2019-01-28 Form 410 - KorsStatement of Organization
Recipient Committee
Dat e Stam p
Statement Type r::=--------r=------r-:-------f'ttFCEIVED AN D FIL E
Initial Amendment D Termination -See Part tile office of tile Secretary of
0 Not yet qualified of th e State of Californi a
or
0 Date qualification thres hold met Date qualification th resho ld met
I 1--
1. Committee Information
NAME OF COMM ITTE E
I.D. Number
(if applicable) 1376802
G9off Kon; fGr CiPj Counoil 201~
CjECrr ~£.5 ro~ Cil'( CO(..IrJeU-1 DIJ'Tr0c;/ 3, 2.0/}
STREET ADDRESS (N O P.O. BOX)
CI TY STATE ZIP CODE AREA CODE/PHONE
Palm Springs CA 92262
FULL MAILING ADDRESS (If DIFFERENT)
E·MAIL ADDRESS (REQU IRED)/ FAX (OPTIONAL)
COU NTY OF DOMICI LE JU RISDICTION WH ER E COMMITT EE IS ACT IVE
Riverside City of Palm Sp rings
Attach additional information on appropriately labeled continuation sheets.
Date of termin ation JAN 28 2019
I I
2 . Treasurer and Other Principal Officers
NAME OF T REAS URER
James Williamson
ST REET ADDRESS (NO P.O. BOX)
CITY STATE
Palm Springs CA
NAME OF ASS ISTA NT TREAS URER, IF ANY
S TREET ADD RESS (NO P.O. BOX)
CITY STATE
NAME OF PRI NCIPA L OF FICE R(S)
STREET ADDRESS (N O P.O. BOX)
CITY STATE
:· _, ...
'rr. ~:-.'J --
ZIP CODE AREA CODE/PHONE
92262
ZI P CODE AREA CODE/PHONE
ZIP CODE AREA COD E/PHON E
--· • 7
3. Verification .. -) '" ... _,
I have used all r eas onable diligence in preparing this statement and to the best of my knowledge th e information contained herein i s tru e and compl e:te. ~l ~ce r ti"N und ~t
penalty of perjury unde r th e laws of the Sta te of Cali fornia that the foregoing is ru e and co rrec t. ........ : --· ~ ·' "
Jan 24, 2019 -, · ; en ·r:
Execu t ed on By -' • :>
DATE
Execu t ed on Ja n 24, 2019
By
DAT E
Executed on By
DAT E SIG NATURE OF CON TROL LING OFFICE IIOLDER. CANDIDATE. OR STATE MEAS URE PROPONENT
Executed on By
DATE SI GNATU RE OF CON TRO LLIN G OF FICEHO LDEH. CAN DIDATE, OR STATE MEASUR E PROPONENT
-1 1 ~
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FPPC Form 410 (Au g ustl2018)
FPPC Advice: a dvi ce@fppc.ca .gov (8661275-3772)
www.fppc.ca .gov
StatE:nnent of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Geo« Kori for City CouRoil 29'fcl, c;JE.'Of-F J<cC..S FaQ_ ~·rt ~NC:./1_. DIJi'?jUc7 Jl, '2J:Jl<(
• All committees must list the financial Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
Bank of America 760.864.8611
ADDRESS CITY
588 S Palm Canyon Drive Palm Springs
4. Type of Committee Complete the applicable sections.
Controlled Committee
BANK ACCOUNT NUMBER
3250 1336 9028
STATE
CA
'' ',.
ZIP CODE
92264
1376802
• 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
Geoffrey R. Kors City Councilmember, Palm Springs, District 3 2019 0
Nonpartisan
D
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.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
Partisan
D
Partisan
D
(list political party below)
{list political party below)
CHECK ONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statem.ent of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Geoff Kors for City Con~Jcil 201-a. c.;~ )c:t.lczg f"eQ_ ~\l'f ~f!.I'-J DIS1l?-4C( 3, 2..Jl'i<j
4. Type of Committee (Cont:fnued) l::
CALIFORNIA 41 0
FORM
s
J.D. NUMBER
1376802
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee D STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee list additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION Of SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee 0 1 .1--
Date qualified
5. Termination Requirements By signing the verificatfon, the t~asurer, assistant treasur~r and/or candidate, officeholder, or propone~t certify that all of the following conditions have been met:
• 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@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov