HomeMy WebLinkAbout410 09/24/2012 Statement of Organization Recipient Committee Termination David Sloan Received from OC ROV3°
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
,Type,or print In Ink
❑ Amendment
List I.D. number:
Date qualified as committee Date qualified as committee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
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Termination - Sie a of
Gst .D. number: '(t\ih Ot t
Date of Termination
L /TI L U/(iL -fL
STREET ADDRESS (NO P.O. BOX)
CITY 1 STATE ZIP CODE AREA CODE /PHONE
OPTIONAL: FAX /E -MAIL ADDRESS
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
COUNTY
Attach additional Information on appropriately labeled continuation sheets.
1 211 IM
C a
2. Treasurer and Other Principal
STREET ADDRESS
CITY
NAME
STREET ADDRESS
IFANY
STATEMENT OF ORGANIZATION,
24 2012
STATE ZIPCODE AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODEIPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
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 knowledge the information contained herein is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true a
Executed on A y 4% U S I `i l; )) /�-L By
DATE
f
Executed an all By
r). J .�
Executed on DATE By 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 (8661275.3772)
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Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
5'L.�'�irN / % ✓c /:� Vic;
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, 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.
NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
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s l3 U a�U; ry'c �, U/
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><•Non- Partisan
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
�6/r /L,l<" '
ADDRESS STATE ZIPOODE
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
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline; 8661ASK -FPPC (8661275.3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I. u, nueion
1, 1: s ' /- -r 514"i14JLl /v LvUluei L-
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
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
UKUUK UK A" ILIA I Ivry Ur SKUNSUK
STREET ADDRESS NO. AND STREET
❑ t Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1, 2001, enter 111/01.
S.Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all ofthe 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.
FPPC Form 410 (January105)
FPPC Toll -Free Halpllne: B661ASK -FPPC (8661275.3772)