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Harney, Dan - Form 410 (City Council 2018 - termination)Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or uate quantlec as committee 1. Committee Information NAME OF COMMITTEE Harney for Council 2018 STREET ADDRESS (NO RO, BOX) JURISDICTION WHERE COMMITTEE 15 ACTIVE Gilroy Attach oddltional Information on appropriately labeled continuation sheets, 2. Treasurer and Cli NAME OF TREASURER Joan Lewis STREET ADDRESS (NO P.O. BOX) AREA CODE/PHONE 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 of California that the foregoing Is true and correct, Executed on ` /7 .;Lo ,-4—o By \-- DATE - OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFIC D R, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Jon/2016) FPPC Advice: advice@fppc.ce.gov (866/275.3772) www.fppc.ce.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Harney for Council 2018 a All committees must list the financial; Institution where the campaign bank account Is located, NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE Pinnacle Sank 1(408)842 8200 ADDRESS CITY 7597 Monterey St. Gilroy 4. Type of Committee Complete the applicable sections. Conlrollvd Committee BANK ACCOUNT NUMBER STATE ZIP CODE CA 95020 CALIFORNIA 1 •- Page 2 I.D. NUMBER 1386442 • 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, Ilst 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 Daniel Harney Council Member, City of Gilroy 2018 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) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE($) JURISDICTION (INCLUDE DISTRICT NO,, CITY OR COUNTY, AS APPLICABLE) PARTY ® Nonpartisan ❑ Nonpartisan CHECK ONE SUPPORT OPPOSE II SUPPORT 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 COMMITTEE NAM Harney or Council 2016 4. Type of Committee (Continued) CALIFORNIA FORM Page 3 I,D, NUMBER 1386442 } Ecfi•ic-candfclate* v, ,I ccou, co I,, a .1,tale elet Llv,i. CIiet k orily one dbx: O CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY m List additional sponsors on an attachment. NAME OF SPONSOR (INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRBSS NO. AND STREET CITY STATE ZIP CODE Date qutllMed 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 Cade Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Jan/2016) FPPC Advice; advlce@fppc.ca-gov (866/275.3772) www,fppc.co.gov