2018-09-17 Form 410 - PS Fire SafetyStatement of Organization
Recipient Committee
Statement Type O Initial
0 Not yet qualifi ed
or
0 Da te q ualifie d as com mittee
--1 I
i. Committee Information
NAME OF COMMITTEE
Palm Springs Firefighters Association PAC
STR EET ADD RESS (NO P.O. BOX )
CITY STATE
Palm S pr ings CA
E·MAIL ADDRESS (REQU IRED)/ FAX (O PT IONA L)
li2l Amen dment
08 06 1988
--.1 1---
Da te qualifi ed as co mmittee
(If amending to provide this date)
I'. D. Number·(// applicable)
981536
Date Stam p
•. ~:CE11ft:.
0 Termination -See Part 5 1 f r .' l ;--: S.
201 6 Sr P I 7 Pill2 : 06
--1 1---
Date of termina ti on • I j _,;: 1 ~
2. Tr easurer and Other· Principal Offic.er s
NAM E O F TREASURER
Brandon Wright
STREET ADD RE SS (NO P.O. BOX)
CITY STATE
Yucaipa CA
ZI P CODE AREA CODE/PHONE NAME OF ASSISTANTTREASURER,IF AN Y
92262 (
STREET ADDRESS (NO P.O . BOX)
CIT Y STATE
CALIFORNIA 41 0
FORM
For Officio I Use Only
ZIP CO DE ARE A CODE/PH ONE
92399 (
ZI P CODE AREA CO DE/PHONE
COUN TY OF DOMICILE JUR IS DICTION WHER E COMM ITTEE IS ACTIVE NAME OF PRI NCIPA L OFFICE R(S)
A ttach add itional info rmatio n on appropriat ely labeled con tinuatio n shee t s.
3. Veri fication
Damien Myer s
STRE ET ADD RES S (NO P.O. BOX)
CITY
Te m ec u la
STATE ZIP CODE AR EA CODE/PIIO NE
C A 92592 (
j h ave-us ed a ll reasonab le d ili gence in-preparin g-t hi s s ta te m e nt a nd to the bes t o f my knowiedge t he informati on conta1necfi1e-rein is tr u e and co m Ple te. I ce rtify und er -
pe na lty of perj ury un der the laws of t h e St ate of
E OF TREASURER OR ASSISTANT TREAS URER DATE
Exec u t ed on
DAT E
By
Execu t ed on
DATE
By
Executed o n By
DATE
SIGN ATURE OF CONTROLLING OF FIC EHOL DE R, CA ND IDATE, OR STATE MEASURE PllOPO NENT
SIGNATURE OF CONTROLLI NG OFFICEHO LD ER, CANDIDATE , OR STATE MEASURE PII OPONENT
SIGNAT UR E OF CO NTR OLLING OFFICEH O LD ER, CANDIDATE, OR STATE MEASURE PROPONE NT
FPPC Form 4 10 (M a y/2017}
FPPC Advice: a dvice@fppc.ca.gov (866/275-3772)
www.fp p c.ca.gov
Statement of Organization
Recipient Committee
INSTR UCT ION S ON REVERSE
COMMITTEE NAME
Palm Springs Firefighters As sociation PAC
• All committees must list the financial institution where the campaign bank account is located.
NAME Of FINANCIAL INSTITUTION AREA CODE/PHONE
Firefighters First Credit Union (800) 231-1626
ADDRESS CIT Y
P.O . Box 60890 Los Angeles
4. Type ~fto.mmittee Complete the app~~sections.
Controlled Committee
BANK ACCOUNT NUMBER
10002679256
STATE
CA
ZIP COD E
90060-0890
CALIFORNIA 41 0
FORM
I. D. NUMBER
881536
o Li st the name of eac h controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sough t or held, and
dis t rict number, if any, and the year of the election .
• Li st the political party with which each officeholder or candidate is affiliated or check "nonpartisan."
o If thi s committee ac ts jointly with another controlled committee, li st the nam e and identification number of the other controlled committee.
NAME OF CANDIDATE/OFF ICE HOLDER/STATE MEASURE PROPONE NT
ELECTIVE OFF I CE SO UGHT OR HELD
(INC LUDE DISTRICT NU MBER IF APPLICABLE) YEAR OF ELECTI ON
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CAND I DATE(S) NAME OR MEAS URE(S) FUL L TITLE (INCLUDE BALLOT NO. OR LETTER) CAN DI DATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISD I CTION
(IN CLUD E DISTR I CT NO., CITY OR CO UNTY, AS APP liCABlE)
PAR TY
0 Nonpartisan
0 Nonparti san
CHECK ONE
SUP PORT OPPOSE D D
FPPC Form 410 (May/2017}
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.go v
Statement of Organization
Recipient Committee
INSTRUCTION S ON REVERSE
COMMITIEE NAME
Palm Springs Firefighters Association PAC
CALIFORNIA 41 0
FORM
I.D. NUMBER
881536
General Purpose Committee Not form ed to support or oppose specific candidates or measures in a sin gle election. Check only one box:
i2J CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIV ITY
Support Candidates and Measures within the City during a single election.
Sponsored Committee List additional spo nsors on an attachment.
NAME O F SPONSOR INDUSTRY GROUP OR AFFiliATION OF SPONSOR
Palm S prings Firefighters Association PAC Palm Springs Firefighters Association
STREET ADDRESS NO. AND STREET CITY STillE ZIP CODE AREA COD E/PHONE
180 N . Lurin g Dr Palm Springs CA 92262 (760)861-1230
Small Contributor Committee D---' 1---0itO quoalificd
5. Termination Re~ulrements By signing the vetiHcat1on, the treasurer, as.slstan t treasure r and/or candida te, offlcehold er, or proponent certify that all oftn'e following conditions have b,een met:
.::, -..~. • . ft.\. ~.1._... ... ~ . . .. ·---.. ._ ....... --.. ....... :.:.-....-
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receivi ng co ntributions or making expend itures in the future;
• This committee has eliminated or has no intention o r ab ility to discharge all debts, loans received, and other obligations;
• This committee has no su rplus funds; and
• This comm ittee has filed a ll campaign statements required by the Political Refo rm Act disclosing all reportable transactions.
--There are r est rictions on the disposition of surplu s campaig n funds held by el ected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
--Leftover funds of ballot me as ure committees may be use d for political, legislative or governmental purposes under Gov ernment Code Sections 89511-89518, and ar e
subject to El ections Code Sectio n 18680 and FPPC Regulatio n 18521.S.
FPPC Form 410 (May/2017}
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
. www.fppc.ca.gov