2019-10-23 Form 410 - PS Fire Management (Amended)Statement of Organization Date Stamp
RECEIVED
CALIFORNIA 41 Q
FORM Recipient Committee
=--------"-r.:=---------.:::---------1"1,tt Statement Type D Initial i2J Amendment • Termination-See Pan 5 OF p hLH SPRINGS For Official Use Only
0 Not yet qualified
or 201 OCT 23 PM ~: 27
0 Date qualification threshold met Date qualification threshold met Date of termination OFF I E OF THE CITY CLER!i
1--___ ,. __ _f, __ _
NAME Of COMMITTEE
I.D. Number
(if applicable)
Palm Springs Fire Management Association PAC
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE
Palm Srings CA 92262
FULL MAILING ADDRESS (IF DIFFERENT)
E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMICILE JURISOICTlON WHERE COMMITTEE IS ACTIVE
Riverside
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
--1
Michael J. Smith
STREET ADDRESS (NO P.O. BOX)
CITY
Indio
NAME OF ASSISTANT TREASURER, IF ANY
Jason Loya
STREET ADDRESS (NO P.O. BOX)
CITY
La Quinta
NAME OF PRINCIPALOFFICER(S)
Greg Lyle
STREET ADDRESS (NO P,O, BOX)
CITY
Calimesa
STATE ZIP CODE AREA CODE/PHONE
CA 92201
. STATE ZIP CODE AREA CODE/PHONE
CA 92201
STATE ZIP CODE AREA CODE/PHONE
CA 92320
3~}'.;Vet:ifi·catiore1f1;1~1:12;¢;(,;:;'."+1t+:4~f'<r1:::1:::·d0't~:4;;:.:::v-:.;,;-:x · .· :':(;:·~:t,. ~ \.:/, -:11~0 ,~~"?'iit"? (~t, ·/;:, :.~ , ~;,"',pl,4,~A §;* ,/,.,,<ef ¾ :::::,.,., :{(-" • .:~---~~~~10~i:1:::::1~~x:~:AaiJ~:.:;•i:C::>, ,* :0;~HA/1t""' 41"1 ~t~~ /·r>-,:•::is::+:·z ;a1
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify u~d~r' J. ',
penalty of perjury under the laws of
Executed on 10123/2019
DATE
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE , SIGNATURE OF CONTROLLING OFFICEHOLDER, 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
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Palm Springs Fire Management Association PAC
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
Sun Community Federal Credit Union 760-327-7474
ADDRESS CITY
P.O. Box 4210 El Centro
Controlled Committee
BANK ACCOUNT NUMBER
50109510
STATE
CA
ZIP CODE
92244
CALIFORNIA 41 Q
FORM
I.D. NUMBER
• 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 • • Nonpartisan Partisan • •
(list political party below)
(list 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 "RECALL'' IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDJDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
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
Palm Springs Fire Management Association PAC
II,. Tyee QfCommittee. : ' (Cont(nued)
CALIFORNIA 41 Q
FORM
I.D, NUMBER
General Purpose Commiftee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
Iii'.! CITY Committee O COUNTY Committee O STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Palm Springs Fire Management Association
STREET ADDRESS NO. AND STREET CITY STATE ZJP CODE AREA CODE/PHONE
P .0. Box 1761 Palm Springs CA 92263
Small Contributor Committee •--!--.!--
Date qualified
5.iTe rm irlatiOn Re"q,.::u::ir:..;e::;m:::· .:;e::;n::ts=· ·. _ _:B::;.Yc:'::,lg,:;n;:;l~,,_g.:.:th.:;•::::v.:;e~;:;'ifi.:;"C.:;ati::.:" O:;:n,_, l:;;h::;• .:.:''.::••;::'.:.:"·:::'•::.:'·.:.:·•;::ss:::' is::.:l•::;~::;t, t::.'•::•::'":::'::"':::"::.:· n::dic.:~:.::' ::;C':c":::d:::ld::.••=••:.;o::;ffic:c:::•h:.::o::;ld::.:•::;'•c:· o;:_' r cPr:::O,:PO:::' n;;:e::;nl:..;. <:::•::..;"';:;'fv:..;:t::;h::•':.:•:::11;:;o:..;f t::;h;,e c:fo::;(IO::;. W::;f;;;nge.c::o:::n:::di::;tfo::;n.:;S.cP:::•v:.:•:.:·b:::•:::•n.;:;'. ~cc•::':.::' --~,J
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving con'tributions 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@flJpc.ca.gov (866/2754 3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee ~--------------------~-------------1 Statement Type D Initial li2I Amendment
0 Not yet qualified
or
0 Date qualification threshold met Date qualification threshold met
--1--
NAME OF COMMITTEE
I.D. Number
(if applicable)
Palm Springs Fire Management Association PAC
STREET ADDRESS (NO P.O. BOX)
300 N. El Cielo Rd.
CITY STATE ZIP CODE
Palm Srings CA 92262
FULL MAILING ADDRESS (IF DIFFERENT)
P.O. Box 1761 Palm Springs CA 92263
E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
psfmapresident@gmail.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Riverside
1---
AREA CODE/PHONE
760-323-8181
Attach additional information on appropriately labeled continuation sheets.
D Termination -See Part 5
Date of termination
---1
NAME Of TREASURER
Michael J. Smith
STREET ADDRESS (NO P.O. BOX)
49707 Escalante St.
CITY
Indio
NAME OF ASSISTANT TREASURER, IF ANY
Jason Loya
STREET ADDRESS (NO P.O. BOX)
78-465 Via Sevilla
CITY
La Quinta
NAME OF PRINCIPAL OFFICER(S)
Greg Lyle
STREET ADDRESS (NO P.O. BOX)
369 County Line Rd.
CITY
Calimesa
Date Stamp
STATE
CA
STATE
CA
STATE
CA
CALIFORNIA 41 Q
FORM
ForOffidal Use Only
'' 'J:c•
ZJP CODE AREA CODE/PHONE
92201 760-777-0442
ZIP CODE AREA CODE/PHONE
92201 760-641-5243
ZIP CODE AREA CD DE/PHONE
92320
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 10/23/2019
DATE
Executed on
DATE
Executed on
DATE
Executed on
DATE
By _____________ =============~------------
SIGNATURE OF TREASURER OR ASSISTANT TREASURER
By
By
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov