HomeMy WebLinkAbout410 09/07/2016 Statement of Organization Recipient Committee Amendment - Schelly SustarsicStatement of Organization
Recipient Committee
Statement Type ❑ Initial
NotyettUbIlied ❑ Or
8 10 16
Date qualified as committee
® Amendment
List I. D. number'.
1388801
a
Date qual qualified as
(If applicable)
Sustarsic for City Council 2016
STREET
MAILING ADDRESS (IF DIFFERENT)
COUNTY Of DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Orange City of Seal Beach
Attach additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in preparing this
penalty of perjury under the I ws of the State of Cali
Executed on 9 A By
DATE
Executed on q / b By
DATE
Date Stamp
RECEWED
SEP 67 2016
CITY CLERK
CITY OF SEAL BEACH
NAME OF TREASURER
Patricia Campbell
Use Only
STREET ADDRESS (NO Po. BOX)
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS (NO P.O. BOX)
Tent and to the best of my kn
that the foregoin true and
OF
CITY STATE ZIP CODE AREA CODE /PHONE
contained herein is true and complete. I certify under
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(Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
• All committees must list the financial institution where the campaign bank account is located.
,.NAME OF FINANCIAL INSTITUTION
Wells Fargo Bank
AREACODE /PHONE BANK ACCOUNT NUMBER
(
CODE
Type of�ommltteeGomplete the ?appl ci able•sedt ons !IM .._a : a f[ R,,; °f' x " ' . k ". i v-
e 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.
v 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
Schelly Sustarsic
City Council, District 4
2016
Q Non partisan
SUPPORT
❑ Nonpartisan
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 MEASUREN JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
r
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
NAME OF SPONSOR
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑. COUNTY Committee ❑ STATE Committee
List additional sponsors on an attachment.
NO. AND STREET
CITY
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
Page 3
Will I R I
Date Qualified -
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�TeGminattOnFRe °qulrements By- slgmngjhe ,ver{rytano'n`�tLea�reesurar; assistant treasurerand(orcandidate officepoWer- or- p�opone0t' certify" 2haYalloftk�e #o(IowingcondmoDShave6eenmet�-
• 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