CA Form 410 Committee To Support Ken Dyda for Council 2015 - Aug 7, 2015Statemen-E of Organization Date Stamp
Recipient Committee
Statement Type 191nitial
❑ Amendment ❑ Termination —See Part S
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I.D. number: Not yet qualified or list List I.D. number: C1W OF RANCHO PALOS VERDE
# AUG 0 7 2015
Date qualified as committee Date qualified as committee Date of Termination
i. -"'Committee, -=Information
NAME OF COMMITTEE
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
FAX / E-MAIL ADDRESS
(If applicable) &"
W5 OF9`,
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2. Treasurer and Other: Prindpal Officers
.� NAME OF TREASURER
re;t •
STRE ADDRESS (NO P.O. BOX)
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CO,DE//PHONE CIA;'- STATE YIP CODE AREA CODE/PHON
COUNTY OF DO MI ILE'-' JURISDICTION WHERE COMMITTEE IS ACTIVE
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Attach additional information on appropriately labeled continuation sheets.
3. -Veri 'cavi tion
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
RE ADDR S_(NO P
STATE ZIP CODE AREA CODE/PHONE
I have used all reasonable diligence in preparin atement 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 is that the foregoing is true and correct.
Executed on
6y;
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on By
DATE
SIGNATURE OF CONTROLLINGW OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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Executed on By
GATE — -
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAW
• All committees must list the financial institution where the campaign bank account is located.
4
NAME OF FINANCIAL INSTITUTION
BANK ACCOUNT NUMBER
ADDRESS CITY STATE 2(P CODE
4:{Type:of.00mmittee Complete,the"applicable.seWons "
I Page 2
• 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• •• • •..• •. � .... ...`v �v •rv'+rv• v1 vV ff%W V% J f% -%.11I I%.. %.uI IuIvu«.J %JI I I ICQJ\II CJ 111 Cl a I I )SIC CICI.LIuI I. LI. -)L UCluw.
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)
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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SUPPORT
OPPOSE
SUEEQ&T
O
FPPC Form 410 (Dec/2012)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
40
I AW
4-
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Page 3
I.D. NUMBER
pose Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
General PurCommittee
OCITY Committee []COUNTY Committee El STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors onan attachment.
Sponsored Committee
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE lip fWut
small Contributor Committee
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Date qualified
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e 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;
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• 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 (Dec/2012)
FPPC Advice: adVice@fppc.ca.gov (866/275-3772)
www.fppc.ca-gov