HomeMy WebLinkAbout410 12/22/2016 Statement of Organization Recipient Committee Termination - Schelly SustarsicStatement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment
Notyetqualified❑ or List I.D. number:
® Termination — See Part
List I.D. number:
1388801
n
8 10 16 12 22 16
/ / / / —/—/
Date qualified as committee Date qualified as committee Date of Termination
(if apPltea ble)
ly Sustarsic for City Council 2016
ST R EET ADDRESS (NO PO, BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
MAILING ADDRESS (IF DIFFERENT)
FAX / EMAILADDRESS
COUNTY OF DOMICILE
Orange
Attach additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in prepari
penalty of perjury under the laws of the State
Executed on o By
DATE/
Executed on / a''f • v By
DATE
Executed on
DATE
Executed on
DATE
By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
NAME OF TREASURER
Patricia Campbell
Date Stamp
DEC 2-2 2016
CITY CLERK
CITY OF SEAL BEACH
For Official Use Only
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO RD BOX)
CITY STATE NP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO PO.
CITY STATE ZIP CODE AREA CODE /PHONE
ng this statement and to the best of my knowledge the
true
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 ()an/2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
9
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
Wells Fargo Bank
ADDRESS CITY STATE ZIP CODE
.D. NUMBER
1388801
Ty. pe of Committee) Complete tffe appl(cWbl- se'c ions.
• 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 SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Schelly Sustarsic
City Council, District 4
2016
® Nonpartisan
SUPPORT
El
❑ 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 MEASURE(S) 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
El
OPPOSE
D
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 3
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
GM,Small Con[hbutor Comm�tteeiry" �
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
••..•,�• i ,, °{ - •••.,•,•,. .-•�•• •».••: •• a - *353'xRf3: w w6�"�.'�'"t-: 3 .wµ+mmn:.*i'fii::ss'�G5';:«atev wa �iaas:r ° a- ra+ jvr- rvw4 .v,e EEm et'*cna M:an m Hr v a �a ••,n'� x z..
been me
:. Te[ iT 11n�.tlOn- �e{�Id1Y81"IIeC),t5., Ba±3igping thg,penH�ario�Yhe tre�sprer, asslstant�Yrea& oreranrl�rc�ndid�te ,.oBir�NOtdor,oRproponent rMyithat �Il'ofthefollowmgcond�onf =haue 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 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