2019-07-31 Form 410 - PS Fire Management (Amended)~--Statement of Organization
Recipient Committee
Date Stamp . -CALIFORNIA 41 0
FORM RECE I VED
Statement Type ,------------..------------,.----------~~ 0 Amendment D Termi nation -See Part OF p ALM SPRINGS D Initial
0 Not yet qualifi ed
or
0 Date qualification threshold met Date qualification threshold met ___ / __ _, __ _ ---1---1---
Date of termina tion
OF
---1---,1---
19 JUL 3 I PM 5: 21
ICE OF TH£ CITY CL ER/\
1. Com~ittee 1nformation I.D. Number
(if applicable)
I ;).'-f[i 9 7
:J13S52Q85 @ 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
Palm Springs Fire Management Association PAC
STREET ADDRESS INO P.O. BOX)
CITY STATE ZIP CODE
Palm Springs CA 92262
E-MAIL ADDRESS I REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS A CTIVE
Ri ve rside
NAME OF TREASURER
Ryan Barrier
STREET A DDRESS (NO P.O. BOXI
CITY
Morongo Vall ey
AREA CODE/PHONE NAME OF ASS ISTANT TREASURER, IF ANY
760-323-8181
STREET ADDRESS (NO P.O. BOXI
CITY
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O . BOX)
CITY
Attach additional information on appropriate ly labe led continuation s heets.
Executed on By
DATE SIGNATURE OF CONTROLLIN G OFFICEHOLDER, CANDIDATE, OR STATE M EASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONEN T
Executed on By
STATE
CA
STATE
STATE
For Official Use Only
ZIP CODE AREA CODE/PHONE
92256
ZIP CODE AREA CODE/PHONE
ZIP CODE AREA CODE/PHONE
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@ fppc.c a .gov (866/27 5-3772)
www.fppc.ca.gov