2019-03-04 Form 410 - MiddletonStatement -of Grganization
Recipient Committee
Initial ~--------------------=~--------------~~--------~~~~ i2l Amendment D Termination -See Statement Type
Not yet qualified
or 20 9 HAR -4 PH 2: 59
0 Date qualification threshold met Date qualification threshold met
NAME OF COMMITIEE
Lisa Middleton For Palm Springs City Council 2017
STREET ADDRESS (NO P.O. BOX)
CITY STATE
Palm Springs CA
FULL MAILING ADDRESS (IF DIFFERENT)
E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
ZIP CODE
92264
12 I 14 I 2016
1394265
AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
3.· Jlera ca on _ : _ .· .. : · .. ; . . .. :: .· .: . . ,
Date of termination __ _,, , ___ _
NAME OF TREASURER
Lisa Middleton
STREET ADDRESS (NO P.O. BOX)
CITY STATE
Palm Springs CA
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE
ZIP CODE
92263
ZIP CODE
ZIP CODE
I have used all reasonable diligence in preparing this
~~~:::-:::::-::-::=-===:-::::~::-:=:==:::=-::":':"::":":":":'o:-------------~ I'-\ f'to '~ Executed on By
DME ----------------±~~~~~~~~~~~~~~~~~~~~~~~_..._,.._......__......__..._
Executed on
DATE
Executed on
DATE
By_......__......__..._...__....._~~~~~~~~~~~~~~~~~~~~~~~~----------------------------SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
BY._.....__......__..._...__.._...~~~~~~~~~~~~~~~~~~~~~~~~----.._._......_...__..._..._
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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AREA CODE/PHONE
AREA CODE/PHONE
· • ARb:£0DE/PHONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
R·ecipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Lisa Middleton For Palm Springs City Council 2017
• 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 •. Jype _()f Committee Comp.lete the applicable se·cti~:ms .. ·
Controlled Committee
1394265
BANK ACCOUNT NUMBER
325085363706
STATE ZIP CODE
CA 92264
• .• ;:, ·.:·~ v ~ ~ ••
• ~ ;:.;, '; ', :_, •. .:, ',_;;*I~' . "',-:,;--\ '. , '•,' ~I ·,"~' ~
• 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
D D
Nonpartisan Partisan
D 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 LETIER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
Lisa Middleton
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
Palm Springs City Council
(list political party below)
(list political party below)
CHECK ONE
SUPPORT "[5 D
[jRT LJ
FPPC Form 410 (August/2018)
FPPC Advice: advlce@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov