HomeMy WebLinkAbout410 09/30/2016 Statement of Organization Recipient Committee Amendment - Schelly SustarsicStatement of Organization
R>cipient Committee
Statement Type ❑ Initial
Notyetqualfied ❑ or
8 /10 16
Date qualified as committee
® Amendment
List I.D. number:
1388801
If
❑ Termination - See Part 5
List I.D. number:
tl
Date qualified as committee Date of Termination
pfapplicable)
Sustarsic for City Council 2016
STREET ADDRESS (NO PO. BOX)
4288 Candleberry Ave
CITY STATE ZIP CODE AREACODE /PHONE
Seal Beach CA 90740 (562)431 -3466
MAILING ADDRESS (IF DIFFERENT)
FAX/ E-MAIL ADDRESS
Schelly4Council @gmail.corn
Orange
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
RECEIVED A IL�
in th office of the Se of Sta
of the State of fo to
SEP 12 016 SI
REGISi I
ShA l p la-e t`
P 16 2616
NAME OF TREASURER I JL.F J0 �Ulf)
Patricia Campbell J l V
STREETADDRESS (NO P.O. BOX)
4433 Ironwood Ave CITY OF SEAL BEACH
CITY STATE ZIP CODE AREA CODE /PHONE
Seal Beach CA 90740 (562) 598 -3941
NAME OF ASSISTANT TREASURER, IF ANY Y
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICEMS)
STREET ADDRESS INO P.O.
CITY STATE ZIP CODE AREA CODE /PHONE
I have used all reasonable diligence in preparing this statement and to the best of my Knowledge
penalty of perjury under the laws of the State of Calif rniia— tthha -t the foregootag its �trruue and correct.
Executed on 7 /(.� Z/rp By �t~Qi( Y u-..v "�"- 9/iC.� - 111
ATE // 8 TU OF TREASURER OR
Executed on //w By
( .��....., .�.�.�DATE n �..
Executed on
DATE
Executed on
DATE
contained herein is true and complete. I certify u
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
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
Page 2
I.D. NUMBER
1388801
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCUUNI NUMBER
Wells Fargo Bank (562) 594 -0975 7948076570
ADDRESS CITY STATE ZIP CODE
12310 Seal Beach Blvd Seal Beach CA 90740
�l. T of Comer iti tittee�oPn lete the a Ilci?I,ee ect ons' I^ 'a "`Ia 3 E t
• 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 "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 SOUG14TOR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Schelly Sustarsic
City Council, District 4
2016
12 Nonpartisan
SUPPORT
❑ Nonpartisan
° • e r ° I' 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(5) OFFICE SOUGHT OR HELD OR MEA5URE(5) JUR15DICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410(lan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410(lan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
0751
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee El COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
Dam qualified
:s,wPg.. As'LW M..5iG1 3.''XYY#x5�it3(fi :a'nPFt: {:°SPaP yl. .eH"nL i °['ek :t'•i nWA9 °.'°R'{+ °` '&SP.A,
v ®. n- .. ........ ..w fat.t' 4X!tSb a�+`YV. i*.J.r'nL
." �e1 'fY11Y18tIORi3EglCelYtel't5.,' A'�9y -v8m th'"ver hcangn, the�treas�rer- assistant taa_urer =andlortcanP,'idate, ofhceholde�orpropD.eyt certif>fyyh tiaL th �fibllot++gcontlrtiDn�.have teen met-
• 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 maybe 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