HomeMy WebLinkAboutDan Carpenter - Form 410 - Initial - 04-15-2008 (2)Statem t of Organization
Reci )1 nt Committee
Statement Type 0Initial
Not yet qualified ❑ or
IL / � , 0?
Date qualified as committee
1. Committee Information
Type or print in Ink `PIS d
❑ Amendment
List I.D. number:
Date qualified as committee
(B appuable)
NAME OF COMM E
Vtx v\ C� e W4� -�a Lt� CO �i
❑ Termination — See Part fcof In th 0111
List I.D. number,
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
ADDRESS (IF
OPTIONAL: FAX/ E -MAIL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF
THAN COUNTY OF DOMICILE
Attach additional Information on appropriately labeled continuation sheets.
1E ANt7 FIL
;e of the secretary
time State ', c
APR 2 2 NN
EERS► E®WE
Date of Termination D o� ���
secretary
2. Treasurer and Other Principal Officers
X
'STATEMENT OF ORGANIZATION
ZIP CODE AREA CODEIPHONE
CITY STATE ZJP CODE AREA CODEIPHONE
NAMEAND
�S.
MAILING ADDRESS
PRINCIPAL
CITY STATE ZIP CODE AREA CODEIPHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowI d the information contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of C lifornla that the foregoing is true and co
Executed on .5 ,70 9 By
TREASURER OR ASSISTANT TREASURER
Executed on & C. f l By 4
�/,MaTWWOFtONTROLLING OFF= HOLDER, CAN010ATE, 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 (January/05)
FPPC Toll -Free Helpline: 8661ASK -FPPC (86612753772)
NIAll MINI Ill (00- ANI /A11►I
.�t of Organization
CALIFORNIA ,�,ient Committee FORM
1
INSTRUCTIONS ON REVERSE nqu x
1 i TJi 1MI11 [Z
COMMITTEE NAME
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, I 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
) ,R'Non- P
O,tn Co. PC( (,� artisan
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
�, 1
63S4r��/or�r�l
ADDRESS
N
AREA CODE/PHONE BANK ACCOUNT NUMBER
CITY STATE ZIP CODE
So a Luis CA's Cf
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)
I J a VA (f av'r, -ekrte
--'? (/e
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURiSDICTiON
(INCLUDE DISTRICT NO., CITY OR COUNTY,. AS APPLICABLE)
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (86612753772)
Statement of Organization
Recipient Committee
Statement Type 01nitial
Not yet qualified ❑ or
c
Date qualified as committee
1. Committee Information
NAMEOFCOMMI EE
STATEMENT OF ORGANIZATION
Type or print in ink
Date Stamp
❑ Amendment Termination — See Part 5 RECEIVED
For Official Use Only
List I.D. number: List I.D. number: APR 16 2008
I
SLO CITY CLERK
Date qualified as committee Date of Termination
(If applicable)
2. Treasurer and Other Principal Officers
f NAME OF TREASURER
STR ET ADDRESS
STREET ADDRESS (NO P.O. BOX)
CITY
CITY_ . NAME O
STATE ZIP CODE AREA CODE/PHONE
L� Z- L.i i �� �✓ ai C �/J�_ � (� 5 a te•-> 2 t
MAILING ADDRESS (IF DIFFERENT)
STREET
OPTIONAL: FAX/ E -MAIL ADDRESS
COUNTY OF
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
CITY
SISTANT TREASURER
V
.
ZIP CODE
NAMEAND POSITION OF OTHER PRINCIPAL OF ICER( ). IF APPLI
MAILING ADDRESS
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 knowled9f the information contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of Califomia that the foregoing is true and correc
Executed on , By
DATE : - SIGNATURE OF TREASVriER ORASSISTANT TRrASURER
Executed on 1J C. By
A GI`0 tOrCONTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By - (1f v
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 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
ID]
4. Type of Committee Complete the applicable sections.
OF ORGANIZATION
• 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
• List the financial institution where the campaign bank account is located (controlled "candidate election' committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS
CITY
, ;C, ,Non- Partisan
STATE ZIP CODE
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election' committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS
CITY
STATE ZIP CODE
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
SUPPORT OPPOSE
r
l �
SUPPORT OPPOSE
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772)