CA Form 410 Termination Susan Brooks for Rancho Palos Verdes Council 2015 Statement of Organization
Date Stam
1
CALIFORNIA 41 0
Recipient Committee RECEIVEDFORM
Statement TypeOF ECHO Pte$
InitialAmendment Termination— For Official Use Only
® 0 See Part
0
o Not yet qualified DEC 0 6 2019
or
0 Date qualification threshold met Date qualification threshold met Date of termination
11 3 15 12 4 19CITY CLERKS OFFICE
.____../...._.__t_._.__ ._._.__/_...._./..._.__ .._.__/____/___
1. Committee Information I.D. Number 1378646 2.
(if applicable)
Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Susan Brooks for Rancho Palos Verdes City Council 2015 Ann Marinovich
STREET ADDRESS(NO P.O.BOX)
7315 Berry Hill Drive
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
3419 Corinna Drive Rancho Palos Verdes CA 90275 310-265-7246
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Rancho Palos Verdes CA 90275 310-541-2971
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
EMAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Los Angeles City of Rancho Palos Verdes
STREET ADDRESS(NO P.O.BOX)
Attach additional information on appropriatelyCITY STATE ZIP CODE AREA CODE/PHONE
f labeled continuation sheets.
. Te +ca on
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 o a ifornia that the foregoing is trIe and Qorrct.
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Executed on i / By i (y':�. /'/ 4��,Q_�
j DATE 2 I SIGNATURE OF TREASU ER OR ASSISTANT TREASURER
Executed on 4-;('``C. ___5- L../5 By ,--y`-.--J 1
DATE SIGNATURE OF CONTROLLING OFFICER LDER,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(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
Clear Page Print www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Susan Brooks for Rancho Palos Verdes City Council 2015 1378646
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Union Bank 310-519-7300 0041283318
ADDRESS CITY STATE ZIP CODE
20 Miraleste Plaza Rancho Palos Verdes CA 90275
4.Type of Committee Complete the applicable sections.
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." 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 APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
Susan Brooks City Council, Rancho Palos Verdes 2015
Nonpartisan Partisan (list political party below)
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
IF A RECALL,STATE"RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT O
FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
Clear Page Print www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Susan Brooks for Rancho Palos Verdes City Council 2015 1378646
4.Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Candidate for City Council, Rancho Palos Verdes
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee
El
-1--I-
Date
/Date qualified
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.
Clear Pae Print FPPC Form 410(August/2018)
Page FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov