HomeMy WebLinkAbout410 08/30/2018 Statement of Organization Recipient Committee Initial - Peter Amundson�j 1 'Ti
Statement of Organization
Recipient Committee
Statement Type ® Initial
® Not yet qualified
or
0 Date qualified as committee
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❑ Amendment ❑ Termination — See Part 5
Date qualified as committee Date of termination
1. Committee Information I.D. Number
(if applicable)
NAME OF COMMITTEE
Amundson for City Council 2018
STREET ADDRESS (NO Pa. BOX)
E-MA ILADD BESS (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOM I C ILE JURISDICTION WHERE COMMI77Et 6 ACT IVt
Orange Seal Beach
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
:EIVED A
office of the S(
of the State of
JUL 09 2010
2. Treasurer and Other Principal t�ce
JUL 2 7 2018
Ten Slater CITY Q
STREET ADDRESS (NO P.O. BOX)
9070 Irvine Center Drive, #150
CITY STATE ZIP CODE AREA CODE /PHONE
CONTROII IN9 OFFCEHOLDER. CANDIOATF. OR STATE MEASURE PROPONENT
Executed on
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 430 (February/2018)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
i
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME I I.O. NUMBER
Amundson for City Council 2018
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
4. Type of Committee Complete the applicable sections.
STATE ZIP CODE
2 of 3
• 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 APPLI CABLE) ELECTION CHECK ONE
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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
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, Jr
I
2018
X
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)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
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
Type of Committee (Continued)
OF ACTIVITY
NAME
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
List additional sponsors on an attachment.
GROUP OR AFFILIATION OF SPONSOR
Page page 3 of 3
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE /PHONE
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Date qualiRetl
5. 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