HomeMy WebLinkAbout2022-01-24 - Form 410 - Bernstein (2)Rejected:
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Statement of Organization C� / f\eturned:_,�
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Recipient Committee (J
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Statement Type
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JAN 28 2022 2 22 MAR l4 Alf ;l: 22
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Committee1. r 1711
2. Treasurer and
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NAME OF COMMITTEE
NAME OF TREASURER
of the ���
JeffreyBernstein for City Council, District 2, 2022
t}'
James Williamson
FEB2022 0 8 2022
STREET ADDRESS (NO P.O. BOX)
1455 N.Vine Ave
STREET ADDRESS INO P.O. BOX)
CITY
STATE
ZIP CODE AREA CODE/PHONE
2471 E Camino Pelican
Palm Springs
CA
92262 760-537-0060
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Palm Springs CA 92262 917-626-2630
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAILADDRESS(REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE AREA CODE/PHONE
SEFF &E' Y iF40 {L,p,S � C t lAl L-C-0 rl
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Riverside
City of Palm Springs
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY
STATE
ZIP CODE AREA CODE/PHONE
Verification3.
I nave uses ah reasoname aingence in preparing 1E s statement ana To The nest oT my Knowleage the Information contained herein is true and complete.
penalty of perjury under the laws of the State of California that t7fooing is t orrect.
Executed on Jan 24, 2022 By .000
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on Jan 24, 2022
DATE
Executed on
Executed on
By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
BY
I certify under
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice0fonc,ca.gov (866/275-3772)
www.fppc.ca.goov
Statement of Organization CALIFORNIA
Recipient Committee FORM
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 CODE/PHONE I BANK
CITY 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 NUMBER IF APPLICABLE) ELECTION
Jeffrey A. Bernstein
City Counciimember, Palm Springs, District 2
allonpartisan
aoa
�
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 MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice(sfDDc.ca.eov (866/27S-3772)
www.fDDc.Ca.ROV
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Jeffrey Bernstein for City Council, District 2, 2022
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 OFACTPM
List additional sponsors on an attachment.
NAME OF SPONSOR
STREET
SmaN Contributor Committee
OR AFFILIATION OF SPONSOR
Page 3
STATE ZIP CODE AREA CODE/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 Form 410 (August/2018)
FPPC Advice: advice fpOc.c4.l9ov (866/275-3772)
wWw.fPPC-ca.eov