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HomeMy WebLinkAboutTerri Aulman - Form 410 - 2012 TerminationStatement of Organization Recipient Committee Statement Type ❑ Initial Notyetquahfied ❑ or Date qualified as committee 1. Committee Information FILED in the office of the Secretary of State of the State of Califomia Type or print in ink ❑ Amendment 0 Termination — See Part 5 List I.D. number: List I.D. number. # # 1348250 J J 12 t 31 1 12 Date qualified as committee Date of Termination pr applicable) NAME OF COMMITTEE TERRI AULMAN FOR GILROY CITY COUNCIL 2012 STREET ADDRESS (NO P.O. BOX) 1512 BIANCA WAY CITY STATE ZIPCODE AREA CODEIPHONE GILROY CA 95020 (408)391 -6268 MAILING ADDRESS (IF DIFFERENT) 777 FIRST STREET PMB #200 GILROY, CA 95020 OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY OF DOMICILE COUNTY "ERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE SANTA CLARA Attach additional information on appropriately labeled continuation sheets. STATEMENT OF ORGANIZATION 2. Treasurer and Other Principal Officers NAME OF TREASURER DENISE BROLIN STREET ADDRESS (NO P.O. BOX) 785 NICOLE COURT CITY STATE ZIP CODE AREACODE /PHONE GILROY CA 95020 (408)848 -3861 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREACODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY 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 %th StateSalifornia that the foregoing is true and correct. Executed on I - G- I By j!_ I� DAT NATURE OF TR SURER OR ASSISTANT TREASURER Executed on By By ` /' Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ATE MEASURE PROPONENT FPPC Form 410 (June108) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE TERRI AULMAN FOR GILROY CITY COUNCIL 2012 STATEMENT OF ORGANIZATION 2 1348250 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 "non - partisan." • 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 TERRI AULMAN CITY COUNCIL MEMBER 2012 XD Non - Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER PINNANCLE BANK (408)842 -8200 201002300 ADDRESS CITY STATE ZIP CODE 18181 BUTTERFIELD BLD STE. 135 MORGAN HILL CA 95037 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) CHECKONE RT OPPOSE FPPC Form 410 (June/09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE TERRI AULMAN FOR GILROY CITY COUNCIL 2012 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 PROVIDE BRIEF DESCRIPTION OF ACTIVITY N/A List additional sponsors on an attachment. NAME OF SPONSOR (INDUSTRY GROUP OR AFFILIATION OF SPONSOR N/A STREETADDRESS CITY STATE ZIP CODE STATEMENT OF Page 3 1348250 w.r• u�siuurancn�...mu.nna =a ❑ _ I I 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 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE Type or print in ink STATEMENT OF ORGANIZATION Date Stamp ❑ Amendment © Termination — See Part 5 ' ~ For Official Use Only List I.D. number: List I.D. number:ttFL'� (,a t 9 # # 1348250' —J 1 12 / 31 1 12 Date qualified as committee Date of Termination (If applicable) TERRI AULMAN FOR GILROY CITY COUNCIL 2012 STREET ADDRESS (NO P.O. BOX) 1512 BIANCA WAY CITY STATE ZIP CODE AREACODE /PHONE GILROY CA 95020 (408)391 -6268 MAILING ADDRESS (IF DIFFERENT) 777 FIRST STREET PMB #200 GILROY, CA 95020 OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY SANTA CLARA 2. Treasurer and Other Principal Officers NAME OF TREASURER DENISE BROLIN STREET ADDRESS (NO P.O. BOX) 785 NICOLE COURT CITY STATE ZIP CODE AREA CODE /PHONE GILROY CA 95020 (408)848 -3861 NAME OF ASSISTANT TREASURER. IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE NAME OF PRINCIPAL OFFICER(S) COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. CITY 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 of California that the foregoing is true and co ct. Executed on / 2 ( –/ A E \` �// M By �° SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on l �'_12f'/-�? By �.��`e� ' �Q1�, DATE �TSIC SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee CALIFORNIAA1 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER TERRI AULMAN FOR GILROY CITY COUNCIL 2012 1348250 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 "non- partisan." • 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 TERRI AULMAN CITY COUNCIL MEMBER 2012 Non - Partisan © ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANKACCOUNT NUMBER PINNANCLE BANK (408)842 -8200 201002300 ADDRESS CITY STATE ZIP CODE 18181 BUTTERFIELD BLD STE. 135 MORGAN HILL CA 95037 Primarily Formed Committe e 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 OPPOSE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE TERRI AULMAN FOR GILROY CITY COUNCIL 2012 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 PROVIDE BRIEF DESCRIPTION OF ACTIVITY N/A NAME OF SPONSOR N/A List additional sponsors on an attachment. W. ANU S 1 KEE I ❑ _J1 Date qualified INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE STATEMENT OF ORGANIZATION Page 3 1348250 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 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)