2022-06-27 - Form 410 - NevinsRECENED AND FiL�:iJ
in the office of the Secretary of state
of the Slate of California
Statement of Organization (/
(
�
JUN 13
Date A
• -
Recipient Committee //
2022
R L C E I V E D
e.
Statement Type ® Initial ❑ Amendment
❑ Termination — '" ? b0 F P A L t i S P R I l'
For Official Use Only
0 Not yet qualified
—g '10:
or
2022 JUN 21
P6fih
O Date qualification threshold met Date qualification threshold met
Date of termination
i : I- I C
CommitteeI. I.D. Number
2. Treasurer and Other
PrincipalOfficers
a llmbk
NAMEOFCOMMITTEE
NAME OF TREASURER
Scott Nevins for Palm Springs City Council District 1, 2022
Scott Nevins
STREET ADDRESS (NO P.O. BOX)
4426 Vantage Lane
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
AREA CODE/PHONE
4426 Vantage Lane
Palm Springs
CA 92262
917.693.5572
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Palm Springs CA 92262 917.693.5572
FULL MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE ZIP CODE
AREA CODE/PHONE
scott@scottnevins.com
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE 15 ACTIVE
NAME OF PRINCIPAL OFFICERS)
Riverside
Palm Springs
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE
AREA CODE/PHONE
3. Verification
I IWVe UDCU dll ICdDVfld Ole aflIVUIILC NI PrePdnng tnis stiitemenE dna to the oest Or my Knowledge the Information comameo nerem is true and complete. I certify under
penalty of perjury under the laws of the State of California at t e fo oing is true and correct.
Executed on By
ATE SIGNAr OF TREASURER OR ASSISTANT TREASURER
Executed on 62 By
TE SIGNATURE OF CO CENOLDER,CANDIDATE,ORST%TE 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: advicetafooaca.eov (866/275-3772)
w.fDDC.Ca.eov
I.
Statement of Organization
'Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
I
I.O. NUMBER
Scott Nevins for Palm Springs City Council District
1, 2022
• All committees must list the financial institutioiwhere the campaign bank account is located.
NAME OF FINANCIAL INSTIMION j
AREACODE/PHONE
BANKACCOUNTNUMBER
Wells Fargo i
(760) 416-3087
Pending
ADDRESS I CITY
STATE ZIPOODE
543 S Palm Canyon Dr I Palm Springs
CA 92264
• 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
I
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Scott Nevins
City Council, District 1
•20•j•
Nonpartisan
If
Partisan
(IM political party below)
Democratic
I
)
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)
IF A RECALL, STATE "RECALL• IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECKONE
SUPPORT I OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: adviceTafooc.ca.gov (866/275-3772)
www.fooc.Ca.eov