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Home My WebLink AboutFred Tovar - Form 410 TerminationStatement of Organization Recipient Committee Statement Type 0 Initial Omenciment XTermination — See Part 5 Q Not yet qualified f or O Date qualified as committee Date cl _Ialified as committee Date of termination -/� (If ame -Jding to provide this date) 1. Committee Information I I.D. Number (if applicable) NAME OF COMMITTEE �,t�t lum, STREET ADDRESS (NO .O. BO%) � QL S t� if i,l�> -- �> V - �Iy7, STATE ZIPCODE AREACODE /PHONE MAILING ADDRESS FDIFFERENT) E NI L ADDRESS(REQUIRED)/ %(OPTIONAL) ({ I t1Je^ J 4V-- ' r Ia.Y "(' . 1� L,/ CO NTY OF DOMICILE . I JURISDICTION WHFRF CnMMfTTf FJ ACfTIVF Attach additional information on appropriately labeled continuation sheets. Date Stamp 2. Treasurer and Other Principal Officers For Official Use Only NAM OF TREASURER r- ,fit. l6t"�«V STREET ADDRESS (NO P.O. BOX) bV CITY 1 f (� j�� STATE `ZZiPCODE AREA CODE /PHONE NAME OF ASSISTANT TR*SURER, V.&%*- ' STREET AAADDDDR� -E -SS (NO P.O. BOX) / CITY n STATE ZIP CODE AREA CODE /PHONE A n rte_ I have used all reasonable diligence in preparing this statement and to the best of my knowledge the penalty of perjury u �der, the laws of the State of California that the foregoing is true and correct. Executed on // (/ l /J By E D j, Executed on f t�l l By DATE Executed on DATE Executed on DATE By contained herein is true and complete. I certify under SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (May /2017) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee • ' ' INSTR CTIONS ON REVERSE • _ , COM Page 2 .: M EE NAM / ^/ —, I � � • � I.D. NUMBER 2,0 13 3 fSLI, • All committees must list the financial institution where t e ca,npaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE �IVK ACCOUNT NUMBER ADDREt�15> �16 I �K/ �.' v �1 ` -0— 21 OD 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 car didate 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 ❑ Nonpartisan Nonpartisan �' Primarily formed to suppert 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 SUPPORT I OPPOSE OPPOSE FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE \ COMMITTEE NA � �L I.D.NUMBER b!=-p ��./ � �� D 4. Type of Committee (Continued) % �1 Not formed to support: or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee I] COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on &n attachment. NAME OF SPONSOR STREET ADDRESS NO. AND STREET SmallContributorCommittee ■ N�� CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE AREA CODE /PHONE 5. Termination Requirements Hy signing the verification, thr, 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 contribution_ and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention Tr 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 mi y be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPFC Regulation 18521.5. FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type 0 Initial Omendment XTermination — See Part 5 O Not yet qualified or / O Date qualified as committee Date qualified as committee Date of termination (If amending to provide this date) NAME OF COMMITTEE �VQA �jw /3 . 3 kj-qc -& STREET ADDRESS (NO .O. Box) I l / � Ji/1 ►� l.`�1 L 4J�i NAM OF TREASURER Date Stamp ECEIVED AND FIL the office of the Secretary of of the Stale of Califomia NOV 2 0 2011 For Official Use Only STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE (� - C'k 4� ta 10 CIT STATE ZIP CODE AREA CODE /PHONE NAME OF A SISTANT TRtSURE%g.AAV-- MAILING ADDRESS F DIFFERENT) STREET ADDRESS (NO P.O. BOX) I 22 - % " -tt 10"I CITY STATE ZIP CODE AREA CODE /PHONE rn.E Ld- C4 . 4 Lt) Attach additional information on appropriately labeled continuation sheets. 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 7tl d7�:l h laws of the State of California that the foregoing is'true and correct. Executed on I — By " i/f 1�11 4v vj WE SIGNAT E OF TREASURER OR ASSISTANT TREASURER Executed on 14" / By fAl , f` DATE SIGNATJFRE OF CO TROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE By Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT' FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE ..� COMM TTEE NAM I • • All committees must list the financial institution where de campaign bank account is located. ,2,D1 NAME OF FINANCIAL INSTIIOI AREA CO NE INK ACCOUNT NUMBER Lt�f ADDRESS ITY /o`'[� /- STATE v ZZIP CODE t-4-.54,+ aA , -7 ) Page 2 I.D. NUMBER • 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: CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT 1:1 OPPOSE 11 SUPPORT OPPOSE FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NA � I.D. 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. NAME OF SPONSOR BY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE /PHONE Smuff Contributor Committee F-1 I Date qualified QY 8�S1,S@F i1 -T'lCw %'9Jfi wQ!i? • 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 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov