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Home My WebLink AboutDon Gage - Form 410 - TerminationStatement of Organization Recipient Committee Statement Type ❑ Initial ❑ Amendment Not yet qualified ❑ or List I.D. number: a Date qualified as committee Date qualified as committee (If applicable) 1. Committee NAME OF COMMITTEE Don Gage for Mayor 2012 ® Termination — See Part 5 List I.D. number: a 1346217 12 .(31 2015 Date of Termination STREET ADDRESS (NO P.O. BOX) 771 4th Street CITY STATE ZIP CODE AREACODE /PHONE Gilroy CA 95020 (408)842 -2968 Stamp DEC 3 1 For Oftal Use Only 2. Treasurer and Other Principal Officers NAME OF TREASURER Sara Humphrey -Nino STREET ADDRESS (NO P.O. BOX) 7937 Hanna Street CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4330 MAILING ADDRESS (IF DIFFERENT) NAME OF ASSISTANT TREASURER, IF ANY FAX / E-MAIL ADDRESS STREET ADDRESS (NO P.O. BOX) snino @vannihumphrey.com COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE /PHONE Santa Clara NAME OF PRINCIPAL OFFICER(S) Attach additional information on appropriately labeled continuation sheets. 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 the State of California that the fAregoing is true and correct. Executed on 21 ' S y Vll f� nC ATE y qt2E OF TREASURER OR ASSISTANT TREASURER Executed on !,�"` 3c,� -20) �� By y SIGNAT OF. NTROLLING OFFICEHOLDER, CANDIDATE, 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 (Dec /2012) 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 ,.u.numocn Don Gage for Mayor 2012 1346217 • All committees must list the financial Institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Union Bank ADDRESS AREA CODE/PHONE (408)848 -2162 Cm RANK ACCOUNT NUMBER 0103877841 STATE ZIPCODE 8000 Santa Teresa Blvd. Gilroy CA 95020 – — - 14 Type Of, Committees ,Completetheppllcable,sec4ions • 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 partywith 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. NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Don Gage. Mayor of Gilroy, California 2012 Ia Nonpartisan "IM ❑ Nonpartisan 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) CANDIDATES) OFFICUSOUGHT OR HELD OR MEASURES) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS- APPLICABLE) CHECK ONE , FPPC Form 410(Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275- 3772) www.fpoc.ca.gov SUPPORT El - OPPOSE o "IM Did , FPPC Form 410(Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275- 3772) www.fpoc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE FD NUMBER Don Gage for Mayor 2012 1346217 • • • 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 NO. AND STREET r3ma!l'Coitrlbutor.':CommitteP I- CITY GROUP OR AFFILIATION OF SPONSOR STATE I ZIP CODE 5: i'ermina _on =R a , i - 1 I tl a uirements 1 si n .the verif�cat�on ;the treasurer- 'assistant+freaiure� and or candidate officehold r <o o .,�. �,._�_ � Q , . _ Y � g ,, ,- ,, .. _ ,�„ �,:.. _ ...., / _ e ,_ C,prop vent certify that alf of thelfoliowing coniilHonsfhave 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 (Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov State -ment of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date committee NAME OF COMMITTEE Don Gage for Mayor 2012 ❑ Amendment List I.D. number: # Datqualified miltee (If applicable) ® Termination —See Part 5 C List I.D. number: 1F # 1346217 in 12 / 3/ 2015 Date of Termination STREET ADDRESS (NO P.O. BOX) 771 4th Street CITY STATE ZIPCODE AREA CODE /PHONE Gilroy CA 95020 (408)842 -2968 MAILING ADDRESS (IF DIFFERENT) FAX/ E -MAIL ADDRESS snino @vannihumphrey.com COUNTY OF DOMICILE IIU RISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Attach additional information on appropriately labeled continuation sheets. Date Stamp ;EIVED AND FILED r Official Use Only office of the Secretary of State 0- of the State of California 04 l9 JAN 04 2016 �f6 NAME OF TREASURER Sara Humphrey -Nino �! STREET ADDRESS (NO P.O. BOX) 7937 Hanna Street CITY Gilroy STATE CA ZIP CODE 95020 AREA CODE /PHONE (408)847 -4330 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE 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 ff 8regoing is true and correct. Executed on w L By ATE SI AT E OF TREASURER OR ASSISTANT TREASURER Executed on By DATE SIGNATV OF NTROLLING 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(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of- Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEENAME 1.0; NUMBER Don Gage for Mayor 2012 11346217 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER Union Bank (408)848 -2162 0103877841 ADDRESS CITY STATE ZIPCODE 8000 Santa Teresa Blvd. Gilroy CA 95020 • 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#ts 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 Don Gage Mayor of Gilroy, California 2012 Nonpartisan ',. SU[7 ❑ Nonpartisan Pritnofflyformed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAHDIDATE(SI:NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE S }OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION i IINCI 110E OISTRIfT N(1 fITV AR fn11NTV eC eDOI IfAAI d FPPC,Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE ❑l ',. SU[7 OPPPPOSE FPPC,Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov ,Statement of Organization Recipient Coirimittee INSTRUCTIONS ON REVERSE 6UMMITTEE NAME I.D. NUMBER Don Gage for Mayor 2012 11346217 a 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 STREET ADDRESS NO. AND Date qualified CITY • This committee has ceased to receive contributions and, make expenditures; GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE • 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 committe&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 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 tolElections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov