RAY RUSSOM, CAREN - FORM 410 - AMENDMENT (2) (Stamped by SOS) r. -y. I
Statement of Organization ar$tamp f Ems' rs �,r.iCA �k ° *s
Recipient Committee `,~?� ..1%% cl �`�tt: ° J<ti.- " �iPQRNIAi �
in the cfke of the Secretary Tiof State n }? gii .•.a..�r;o
Statement Type ❑ initialat theStaaofCalifornia For Official Use Only
v[j Amendment 0 Termination—See Part 5
0 Not yet qualified MAR 16 2020 '
or L
• 0 Date qualification threshold met DD=_te qualification threshold met Date of termination I
/ / / / / /
1. Committee Information I.D. Number 2 Treasurer and Other Princi pal Officers
(if applicable) 1406391 - -
NAME OF COMMITTEE NAME OF TREASURER
Caren Ray Russom for Mayor 2020 i
Caren Russom ,
STREET ADDRESS(NO P.O.BOX)
756 Myrtle Street
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
Arroyo Grande , CA 93420
CITY - STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Arroyo Grande CA 93420
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
I
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
.
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
San Luis Obispo City of Arroyo Grande •
\ STREET ADDRESS(NO P.O.BOX)
(
Attach additional information on appropriatelylabeled CITY STATE ZIP CODE AREA CODE/PHONE
f continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and t. 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 of California that -- .re_• •• is true and correct.
03/09/2020 . �
CANDIDATE,OR STATE 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:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee r �A ��a4 I 'k
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
Caren Ray Russom for Mayor 2020 1406391
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Coast Hills Credit Union 805-733-7600
ADDRESS . CITY - STATE ZIP CODE
1580 West Branch Street Arroyo Grande CA I 93420
4 Type of Committee Complete the applicable sections
Controlled'Cammittee v.:
• 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
Nonpartisan Partisan (list political party below)
Caren Ray Russom Mayor, City of Arroyo Grande 2020
Nonpartisan Partisan (list political party below)
u
PtimarilirFcirmedCominittee2W4 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(5)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 OPPOS1
FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
` I