2022-06-29 - Form 410 - Renee BrownStatement of Organization
Date Stamp
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T e Initial ❑Amendment ❑Termination —See Part 5
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Information1. Committee I.D. Number
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Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE
AREA CODE/PHONE
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 un er the wss of the State of California that the foregoing i ue anc correct.
Executed on By
TE SI ATURE OF TREASURER OR ASSISTANT TREASURER
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
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advicePfupc.ca.gov (866/275-3772)
www.fpac.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
AREA CODE/PHONE
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
Page 2
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 YEAR OF PARTY
(INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
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Nonpartisan
artisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice(oDfoac.ca.gov (866/275-3772)
www.fooc.ca.gov
Instructions for
Statement of Organization
Statement Type: Identify the jurisdiction where the committee is active. Primarily Formed Committees
Initial For example a city committee lists the name of the city.
Mark the "Initial" box and enter the date the Ballot Measures: The name of each
committee qualification threshold was met. Committee Name Requirements committee primarily formed to support or
If the committee has not met the qualification threshold,
mark the "Initial" and "Not Yet Qualified" boxes.
Qualification Threshold
The "date qualification threshold met" is the date
the committee received contributions totaling
$2,000 or more during a calendar year.
Amendment
If any of the information reported on an initial
statement of organization changes:
• Mark the amendment box;
• Include the committee's ID number and name;
• Provide the changed information; and
• Complete the verification.
Candidates: Under certain circumstances, a candidate
for local office may amend the Form 410 to indicate
that he or she is seeking re-election to the same office.
A candidate for state office must open a separate
committee for each term of office and may not amend
the Form 410 to redesignate an election committee.
Termination
List the committee's name, identification
number and indicate the date of termination,
including completing the verification.
1. Committee Information:
Provide the full name of the committee. A
committee may use only one name.
The committee's street address, email address; and
telephone number must be reported. A post office box
is not acceptable. The committee's mailing address
must also be reported if it is different from the street
address. A post office box is acceptable for the mailing
address. A committee's "domicile" is its address as
listed on the Form 410. Los Angeles is the county of
domicile for committees located outside California.
The following committee name rules apply to the Form
410, the committee's campaign statements and to any
other references to the committee required by law. See
the instructions for Part 4 for committee definitions.
Candidate Controlled Committees: Any committee that
is controlled by a state or local candidate or officeholder
must include the last name of the candidate in the name
of the committee. In addition, the following rules apply:
• An election committee controlled by one or
more state or local candidates must also include
the office the candidate(s) is seeking and the
year of the election (e.g., Friends of Smith for
Assembly 20XX, Jones for Council 20XX).
• An officeholder committee set up by a state
officeholder must also include the office held, the
year the officeholder was elected to the current
term of office, and the words "Officeholder
Account," as part of the committee name (e.g.,
Anderson Assembly 20XX Officeholder Account).
• A legal defense fund setup by a state or local
candidate or officeholder must also include the
words "Legal Defense Fund" as part of the committee
name (e.g., Senator Smith Legal Defense Fund).
• A ballot measure committee controlled by one
or more state candidates must also state that it is
a ballot measure committee (e.g., Senator Lee's
Ballot Measure Committee) prior to the designation
of the ballot measure number. See additional
requirements for primarily formed committees.
Sponsored Committees: A sponsored committee
(including most political action committees) must include
the full name of its sponsor in the name of the committee.
If the committee has more than one sponsor and the
sponsors are members of an industry or other identifiable
group, include a term identifying that industry or group.
oppose a ballot measure must include:
• A statement identifying the ballot measure(s)
number or letter and whether it supports
or opposes the measure(s) (e.g., Committee
For Proposition/Measure _ or Committee
Against Proposition/Measure _).
Recalls: Each committee established for a recall
election must include the name of the officeholder
subject to the recall. If the committee is not
controlled by the officeholder, the committee must
state its support or opposition (e.g., Committee
Opposing the Recall of Council Member Doe).
Supporting or Opposing a Candidate: The name of
each committee primarily formed to support or oppose
a state or local candidate(s) being voted on in a single
election, other than a recall election, must include
the last name of each candidate, the office sought,
the year of the election and must state whether the
committee supports or opposes the candidate(s)
(e.g., Committee to Support Doe for Senate 20XX).
FPPC Form 410 (August/2018)
FPPC Advice: advice@foDc.ca.sov (866/275-3772)
www.fpRc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
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
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have been met:
• 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.
FPPC Form 410 (August/2018)
FPPC Advice: advice@fRRc.ca.ggv (866/275-3772)
www.fppc.ca.gov
J
Instructions for
Statement of Organization
2. Treasurer and Other Principal Officers_:
A committee may have only one treasurer and
one assistant treasurer. A candidate may be his
or her own treasurer or assistant treasurer. A
committee may not accept a contribution or
make an expenditure without a treasurer.
A committee that is not controlled by a candidate or
officeholder must disclose the name, street address,
and telephone number of the committee's principal
officer(s). The principal officer(s) of a committee are
the individual(s) primarily responsible for approving the
political activity of the committee, including authorizing
the content of communications, authorizing contributions
and other expenditures, and determining strategy. If
more than three individuals qualify as principal officers
of the committee, identify no fewer than three.
If no individual other than the committee treasurer
qualifies as a principal officer, identify that
individual as both the treasurer and the principal
officer. An attachment may be necessary.
3. Verification/Original Ink Signature(s):
The Form 410 filed with the Secretary of State must
contain an original signature(s). The committee treasurer
or assistant treasurer must sign the Form 410. Also,
each controlling officeholder, candidate or state ballot
measure proponent must sign the Form 410. If more
than three control the committee, one of them may sign
on behalf of all controlling individuals. If a candidate
will serve as his or her own treasurer, he or she must
sign as the candidate and again as the treasurer.
Bank Account Information
• Qualified committees must list the name and address
of the financial institution where the campaign bank
account is located and the bank account number.
• Non -qualified committees are not
required to list a bank account.
4. Type of Committee:
Controlled Committee
A "controlled committee" is one which is controlled
directly or indirectly by an officeholder, candidate,
or state measure proponent, or which acts jointly
with an officeholder, candidate, state measure
proponent, or another controlled committee
in connection with making expenditures.
A committee is controlled if the officeholder,
candidate, or proponent, his/her agent, or any other
committee he/she controls, has a significant influence
on the actions or decisions of the committee.
"Proponents" of state measures are persons who
request the Attorney General to prepare a title and
summary of a state initiative, referendum, or measure.
Candidate Election Committee: Identify
the candidate's last name, office, election
year and party, if applicable.
Ballot Measure Committee Controlled by State
Candidate: Identify each measure on which the
committee has spent or anticipates spending $50,000
or more in the current two-year period, beginning
with January 1 of an odd -numbered year. If the
ballot designation has not been assigned, describe
the purpose of the anticipated measure(s). Amend
the Form 410 when a ballot designation is assigned.
Provide this information in the primarily formed or
general purpose section or on an attachment.
Legal Defense Committee: On an attachment,
describe the specific legal dispute(s) for which the
legal defense fund was established. The Form 410
must be amended within 10 days when legal disputes
are either resolved or new disputes are initiated.
Primarily Formed Committee
A committee is "primarily formed" when it makes or
initially plans to make more than 70% of its contributions
and expenditures to support or oppose a specific
candidate or measure, or a group of measures or specific
local candidates all being voted upon in the same
election on the same date. (FPPC Regulation 18247.5)
New committees: A new committee formed within
six months of a statewide regular election or within
30 days of a state special election is presumed to be
primarily formed if the committee makes at least
$25,000 in independent expenditures to support or
oppose a state candidate or measure. Monthly review
is required for other new committees that spend at
least $1,000 a month and were formed within six
months of an election in connection with which the
committee makes contributions or expenditures.
Quarterly review at the end of March, June, September
and December is required for other committees.
A committee controlled by a candidate for his or her
own candidacy is not a primarily formed committee.
State ballot measures - qualification ID number: Certain
committees must list in Section 4, Primarily Formed
Committee, the Attorney General's Office assigned
identification number to a proposed state ballot measure:
• A committee submitting the title and summary;
• A committee primarily formed for the measure; or
• A committee that spends $100,000 or more
on petition circulation for the measure.
Recall Committees: A committee supporting or opposing
a recall must list "Recall [Officeholder's Name];' the
office held by the recall target officeholder, and mark
the appropriate box to indicate whether the committee
supports or opposes the recall of the officeholder.
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.eov (866/275-3772)
www.fppc.ca.eov