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HomeMy WebLinkAboutDaniel Harney - Form 410 InitialStatement of Organization �� " DateSta" Recipient Committee Q Statement Type ❑ Initial ❑ Amendment ❑ Termination —See Part 5 'Q � * �> Not yet qualified IZI or List I.D. number: List I.D. number: JUN— 9 2016 # # f Date qualified as committee Date qualified as committee Date of Termination (If appllcable) _11 9 C 4'9' 1. Committee Information NAME OF COMMITTEE Harney for Council 2016 STREET ADDRESS (NO P.O. BOX) 1565 Calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 4086138744 MAILING ADDRESS (IF DIFFERENT) FAX/ E -MAIL ADDRESS djharn @yahoo.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and Other Principal Officers NAME of TREASUREP Michelle Limon For Official Use Only STREET ADDRESS (NO P.O. BOX) 1565 Calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 4088961968 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) Daniel Harney STREET ADDRESS (NO P.O. BOX) 1565 calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 313 -7316 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 CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE Executed on DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 Page 2 COMMITTEE NAME I.D. NUMBER Harney for Council 2016 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Pinnacle Bank ADDRESS AREA CODE /PHONE (408)842 8200 CITY BANK ACCOUNT NUMBER STATE ZIP CODE 7597 Monterey St. Gilroy CA 95020 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. NAME OF CAN MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Daniel Harney C!, k- Member, City of Gilroy 2016 ❑ Nonpartisan SUPPORT 1:1 ❑ Nonpartisan l Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(5) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT N0. 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 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT 1:1 OPPOSE EL 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 Page 3 COMMITTEE NAME I.D. NUMBER Harney for Council 2016 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 Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET F / Date qualified CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE S. 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 (Jan /2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov -Statement of Organization RecipicAt Committee l� S� N2,", i Statement Type © Initial ❑ Amendment Not yet qualified Q or List I.D. number: Date qualified as committee NAME OF COMMITTEE Harney for Council 2016 ❑ Termination — See Part 5 List I.D. number: Date qualified as committee Date of Termination (If applicable) STREET ADDRESS (NO P.O. BOX) 1565 Calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 4086138744 MAILING ADDRESS (IF DIFFERENT) FAX / E-MAIL ADDRESS djharn @yahoo.com �URI�uIC I IUN WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy Attach additional information on appropriately labeled continuation sheets. NAME OF TREASURER Michelle Limon Date Stamp ECEIVED AND FIL the office 61 the Secretary of Of the State of Califnmla JUN 13 2016 For Official Use Only STREET ADDRESS (NO P.O. BOX) 1565 Calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 4088961968 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICERS) Daniel Harney STREET ADDRESS (NO P.O. BOX) 1565 calabrese way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 313 -7316 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 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 (Jan /2016) 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 Harney for Council 2016 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER Pinnacle Bank 1(408)842 8200 ADDRESS CITY STATE ZIP CODE 7597 Monterey St. 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 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 Daniel Harney e= -)a- it-Mernber, City of Gilro 2016 ❑ Nonpartisan SUPPORT 1:1 ❑ Nonpartisan Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(s) JURISDICTION (INrI unr nISTRIrT Nn rITY nR rnUNTV At ADDI IrAGI P1 FPPC Form 410 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov "c SUPPORT ­- OPPOSE SUPPORT 1:1 OPPOSE El- FPPC Form 410 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov - Statement of Organization Recipient Committee INSTRUCgIONS ON REVERSE 0 Page 3 COMMITTEE NAME Harney for Council 2016 I.D. NUMBER PRUVIUt OKI tt Utx RIP] ION Ut Ac NAMt UP %PUNSOR STREET ADDRESS Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee []COUNTY Committee ❑ STATE Committee List additional sponsors on an attachment. INDUSTRY GROUP OR AFFILIATION OF SPONSOR NU. ANU S]RttI CITY STATE ZIP CODE Date qualified • 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 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov