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HomeMy WebLinkAboutReid Lerner - 2016 - Form 410Statement of Organization Recipient Committee; : 6' 4�7 Statement Tvpe_ Initial" ❑ Amendment ❑ Termination —See Part 5 Not yet qualified V or List LD. number: List I.D. number: In Date qualified as,committee Date qualified!ascommittee Date of Termination (If applklible) NAME OF COMMITTEE Recd t eirvgy �r 6th rdy C�i Covwci( 2 16 STREET ADDRESS (NO P.O. BOX) - - 71�a0 rUloln kev-eu S� ��e� CITY STATE ZIP CODE AREACODE /PHONE -5 L' (z 0,4 Ck 95b20 MAILING 'ADDRESS .(IF .DIFFERENT) FAX / E-MAIL ADDRESS 4���42���t reed 1 +rnev g (i ©o, wrn DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Attach additional information on appropriately labeled continuation sheets. NAME OF TREASURER Date Stamp For Official Use Only .EIVE'D AND FILE office of the Secretary of Sta e of the State of raliforria OCT '0 5 2016 IRtak- Gh e-W000 STREET ADDRESS (NO P.O. BOX) t 5a0 5 Vobvr Oaks CITY. . STATE ZIP CODE AREACODE /PHONE Sa r 4osR cA 9513) Aob Jq �[ -1500 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICEHIS) _1�.eld (—,er &ear C JCL STREET ADDRESS (NO P.O. BOX) ?ry -5 o Agvr- ftv&::� Si' *fog CITY STATE ZIP CODE AREA CODE /PHONE C_—)1 re Li CA- R Sti-LV 'to r jgv9jgv 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 correct. Executed on V s'GYO} I-CL io By r iGk C44 It DATE SIGNA - REASURER OR ASSISTANT TREASURER Executed,on By r%l AT SIGNATURE OF CONTROLLING 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 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of, Organization Recipient�Committee :. INS TRUCT4ONSON'REVERSE e.;U - �v ✓' Gn l r t CL, • All committees must list the financial institution where the campaign bank account is located. NAME OF F1 NCI - ' ADDRESS 2 9 7 9F AREA CODE,PHO CITY Page 2 I.D. NUMBER BANK ACCOUNT NUMBER 3+0 1-0 loo `f3g� STATE ZIP CODE • 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 control led� committee. ELECTIVE OFFICE SOUGHT OWHELD NAME,OF CAN MEASURE PROPONENT (INCLUDE DISTRICT 'NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY • ON 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 NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(5) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CL Cc)wc c to (6 Nonpartisan SUPPORT ❑ Nonpartisan • ON 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 NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(5) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) FPPC form 410'(Jan/2016) FPPC Advice: advice @fppc.ca.gov.(866 /275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT OPPOSE FPPC form 410'(Jan/2016) FPPC Advice: advice @fppc.ca.gov.(866 /275 -3772) www.fppc.ca.gov Not formed to support,o.r oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee E COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY .. List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS - . NO. AND STREET CITY STRY, GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE Dale qualified a :,. M. :.� a: i .c y .; »¢; e��._• i -. x' ,- ry a-e:se z-c'ty 5. Ter Inaition Re uII'eiments •a 5i nin the verfficatlop athe,treaSUrer a glStapt reasurer and /orcandldate offtceholder,•or roponenttertt that ali f the folloi iTn - condlttogs have b en met., z • This committee 'has ceased toireceive contributions and make expenditures; • This committee doesinot 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 (866/2753772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type %jinitial Not yet qualified W or Date qualified as committee 1.. Committee' Information NAME OF COMMITTEE ❑ Amendment ❑ Termination — See Part 5 List I.D. number: List I.D. number: Date qualified as committee (If applicable) Red I -efvgy �r Q roS Ci� (bmiccdl 2016 OCT - E /--� Date of Termination STREET ADDRESS (NO P.O. BOX) 7 9Sk O AAo N �ev-e� S' 1 CITY STATE ZIP CODE AREACODE /PHONE -5iI.2 0,4 C 2 95'0 -ZL) MAILING ADDRESS (IF DIFFERENT) 2. Treasurer and Other NAME OF TREASURER R c c IL Gh e_1/1000 W% * For Official Use Only STREET ADDRESS (NO P.O. BOX) t'51016 Piw oaks Load CITY STATE ZIP CODE AREA CODE /PHONE ,gar, dose cA 9SI31 40D 141F-1509 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) FAX /E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE 4o��bd2�`i71 Y-eid l.evnev q(1001 "M COUNTY OF DOMICILE RISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) 6ck �, Gla.tom 17. , G;I J``') _ i - C-A %,Ckd —er&ec C GC'Vtd,�� STREET ADDRESS (NO P.O. BOX) 1650 AQWky!'4 CITY STATE ZIP CODE AREA CODE /PHONE Attach additional information on appropriately labeled continuation sheets. r`d C � � �,�� �0 � $�� "� 99 4f 1 3. Verification I have used ail 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 rue and correct. Executed on y s'GyQ} I By (614- C441! Ma DATE SIGNA REASURER OR ASSISTANT TREASURER Executed on *ATE By 13i i.�iF: 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 (!an /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov y, Statementof Organization Recipient Committee, INSTRUCTIONS OWREVERSE ' COMMITTEE NAME r},, • All committees must list the financial institution where the campaign bank accouals located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE r1N r4 ADDRESS CITY -7 9 -7 5�F �V" Page 2 BANK ACCOUNT NUMBER k� l 21 ( +4- 3'f 0 20 l o a `F 3 STATE ZIP CODE 9 (Ou • 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 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) Coo, ej to i � � Nonpartisan - SUPPORT 1:1 ❑ Nonpartisan 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) FPPC Form 430 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866 /275 -3772) www.fppc.ca:gov _ SUPPORT OPPOSE - SUPPORT 1:1 OPPOSE EL FPPC Form 430 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866 /275 -3772) www.fppc.ca:gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEENAME Page 3 lZe! t d- L ev ne-v P;lIr 6(<VAA a �A Cowl CJ Zvi ry '.4D. NUMBER 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. Z NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET - CITY STATE ZIPCODE Date quallRed i ,erm n'a On'. e u r- ements; 9 "- °si in' ;tfie ver fficatian the,treasurerxassistant treasurer and /or candidatfflceholder or, proponentcertif ;that all�of +the followin co � ' "i ' • : ;y: �� - _Y1 gn g nditionst have beenmet �-J • This committeehas ceased to receive, contributions and make expenditures; • ThIs committeeAcIes 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 (866/276 -3772) www.fppc.ca.gov