HomeMy WebLinkAbout410 07/09/2018 Statement of Organization Recipient Committee Initial - Peter M. Amundson, Jr.Statement of Organization
Recipient Committee
Statement Type ® Initial
❑ Amendment ❑ Termination — See Part 5
Date Stamp
IRIECEM D
® Not yet qualified JUL 0 9 2018
or
Q Date qualified as committee CITY CLERK
qualified as committee Date of termination
CITY OF SEAL BEACH
1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE
Amundson for City council 2018
CITY STATE ZIP CODE AREA CODE /PHONE
Seal Beach
Attach additional information on appropriately labeled continuation sheets.
For Officlal Use
Jen Slater
STREET ADDRESS (NO PO. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO P.O.
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 knowledge the information contained herein is true and complete. I certify under
penalty of perjury u der a laws of the State of California th�t t,heetforregol ggiis true and correct.
Executed on / / j _ 8y /
^^ff0 TE / SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on f" / By _
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(February/2018)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA '
Recipient Committee •
INSTRUCTIONS ON REVERSE
Paget Page 2 of 3
COMMITTEE NAME I.D. NUMBER
Amundson for City Council 2018
• All committees must list the financial institution where the campaign bank account is located.
ADDRESS
4. Type of Committee Complete the applicable sections.
CITY
STATE ZIP CODE
• 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." Stating "No party preference" is acceptable.
• 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 YEAR OF PARTY
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
OPPOSE
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
City Council Member: City of Seal Beach
Nonpartisan
Partisan
(list political party below)
Peter M. Amundson, Sr
2018
%
Nonpartisan
Partisan
(list political party below)
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
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
OPPOSE
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Amundson for City Council 2018
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party /Central Committee
PROVIDE BRIEF
List additional sponsors on an attachment.
NAME OF SPONSOR
OR AFFILIATION OF SPONSOR
Page pace 3 of 3
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE /PHONE
❑ I ---/
Dale quallfied
S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent Certify that all of the following conditions have been 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 (February/2018)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov