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Home My WebLink AboutPaul Kloecker - 2016 - Form 410 TerminationStatement of Organization Recipient Committee Statement Type ❑ initial 0 Not yet qualified or 0 Date qualified as committee 1. Committee Information NAME OF COMMITTEE STREET ADDRESS (NO P.O. BOX) ❑ Amendment Date (If ame Aing to provide this date) ATermination – See Part 5 1. D. Number (if applicable) —.1 1 J15, i� Date of termination CITY STATE ZIP CODE AREA CODE /PHONE G-ymo k4 C. P, °�r3b'� T� °i z sct�2 MAILING ADDRESS (IF DIFFERENT) E -MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE CO MMITTEF IS ACTIVE Date Stamp 2. Treasurer and Other Principal Officers For Official Use Only NAME OF TREASURER ' Rtw.,=% i1- - t7- kM1L STREET ADDRESS (NO P.O. BOX) L 4 4-0 R' ta�trzc�r.� 'P�w. Gdr CITY STATE ZIP CODE �K `OWPHO�IE�� C' LUtt,04 C Y4 of �Za 8 Tn GY,i NAMEOF TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE ,?(?u.l V QT)9.CQA/'-' 611 STR r(NO P.O. 80 %) q,5()?o WA---5/61 qM— 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 Cali ni t r—peggoirg is tr and correct. I�Executed on 7 gy DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on f r! /- I— +.�1- -- By a �� IL�p�-V` � *E SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT 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 (May /2017) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee, INSTRUCTIONS ON REVERSE Page 2 {COOMM�ITTEE NAME �T y� P.�'P ypy r^ry�_ n o p V��W �, \4 LO WMW / rOW `7W-M `zvpa IL 0 NUMBER !ry E� 4'3 � eo • All committees must list the financial Institution where the campaign bank account is located. NAML OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER *5l2i - C)%(..:K I t � -7 S-2,A-0 A; ADDRESS CITY STATE ZIP CODE 4• Type of Comm -ittee Complete the applicable sections. -� lControlled Committee • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily Formed,Committee - 11: 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 GA," �I+Ve %Le Z��y onpartlsan SUPPORT ❑ Nonpartisan Primarily Formed,Committee - 11: 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 FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CHECK ONE SUPPORT OPPOSE 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 COMMITTEE NAME 4'. Type of Committee Yes GiItft(X <<V4 (Continued) ceuiCIA. �'ol b Committee General Purpose 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. ---- — .—MUM CITY INDUSTRY GROUP OR AFFILIATION OF SPONSOR Page 3 4 ks6(0 STATE ZIP CODE AREA CODE /PHONE Small'Contributor Committee Date qualified S. Termination Requirements By signingdhe verification, the treasurer, assistant treasurer, and /or,candidate, officeholder, or proponent certify that all of the following conditions have been met: • This committee has cease6to 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 41M(May/2017) FPPC Advice: advice @fppc.ca.gov,(866 /275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type ❑ Initial Q Not yet qualified or O Date qualified as committee ❑ Amendment Termination - See Part 5 --1, ice— /� Date qualified as committee Date of termination (If amending to provide this date) 1. Committee Information I.D. Num NAME OF COMMITTEE {> V L — t �GtL CZ BIZ G'C1. Qp`t applicable) `I" f6t, iU 61 L STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE G-c tit o G p gg o7.0 1��- ��slcoZ MAILING ADDRESS (IF DIFFERENT) E -MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE qZ(; ` f •L JURISDICTION WHERE COMMITTEE IS ACTIVE P VI►-c> t sJ— I-o W c to Ic 'rZ C t+�c soy f ct.izo Y Attach additional information on appropriately labeled continuation sheets. Date Stamp ,EIVED AND FIL office of `the oSf Cal fomia f of the S a Nov 20 2017 2. Treasurer and Other Principal Officers NAME OF TREASURER For Official Use Only R-ew., —t L-, J�t klc STREET ADDRESS (NO P.O. BOX) 644-0 R W N2 CITY STATE y w vVVWP v 7 i NAME OF TREASURER, IF ANY STREET ADDRESS (NO P.O -BOX) CITY _ _ _ . i STATE ZIP CODE AREA CODE /PHONE 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 -jpenalty of perjury under the laws of the State of Calif ni for oing is tr and correct. /4 Executed on By 1' < 7 DATE �1IG-. SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on ` 0 gy�� ( `-'l i" v D E SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE Executed on DATE By By 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 Sthtement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Pty- V, V-1-43 ft c-Vc W r, lv:b t (74 -r-01 ((" CQup a t L o 0 t (o i t 4, t-). eev • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER 45; - "I X24 o q Qc ADDRESS CITY STATE ZIP CODE 71-1 CtL of <-' h, c1,*-(h-za Controlled Committee • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY �j h /►� J t onpartisan SUPPORT ❑ Nonpartisan Primarily Formed Committee 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 hNn Imp niKTDIrT Nn rITV nD rniWTV Ac ADDI IrADI cl FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (May /2017) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER Ccup Gtt. �aU� v ��M� � �tx VV A16 - _ _- - - -- � 4 k2acv General Purpose Committee 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 STREET ADDRESS NO. AND STREET =Small utor Committee ■ CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE AREA CODE /PHONE 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions have b • 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