GILPAC - Form 410 Inital (2012)Statement of Organization
Recipient Committee
Statement Type n Initial
Not yet qualified ® or
qualified as
Type or print in ink
❑ Amendment ❑ Termination — See Part 5
List I.D. number: List I.D. number:
Dat�____Jommittee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
Gilroy Business Political Action Committee (GILPAC), Sponsored by the
Gilroy Chamber of Commerce
STREETADDRESS (NO P.O. BOX)
7471 Monterey Street
STATE ZIP CODE AREA CODElPHONE
CITY
Gilroy CA 95020 (408) 842 -6437
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX/ E- MAILADDRESS
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
AN COUNTY OF
Santa Clara
Attach additional information on appropriately labeled continuation sheets.
Date of Termination I
Date Stamp
0S
r
L)
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Susan Valenta
STATEMENT OF ORGANIZATION
or Official
STREETADDRESS (NO P.O. BOX)
7471 Monterey Street
CITY STATE ZIP CODE AREA CODE/PHONE
Gilroy CA 95020 (408) 842 -6437
NAME OF ASSISTANT TREASURER, IF ANY
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
NAME OF PRINCIPAL OFFICER(S)
Gregg Giusiana
STREETADDRESS (NO P.O. BOX)
7471 Monterey Street
CITY STATE ZIP CODE AREA CODEIPHONE
(' ilrnv
CA 95020 (408) 842 -6437
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 o
perjury under the lawns of the State of California that the foregoing is true air - -
Executed on ( By
DATE
Executed on By
DATE
Executed on DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (April /2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
r;;i gaticincec Pnlitirnl Antinn Committee (GILPAC), Sponsored by the Gilroy Chamber of Commerce
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
I.D. NUMBER
Pending
,Controlled Committee 1 onent. If candidate or officeholder controlled, also fist the elective office sought or held, and
• List the name of each controlling officeholder, candidate, or state measure pr po
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "non- partisan."
• 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 ELECTION
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE)
. List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODEJPHONE
CITY
STATE ZIP CODE
PARTY
❑ Non - Partisan
❑ Non - Partisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE
SUPPORT OPI
FPPC Form 410 (April/2011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
OMMITTEE NAML
; — Dr,r+iral Antinn Committee (GILPAC), Sponsored by the Gilroy Chamber of Commerce
VIII Vy "w....._
4. Type of Committee (Continued)
• , Not formed to support or oppose specific candidates or measures in a single election. Check only one box.
® CITY Committee ❑ COUNTY committee ❑ STATE committee
DESCRIPTION
Support/oppose State and Local Candidates & Ballot Measures
Sponsored Committee
IMT • •• •'
List additional sponsors on an attachment.
Gilroy Chamber of Commerce
--caT ennRFSS NO. AND Si
7471 Monterey Street
Small Contributor Committee
Date qualified
Gilroy
JDUSTRY GROUP OR AFFILIATION OP Sru;vaUM
Chamber of Commerce
J IAIC -
CA 95020
STATEMENT OF ORGANIZATION
Pending
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:
fi
• 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 officers whollreportable leaving trans ctio by defeated candidates. Refer to
-- There are restrictions on the disposition of surplus campaign funds held by elected
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 (Apri112011)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Li
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ® or
Type or print in ink
❑ Amendment ❑ Termination — See Part 5
List I.D. number: List I.D. number:
( —J
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1. Committee Information
NAME OF COMMITTEE
Gilroy Business Political Action Committee (GILPAC), Sponsored by the
Gilroy Chamber of Commerce
STREETADDRESS (NO P.O. BOX)
7471 Monterey Street
CITY STATE ZIP CODE AREA CODE/PHONE
Gilroy CA 95020 (408) 842 -6437
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E- MAILADDRESS
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Santa Clara
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
►ECEIVED s t F-
the office of the & re,ar.'
of the Staic ^, di}ar^
APR 3 Q 2012
t.
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Susan Valenta
STREETADDRESS (NO P.O. BOX)
STATEMENT OF ORGANIZATION
Use Only
7471 Monterey Street
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408) 842 -6437
NAME OF ASSISTANT TREASURER, IF ANY
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
Gregg Giusiana
STREETADDRESS (NO P.O. BOX)
7471 Monterey Street
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy
CA 95020 (408) 842 -6437
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 foregoing is true ar
Executed on ^ l 2 By
DATE
Executed on By
DATE
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Apri1 12011
FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE Page 2
I.D. NUMBER
COMMITTEE NAME
Gilroy Business Political Action Committee (GILPAC), Sponsored by the Gilroy Chamber of Commerce Pending
4. Type of Committee Complete the applicable sections.
• 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 "non- partisan."
• 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
• List the financial institution where the campaign bank account is located (controlled "Candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
1W7r1_1rWiWx@7T 1=0 Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT N0. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE
C
FPPC Form 410 (April /20'
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -37,
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
I.D. NUM
COMMITTEE NAME BtK
Gilroy Business Political Action Committee (GILPAC), Sponsored by the Gilroy Chamber of Commerce Pending
4. Type of Committee (Continued)
pose Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
® CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Support/Oppose State and Local Candidates & Ballot Measures
• . List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Gilroy Chamber of Commerce Chamber of Commerce
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE
7471 Monterey Street
Gilroy
CA 95020
. . 11 1
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 (April /2011
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772