2020-02-13 Form 410 - MiddletonStatement of Organization
Recipient Committee
Date Stamp
..-----------------------~....-------------1 Statement Type D Initial 0 Amendment
RECE I VE D
0 Not yet qualified
or
0 Date qualification threshold met Date qualification threshold met
. Committee Information I.D. Number
(if applicable)
NA¥~ O F CQMMITTq Lisa Middle ton tor City Council, District 5, 2020
STREET ADDRESS (N O P.O. BOX)
CITY STATE
Palm Springs CA
FULL MAILING ADDRESS (IF DIFFERENT)
E·MAIL ADDRESS (REQUIRED)/ FAX (OPTION AL)
ZIP CODE
92264
12 14 2016
1394265
AREA CODC/PHONE
COUNTY OF DOMICILE JURISDICTION WHE RE COMMITTEE IS ACTIVE
Riverside City of Palm Springs
Attach additional information on appropriately labeled continuation shee t s.
D Termination -See Pc(tt ~ OF Pi\ U1 SPRINGS
Date of termination
OFFI E OF THE Cl r Y CU:.RI
2. Treasurer and Other Principal Officers
NAM E OF TREASURER
Dave Baron
STREET ADDRESS (N O P.O . BOX)
CITY
Palm Springs
N AME OF ASSISTANT TRE ASURER, IF A N Y
Lisa Middleton
STREET ADDRESS (N O P.O. BOX)
CITY
Palm Springs
NAME OF PRINaPAL OFFICER(SJ
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
CA
STATE
CA
STATE
CALIFORNIA 41 0
FORM
For Official Use Only
ZIP CODE AREA CODE/PHONE
92262
ZIP CODE AREA CODE/PHONE
92264
ZIP CODE AREA CODE/PHONE
I have used all reasonable diligence in preparing this stateme
SIGNATURE OF CONTROLLIN G OFFICEHOLDER, CAN DIDATE, OR STATE MEASURE P ROPONENT
SIG N ATURE OF CO NTRO LLING OFFICEHOLDER, CA NDIDATE, OR STATE MEASURE PRO PO N EN T
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
°tTi~1{}ii~m\iton for City Council, District 5, 2020
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
ADDRESS CITY
:~ontrol/ed Committ_ee ·
CALIFORNIA 4· 1 o·
FORM . . ,
1.0. NUMBER
BANK ACCOUNT 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
Nonpartisan
Lisa Middleton for City Council, District 5, 2020 Palm Springs City Council, District 5 2020 0
Nonpartisan •
Primarily F,ormed t;ommittee . Primarily formed to support o'r 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.
CANOIOATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
Partisan • Partisan •
(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
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
· CALIFORNIA 4· 1· ·O
F0RM · · ..
COMMITTEE NAME 1,D. NUMBER
.. e of. ~ofuffiittee '(Co~tir\ued)'
General Purpose ~omrpittee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee O COUNTY Committee O STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Comf!litiee· . 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 Contrib(!to[ qcu;Ylinif-!_ee .: □--•--✓--
Date qualified
-~rer:ro1na_~Q~R8'JJir:e~r,Yents ~~~v:s_1g~~lffrfffi;:!1iiij~at1o'ryJJti~t~11rer/a)~!It~rtr1a1~rs~J~1!irifca~1~i-wroffi'tC_ffiiJcf€fte>rprcip-o-n~rn:*~~Wi~at-aff9Xth~J?ll]~1-ng conatt19fll~Ji~-_been~mer~l:i~'--
• 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
• Th[s 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