CA Form 410 Ben Kelly for Rancho Palos Verdes City Council 2017 T
Statement of Organization RECEIVED
Recipient Committee (MYOf RANCHO PALOS ,: 1
4 Statement Type .t Initial ❑ Amendment ❑ Termination—See Part 5 For Official Use Only
Q Not yet qualified IJUL' 31 2017
Or
0 Date qualified as committee / / / /
iQ Date qualified as committee Date of termination
{ V (If amending to provide this date) CITY CLERK'S OFFICE
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NAME OF COMMITTEE NAMEJ� OF TREASURER
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Attach additional informai7oc )n appropriately labeled continuation sheete.
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
OR crATE MEASURE PROPONENT ----
Executed on __— By
0'51; SIGNATURE OF CONTROLLING OFFICEHOLDER.CANDIDATE OR STATE MEASURE PROPONENT
Executed on By
CAFE `- SIGNATURE OF CONTROt.LING OFFICEIIOLDii R CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(May/2017)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
t
Statement of Organization
Recipient Committee 4 0
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
IDNUMBER
Ke-Ali rer S C una
• All committees must list the financial institution where the campaign bank account is located.
:NAME 01 .::NANC,A! 5510 Ui:ON ARE,CODE/PHONE -----.- BANK ACCOUNT:C11MBEP - ----`-...-- _-_—_
MD-ka -20\ 5g1'..3(-)°°
:TAN ..
cont,oiled Lommit:ee
;i _1: -. -iE .D: T01(Ing , I1: .enO!(1L". Ti ,. ! :LIfldldatL- f-h(Phi)IdU ii.i : '.i,1 filch •.rlr,
1,1mDem :my and the yea. ;i,, .Yiectio;
• ist the Vy with, which each officeholder of i.andidate ii affiliated ni .::heck nonpartisan
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee
LUX]IVE OFFICE SOUGHT OR HELD
NAME OF CFN7D IDA--E/OFFICEHOLDER/STAT Ii MEASURE'ROPONEi\ (INCLUDE DISTRICT NUMBER IF APPLICABLE; :AR OF E. •i Oi. SARI'•'
Nonp artisar
a ;7) l4-eq P Uel s , C.'3«�.� O t t
-- -- --- ---- ------ Nonpartisan
Primarily
-----_..
Primarily TT0!mer ::o)rrnrit e 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
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(May/2017)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
•
Statement of Organization
Recipient Committee 4 1
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME -- I D NUMBER
1-;q'76/P5
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
CITY Committee ID COUNTY Committee[j] STATE Committee
TO`,, 0 AT,f ')ESCRIPON OF I:VI'1
Sponsored Conlynitte :.ist additional sponsors sponsort -)ri an attachment
Small Contribtoo, .utornittei [1]
,immittee has teased to receive contributno and make expenditures,
ommittee doe ont anticipate receivink ,rLtbunOnsor hialting expenditures in the inture
-ommittee has eliminated or has no ntcrn ion or ability to discnarge all debts, loans received, and other oniiga,,c,p,-
.
This committee has no surplus funds; and
This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactons
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 18521.3.
FPPC Form 410(May/2017)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov