Committee for Measure F Quality of Life - Form 410 AmendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
qualified as
1. Committee Information
Type or print In Ink
0 Amendment
List I.D. number:
# 1370490
09 1 11 1 2014
Date qualified as committee
(If applicable)
❑ Termination - See Part 5
List I.D. number:
Date of Termination
NAME OF COMMITTEE
Committee for Measure F Quality of Life
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
Same
OPTIONAL: FAX/ E -MAIL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Santa Clara
Attach additional information on appropriately labeled continuation sheets
Date Stamp
STATEMENT OF ORGANIZATION
For Official Use
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Sara Humphrey Nino
STREET ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPALOFFICER(S), IF APPLICABLE
Donald F. Gage
MAILING ADDRESS
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 la s f the taa u of California that the foregoing is true and
Executed on ti Z1i ` By
DATE
Executed on Z - / i By
DATE
Executed on
Executed on
DATE
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
F of lality of Life
- All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
7597 Monterey Street
AREA CODE /PHONE
(408)762 -7171
CITY
Gilroy
RANK ACCOUNT NUMBER
201002854
STATE 21P CODE
CA 95020
I.D. NUMBER
d 37DY9y
• l candidate, or state measure proponent, if candidate or officeholder controlled, also list the elective office sought or held, and
List the name of each controlling officeholder,
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 umbe Hof he other controlled committee. PARTY
ELECTIVE YEAR OF ELECTION
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT- (INCLUDE DISTRICT NUMBER IF APPLICABLE) �] Nonpartisan
Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASUREIS) JURISDICTION CHECK ONE
I I • (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) SUPPORT OPPOSE
CANDIOATEIS) NAME OR MEASURE(S) FULL TITLE ( INCWDE BALLOT NO. LETTER) ❑
�r,mmittAr? for Measure F Quality of Life Gilroy 9UPP T OPpOS1
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (8661275 -3772)
www.fppc.ca.gov
StatemerA of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
Committee for Measure F Quality of Life
Type or print In Ink
® Amendment
List I.D. number:
# 1370490
09 I 11 t 2014
Date qualified as committee
(If applicable)
R
❑ Termination — See Part 5 in t
List I.D. number:
—J j
Date of Termination
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
Same
OPTIONAL: FAX/ E -MAIL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODEIPHONE
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
Donald F. Gage
MAILING ADDRESS
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 la s f the taat�e. of California that the foregoing is true and
Executed on 4 j t Z/j 1 By
a DATE
Executed on �! Z - / VTE By
Executed on
DATE
By -
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 (January/05)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
c— 11rc G nlinlity of Life
k.jUI 111111 L1 ,v, .........._. ....- . - - -
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
E); n, hz Rank
ADDRESS
7597 Monterey Street
AREA CODE/PHONE
(408)762 -7171
CITY
Gilroy
BANK ACCOUNT NUMBER
201002854
STATE ZIP co DE
CA 95020
I.D. NUMBER
o
• Committee
me it officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
List the each controlling
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. PARTY
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF ELECTION
NAME OF CAN 0I DATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ❑ Nonpartisan
I] Nonpartisan
Formed Primarily formed to support or oppose specific candidates or measures in a single election. List below:
rit" CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION [HECK ONE
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) SUppo RT OPPOSE
Committee for Measure F Quality of Life Gilroy SDPP T OpPn
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov