CA Form 410 Termination Dyda for Rancho Palos Verdes Council 2019 Statement of Organization RECEIVED CALIFORNIA 41 0
Recipient Committee CITY OF RANCHO PALOS VERD FORM
Statement Type 0 Initial ❑ Amendment ® Termination—See Part 5 DEC 23 2019 For Official Use Only
O Not yet qualified
or
Q Date qualification threshold met Date qualification threshold met Date of termination I
/ 1. 5 2TY CLERKS OFFICr
/ I / I I /
1. Committee Information I.D. Number �.. 2. Treasurer and Other Principal Officers
(if applicable) 1 I i 1 5 p
NAME OF COMMITTEE NAME OF TREASURER
0 v OA reiR./k lj t. c' P/4 u)s tie-iZo e. c t-r CooAJ C.t . .1. i i7, rok-t t-I T- *-7- (C.
STREET ADDRESS(NO P.O.BOX)
3o.eE:(7 CA c I i. r 'JA ba.%%
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
3cç4o C..�► .st L./.-A ha...ve RAJ.; pia 1,0S kip:=Role s c A q0 2,1 s 3 i 90‘ 3 v. 7
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
fl.. A) -4o P4 LS uerIA?5 CA f10zl 5 3 la C101 30:3„7
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
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 that the fo e and correct.
Executed on i,2- 12.3 /2-,, I By (--- . " /—
DATE ( GNATURE OF TREASURER OR, •ISTANT TREASURER
k2, /2J CZ J i5 41011.1 _J
Executed on By t1 P. _ : ......t .rise,
DATE SI ATURE OF CO f'.LLI
G OFFIC/OLDER,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)
1FPPC Advice:advice@fppc.ca.gov(866/275-3772)
Clear Page Print www.fppc.ca.gov
Statement of Organization CALIFORNIA A n
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME , I.D.NUMBER
v'p Fug.. i Mc., �'�(A?S VL C S C..tT`t Co�.�,Ili�✓1 t 2- 192105
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
11(\rov g AAA< 21, 54 300_, 311 Li 2.5 2_0 y
ADDRESS CITY STATE ZIP CODE
—79 5O RcoE vitas C.. L\ v o ')
1-1
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)
KeN P-AM--K'P u l.��i +5 cm, ACPVeLic AAI
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 OPPOS
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
A3Cao PAS c,' x,53 C crticO1,"dc•L 2-c) (Zi `7S
4. Type of Committee (Continued)
Gene al 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
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 ❑ /
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.
FPPC Form 410(August/2018)
Clear Page Print FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov