CA Form 410 Committee To Support Ken Dyda for Council 2015 - Aug 7, 2015 •
Statement of Organization Date Stamp
CALIFORNIA 41 0
Recipient Committee
FORM
Statement Type
igInitial El Amendment 0 Termination—See Part S • * i TM tv
Not yet qualified J.or List I.D.number: CIT' OF RANCHO PALOS VERDES
List I.D.number:
AUG 07 2015
-/ / -/ ..__,_A____/
Date qualified as committee Date qualified as committee Date of ination • CLERICS OFER
1:-=Committee=Information;::�.,: =,:, . : : - _ -: .:{. : 2. Treasurer and Other Principal-Officers
NAME OF COMMITTEE NAME OF TREASURER
(1,CD/11 44 I .rnC:--- 7P 154/77P171er KEA/ 4 It. R (Mhtiej z. ?c,',r ‘04d1.1.4C) 49_ 6 ,e_A_
STREET ADDRESS No P.O.BOX)) STRE ADDRESS(NO P.O.BOX) Jo
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MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
COUNTY OF DOMI ILE JURISDICTION WHERE COMMITTEE IS ACTIVE STATE ZIP CODE AREA CODE/PHONE
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NAME OF PRINCIPAL OFFICER(S)
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RE ADDR S_(NO P•.•• Q 9cf
Attach additional information on appropriately labeled continuation sheets.
Cid _ 0 ii. # II' OA *.itrAir- LP IWIF
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STATE ZIP CODE AREA CODE/PHONE
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3. -Verification =:* �. ... :.
I have used all reasonable diligence in preparin: •. atement and to the best of my knowledge the information contained herein is true certify I complete.and under
penalty of perjury under the laws of the S - • • or is that the foregoing is true and correct.
Executed on ` ,2".i /
DATE •
SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on By
DATE
SIGNATURE OF CONTROLLINC#OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE 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(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization
CALIFORNI
Recipient Committee FORM 41 0
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
Ce;/11/11t 77Z-- -OyD/,) Ciot: c',/z•__
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
4:{Type:of.Committee•Completethe'applicable.sections : _ 1111
Controlled Committee
• 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
❑ Nonpartisan
❑ Nonpartisan
Primarily Formed Committee 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
ff
,/ SUPPORT OPPOSE
yP4 / 6)0
SUPPO T ors)
FPPC Form 43,0(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
•
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE Page 3
COMMITTEE NAME I.D.NUMBER
Typelotp***:*--k.,t:„(Cond,ted)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box;
CITY Committee El COUNTY Committee El STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on,an attachment. 111
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
Small Contributor Committee
El--I.
Date qualified
5TOYOrkatigitlit#91.4tetTleritqV:"k'' -BisiOipgt11egriflaiiion;:itielke**ree,*#ink*diurei.indiocandidate,officelloiger,oipritiglong*cer*P*4-6tthe followingconditlons 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(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov