2021-10-26 Form 410 - HolstageStatement of Organization
Rec�)ient Committee
Statement Type 0 Initial
Not yet qualified Q or
Date qualification threshold met
®Amendment
Date qualification threshold met
2017-03-31
NAME OF COMMITTEE
Christy Holstege for Palm Springs City Council, District 4, 2020
® Termination - See Part 5
CITY STATE ZIP CODE AREACODE/PHONE
Palm Springs, CA 92264 916-397-6114
MAILING ADDRESS (IF DIFFERENT)
FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets
Date of termination
2021-10-31
NAME OF TREASURER
Scott Gordon
Date Stamp
R t-,EIVEQ
CITY OF PAL11 SPRIllc'l,2021 NOY 18 PH 3:
OFFICE CF TIME CITY G
For Official Use Only
STREET ADDRESS (NO P.O. BOX)
STATE ZIP CODE AREA CODE/PHONE
Palm Springs, CA 92262 9176170852
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
i nave used all reasonable diligence in preparing this statement and to the best of my knowledg
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 10/26/2021 By Scott Go
SIGNATURE OF TREASURER OR
Executed on 10/26/2021 By Christy Hol
SIGNATURE OF CONTROLLING OFFICEHOLDER, CA
Executed on By
Executed on
contai
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
is true and
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72;
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Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
2
COMMITTEE NAME I. D. NUMBER
Christy Holstege for Palm Springs City Council, District 4, 2020 1 1395520
■ All committees must list the financial Institution where the campaign bank account Is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Pacific Premier Bank 1(760) 969-4557
ADDRESS CITY STATE ZIP CODE
Palm Springs, CA 92262
4> TYPO Of COITIrWe e -
Complete the applicable 8eC#ions.
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."
, 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
LUDE DISTRICT NUMBER IF APPLICABLE)
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)
OF ELECTION
CANOIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO. CITY nR M1 INTY AS APPI ICARI M
PARTY
InNonpartisan
Nonpartisan
CHFCK nNF
n
u
SUPPORT
OPPOSE
El
E1_
SUPPORT
OPPOSE
FPPC Form 410 (Au usV2018
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Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME I. D. NUMBER
Christy Holstege for Palm Springs City Council, District 4, 2020 1 1395520
4. TV 6FC611'iM1tW0
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑CITY committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
• •---------
J List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OF AFFILIATION OF SPONSOR
STREET ADDRESS NO, AND STREET CITY STATE ZIP CODE
• ❑
Date Qualified
S� T 1'fit#it8�l i�ii # 1#te_varitl atlanl itlfl purer, asa} tft t,lfeseurer and/or candldate, officeholder. or proponent cedityloat all of the €oitawing conditions have been net
• 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
• 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.
I
FPPC Form 410 (Au uat/2018)
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Statement of Organization
Reci'pierit Committee
INSTRUCTIONS ON REVERSE
2
COMMITTEE NAME
I. D. NUMBER
Christy Holstege for Palm Springs City Council, District 4, 2020 1395520
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES NAM CANDIDATE(S) OFFI E E OR MEASURE S F LLC SOUGHT OR HELD R MEASURE(S)
U TITLE INCLUDE BALLO SURE S JURISDICTION
( ) BALLOT NO. OR LETTER O
() ( ) () CHECK ONE
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
I
SUPPORT OPPOSE
0 D
SUPPORT I OPPOSE
El El
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www.fppc.ca.gov