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Home My WebLink AboutPerry Woodward - Form 410 - 2012 TerminationStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (If applicable) NAME OF COMMITTEE �o,�.,..t : f�� -,w EI�c -f w.s.lw..d Dwyer 2• tZ Date Stamp Termination – See Part 5 �,� 4��1 List I.D. number: \, 7 1 it/ 12- Date of Termination STREET ADDRESS (NO P.O. BOX) 73-tt t r,� CITY STATE ZIP CODE AREA CODE /PHONE l «,y C/4 ?I-02a gar-8i1-4 2o-t MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS L COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Sal'.- G/a Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and Other Principal Officers NAME OF TREASURER /� AAaik W (iQed STATEMENT OF ORGANIZATION For Official Use Only STREET ADDRESS (NO P.O. BOX) 7 ro L ce 6---14-- CITY STATE ZIP CODE AREACODE /PHONE c' A- f flo2o Z161- t Y2 -9033 NAME OF ASSISTANT TREASURER, IF ANY STREETAD ESS (NO P.O. BOX) 72-tii +i it le..�s C_ Ar. CITY STATE ZIP CODE AREACODE /PHONE 6:• %►y CA frame Yob- 611-1204f NAME OF STREETADDRESS (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 t mation perjury under the laws of the�StStat /of C lifornia that the foregoing is true and correct. Executed on / I By DApE /SIIGN-A' 7 Executed on /�0 // 7— By �jjyj DATE inninl i LCM nF is true and complete. I certify under penalty of 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 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME -- G jc c� G>%oa�w.v� �� ya✓ ?� 1 2 4. Type of Committee Complete the applicable sections. STATEMENT OF ORGANIZATION I.D. NUMBER � ((J LJJ /^ 2 • 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 neininme�nCC�n PUn� nFRtRTATF MFASURF PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY CJood��rd ,vl* o� 2e r 2 Non - Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF /,FINANC /A FINANCIAL INSTITUTION ' IV -C( /5 rSb 9* "1 / ADDRESS 12 I ?a .1k <<••1 ti ✓ ?/,* za- AREACODEIPHONE q,Q6- 277 -45'3S CITY Sa ./ � 5c BANKACCOUNT NUMBEK g02-12-69 199 STATE ZIP CODE CA `75-113 Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE c ioo no[ FPPC Form 410 (April/2011) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) Statement of Organization Recipient Committee STATEMENT OF ORGANIZATION INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER CoMw+f' c 4. EI -tt CJooa(ward 0,, e/ 2o 3 J 4. Type of Committee (Continued) Purpose General . 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 • , . List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE _�- 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 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee Statement Type ❑ initial Not yet qualified ❑ or f3 Date qualified as committee 1. Committee Information Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (It applicable) NAME OF COMMITTEE t / ,/ &A14 ' T 4C 4& G C 4 ldc his •�W41 Nrwy#v' Ze 17— Termination — See Part 6 List I.D. number: # / 33q2 -11 %J it t 12 Date of Termination STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE "y C14 9SZ12o gor-8v-92o`f MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS DWOeyd....� rd c �s.rr� —lR t�J. CeiK N I Y Ur UOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE SRS G /��•.- Attach additional information on appropriately labeled continuation sheets. RECEIVEWAND FIL in t ie office of the Secretary of of the State of California JUL 19 2012 DEBRA BOWE Secretary of Sta STATEMENT OF ORGANIZATION y7 Y•SQ` y��. C�ER r r v 2. Treasurer and Other Principal Officers =� NAME OF TREASURER ,U,a •x W. Ce- d STREETADDRESS (NO P.O. BOX) 7So Lem G.✓a-- CITY 6' -1�°y STATE ZIP CODE Cl� ff`o2o AREACODE /PHONE �faJ- rY2 -4ow NAME OF ASSISTANT TREASURER, IF ANY E7e torY we' dwa rd STREETADDRESS (NO P.O. BOX) . 72-ti &,t t 1e -_WJ C_ CITY a: STATE ZIP CODE AREA CODE /PHONE Cj4 ffb z-, Yob -C' I- 92D'f NAME OF PRINCIPAL STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification have used all reasonable diligence in preparing this statement and to the best of my knowledge t mation perjury under the laws of the Stat of C lifornia that the foregoing is true and correct. "liq Executed on � � 1 Z_� By SIGNAI Executed on 71 /O 11.2— %�J/JAw //J /SI - DATE Executed on DATE Executed on DATE is true and complete. I certify under penalty of By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFI EH LDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION COMMITTEE NAME I.D. NUMBER 66^4 4- ge 201 2- 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 � tt / q"' JaML5 tNOoJiJ't" -C �(/iw p,/ � / 2 � Non- Partisan ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREACODE /PHONE BANKACCOUNTNUMBER 1,& !l5 �, o $„ ,�v qc6 - 7-77 - G 5' 3 5_ g D Z 1 'Z C 9 191 ADDRESS CITY STATE ZIP CODE 12 �a ik C�.�1 -�✓ 1� /�e2a Sa ✓ .15e CA '75-11 ` Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) 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 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE STATEMENT OF ORGANIZATION Page 3 - C'm'— ! ,c- -/v o0e c+- Y f 0 — U. "/VM303 Z11 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 PROVIDE BRIEF DESCRIPTION OF ACTIVITY NAMt Uh SNUNSUR SIKttIADDRESS List additional sponsors on an attachment. r Date qualified GITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR ZIP CODE 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 (April /2011) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)