Cat Tucker - Form 410 - 2017 Amendment1I
Statement of Organization Date Stamp • _
'Recipient Committee a
Statement Type ❑ Initial Amendment ❑ Termination — See Part 5 For Official use Only
Q Not yet qualified
or
O Date qualified as committee
Date qualified as committee Date of termination
-� - -/ (If amending to provide this date)
b - -
. Committee Information I'f' Opp 'cQ le 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
CAT i �f "uc�.� 2 f rx C4-1 �/�c� 1, a �� Sic v -�`�
j — STREET ADDRESS (NO PO BOX)
NAME OF ASSISTANT TREA RER, IF ANY
/�.
E -N�A IL ADDRESS (REQUIRED) / FAX (OPTIONAL)
Attach additional information on appropriately labeled continuation sheets.
g: vermcation
I have used all reasonable diligence to preparing
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization iCALIFORNIA
Recipient Committee FORM 41.
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I D NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
- - - -. - .T - . - - - - - -- - - - -
4'. Type of Committee Complete the applicable sections. - I
• 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 NUMBERAF APPLICABLE) YEAR OF ELECTION PARTY
It ", '
r
CI—f--j
SUPPORT
Nonpartisan
F-1
El
SUPPORT
❑ Nonpartisan
Formed Primarily Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASUREIS) 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)
CHFCK ONF
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
F-1
El
SUPPORT
OPPOSE
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization _
Recipient Committee _ 410.
INSTRUCTIONS ON REVERSE
Page 3
COJMITTEE NAME 1 D NUMBER
4 Type of Committee (Conhnued)
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
STREET ADDRESS NO AND STREET CITY STATE ZIP CODE AREA CODE /PHONE
Date qualified
S. 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 nointention 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 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
1
Statement of Organization
Recipient Committee
Statement Type ❑ initial Amendment
0 Not yet qualified
or
O Date qualified as committee Ir
Date qualified as committee
-�/ (If amending to provide this date)
Number (if
1. Committee Information I.D. Nu , _
❑ Termination — See Part 5 "
NAME OF COMMITTEE
C A i %. P, Fcx G oaJ
► z919St)
STREET ADDRESS (NO P.O. BOX)
Date of termination
COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
:EIVED AND FILED
Office of the Secretary of $lets
of the State of Califomis
NOV 2 0 2017
For Official Use Only
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Sco�`�-
STREET ADDRESS IN P.O. BOX)
RER, IF ANY
Y-'� , ��Tc-Ve-2.
STREET ADDRESS (NO P.O. BOX)
NAME OF PRINCIPAL OFFI RIS)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE /PHONE
VcrinrLauvn
I have used all reasonable diligence in preparing this statem t and to the best of my knowledge the information contained herein is true and complete. I
penalty of perjury under the laws of the State
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
under
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA '
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
VYV L0K� P) a- I qo8 8q8- q i o
ADDRESS CITY STATE ZIP CODE
• 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
\ , it W
L�
� ('�
1 ��
SUPPORT
Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily Formed Commiffee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
CANDIDATE CANDIDATES)
S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT N0. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
rwr— nmr
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME
j I.D. NUMBER
General Purpose Committee 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
Sponsored Committee I List additional sponsors on an attachment.
NAM[ U1 WUNSUR
31 M1[[1 AUUnt» NO, AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Small Contributor Committee
Date qualified
• This committee has ceased to receive contributions and make expenditures;
STATE ZIP CODE AREA CODE /PHONE
• 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 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov