2019-10-15 Form 410 - MiddletonStatement of Organization
Recipient Committee
RECEIVED
CI TY OF Ps\U1 SPRINGS
Date Stlmp
REC EIVE D =------------r.=----------==---------tt11 Statement Type O Initial 0 11JM1fffi~ I (3 g e rmination -See Part 5 y OF P f, L H S P R ING S
0 Not yet qualified
or
0 Dat e qualificati on threshold met
AH
9
2 190CT IS AM 9: 48
o.Rf [ub~ifuaQfn ~hblb 1,,"t LE Rt Date o f termination OF ICE OF THE Cr T y CLE rt
1 . Committee Information
NAM E OF COMM ITTEE
1.0. Number
(if applicable}
Lisa Middleton for City Co uncil , Distri ct 5 , 2020
STREET ADDRESS (NO P.O. BOX)
CITY
P al m Springs
FULL MAILI NG ADDRESS flf DIFFEREN T)
STATE ZIP CODE
CA 92264
E-MA IL ADDRESS (REQU IRED)/ FAX (O PTIONAL )
CO UNTY OF DOMICILE
Riverside
JURISDICTIO N WHERE COMMITTEE IS ACTIVE
City of Palm Sp rings
AREA CODE/PHON E
Attach additional information on appropriately labeled continuation sheets.
3. Veri cation
2. Treasurer and Other Principal Officers
NAME Of TREASURER
David Baron
STREET ADDRESS (NO P.O. BOX)
CITY STATE
Palm Springs CA
NAM E OF ASS ISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE
NAME OF PRI NCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE
CALIFORNIA 410
FORM
For Offitlal Use Onlv
RECEIVED ANO FILED
1n the o ice o e . .., ate
ot the St;ite of Califo rnia
HOV 04 2019
ZIP CODE /\REI\ CODE/PHONE
92262
ZIP CO DE AREA CODE/PHONE
ZI P CODE AREA CODE/PHONE
I have u sed all reaso nable diligence in preparing
STATE MEASURE PROPONENT
SIG NATURE OF CONTROLLIN G OFFICEHOLDE R, CAN DI DATE, OR STATE MEASURE PROPONEN T
SIG NATURE OF CO NTR OLLING OFFICEHOLDE R, 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
CALIFORNIA 41 0
FORM
INSTRUCTIONS ON REVERSE
COMMlmE NAME
Lisa Middleton for City Council, District 5, 2020
• All committees must list the financial institution where the campaign 'bank a~unt Is located;
I
NAME OF FINA.NCIALINSTfTUTJON
ADDRESS
,',
'
AREA COOE/PHONE
CITY
1.D, NUMBER
BANICACCOUNT NUMBER
STATE ZIP CODE
4:Type"ofCorrimittelid:omplete theapplicable sections.:;,. . ' .. '~,. .· .. '. .. . /;';: =~: :j .. ·.~,-.:--·~ ' '~(i'. .. /4 ·,,:±t::i.TL· . ,•0 1::: ca5Ll ""· =:.....~~ __ ,,, -~-~..c.-~~ -"'·----r·------,.,,, ,--·-----t. ,, -·'""·"""·--~-~ = -..... _. -----.. ~~--------... .,,
Controlled Committee 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
I district number, ifany, and the year of the election.:
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party1preference" is acceptable.
• If this committee acts jointly with another controllecl committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PRO~ONENT
' '
ELECTIVE OFFICE SOUGHT OR HELO
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
,ELECTION
PARTY
CHECK ONE
Nonpartisan Partisan • • Nonpartisan Partisan • •
(list polltlcal party below)
(11st 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 "REC.O.Ll" IN FRONT OF THE OFFICE~OLDER'S NAME,
CANDJDATE(S) OFFICE SOUGHT OR H£LD
1
OR MEASURE(S) iURISDICTION
{INCLUDE DISTRICT NO., CITY OR COLIN~, AS APPLICABLE) CHECK ONE
1·
0 IB SUP
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
Lisa Middleton for City Council, District 5, 2020
CALIFORNIA 41 Q
FORM
l,D. NUMBER
4 ~·T,y··pe·ofCom'm' ittee·' '(Con"n'ued)', ·-·~-'t:i. -:·,-.,_ < -,-·.·, ..... -';. C 'T '.:~~t"•--• .L··.'_-__ · ___ ------'-:1';_.~.--·.-_/•·_ ~~----·----··---~y,_-._~: __ ;_,:,,·;·~•--,I ,.,, ---"· , .. _,,_, " --•• .· ,. __ .,,.: __ . --.·-·-·. ----··-· -----~-=-" ........;,,,, --...,..,_~--"'-.....,-~-· -~---~------....,,.,._,...,... ... --~-A---,-·-----• :·--~--""• -~----• -~-~---------
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Not formed to support or oppose specific candidates or measures in a single election,f Check only one box:
D CITY Committet D COUNTY Committee D STATE fommittee
General Purpose Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
J
I
Sponsored Committee List additional sponsors dn an attachment.
I
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
Small Contributor Committee
J INDUSTRY GROUP OR AFFILIATION OF SPONSOR
I
D _ _,_-,-,
Date qualiried
I
CITY STATE
!
ZIP CODE AREA CODE/PHONE
~-~_.Te.rJ1!iniit!_C?!\ ~!~Ulre,!!!_!!!tS -:;!:.~~'.; ~Y. slgnli}B th~ v~@~~~:~L~h~ treas~ij!i~a-nt treasUrE!r.and/o[_c_~m\d~~~h~g~r ~~-rp~p~neMt ce,:tlty_ih~!!!'!Jh~ toilowlng cc!td1tforiS hilve· ~!.e~!;_:.;3 ;.~· .J
' • This committee has ceased to receive contributions.and make expenditures; ,,
• This committee does not anticipate receiving cortributions or making expenditures in the future;
h I . • T is committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
!' ' 1,' • This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
I I
There are restrictions on the disposition of sJrplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519. ! ·
I I
leftover funds of ballot measure committees'.may be used for political, legislative or governmental purposes und~r Government Code Sections.89511-89518,.and are
subject to Elections Code Section 18680 and FPPC-Regulation 18521.5. · ! -. l
'(
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov