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Committee for Measure F Quality of Life - Form 410Statement of Organization Recipient Committee Statement Type `4 Initial ❑ Amendment ❑ Termination — See Part 5 Not yet qualified ❑ or List I.D. number: List I.D. number: Date qualified as committee Date qualified as committee Date of Termination (Il applkable) 1. Committee Information 2. Treasurer and Ot NAME OF COMMITTEE /►�/ { j NA EO�REASURER C'arrl r✓I f i '' ~ rn s ��l,2t� F 'or c 1 STREET ADDRESS (NO P.O. BOXI STREET ADDRESS (NO P.O. BOX) ? MAILING ADDRESS (IF DIFFERENT) 9/1 Al 15, FAX / E-MAIL ADDRESS COUNTY OF DOMICILE I IURISDICTION WHERE COMMITTEE IS ACTIVE sQAvr.4 G L 1* 12 4 ell-)' (I ltz r r c Rv y Attach additional information on appropriately labeled continuation sheets. Date Stamp ck er Principal Officers For Official Use Only CITY STREET ADDRESS (NO P.O. 801). °'r - - Verification ..1 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 tunder the laws of the PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on I By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME r 45u�c • All committees must list the financial institution where the campaign bank account is located. Page 2 I.D. NUMBER NAME OF FINANCIAL INSTITUTION AREA ODE /PHONE BANK ACCOUNT NUMBER ►' nn c� �(. nl'� qN > `7��.- 171 �� I b(��- 5 L/ ADDRESS T5 a 7 fflMWQq 5ACZe-t T Type of Committee Complete the applicable sections. CITY STATE ZIP CODE C'1 c2oY CA '115-000 • 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." • 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 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) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT O[n FPPC Form 410 (Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov U Statement of Organization k�? Recipient Committee Statement Type m Initial ❑ Amendment Not yet qualified ® or List I.D. number: /) —] 0 � O Date stamp CALIFORNIA ' ✓/mil / 4 RECEIVED AND FIL FORM ❑ Termination — See Part 5 in the office of the Secretary of S List I.D. number: of the State of California _ Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1. Committee Information NAME OF COMMITTEE Committee for Measure F Quality of Life STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) Same FAX / E -MAIL ADDRESS WHERE COMMITTEE IS ACTIVE Santa Clara I City of Gilroy Attach additional information on appropriately labeled continuation sheets AUG 2 8 2014 Treasurer and Other Principal Officers NAME OF TREASURER Sara Humphrey Nino STREET ADDRESS (NO P.O. BOX) NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) Donald F. Gage STREET ADDRESS (NO P.O. BOX) 3. Verification I have used all reasonable diligence in preparing PROPONENT Executed on BY GATE 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 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE It I.D. NUMBER COMMITTEE NAME' , - Committee for Measure F Quality of Life • All committees must lit the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Dinnnnlc R7nle ADDRESS 7597 Monterey Street (408)762 -7171 CITY Gilroy BANK ACCOUNT NUMBER 201002854 STATE ZIRCODE CA 95020 • 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." • 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 NeMF.or CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S),OFFICE SOUGHTOR HELD OR MEASURE(S)JURISDICTION •I........ n0 I CTTC01 ........... .•.TV nn rn11.ITV Ac ADDI IrARI. EI rNFrC ONF - SUPPORT OPPOSE - 0 Comrnittee for Measure F Quality of Life Gilroy SUM On FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc ca- gov.(866 /275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME! Committee for Measure F Quality of Life • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREACODE /PHONE BANK ACCOUNT NUMBER Pinnacle Bank (408)762 -7171 201002854 CITY STATE ZIP CODE ADDRESS 7597 Monterey Street Gilroy CA 95020 • 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." • 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) Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CANDIDATE(S) NAME OR MEASURE(S),FULL TITLE (INCLUDE BALLOT NO.OR.LETTER) Committee for Measure F Quality of Life - Gilroy PARTY ❑ Nonpartisan Nonpartisan CHECKONE SUPPORT I OPPOSE OPEUSE FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov N i Statement of Organization Recipient Committee Statement Type [✓] Initial Not yet qualified ❑ or 09 (22 /2014 Date qualified as committee NAME OF COMMITTEE 2, Z o 2, 3 ❑ Amendment ❑ Termination — See Part 5 List I.D. number: List J.D. number: l I Date qualified as committee (R applicable) M Date of Termination Gilroy Citizens Opposing Measure F STREET ADDRESS (NO P.O. BOX) FAX / E -MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVF Monterey Santa Clara Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing this statement a penalty of perjury undgr the laws of the State correct. DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, 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 (Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON- REVERSE COMMITTEE NAME Page 2 I.D. NUMBER Gilroy Citizens Opposing Measure F • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER Pinnacle Bank (408)842 -8200 201003928 ADDRESS CITY STATE ZIP CODE 7597 Monterey St Gilroy CA 95020 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." If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (Imn 11f1F IIIGTRIrT All I —. - n— iron - vc -r 11 11r....1 Prim Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURES) 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 Measure F Quality of life TAX Gilroy El R1_ SU�T D0 FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization • Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Gilroy Citizens Opposing Measure F ' 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 List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR ET ADDRESS NO. AND STREET CITY STATE - ZIP CODE Page I.D. NUMBER Date gpalified y, 3 '= w r eaAon thetfeas4rerassfstant <treasurerand ,or candidate o_fficeholderj or proponent cerfify that all of the following condtnons have been mett y 5 Termirrafion Re wrernents - By signing the • 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 maybe 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 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc:ca.gov