
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 Z 1 Z y By IV :
DATE SIGNATURE OFTR A URER OR ASSISTANT TREASURER
Executed on . 2 r 7 / I' 2— By
PATE
Executed on
DATE
Executed on
DATE
By
By
SIGNATURE OF CONTROLLING I EH LDER, CANDIDATE, OR STATE M E A URE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)