Gilroy Fire Fighters PAC - Form 410 - Statement of Organization
FILE AN ORIGINAL AND ONE AND. IF APPLICABLE. FILE ONE
COpy. OF THIS FORM~: OPY F THIS FORM WITH:
Secretary of State ~ IP 0""0" fHio. off'""" '0"
Political Reform D,v n WI om the committee must file Its
P.O. Box 1467 on al campaign disclosure
Sacramento. CA 95B - st ments.
STATEMENT OF ORGANIZATION (RECIPIENT COMMITTEE)
Form 410
1990
900434
(Government Code Sections 84101-84103)
IF AMENDMENT
ENTER 1.0. NUMBER
(Type or Print in Ink)
FULL NAME OF COMMITTEE:
Gilroy Fire Fighters, Political
STREET ADDRESS OF COMMITTEE: NO. ANO STREET
(NOT P.O. BOX) 7070 Chestnut St.
Action Committee
STATE
CA
ZIP CODE
OTY
Gilroy
95020
COUNTY:
Santa Clara
95021
MAILING ADDRESS (IF DIFFERENT):
P.O. Box 875
DATE QUALIFIED AS COMMITTEE (MO.. DAY. YR.): AREA CODE
Not yet qualified 408
I TREASURER AND OTHER PRINQPAL OFFICERS
NO. AND STREET (OR P.O. BOX)
OTY
848-0370
FOR OFFICIAL USE ONLY B FOR OFFICIAL USE ONLY
PHONE NUMBER
STATE
ZIP CODE
CA
POSITION NAME MAILING ADDRESS, IF DIFFERENT THAN ABOVE tAREA DAYTIME
ODE) PHONE NO.
TREASURER Clay Bentson 408 848-0370
-
Attach additional information on appropriately labeled continuation sheets.
II IS THIS COMMITIEE CONTROLLED BY A CANDIDATE. OFFICEHOLDER OR STATE MEASURE PROPONENT? (See
definition and important information on reverse.)
o YES (Complete the following) [Xl NO
· IF THIS COMMITTEE IS CONTROLLED BY AN OFFICEHOLDER OR A CANDIDATE, THE NAME OF THE CONTROLLING CANDIDATE OR OFFICEHOLDER, TH E
ELECTIVE OFFICE SOUGHT OR HELD AND DISTRICT NUMBER, IF ANY, MUST BE LISTED.
· IF THIS IS A BALLOT MEASURE COMMITTEE CONTROLLED BY MORE THAN ONE CANDIDATE, THE NAME OF EACH CONTROLLING CANDIDATE MUST BE
LISTED.
· IF THIS COMMITTEE IS CONTROLLED BY A STATE MEASURE PROPONENT, THE NAME OFTHE STATE MEASURE PROPONENT MUST BE LISTED.
· IF THIS COMMITTEE ACTS JOINTLY WITH ANOTHER CONTROLLED COMMITTEE, YOU MUST LIST THE NAME AND IDENTIFICATION NUMBER OF THE
OTHER CONTROLLED COMMITTEE.
III IF THIS IS A BROAD BASED COMMITTEE (see definition and important information on reverse). AND YOU WISH TO
MAKE CONTRIBUTIONS TO CANDIDATES IN EXCESS OF THE $2.500 CONTRIBUTION UMIT, YOU MUST CHECK THE BOX
BELOW AND ENTER THE DATE ON OR BEFORE WHICH THE COMMITTEE QUAUFIED AS A BROAD BASED POUTlCAL
COMMITTEE. YOU MUST COMPLETE THIS SECTION BEFORE MAKING CONTRIBUTIONS OVER THE $2.500 UMIT. Jlf the
committee is not a broad based committee, or does not WISh to make contributions in excess of the $2.500 limit. 0 not
complete this section.)
o THIS COMMITTEE IS A BROAD BASED POLITICAL COMMITTEE. THE COMMITTEE QUALIFIED AS A BROAD BASED POLITICAL COMMITTEE ON OR BEFORE:
(month)
(day)
(year)
Attach additional information on appropriately labeled continuation sheets.
YOU MUST COMPLm THE VERIFICATION ON PAGE 2
F.or information required to be provided to you pursuant to the Information Practices Act of 1977, see Information Manual on Campaiqn Disclosure
Provisions of the Political Reform Act.
- 1 -
.
NAME OF
COMMITTEE
Gilroy Fire Fighters, Political Action Committee
IV IS THIS A SPONSORED COMMITTEE? (Refer to the instructions on the reverse side for definitions and rules regarding
the name of a sponsored committee.)
o NO
K1 YES (Provide name and address of sponsor. If the committee has more than one sponsor, provide the name and
address of each sponsor on an appropriately labeled attachment.) .
Name of Sponsor: Gi 1 roy Fi re Fi ghters, Local 2805
Address of Sponsor: P.O. Box 875, Gilroy, CA 95021
V IF PRIMARILY FORMED TO SUPPORT OR OPPOSE SPEOFIC CANDIDATES OR MEASURES, UST SPECIFIC
CANDIDATES OR MEASURES SUPPORTED OR OPPOSED.
CANDIDATE'S NAME/MEASURE'S FULL TITLE SUPPORT OPPOSE OFFICE SOUGHT OR HELD BY CANDIDATE OR MEASURE'S
INCLUDING BALLOT NUMBER OR LETTER JURISDICTION (Include district number, city or county, as applicable.)
.
Attach additional information on appropriately labeled continuation sheets.
VI COMMITTEE'S PRINOPAL ACTIVITY IF NOT SUPPORTING OR OPPOSING SPEOFIC CANDIDATES OR MEASURES -- PLEASE
CHECK BOX TO INDICATE THE COMMITTEE'S LEVEL OF ACTIVITY: 0 CITY 0 COUNTY 0 STATE
To support candidates and measures supporting labor, retirement, fire, and hazardous
material issues effecting firefighters.
Attach additional information on appropriately labeled continuation sheets.
VII YOU MUST SPEOFY WHAT DISPOSITION WilL BE MADE OF SURPLUS FUNDS IN THE EVENT OF TERMINATION.
To be donated to a charitable orgination of committee's choice.
VERI FICA TlON
I HAVE USED All REASONABLE DIUGENCE IN PREPARING THIS STATEMENT. I HAVE REVIEWED THE STATEMENT AND TO THE BEST OF MY KNOWLEDGE THE
INFORMATION CONTAINED HEREIN IS TRUE AND COMPlETE.
I CERTIFY UNDER PENAL TV OF PERJURY UNDER THE LAWS OF THE STATE OF CAUFO
12-21-91 Gilroy, CA
EXECUTED ON AT BY
(DATE) (OTY AND 5T A TEl
EXECUTED ON AT
(DATE) (OTY AND STA TEl
EXECUTED ON AT
lOA TE) (CITY A NO ST A TEl
EXECUTED ON AT
lOA TEl (OTY AND ST A TEl
BY
(SIGNATURE Of CDNTRo'LUNG CANDIDATE. OFFICEHOLDER OR STATE MEASURE PROPONENT)
BY
(SIGNATURE Of CDNTROLUNG CANDIDATE. OFFICEHOLDER OR STA TE MEASURE PROPONENT)
BY
(SIGNATURE Of CONTROlLING CANDIDATE. OFFICEHOlDER OR STATE MEASURE PROPONENT)
- 2 -
Form 410
1989
r ..... - .............-.. "',... ....l~" ""NU, ~ iIU'~", HUi 0Ii6l J J 3
copy OF THIS fOtW WITH: C()ft'( OF THtS POMl WITH: ....., .
~ of SUM The city Of county fill,.. officer. if any,
itkal Reform DtvlSion wlttl wl\om .. cemlftitt..must file ,u
PO.IOII '467 orlOlMl cant,...n dlKlolure
Sauamento. CA 9Sa 12-1467 statemenu. !' NO f Il E D
STATEMENT OF ORGANIZAnON (IItEOPlENT COMMrrrEELoI:,c ffi<eofth.s.c,.!aryofStat.
q . i tho St"'. of Co'''''.
0046t.,L (Government Code SectionS i4101-14103)
IF AMENDMENT" /
ENTERI.D. NUlMER fEB , 6 1990
(Type or Pnnt in Ink)
KECEIVEO
.
FULL NAME OF C~E:
Gilroy Fire Fighters, Pol itical Action Committee
STRE ET AOOAESS OF COMMITTEE; NO. AtID STMET OlY
.-ono...) 7070 Chestnut Street Gi Iroy
MAILING ADOMSS (IF DIFFERENT): NO. AtID STIIUT (OII'.O.IOXI
P.O. Box 875 Gilroy
of SIc
SlATE ZIP COOf MA ,
CA 95020 Santa Clara
OTY nAn lJ# COOf
CA- 95021
DA TE QUALIFIED AS COMMITTEE lMO.. DAY.n.):
Not yet qual ified
AAfA COOE
408
~_II
842-5656
A FOR OFFICIAL USE ONLY
FOR OFFICIAL USE ONL
THASU" AND OTHER ptUNOPAL OfACERS
POSITION NAME AND ADDRESS AND MAILING AOORfSS, If DlfFERfNT ~ARfA BUSINESS
OOE) PHONE NO
TREASURER
Clay Bentson 7070 Chestnut Street, G i I roy, CA 95020 408 842-5656
P.O. Box 875 Gi 1 ray CA 95021
.4ft<<h ...NI&..tM~ on~ ~coMMu.ItienshHts.
II IS THIS A _OAD lASED POUTlCAL COMMlTTH1 (SM definition and important information on reverse.)
DYES
Enter the date on or before which the committee qualifed.as.abroad
baled committ..: .
~ NO
HI IS THIS Co.-TTEE CONTltOWD IV A CANDIDATE. OFftaHOlDIR OR STATE MEASURE NOPONENT7 (See
definition and importAnt information on r.verse.)
DYES (Compi.te the follQWing) ~ NO
IF THIS COMMITTEE IS CONTROLlED BY AN OffICEHOLDER OR A CANDIDATE. THE NAME OF THE CONTROLLING CANDIDATE OR OfFICEHOLDER, THE
ELECTIVE OFFICE SOUGHT OR HELD AND DISTRICT HUMlER. If ANY, MUST BE LISTED IF THIS IS A BALLOT MEASURE COMMITTEE CONTROLLED BY
MORE THAN ONE CANOtOATE, THE NAME OF EACH CONTROlliNG CANDtOATE MUST BE LISTED. IF THIS COMMITTEE IS CONTROLLED BY A STATE
MEASURE PROPOHlNT. THE NAME OF THE STATE MEASURE PROf'ONENT MUST BE LISTED.
I
AttM:h ~I ~ on .ppro,w;.f.1y '*'<<J continweion sIlMU.
IV IS THIS COMMInEE ACTING JOINTLY WITH 0THEl COMMITTElS7
DYES (Compfete the following) ~ NO
NAMES OF COMMITTEES WITH WHICH THIS COMMITTEE ACTS JOINTLY. AlSO PROVIDE THE COMMITTEES' IDENTIfICATION NUMBERS OR THE
TRlASURHS' NAMES AND PERMANENT STMET ADOIfSSES.
A.... . Mt'1 ... tft IJIJiWI.1M ...........r\ ........-'#' LJ.'.l.....
YOU..., te..... _ '_I -~_.. MM a
,. i._II.... ,... .. .. .. JIll l..... .. ~ ..1I...... .. Me .lIl~ 11"1" "..... Act ., "", .. ....Ill.._"".,..,., _ C...... OItclos6lr.
".\1.....,..,.""...... Act · .
"
.-.Vt"'4.~H; \ 0;...
...lo.
,. 1 . 0 ' ...
. '~
. ., , -..
lOll ' ~.I.,l, j ... .A.it.... ~.. t. . _....
V IS .THIS A' SPONSORED COMMITTEE? (Refer to the instructions on the reverse side for definitions and rules regardi ng
the name of a sponsored committee.)
o NO
CiI YES (Provide name and address of sponsor. If the committee has more than one sponsor, provide the name and
address of each sponsor on an attachment.)
Name of Sponsor: Gilroy FirE' FightE'r", Inr.:ll 7Roo:;
Address of Sponsor: P 0 Rnll R75. r.ilrny. rA 95n71
VI IF PRJMARll Y FORMED TO SUPPORT OR OPPOSE SPEOFlC CANDIDATES OR MEASURES, UST SPEOFIC
CANDIDATES OR MEASURES SUPPORTED OR OPPOSED.
CANDIDATE'S NAMEJMEASURE'S FUll TITLE SUPPORT OPPOSE OFFICE SOUGHT OR HElD BY CANDIDATE OR MEASURE'S
INCLUDING BALLOT NUMBER OR lETTER JURISDICTION (InClude district number. city or county. as applICable)
Attach iIdditional information on appropriat"y labelf!d continuation shHts.
VII COMMITTEE'S PRJNOPAL ACTIVITY IF NOT SUPPORTING OR OPPOSING SPEOFIC CANDIDATES OR MEASURES -. PLEASE
CHECK BOX TO INDICATE THE COMMITTEE'S LEVEL OF ACTIVITY: 00 CITY [] COUNTY 00 STATE
To support candidates and measures supporting labor, retirement, fire, and hazardous
material issues effecting firefighters.
Attach additional infDrmation on appropriat~/y labelf!d continuation sheets.
VIII YOU MUST SPEOFY WHAT DISPOSITION WlUIE MADE OF SURPlUS FUNDS IN THE EVENT OF TERMINATION..' .
Tn hA rff'"\n::a~lPrI Tn ~ rh~rit-~hl.:1 nrSJin~tinn nf rnmmittp~lc: rhnirp
VERlACA TlON
I HAVE USED AU UASONABlE DI.IGINCE. PREPARING THIS STATEMENT. I HAVE ItEVlEWED THE STATEMENT AND TO THE lEST OF MY KNOWlEDGE THE
INFORMA TIOII corn A.ED HOf.1S flUE AND Coa.LfTE.
I CfltTlfY UNDEIt PINAL TV Of PlIUURY UNOfIt THE LAWS OF THE STATE OF CAlI'
EXECUTED ON 2-13-90 AT Gi I roy, CA BY
IDA Tf) "(OTY ANO STAn)
EXECUTED ON AT BY
IDA Tf) (OTY AIIO STA TEl
EXECUTED ON AT BY
IDAT() (CITY ANO Sf A Tf)
EXECUTED ON AT IY
COATEI (CITY AlII) ST A TEl
(SlGNATUllf Of CONTI'Ol.UIIG CANOlOATE. OffICfHOlOlIl 011 STA Tf MEA SUIII' I'tlOPONENT)
~ TUIIl Of CONTIIClU.JMO CAHOlOA TE. OfflQHOlOlIl 011 Sf A TE MEA SuIII' I'IlOPONf NT)
(SlGNATUIlE Of CONTIlOWIIIG CNIDlOATl, OfflCtHOlDUI 011 STATE MlASUIIf PlIOPONfNT)
March Fang Eu
Secretary of State
1230 J Street
P.O. Box 1467
Sacramento, California 95807
POLITICAL REFORM DIVISION
(916) 322-4880
September, 1991
CLAY BENTSON 43
GILROY FIRE FIGHTERS, POLITICAL
ACTION COMMITTEE
7070 CHESTNUT ST
GILROY CA 95020-0000
RE: 1.0. # QO()tj3Y
Dear Treasurer:
On ~/4?/qtl a Statement of Organization, Form 410, was filed for the
above-referenced committee. To date, we have not received any campaign
disclosure statements, which are required by the Political Reform Act of 1974,
from your committee.
If you are a bona-fide local committee and have been filing campaign statements
with your city or county filing officer, you must amend your Statement of
Organization to so indicate. Additionally, please provide us copies of the
endorsed cover page of all statements filed.
If your committee was organized in anticipation of qualifying (raising or
spending $1,000) and has never done so, please file a Statement of Termination
(Form 415) retroactive to the date the committee organized as soon as possible.
However, if your committee has qualified as a state committee you must bring
your reports current by filing semi-annual statements immediately.
The following forms are available from this office or you may use photocopies of
forms currently in your possession. Additionally, if statements are due for
more than one filing period, they can be consolidated into one filing for each
calendar year.
Form 420 Recipient Committee Campaign Statement, Long Form
Form 425 Semi-Annual Statement of No Activity
Form 450 Recipient Committee Campaign Statement, Short Form
-2-
If you have any questions regarding your filing obligation, or if our records
appear to be incorrect in any way, please call Kellie Smith at (916) 327-9809 or
Brenda Richards at (916) 327-3051.
Sincerely,
.-~ n ;'~'.'!' /i'
~ ,,__...1_....,..1 _.
fT- ) ~.ij.l ....-..1" ;.;.~ ,;-?5:~
..::.~ ~ CJ ~l-!;...;'~"""-<'-'~/
t "" ,.#".
BOB STEELE, Chief
Political Reform Division
BS:KS:BR:rjd