HomeMy WebLinkAboutPaul Kloecker - 2016 - Form 410Statement of Organization
Recipient Committee
Statement Type
1. Committee I
NAME OF COMMITTEE
❑ Initial
Not yet qualified ❑ or
Date qualified as committee
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IS (D. number:
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Date qualified as committee
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❑ Termination — See Part 5
List I.D. number:
Date of Termination
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Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
JUL I o 2016
For atfidel Use Only
STREET ADDRESS IND P.O. BOXI rJ
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CITY STATE ZIP CODE AREA CODE /PHONE
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NAME OF ASSISTANT TREASURER, 14
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CITY STATE ZIP CODE AREACODE /PHONE
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NAME OF PRINCIPAL OFFICER(S)
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STREET ADDRESS (NO P.O. BOX)
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CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
I have used all reasonable diligence in preparing
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 (866/27S -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
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• All committees must list the financial institution where the campaign bank account Is located.
NAME OF FINANCIAL INSi ITUIION AREA CODE /PHONE tlANR ACCDUX I XUM9ER
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ADDRESS CITY STATE ZIP CODE
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• 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 dR HELD
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
• Primarily formed to support or oppose specific candidates or measure's in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
(INCLUDE DISTRICT NO.; CITY OR COUNTY, AS APPLICABLE) rHFry nNF
SUPPORT
asNonpartisan
SUPPORT
11 1
❑ Nonpartisan
• Primarily formed to support or oppose specific candidates or measure's in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION
(INCLUDE DISTRICT NO.; CITY OR COUNTY, AS APPLICABLE) rHFry nNF
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
11 1
OPPOSE
EL
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov