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Reid Lerner - Form 410 Amendment (2018)Statement of Organization Recipient Committee Statement Type ❑ Initial ® Amendment Q Not yet qualified or O Date qualified as committee Date qualified as committee ❑ Termination —See Part 5F In Date of termination Date Stamp VVED AND FILE office of the Secretary of Sty of the State of Califomia AUG 15 2018 1. Committee Information I I.D. Number 1391468 2. Treasurer and Other Principal Officers (if applicable) NAME OF COMMITTEE Reid Lerner for Gilroy City Council 2018 STREET ADDRESS (NO P.O. BOX) MAILING ADDRESS (IF DIFFERENT) E -MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE riRlIDICT11INWHERE COMMITTEE IS ACTIVE Santa Clara ty of Gilroy Attach additional information on appropriately labeled continuation sheets. NAME OF TREASURER Rick Chehab STREET ADDRESS (NO P -O. BOX) AREA CODE /PHONE STATE ZIP CODE AREA CODE /PHONE 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 CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE Executed on DATE By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(February /2018) 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 I.D. NUMBER Reid Lerner for Gilroy City Council 2018 1391468 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Pinnacle Bank ADDRESS AREA CODE /PHONE 4088428200 CITY BANK ACCOUNT NUMBER 201004389 STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 4. Type of Committee Complete the applicable sections s,f, • 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." Stating "No party preference" is acceptable. • 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 PARTY NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAN DIDATE(S) NAME OR MEASURES) FU LL TITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) SUPPORT F-1 Nonpartisan Partisan (list political party below) Reid Lerner Gilroy City Council 2018 I❑ Nonpartisan Partisan (list political party below) El Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAN DIDATE(S) NAME OR MEASURES) FU LL TITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) FPPC Form 410(February /2018) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT F-1 OPPOSE El SUPPORT 1:1 OPPOSE EI- FPPC Form 410(February /2018) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME I I.D. NUMBER Reid Lerner for Gilroy City Council 2018 1391468 4. Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party /Central Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE AREA CODE /PHONE �• Tii771 Lir�7ifi717Til�Ti�i7i�T -7� ❑ Date qualified 5 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 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(February /2018) Clear Page Print FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(February /2018) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov A111111111111k 234 0 F,' AMA Statement of Organization Date StainP CALIFORNIA , Recipient Committee u FORM k'`'' Statement Type El ®Amendment El —See Part 5 1 — For Official Use Only v 0 Not yet qualified CIF OFFICE or GILERK / / / / � , Cq O Date qualified as committee Date qualified as committee Date of termination 1. Committee Information I.D. Number 1391468 2. Treasurer and Other Principal Officers (if applicable) NAMEOFCO M MITTEE NAME OF TREASURER Reid Lerner for Gilroy City Council 2018 Rick Chehab STREET ADDRESS (NO P.O. BOX) 7660 Monterey Street STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 7680 Monterey Street #105 Gilroy CA 95020 4089811565 CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY Gilroy CA 95020 4088429942 MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) E -MAIL ADDRESS (REQUIRED) /FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE /PHONE reid @reidlerner.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Santa Clara 1C ity of Gilroy STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Attach additional information on appropriately labeled continuation sheets. AREA CO DE /PHONE 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 f Ca or that the regoing is true and correct. Executed on Lisl "A By DATE SIG TURE OF TREASURER OR ASSISTANT TREASURER �� 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 Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(February /2018) 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 Reid Lerner for Gilroy City Council 2018 1391468 • All committees must list the financial institution where the campaign bank account is I I Icated. NAME OF FINANCIAL INSTITUTION PHbNE BANK ACCOUNTNUMBER Pinnacle Bank FAREACOD2 82100 201004389 ADDRESS CITY STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure propc nent. 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." Stating "No party preference" is acceptable. • If this committee acts jointly with another controlled committee, list the name a d identification number of the other controlled committee. ELECTIVE NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE OFFICE SOUGHT OR HELD YEAR OF PARTY DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE Nonpartisan Partisan (list political party below) Reid Lerner Gilroy City Council 2018 ❑El Nonpartisan Partisan (list political party below) E] Primarily Formed Committee 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 IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE F-1 El SUPPORT OPPOSE FPPC Form 410(February /2018) 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 Reid Lerner for Gilroy City Council 2018 1391468 4. Type of Committee (Continued) 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 ❑ Political Party /Central 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 l7 �iI�IILS�LI { {I�IU {�liUAiliilG {4 =� ❑ Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer, and /or candidate, officeholder, or proponent certify that. aII of the following conditi ons 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. Clear Page Form 410(February /2018) Print FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov