410 Statement of Organization 12-20-2010 Statement of Organization TATEMENTOFORGANIZATION
Recipient Committee Type or print in ink ry
111 M V E :.ALFOIFORNIA RM 410
❑ Termination -See Part 5 For official Use only
Statement Type
❑ I IN A men d men t DEC 2 0 200
Not yet qualified ❑ or List I.D. number: List I.D. number:
# l 3 e ei 3e7 ._.1
�_ J i J_1 i
I CITY CLERK
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
/14IfY/' -Cr ag —
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE NAME ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO ` PP.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
r!TY GTA; E ZIP CODE AREA C0UE /NHUNE
OPTIONAL: FAX / E -MAIL ADDRESS
NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE STREETADDRESS (NO P.O. BOX)
.f4 &„, c(40 P
CITY STATE ZIP CODE AREA CODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true an complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true and correct. ��
OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By I
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OI4 STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
I FPPC Form 410 (June /09)
FPPC Toll -F{ Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization CALIFORNIA 410
Recipient Committee FORM
When to File Amendments amendment must be filed with the filing officer
File the Form 410 within 10 days of receiving When information contained in the committee's receiving th6 committee's original campaign
$1,000 in contributions. See 24 -hour reporting if Statement of Organization changes, file an statements within 24 hours of the change.
the committee qualifies 16 days before an election. amendment within 10 days of the change with The amendment must be sent by fax, online
The date the form is postmarked is the date it is the Secretary of State and local filing officer (if transmission, guaranteed overnight delivery, or
considered filed. applicable). During the period 16 days before an personal d livery.
The "date qualified" as a committee is the date election, file an amendment within 24 hours as
Recipient ommittee Definition
that the committee received contributions totaling
described below.
$1,000 or more during a calendar year. If a A recipient co mittee is any individual (including
Form 410 is filed prior to receipt of $1,000 in 24 -Hour Reporting an officeholde or a candidate), group of
contributions, check the box "Not yet qualified." In addition to the 10 day rule to file an original individuals, or anization, or any other entity that
Once the committee qualifies, file an amended Form 410: receives contr totaling $1,000 or more
Form 410 to report the date qualified. during a calenar year. The term "contribution"
• a recipient committee that qualifies during the includes montary payments, loans and non -
Identification Number 16 days prior to an election in which it must file monetary goods and services received or made for
pre - election statements must file a Form 410 by a political pur ose.
Complete all sections applicable to your committee. fax, guaranteed overnight delivery, or personal
Candidates: he personal connection funds of a candidate ee
Failure to provide all required information will result delivery within 24 hours of qualification with the g
rejection of the Form 410 and may put you in or officeholde used in connection with seeking or
in re
1 y p Y filing officer who will receive the committee's holding elective office are contributions and are
violation of the Act. After filing the Form 410, access original disclosure statements.
the committee's ID number at www.sos.ca.gov. counted towar qualifying as a recipient committee.
• a recipient committee that qualifies during the However, per onal funds used to pay a candidate
Where to File 16 days prior to an election in which the filing fee or a ae for the statement of qualifications
committee makes independent expenditures to appear in the ballot pamphlet are not counted
All Committees: Original and one copy of $1,000 or more to support or oppose a toward the $1,000 threshold.
Secretary of State candidate in that election must file the Form This form was prepared by the Fair Political
Political Reform Division 410 within 24 hours of qualification with the Practices CommI mission (FPPC). For information
1500 11th Street, Rm 495 filing officer who will receive the committee's on Political Reform Act (Act) requirements and the
Sacramento, CA 95814 original disclosure statements and with the Information Pr ctices Act of 1977, see the FPPC
filing officer(s) for the candidate(s) supported C am•ai•n Di losure Manual for your t e of
County & City Y type
or opposed by the independent expenditure. committee. C- mpaign filing deadlines, forms, and
Committees: Also file a copy with These filings must be made by fax, guaranteed
local filing officer who will overnight delivery, personal delivery or onlin _ C ; giber - ---. oval materials are available on the
# � 'FPPC websit: •(ylr a.gov).
receive the original campaign online filing is available). - r f
statements • if, during the 16 days prior to an election wh- r--
a committee is required to file pre-election !, '`i flEC c,
,.....
0 c -,0
Terminating statements, a change occurs in the name of f 1 ! : I
File statements until the termination rules are met the committee, the treasurer or other princip t rk I, ; I }
and the Form 410 Termination is filed. officers, or the controlling candidate, an :. ( '�� 7f ( # ii
FPPC Form 410 (June /09)
FPPC ToII -F ee Helpline: 866 /ASK -FPPC (866/275 -3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNIA 410
FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME / / I.D. NUMBER
cr /c �el IZ T+'�'� �'!'7� 6-; 1-7 ("IA h c (( 2 0 9
4. Type of Committee Complete the applicable sections.
Controlled 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 "non- partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE
DISTRICT OFFICE SOUGHT HELD
NAME OF CANDIDATE/OFFICEHOLDER /STATE MEASURE PROPONENT
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
/r / ( ,h f Non- Partisan
,!�
/1 ( q "/ —' 4'rt 47/4.--6 C 4 o Cj �/vh t l / �-!� 0
❑ Non - Partisan
I I
1
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER
(,a ) L , 11,374 4 4, -f (joy) 2 r — G3
ADDRESS CITY STATE ZIP CODE
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Primarily Formed Committee 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 MEASURES' JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (June /09)
FPPC TollfFree Helpline: 866 /ASK -FPPC (866/275 -3772)
Instructions for CALIFORNIA
Statement of Organization FORM 410
I
I
Statement Type: Committee Name Requirements Primarily Formed Committees
Initial The following committee name rules apply to the Ballot Measu es: The name of each committee
The "date qualified" as a committee is the date that Form 410, the committee's campaign statements primarily formeid to support or oppose a ballot
the committee received contributions totaling $1,000 and to any other references to the committee measure must include:
required by law. See the instructions for Part 4 for • A statement identifying whether it supports or
or more during a calendar year. committee definitions. opposes the ballot measure(s) (e.g., Committee
Amendment For Proposition /Measure _ or Committee
Candidate Controlled Committees (including
If any of the information reported on an initial Against Proosition /Measure ).
ballot measure committees): Any committee g —
statement of organization changes: • The name Must include the economic or other
that is controlled by a state or local candidate
• Mark the amendment box; or officeholder must include the last name of special inte ests of its major donors of $50,000
• Include the committee's ID number and name; the candidate in the name of the committee. In or more, in escending order based on the
• Provide the changed information; and addition, the following rules also apply: amount con ributed to the committee. The list
Complete the verification. of these economic or special interests may not
• Com
P An election committee controlled by one or be intersper ed with constituencies such as
more state or local candidates must also include "concerned citizens, or consumers."
Candidates: the office the candidate(s) is seeking and the
Under certain circumstances, a candidate for local year of the election (e.g., Friends of Smith for • The name o any state or local candidate that
office may amend the Form 410 to indicate that he Assembly 2010, Jones for Council 2010). contributes $50,000 or more.
or she is seeking another term of the same office • An officeholder committee set up by a state • Prior to the designation of the ballot measure
(re- election). A candidate for state office must open officeholder must also include the office held, the number, a p imarily formed ballot measure
a separate committee for each term of office and year the officeholder was elected to the current committee c ntrolled by a state candidate must
may not amend the Form 410 to redesignate an term of office, and the words "Officeholder also state th t it is a ballot measure committee
election committee. Account," as part of the committee name (e.g., (e.g., Senat r Gomez's Ballot Measure
Anderson Assembly 2010 Officeholder Account). Committee).
Termination • A legal defense fund set up by a state or local
Eac
List the committee's identification number and candidate or officeholder must also include Recalls: ust committee established for a recall
indicate the date of termination. the words "Legal Defense Fund" as part of the election must i clude the name of the officeholder
committee name (e.g., Senator Smith Legal subject to the ecall. If the committee is not
Defense Fund). controlled by t e officeholder, the committee must
1. Committee Information: state its suppo or opposition (e.g., Committee
• Provide the full name of the committee. A A ballot measure committe controlled by one Opposing the , ecall of Council Member Doe).
committee may use only one name. or more state candidates must also state that it is
a ballot measure committee (e.g., Senator Lee's Supporting o Opposing a Candidate: The name
The committee's street address must be reported. A Ballot Measure Committee). See additional of each commi tee primarily formed to support or
post office box is not acceptable. The committee's requirements for primarily formed committees. oppose a stat or local candidate(s) being voted
mailing address must also be reported if it is on in a single lection, other than a recall election,
different from the committee's street address. Sponsored Committees: A sponsored committee must include t e name of each candidate, the office
A post office box is acceptable for the mailing (including most political action committees) must sought, the ye r of the election and must state
address. A committee's "domicile" is its address include the full name of its sponsor in the name whether the c mmittee supports or opposes the
as listed on the Form 410. Los Angeles is the of the committee. If the committee has more than
candidate(s) (.g., Committee to Support Doe for
county of domicile for committees located outside one sponsor and the sponsors are members of an Senate 2010)
California. industry or other identifiable group, include a term
identifying that industry or group.
FPPC Form 410 (June /09)
c ODE' T,.11 T.. LL.1..1:....• OCCIA CI! root lOGCI97G 977T