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Home My WebLink About2019-10-23 Form 410 - PS Fire Management (Amended)Statement of Organization Date Stamp RECEIVED CALIFORNIA 41 Q FORM Recipient Committee =--------"-r.:=---------.:::---------1"1,tt Statement Type D Initial i2J Amendment • Termination-See Pan 5 OF p hLH SPRINGS For Official Use Only 0 Not yet qualified or 201 OCT 23 PM ~: 27 0 Date qualification threshold met Date qualification threshold met Date of termination OFF I E OF THE CITY CLER!i 1--___ ,. __ _f, __ _ NAME Of COMMITTEE I.D. Number (if applicable) Palm Springs Fire Management Association PAC STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Palm Srings CA 92262 FULL MAILING ADDRESS (IF DIFFERENT) E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) COUNTY OF DOMICILE JURISOICTlON WHERE COMMITTEE IS ACTIVE Riverside AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. --1 Michael J. Smith STREET ADDRESS (NO P.O. BOX) CITY Indio NAME OF ASSISTANT TREASURER, IF ANY Jason Loya STREET ADDRESS (NO P.O. BOX) CITY La Quinta NAME OF PRINCIPALOFFICER(S) Greg Lyle STREET ADDRESS (NO P,O, BOX) CITY Calimesa STATE ZIP CODE AREA CODE/PHONE CA 92201 . STATE ZIP CODE AREA CODE/PHONE CA 92201 STATE ZIP CODE AREA CODE/PHONE CA 92320 3~}'.;Vet:ifi·catiore1f1;1~1:12;¢;(,;:;'."+1t+:4~f'<r1:::1:::·d0't~:4;;:.:::v-:.;,;-:x · .· :':(;:·~:t,. ~ \.:/, -:11~0 ,~~"?'iit"? (~t, ·/;:, :.~ , ~;,"',pl,4,~A §;* ,/,.,,<ef ¾ :::::,.,., :{(-" • .:~---~~~~10~i:1:::::1~~x:~:AaiJ~:.:;•i:C::>, ,* :0;~HA/1t""' 41"1 ~t~~ /·r>-,:•::is::+:·z ;a1 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 u~d~r' J. ', penalty of perjury under the laws of Executed on 10123/2019 DATE 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 Executed on By DATE , SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Management Association PAC • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE Sun Community Federal Credit Union 760-327-7474 ADDRESS CITY P.O. Box 4210 El Centro Controlled Committee BANK ACCOUNT NUMBER 50109510 STATE CA ZIP CODE 92244 CALIFORNIA 41 Q FORM 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." Stating "No party preference" is acceptable. • 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 CHECK ONE Nonpartisan Partisan • • Nonpartisan Partisan • • (list political party below) (list political party below) 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) IF A RECALL, STATE "RECALL'' IN FRONT OF THE OFFICEHOLDER'S NAME. CANDJDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Management Association PAC II,. Tyee QfCommittee. : ' (Cont(nued) CALIFORNIA 41 Q FORM I.D, NUMBER General Purpose Commiftee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: Iii'.! CITY Committee O COUNTY Committee O STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR Palm Springs Fire Management Association STREET ADDRESS NO. AND STREET CITY STATE ZJP CODE AREA CODE/PHONE P .0. Box 1761 Palm Springs CA 92263 Small Contributor Committee •--!--.!-- Date qualified 5.iTe rm irlatiOn Re"q,.::u::ir:..;e::;m:::· .:;e::;n::ts=· ·. _ _:B::;.Yc:'::,lg,:;n;:;l~,,_g.:.:th.:;•::::v.:;e~;:;'ifi.:;"C.:;ati::.:" O:;:n,_, l:;;h::;• .:.:''.::••;::'.:.:"·:::'•::.:'·.:.:·•;::ss:::' is::.:l•::;~::;t, t::.'•::•::'":::'::"':::"::.:· n::dic.:~:.::' ::;C':c":::d:::ld::.••=••:.;o::;ffic:c:::•h:.::o::;ld::.:•::;'•c:· o;:_' r cPr:::O,:PO:::' n;;:e::;nl:..;. <:::•::..;"';:;'fv:..;:t::;h::•':.:•:::11;:;o:..;f t::;h;,e c:fo::;(IO::;. W::;f;;;nge.c::o:::n:::di::;tfo::;n.:;S.cP:::•v:.:•:.:·b:::•:::•n.;:;'. ~cc•::':.::' --~,J • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving con'tributions 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 (August/2018) FPPC Advice: advice@flJpc.ca.gov (866/2754 3772) www.fppc.ca.gov Statement of Organization Recipient Committee ~--------------------~-------------1 Statement Type D Initial li2I Amendment 0 Not yet qualified or 0 Date qualification threshold met Date qualification threshold met --1-- NAME OF COMMITTEE I.D. Number (if applicable) Palm Springs Fire Management Association PAC STREET ADDRESS (NO P.O. BOX) 300 N. El Cielo Rd. CITY STATE ZIP CODE Palm Srings CA 92262 FULL MAILING ADDRESS (IF DIFFERENT) P.O. Box 1761 Palm Springs CA 92263 E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) psfmapresident@gmail.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Riverside 1--- AREA CODE/PHONE 760-323-8181 Attach additional information on appropriately labeled continuation sheets. D Termination -See Part 5 Date of termination ---1 NAME Of TREASURER Michael J. Smith STREET ADDRESS (NO P.O. BOX) 49707 Escalante St. CITY Indio NAME OF ASSISTANT TREASURER, IF ANY Jason Loya STREET ADDRESS (NO P.O. BOX) 78-465 Via Sevilla CITY La Quinta NAME OF PRINCIPAL OFFICER(S) Greg Lyle STREET ADDRESS (NO P.O. BOX) 369 County Line Rd. CITY Calimesa Date Stamp STATE CA STATE CA STATE CA CALIFORNIA 41 Q FORM ForOffidal Use Only '' 'J:c• ZJP CODE AREA CODE/PHONE 92201 760-777-0442 ZIP CODE AREA CODE/PHONE 92201 760-641-5243 ZIP CODE AREA CD DE/PHONE 92320 a~\VeEi ·canon,y~;:r ✓, /:·-::g;,,;'>"•' >.<',)' r,✓ • j <✓ -'.; /'· ~ $ X ¼ 7 '1,·: ,: 1'"1 ,·: :~ / ✓>~",{ ,;;zt ~ :,,(:::;_,-·,;,;>,~'. ,,, ,";f(':?''7)~A ':;;,::-; / ✓• ' f,t; ;~*'", " '-<)_,. ~%:" i:-,;-~::';/ .;;,r•.;-1•:~, >' ·::✓-:,;,:_-·>::✓·:,,_,;~,jj 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 California that the foregoing is true and correct. Executed on 10/23/2019 DATE Executed on DATE Executed on DATE Executed on DATE By _____________ =============~------------ SIGNATURE OF TREASURER OR ASSISTANT TREASURER By By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov