HomeMy WebLinkAbout2003-01-03 Form 410 - PS Fire Management,. •
Statement of Organization
Recipient Committee Type or print In Ink 0~ l.J
~ndment
Ust I.D. numbe r:
Statement Type O lnltlal
Not yet qualllied D or
Date quafilied as oommltlee
1. Committee Information
OF COMMITTEE
Date qualifi eti as oommittee
(lfapplcable)
~ \....-h._ S~~l f-l ~ ~ · F"°"\ i?-.t= fV\~ tJ ~6,E f'r',,c;~
A550C. ?AC.
0 Termination -See Part 5
List I.D. number.
# _______ _
Date orTermination
I I . I
LI
'.., Dal! Stamj, .
C ' LC~ : R'r:-c
02 NOV 250§' A~~
. . LL 1~[~
CA SCCRE fAlt dli~,
2. Treasurer and Other Principal Officers
NAME OF TREASURER
T""'"P>-R-h \le:~eCL
STATEMENT OF ORGANIZATION
CALIFORNIA 41 0
FORM
For Official UH Only
hH 9: 5r
OF Ul t i,.)
RIVERSI DE
STATE ZJPCODE AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODE/PH ONE NAME OF ASSISTANT TREASURER. IF ANY
PPI L M. 'S(r ~l ~ G s c.A CfL ""2..G:,L\ ,:= _____ _.;::,,.-=------~-------------
------------------------------STREET AODR MAILING ADDRF.SS (IF DIFFERENT}
OPTIONAL: FJ\X/E-MAILADDRESS
COUN'TY OF DOMICILE COUN'TY WHERE COMMITTEE'. IS ACTIVE IF DIFFERENT
n,w,. COUNlY OF DOMICILE
11rrach additlonal lnformatlon on appropriately labeled contfnustlon sheets.
3. Verification ·
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS
CITY STATE ZJPCODE
I have u sed all reasonable dillgence In preparing this statement and to the be st of my knowledge the in
perjury under the laws of the Stat~ of Callfomla that the foregoing Is true and
"""~~~~"ffik:icwiiir.iiniu«~::ii'nirui~--------i ci.i.TE URERORASSISTANTTREASURER
Executedon ______ .,,...,, ______ _
0.-.TE By------,---------------------------====------SIGNATURE OF CONTROLLING OFFICEHOlDER. CANDIDATE. OR STATE MEASURE PROPONENT
Executedon _____________ _ By ____ _,;;__ ___________________ ~~~=------
SIGNATURE OF CONTROLLING OFFICEHOlDER. CANOIOATE. OR STATE MEASURE PROPONENT
Executedon _____________ _
By _____ ======~-====-=--=-:==-==-==-=-=====~-----SIGNATURE OF CONTROLLING OFFICEHOlOER. CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Fonn 410 (Ja n/01)
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Statement of Organization
Recipient Committee·
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
4. Type of Committee Complele lh~ applicable se~tlons.
Controlled Committee
STATEMENT OF ORGANIZATION
CALIFORNIA 41 0
FORM
I.D.NUMBER
, ~,.1st the name of each controlling officeholder, candidate, or state measure proponent. If candidate or office~older controlled, also list the elective office sought or held, and
,lislrlct number, If any, and the year of the election. __ , .
• List the poliUcal party with which each officeholder or candidate Is affiliated or check "non-partisan.• I
• If this committee acts Jointly with another controlled committee. list the name and ldenUficalion number of lhe other controlled committee. . . ' .
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPOilENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
I
I.
I
'
• List the financial lnsUluUon where the campaign bank account is located (controlled "candidate elecllon• committe'es only)
' . ~
YEAR OF ELECTION
•,
NAME OF FINANCIAL INS1TTUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
PARTY
D Non-Par11san
D N9n-Par1lsan
1 -✓AD-D_RE_S_S ________________ .;_ ____ ..,_Lc:-:rrv=-----------+-1-Sl:---ATE __ ._ __ ZI __ P_CO=D:-:E---------------
Primarily Formed Committee Prtmarllytormed lo supportoropposa specific candldales or measures In a single elecuo/ Us! below: •, '
• I
CANDIDATE(S) NAME OR MEASURE(S) FUU. Tl1tE QNCLUDE BAU.OT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO crrv OR coumv. No APPLICABLE) .. • CHECK ONE
'
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC
, . ••
Stat~ment of Organization
Recipient CommitJee '
INSTRUCTIONS ON Rl:VERSE
COMMITTEE NMIE
4. Type of Committee igonunued)
General Purpose Committee i ·Not formed to support or oppose specJffc bndldales or measures In a single elecUon. Check only one ~ox:
. ·[j CITYCommltteli O COUNTYCommlttee, 0 STATECommlttee
,-";~DE BRIEF DESCRIPTION OFACTIVllY
Sponsored Committee Ust addlUonal sponsors on an auachmenl
NAME OF SPONSOR INDUSTRY GRDUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. ANO STREET CITY STATE
'
ZIP cooE
. STATEMENT OF ORGANIZATION
CALIFORNIA 41 O
FORM
g
I.D.NUMBER
Small Contributor Committee 0 __ _, ___ _.___ Check box and provide the date this committee qualified as a small conlrlbulor committee. II tho committee quallfied as a small
Dale qualified conlrlbutorcommlttee on January 1, 2001, enler 111/01.
5. Termination: Requirements Byslgnlng·u,e verlficallon, !he lrea~urer, assistant treasurer and/orcandldale, officeholder, orpropqnent cerllly Iha! all ollhe foffowlng condlUons have been met
~-. i · .•
\ ___ ) This committee has ceased to receive c;ontributlons and make expenditure.s;
• This committee does not anticipa!e receiving contributions cir making expenditures in the future;
• i '
• 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 statement.s required ~y the Political Reform Act dii,closlng all reportab.le transactions.
•· There are restrictions' on the dlsposlUon of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519. ·
•· Additional filing obligations will be Incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
nipayments of loans made to others, or any other receipts.
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC