Daniel Harney - Form 410 AmendmentStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Q Not yet qualified
or
0 Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
KAmendment
Date qualified as committee
(If aminding to provide this date)
I.D. Number
4r-,v--wrr -` �vCv C" t-3 t x l✓ tid i
❑ Termination – See Part 5
- - /— ✓—
Date of termination
�[EM� 0d�r
NOV 21 2017 Ip
2. Treasurer and Other Principal Officers
FF y L1 L
STREET ADDRESS (NO P.O. BOX) �
CITY STATE ZIP CODE AREA CODE /PHONE
q 1 Lrx-ok-\ C-Ac rt m
MAILING ADDRESS (IF DIFFERENT)
E- AIL ADDRESS ()l FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
SA'Zorr,;- G IR-PC Q c L (Lo t j
Attach additional information on appropriately labeler continuation sheets.
NAME OF TREASURER
STREET ADDRESS (NO P.O. BOX)
For Official Use Only
CITY STATE ZIP CODE AREA CODE /PHONE
G i L� (L-e) Ll C/Ar
NAME OF ASSISTANT TREASURER, IF ANY
S/nLET ADD SS(N0 P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
G-- L v-0 C kit- 1:2: o.-k t3 10" le $ 41-T V1 g
AME OF PRINCIPAL OFFI R(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE AREA CODE /PHONE
Verification
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 Cali'ornia that the foregoing is true and correct.
Executed on %.1
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 (May /2017)
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
'e'y � (4> 1-) 1--)C4 i- ZO-I FPIP
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
P I" NJ acct- L (►-Ju-- +o R ?, z 7-01 w. 13 -L, 7,
AUUKk SS CITY STATE ZIP CODE
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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONI_NT
(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 BALLCT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
SUPPORT
Nonpartisan
❑ Nonpartisan
• 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 BALLCT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
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
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
I.D. NUMBER
4. Type of Committee (Continued)
General • • Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee i] COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
TC'g- c= Ta i.c.�c.f �� �. 4w -tj C'`^ -k < % -p-em, C.',�,t
• • List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE /PHONE
Small Contributor
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 (May /2017)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization Date Stamp
Ffecipient Committee -
Statement Type RECEIVED AND ��IL��
❑ Initial Ql Amendment ❑ Termination — See Palf #ie o Ice of the Secretary of State For Official Use Only
• Not yet qualified
o the State of California
or
• Date qualified as committee NOV 2 7 2017
Date qualified as committee Date of termination
(If amending to provide this date)
1. Committee Information i.D. Number (i qp licable) 2. Treasurer and Other Principal Officers I
� ,
NAME OF COMMITTEE
14r,.,v —wE "A %� C 11,3 t t t., 7.01 I
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
30A-,J Lx,,A) s
STREET ADDRESS (NO P.O. BOX)
NAME OF ASSISTANT TREASURER, IF ANY
65-1 l r0 ! R(S) C
AME OF PRINCIPAL OFFI
A ':J l ;' U
STREET ADDRESS (NO P.O. BOX)
2O
CITY STATE ZIP CODE AREA CODE /PHONE
1 L (Zed � �,4- q �a z U � !
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 u
penalty of perjury under the laws of the
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 (May /2017)
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
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
`P n
ADDRESS CITY STATE ZIP CODE
4. Type of Committee SCom ettiie app�ica6]
milli
Controlled Committee
• 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.
NAM E OF CAN DIDATE /OFFICEHOLDER /STATE M EASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
N, x �—v R-P, a �
C, La-,-)'A, QA T- -'� �c v �Cri
2- c� t E
Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
EL
FPPC Form 410 (May /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
CW
4. Type of Committee (Continued)
Committee — General Purpose 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
t_ "(a e��. c� r + FJ�`_(, i-�0.Rt.� C ` \ �i t Lp__e)-"A\, r k
• • List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
Smal! Contributor Committee ■
D
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE /PHONE
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 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 (May /2017)
FPPC Advice: advice @fppc.ca.gov (8661275 -3772)
www.fppc.ca.gov