GILPAC - Form 410 Amendment No. 2 (2018)Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
Amendment
List number:
It if
Date qualified as committee
(If applicable)
❑ Termination — See Part 5
List I.D. number:
Date of Termination
Date Stamp
RECEIVED AND FILED
in If office of the Secretary of State
of the State of Californla
JUN 18 2018
1. Committee Information 2. Treasurer and Other Principal, Officers
NAME OF COMMITTEE NAME OF TREASURER
'61(LJLC)N Acrtq"i CzmntrnE�-
(GI -fRt�&147C,i ClVolv1&Ia-L Cr- CJ�•11)JfU(
X91 i MCkT .J T-
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
ll
A - N W �; ji�E9
K -2 '�18
n A -�In
':l
CITY STATE ZIP CODE AREA CODE /PHONE
& C,A- 9 5tr2o y� - �I Z- �"1 r r�►Z��`j CA tilt W SCE - ` -f Z- (OLF 37
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
AILING ADDRESS (IF DIFFERENT)
FAX / E -MAIL ADDRESS
COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
.,,Verification
have used all reasonable diligence in preparing this state too`the
Veri cation
g p p� g b
penalty of perjury under the laws of the State of Califo nia that t e foregoin
7
Executed on �
s ( — [ (?� By
DATE y
Executed on v / 7 / `` np
' By
DATE SIGNATURE OF CONT
Executed on
DATE
Executed on
DATE
By
By
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
L4a4-,4 mi j�dzaz
STREET ADDRESS (NO P.O. BOX)
I L4-11. ST
CITY STATE ZIP CODE AREA CODE /PHONE
al—
of my knowledge the information contained herein is true and complete. I certify under
true and correct.
OF TREASURER OR ASSISTANT TREASURER
NG OFFICEHOLDER, CANDIDATE, OR 5 [AT E MLASU HE PHU PUN LNI
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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 ' ` t
Recipient Committee rNUMBER
INSTRUCTIONS ON REVERSE
COMMITTEE NAME 15P i 5CfZl f 0 j71� XI I -
611-Ml W>5W( -!S j)L)Ltf ICAL- Jl-Li t.� CIAO � Ti (-c(I L4l✓ t j1 QQ v I ��i Crr m (4
% 3 Z
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE /PHONE I BANK ACCOUNT NUMBER
uNt on F 114 K I -ICS- qB - 2t1-,2, 3 `b 67 209
ADDRESS CITY - STATE ZIP CODE
�'1 CCO -tA-41A I LfLui C,.A, Ii,e�0 7-O
4. Type of Committee Complete the applicable sections.
• 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 MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(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)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
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
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
sa,� �y T�� � r t_(to y
C,tL fc),f tzuSNir, s5 IDO l.trICA t_ Nc5ic�\l bTv iceTiF l 611u- ,A -c__> 1 6 C v &RL -c-- 3`f�i 3Z1
4 Type of Committee (c6nbn6ed)',
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee
List additional sponsors on an attachment.
91
NAME OF SPONSOR JINDUSTRY GROUP OR AFFILIATION OF SPONSOR
C-I i L(2'; v� 5-- b.
STREETADDRESS NO. AND STREET /- CITY STATE ZIP CODE
Smaff Contributor Committee
.Date qualified
5 Termination 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 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 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
Amendment
List .Jp. number:
Date qualified as committee
(If applicable)
❑ Termination — See Part S
List I.D. number:
Date of Termination
Date Stamp
R E C E :f
JUN 1 1 2018
CITY CLERK'S OFFICE
GILROY, CA
For Official Use Only
1.= Committee:.lnformation 2. Tr_ea_s_urer and Other Principal Officers
NAME OF COMMITTEE
NAME OF TREASURER
�sa�i�( i� � d� � �����'�t ��� C�L�Ni(�11iTi = u _ Mae& TIJ014 L(-
1�dB -i��'r C.)''�.&' �4 yO�Jlc�+�`(d�G1yJg9 C�gY670'1ri'0AI o0 STREET ADDRESS (NO P.O. BOX)
1 Li 1 t ��i� oy �� A ILA-7,i
STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE
C:- ( 9� CA- 16G-2- 0 LIQ, , - b-1 i 61I LEO- CA 15/ W i4 CF) _ �)q7 ®ELF 37
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX)
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
I have used all reasonable diligence in preparing this
penalty of perjury
®®,�under the laws of the State of Cali
'�:A
Executed on �Y/ m - 11 ) By
f DATE
Executed on ` / `" By
DATE
Executed on
DATE
Executed on
DATE
By
By
CITY
STATE ZIP CODE AREA CODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
LA 2m--4 m r,rAorz
STREET ADDRESS (NO P.O. O. BOX)
'd GT-
CITY STATE ZIP CODE AREA CODE /PHONE
temept..atKi tdt -p _b st of my knowledge the information contained herein is true and complete. I certify under
nia that t$e foregoin 'is,true and correct.
E OF TREASURER OR ASSISTANT TREASURER
SIGNATURE OF CONTRWmiING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME ��nTi•�i(y'1 1aw� �jr I.D. NUMBER''12
fs
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE /PHONE BANK ACCOUNT NUMBER
ADDRESS
4. Type of Committee Complete the applicable sections.
CITY
O 316`57 20
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.
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(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)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
FPPC Form 410 (Jan /2016)
FPPCAdvice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
d
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (Jan /2016)
FPPCAdvice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
d
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4 Type of Committee Y "'f: (Contfn ed)
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
scLj�-;) f-11 Tae, 6 ( ztoy
L
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee
FAA
STREET ADDRESS
List additional sponsors on an attachment.
NO. AND STREET
Small Contributor Committee
Date qualified
Page 3
I.D. NUMBER 2
2-1
S' Ter1111f18fiOf1 RegUlremerltS 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 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