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410 Statement of Organization Recipient Committee_AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial Amendment Q Not yet qualified or Date qualification threshold met Date qualification threshold met -LL// z a I.D. Number /z,4 �3 Y (%oPplicable) `�J NAME OF COMMITTEE ❑ Termination -- See 134)m (?*4, 657 roz c zT>/ e o u j GsG . CITY STATE ZIP CODE AREA FULL MAIILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS OF COMMI EE (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE idol (A rl"J2 cs-rl or r,, -P6-9T'X-A(0 Attach additional information on appropriately labeled continuation sheets. J Date of termination I C NAME OF TREASURER AUG - 8 2024 ERTINO CITY CLERK STREET EMAILAD DRESS OF TREASURER (REQUIRED) 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 under the laws of the State CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October/2023) FPPC Advice: advice(@fppc.ca.eov_(866/275-3772) www.fp-pc.ca.E?O'J Statement of Organization CALIFORNIA ' Recipient Committee p� - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER r-v/z e r- r, c-o t.,J c:r-L y /l 4 9 4�3 v All committees must list the financial institution where the campaign bank account is located NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER C,ttS F#r- O 6A-ASK CITY STATE ZIP CODE Controiled 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. • 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. ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPI ICARI F1 FI FrTir)KI �,....._ I�A/2 C � �Fur, e t c�v wnf �� -r� Gw CI- 0 c r � cv wiJ c�LM Y� Z B Nonpa an Partisan (list political party below) Nonpartisan Partisan (list political party below) FormedPrimarily 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) rHFrK nNF SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410(August/2018) FPPC Advice: advice@fppc.ca.aov (866/275-3772) www.fppc.ca.eov 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: advicegfppc.ca.xov (866/275-3772) www.fppc.ca.goV Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER —General Purpose Committee I 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 J STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE ContributorSmall • ❑ / Date qualified Termination5. • 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@fppc.ca.eov (866/275-3772) www.fppc.ca.goy 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.gov