2019-10-29 Form 410 - PS Fire Management. .,
Statement of Organization Date Stamp
Recipient Committee
,---------------r--------------.-------------m
Statement Type D Initial 0 Amendment 0 Termination -See Part 5 ECEIVED ANltl>IB
the office of the Secretary of
0 Not y et qualified
or
0 Date qualification thres hold m et Date qualification threshold me t Date of term ina tion
of the State of California
OCT 2 J~a1~0V -
---.l---1-----1--1-----.1---1---REGISTRAI . o.:-\\)TERS
1. Committee Information
NAME OF COMMl11EE
I.D. Number
(if applicable) 2. Treasurer and Other Principal Officers
NAM( or TR(ASURER
Palm Springs Fire Management Associa ti on PAC Michael J. Smith
STREET ADDR ESS (NO PO. BOX)
CITY STATE ZIP CODE AREA COOE/PltONE
Palm Srings CA 92262
FULL MAILING ADDRESS (IF OIHERENT)
STREET ADDRESS (NO PO OOX)
CITY
Indio
NAME OF ASSISTANT TREASURER. IF ANY
Jason Loya
STREET AOOR[SS (NO PO OOX)
STATE
CA
ZIP COO£ AREA CODE/PHO N E
92201
P.O. Box 1761 Palm Springs CA 92263
£·MA IL ADDRESS (REQUIRED)/ FAX (OPTIONAL) CITY STATE ZIP COOF. AREA CODE/PHONE
psfmapresidenl@gmail.com La Quinta CA 92201
COUNTY OF DOMICILE JURISDICTION WHERE COMMl11EE IS ACTIVE NAME OF PRINCI PAL OHICER(S)
R ,,1u--sJe Riverside Greg Lyle
STREET ADDRESS (NO P.O BOX)
.
CllY STATE 71P CODE
Attach additional information on appropriately labeled co ntinuatio n sheets.
AREA COOE/PltONE
Calimesa CA 92320
3. Verification S § ~ *
I have used all reasonabl e diligence in preparing this st atement and to the be st of my knowledge the information conta i ned herein is true and complete.c=. ce,-g;y umfer •
penalty of perj ury under t h e laws of the
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Execut ed o n
Executed on
Executed on
DAT( :I: + > rr,
fT1 ·-
DATE
DATE
DAr[
By -----------::c=-=-::-::-c=::-::=---------------,--,--..,..,.,.==-:-:---------s1GNATURE or CONTROLUNG OrFICEHOLDER. CA NDIDATE, OH STIITE M(ASUR£ PROPO NENr
By -----------::c=-=-::-::-c=::-::~--------------------,--,----,==-=---------s1G NATURE or CON TROLLING OFFICEHOLO(R , CAND IDATE, OR STATE MEASURE PROPO NENT
By ---------;::;::;-:,=::-=::-==~=-===,--,-,,,,.-,c=,,,,.,.:,:--,:~=c-c:-=-:-::c-:-:-:-::==::-:---------s1GNATURE or CONTROLLING orr1C[ltOLDCR. CANDIDATE, OR STATE MEASUR E PROPO N(NT
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FPPC Form 410 (August/2018)
FPPC Advice : advice@fppc.ca.gov (866/27S-3772)
www.fppc.ca.gov
-~ Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
,.
Palm Springs Fire Management Association PAC i
. j
• All committees must list the financial institution where thJ ca~paign 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
BANK ACCOUNT N~MBER
50109510
STATE
CA
ZIP CODE
92244
CALIFORNIA 41 Q
FORM
1,0. NUMBER
~~TYfff.!,,Of.:~OJiinli_ttee~•:c;a~,ete:tffE(~P{>.liC~b~i{"S~~tio,"n_s~ r:~--~.·;:,~·-~~-~:-<:-:-,,;,~---~r-:-:~ '";'r"P'"~":·:~,~--:-,.:""w. *''":"~""'t:-'._t~ ·-,~,,_:-:-,~~-.=,.,..~,~~:-~~.-::--:K'~:~~:,'.·~ .. ;,~:"'.':~~·~7-':?::'!(:~rT~
' , Controlled Committee
• 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. 1
•·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 an_d 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 s~pport or oppose specific candidates or measures in a single election. List below:
'
CANDIDATE{S) NAME OR Mi:ASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOL,DER'S NAME.
CANDIOATE(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
I,
)!
CALIFORNIA 410
FORM
l,D. NUMBER
~f,rf';ye·etOf ~COmfflittee-iz"~·.·"·~··\·(tOritin'U~J:'"·~".;-'!;'_,,,_,-~ _.,·::;~--.~~:-'--~"-:~ -':~"•'-"·:-:,~--~,;:-~-; -• .._,," ::· ;-_,,.:.,it· -• ,".--~ • --;::~'"•.,,-, ·<t:'~"-·if'•·f:~ ,;~~" --1~-,·~·-,~'7-··~t:-~--.,c:"'"',:-,--\-~ ';";'V"'-s;:;."'·~~~<"'"'? I · ···· · · ;z' YJ"1"7
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
li2I CITY Committee I D COUNTY Committee D STATE Ci>mmittee
General Purpose Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee ----i·--------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.O. Box 1761 Palm Springs CA 92263
Small Contributor Committee •--1-.-1--
Date qualified i
' s ~~~ erm i ri3ti on: Re:c:j~lt!.,_ inents:;:~~-~ Bf s,gn,ng.,,.th~~E!'rlfii:_a"tt011;)~e ·treasurer;ass1stallt' tre~sUre r1rrni/Or can-di date: OffiCehOltt~r;: (fr~PrOl?~OJll~t certifythat~ a11 · Of the f6!1~1ng'COrl~i~9ri{hav~: bee·n~ ITiei:it;·;·.:::::, I
• This committee has Ceased to receive contributiohs and·make expenditures; :
• This commitJ:ee 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; I -. . -
• This conimittee. has no surplus·funds; and (
i
• This committee has filed all campaign statements ~equired by the Political Reform Act disclosing all reportable transactions.
--There are restrictions on the disposition of surJlus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519. j
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 F~PC Regulation 18521.5.
I
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov