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Home My WebLink AboutPaul Kloecker - 2016 - Form 410 AmendmentStatement of Organization .,Retripient Committee Statement Type NAME OF COMMITTEE ❑ Initial Not yet qualified ❑ or Date qualified as committee wAmendment List I.D. number: # N- ?:' 7, n& ' -7 2A n Date qualified as committee (IF applicable) ❑ Termination — See Part 5 List I.D. number: Date of Termination � � L �/• �L�n �c k� �, �R �1�� CWt lca,P C L4. (- 2,=9c STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE CYLL MO ilf L `C %. Q big - 61�2 -4-N.I MAILING ADDRESS (IF DIFFERENT) FAX/ E-MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE sF-'-"TA CL(A t &lL (e.cz)ti Attach additional information on appropriately labeled continuation sheets. RECEIVED AND FILED in the office of the Secretary o_f Sttdate t of the Stile of Califomia NOV 21 2016 t. DF= NAME OF TREASURER P— Gu IN %t t.. L ` �yV(4ktW- d U 4 � STREET ADDRESS (NO P.O. BOX) 1.17 L— CITY STATE ZIP CODE AREA CODE /PHONE & "Lv.o -. , 0 � • 919n>2C 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 Executed on DATE Executed on DATE By 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 ..Reoipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME C�' t 1�_ L eC_y_ -e yl 'Vat Gtf-'a m Lt-T-1 rota P Cl L_ • All committees.must list the financial institution where the campaign bank account is located. XF-U ED AND FILED In the office of the Secretary of State of the Sts" of celitgmia NOV 212096 NAME OF-FINANCIAL INSTITUTION ko&�?A-7 C ` A CODE/PHONE BANK ACCOUNT NUMBER 21A � 6 0[ 4 7 J - o,� ADDRESS CITY �iLLCf�rY_ ��• °�o'z�9 STATE ZIP CODE %2,oia • 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) CHECK ONE C6 (J O. C � L (9 onpartisan 07- SUPPORT ❑ 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) CHECK ONE FPPC,Form 410 (Jan /2016) FPPC Advice: advice @fppc.ca.gov;(866 /2753772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT OPPOSE FPPC,Form 410 (Jan /2016) FPPC Advice: advice @fppc.ca.gov;(866 /2753772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type ❑ Initial 9 Amendment Not yet qualified ❑ or list I.D. number: ❑ Termination — See Part 5 List I.D. number: Date qualified as committee Date qualified as committee Date of Termination (If applicable) i /!! c 1. Committee Information 2. Treasurer and Other Princ 'cers NAME OF COMMITTEE NAME OF TREASURER coup C �Lit. STREET ADDRESS (NO P.O. BOX) �!>4 LrW CITY STATE ZIP CODE AREA CODE /PHONE tit 4. 46E_ 6'2 N- 2- MAILING ADDRESS (IF DIFFERENT) FAX/ E-MAIL ADDRESS rfk�''- Izt—t) vEcvj%m Q &u1 V%u s C e I" STREET ADDRESS (NO P.O. BOX) (A40 �i� aru5 �► IF. - CITY STATE ZIP CODE AREA CODE /PHONE &VLEO -t , C fo • 9i9nIi"2.C> NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA LODE /PHONE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) ANA CLIP it &,L Ie .. STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. 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 Caa nn�ia a foregoing is true and correct. Executed on �� -�d �� By / DATE / SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on r ` 0 — 2d (t0 By U 4-a-ee—a- DATE SIGNATURE OF CONTROLLING 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 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov r Statement of Organization Recipient Committee • - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER I: • Albcommittees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION c�2 �( AREA CODE /PHONE -BANK ACCOUNT NUMBER ADDRESS CITY 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 controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUOE;DISTRICTNUMBFR 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(5) JURISDICTION (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) SUPPORT Alonpartisan SUPPORT ❑ 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(5) JURISDICTION (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE) FPPC Form 410 (1an/2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT OPPOSE El FPPC Form 410 (1an/2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov