BARNEICH, KRISTEN - FORM 410 - INITIAL (Stamped by SOS) } V r E ___Date Stamp ?'
Statement of Organization C CALIFOR IA
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Recipient Committee EIED AND FILE] ,FORM< , 4:11:1--::-
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the office f the Secretary of Stat'
Statement Type Initial 0 Amendment 0 Termination—See Part o`F' ForOfflcia Se ly
of the State of California
fik/Not yet qualified or
� �` 20 0 �UN...O 4 2020
0 Date qualification threshold met Date qualification threshold met Date of termination )J
CITY CLERK'S OFFICE
CITY OF ARROYO GRAND
-TreasurerandOther Princi al.Afficers -"..'15-7
1. Committee'Information . LD. Number, 2lit p
- " ' (if appiicable) „'
NAME OF COMMITTEE . 1I 11) .i .ee, - NAME OF TREASURER
ArmyV y Wi lcte Ohl Cuu.1cl. 120 20i0 STREET ADDRESS(NO P.O.BOX)
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
mud G.m-..�.s � cAllS1
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY -
D granak CA. °142D
FULL MA ING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) ..CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OFDOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) -
San @U ti`s- Q b� r►P . ftfl b b &Y d& 1 sl-k n
STREET ADDRESS(NO P.O.BOX) ,
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CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriatelyIabeled continuation sheets. kr- II
O Ck 9:64°20
3.. Verification l',.;-:;:2';•::: r • :', • •
I have used all reasonable diligence in preparing this statement and to the best of my knowledgethe information,contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California thatrethe foregoing is true and correct.
Executed on Si 1'61 71
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR,STATE MEASURE PROPONENT
Executed on By (
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT -
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Executed on By
DATE t - SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROF ONENT
FPPC Form 410(August/2018) -
. FPPC Advice:advice( fppc.ca.gov(866/275-3772)
' www.fppc.ca.gov
•
t Statement of Organization - CALIFORNIA': ..-�' o
Recipient Committee .. FORM=_. '# -
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME i. I.D.NUMBER
(‘,6-Yri n -ec, A-o ,-,\e*4- VAric) bonnie[ch f o ON ClTarl GI (gl°
• All committees must list the financial institution I here the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE/PHONE BANK ACCOUNT FiUMBER
'MC&an(G 16an)_ I kiS`il 3 -- L 7 ✓
ADDRESS CITY STATE ZIP CODE•
1D Gin PCY.C,. i 'O CA- goit2D
4,Type of Committee Complete the applicable=sec1 ns . - ' ' , ' ' -__ z _
Controlled Committee .
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• 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 dist r,ict number,if any,and the year of the election.
• List the political party withwhich 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 EAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE.MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
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b nekth o , CM.nc i 1 —1 DI n --,c,
, Nonpartisan Partisan (list political party below)
Primarily Formed Committee; '1'. Primarily formed to;support or oppose specific candidates or measures in a single electil n. 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:advicef'fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
1 ,
':-• Staiethent of Organization , CALIFORtsilkta
Recipient Committee .-FORIIV, -- -
. _
INSTRUCTIONS ON REVERSE , .
, Page 3
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COMMITTEE NAME. cI • 7,-., I.D.NUMBER
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Chyywn 0-sfi b), Ve, .0,ed Vfol-cp _barlietidi 0 arand alit (Lotkrict 1 0-09-J)
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4. Type of COirmittee :. (Continue4);, ,,-..„„ -,---;:,., - -,:...,- 1:'-, - -`:,2 -=.-z.;"1::".--=',t-----: -, . ,,.„„"-- ;,-;,-_-,:, z-...,,,:,,t,- •;, ,.,-, , ,,l..„ ,.;-:,-, - „ .,..,:,'•',, 2:-.. - :','-..;Ts.;±-....".. , '. ,
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I eneral Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Leck only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE Chmmittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored CoMmittee - List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STAT ZIP CODE AREA CODE/PHONE
[
Stnoll:Contributdr Comlnittee . 0 ,
Date qualified
S:Termination keg uirements .1:Eiy.;,i-in in;
thi;eirti4i)p;:t11;ecieaurer,,4sOstanttreas re-r:and/or candiclate;o-ffieehader,prpbfrentCerVithat all of the flowingpnd-ftiolfii have-beert. t;.-.:
• This committee has ceased to receive contributions and make expenditures;
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• 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,arid 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 transrctions.
— 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.
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FPPC Form 410(August/2018)
( FPPC Advice:advicePfppc.ca.eov(866/275-3772)
www.fopc.ca.gov
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