Roland Velasco - Form 410 - 2016 InitialStatement of Organization
Recipient Committee
Statement Type ® initial
❑ Amendment
Not yet qualified ❑ or List I.D. number:
❑ Termination — see Part 5
List I.D. number:
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1. Committee Information
NAME OF COMMITTEE
Roland Velasco for Mayor 2016
STREET ADDRESS (NO P.O. BOX)
9720 Bunting Court
CITY STATE ZIP CODE AREACODE /PHONE
Gilroy CA 95020 (408)710 -8508
MAILING ADDRESS (IF DIFFERENT)
FAX / E -MAIL ADDRESS
roland @rolandvelasco.com
wUN i i — UUMH-LLC 11JRI1DICFIUN WHERE COMMITTEE 15 ACTIVE
Santa Clara Santa Clara
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
fEe
62016
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Joan M. Lewis
STREET ADDRESS (NO P.O. BOX)
8130 Oak Court
CITY
For Official Use Only
STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408)842 -8698
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
Roland Velasco
STREET ADDRESS (NO P.O. BOX)
9720 Bunting Court
CITY STATE ZIPCODE AREA CODE /PHONE
Gilroy CA 95020 (408)710 -8508
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
ASSISTANT TREASURER
Executed on 02/16/2016 By
DATE
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 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee R60211 4
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME LD. NUMBER
Roland Velasco for Mavor .2016 ..
• All committees must list the financial institution where the campaign bank account Is located.
NAME OF FINANCIAL INSTITUTION
Mayor -City of Gilroy
AREA CODE /PHONE
❑ Nonpartisan
BANK ACCOUNT NUMBER
Pinnacle Bank
❑ Nonpartisan
(408)842 -8200
ADDRESS
CITY
STATE Z P CODE
7597 Monterey St. Gilroy, CA 95020
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• 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 CAN DIDATE / OFFICEHOLDER /STATE'MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Roland Velasco
Mayor -City of Gilroy
201 +6
❑ Nonpartisan
STI
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) 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)
rwmc nNF
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
STI
OM
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee ;FORM 4
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
Roland Velasco for Mavor -2016
UrPO
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
STREET ADDRESS NO. AND STREET
Date qualiRed
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
.-,.;f. - ,. .< -:r r. .:.l r.. .: z..:, +Frr '�T ?�.��,.:. 7': .:. -.�, ._rr` 2: .: :?.:.,. ;� ., .., -: K.,.••, .e:t'a c...�.
Terrn na aIn Re_ uir�ements. ' -.,. By sig ingthe;verifiwtion „the treasurer; assist�n tr surer and /orcandi�l to loffice oltler or. n tcert3 ath�t allPof t e, o oW c�o��id o s havelb'�enmer
• 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 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of
e t Organization
Recipient Committee
Statement Type ® initial
❑ Amendment ❑ Termination —See Part 5
Not yet qualified IN or 4 List I.D. number: List I.D. number:
Date qualified as committee Date qualified as committee
(If applicable)
NAME OF COMMITTEE
Roland Velasco for Mayor 2016
Date of Termination
STREET ADDRESS (NO P.O. BOX)
9720 Bunting Court
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408)710 -8508
MAILING ADDRESS (IF DIFFERENT)
FAX / E -MAIL ADDRESS
roland @rolandvelasco.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara Santa Clara
Attach additional information on appropriately labeled continuation sheets.
11040tyd:
Date Stamp
RE EIVED A
in IN office of the $I
of the Staff of
FEB A
Z MAF c I
NAME OF TREASURER
Joan M. Lewis
For Official Use Only
'ED AND FILED
of the Secretary of State
State of Califomia
1 011 2.9 2016
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408)842 -8698
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICERS)
Roland Velasco
STREET ADDRESS (NO P.O. BOX)
9720 Bunting Court
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408)710 -8508
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
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 (Jan /2016)
FPPC Advice; advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
L Statement of Organization
Recipient Committee
INSTRUCTIONS ON.REVERSE
Page 2
:OMMITTEE NAME
Roland Velasco for Mayor •2016
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Mayor -City of Gilroy
AREA CODE /PHONE
0. Nonpartisan
BANK ACCOUNT NUMBER
Pinnacle Bank
❑ Nonpartisan
(408)842 -8200
ADDRESS
CITY
STATE Z P CODE
7597 Monterey Gilroy, 95020
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sCortrolleii�G_o'mmlttee ��p�
a 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.
a List the political party with which each officeholder or candidate is affiliated or check "nonpartisan."
• If this committee actsJointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CAN MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF'ELECTION PARTY
Roland Velasco
Mayor -City of Gilroy
2016
0. Nonpartisan
❑ Nonpartisan
Primarily formed,to support or oppose specific candidates or measures in a single election. List below:
CANDIDATEW NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO.OWLETTER)
CANDIDATEIS) OFFICE SOUGHT OR HELD ORVEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
T OPPOSE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca:gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Roland Velasco for Mavor 2016
• ' Not formed to support or oppose specific candidates or,measures:in a single election. Check only one box:
❑ CITY Committee ❑' COUNTY Committee [3 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on,an attachment.
NAME OF SPONSOR
STREET ADDRESS
CITY
OR AFFILIATION OF SPONSOR
STATE ZIPCODE
Page 3
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ceased This committee has to receive contributions
• 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`
e 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 committee&may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are
subject to Election&Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/2753772)
www.fppc.ca.gov