HomeMy WebLinkAbout2022-01-24 - Form 410 - Bernsteinozatement or urganization
Date Stamp CALIFORNIA
Recipient Committee
410
Statement Type ❑ initial ❑ Amendment
El Termination — S®e Part 5
FORM
CITY
For Official Use Only
Q Not yet qualified
2022 JAN 24
P11 I: 04
or
Q Date qualification threshold met Date qualification threshold met
Date of termination
E
CITY lr �,
(' ._
I.D. Number
•
. ,
a IJrnble
OF COMMITTEE
71e;ffrWeyBernstein
NAME OF TREASURER
for City Council, District 2, 2022
James Williamson
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
AREA CODE/PHONE
Palm Springs
CA 92262
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Palm Springs CA 92262
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
CITY
STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICERS)
Riverside
City of Palm Springs
STREETADDRESS (NO P.O. BOX)
Attach additional information on a
f appropriately labeled continuation sheets.
CITY
STATE ZIP CODE
AREA CODE/PHONE
Verification3.
I have used all reasonable -diligence in preparing this statement and tote best of my knowledget the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the
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 (August/2018)
FPPC Advice: advice@fppc.ca.eoy (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I............ D, NUMBER
Jeffrey Bernstein for City Council, District 2, 2022
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODUPHONE
CITY
BANKACCOUNT NUMBER
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." 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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NIIMRFR IF APPl 1rARI F1 cI rrTln\I
JeffreyA. Bernstein
City Councilmember, Palm Springs, District 2
NonpartisanV
we
V Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
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.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT tin rITV nR rnl INTV AC APPI Ire RI P1
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.sov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Jeffrey Bernstein for City Council, District 2, 2022
iGe(fiitYl rpose UCommittee I
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 OFACTIVITY
STREET ADDRESS
List additional sponsors on an attachment. I
NO. AND STREET
Sn7fill C01?trit(1tor Cor (?7lttr'
CITY
GROUP OR AFFILIATION OF SPONSOR
Page 3
STATE LP CODE AREACODE/PHONE
• 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 Fonn 410 (August/2018)
FPPC Advice: advicerpfpac.ca.sov (866/275-3772)