RAY RUSSOM, CAREN - FORM 410 - AMENDMENT Stamped by SOS) Cuero 1
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Statement of Organization Date Stamp CALIFORNIA 41
Recipient Committee ` IVED AND FORM
Statement TypeFor Official Use Only
YP 0Initial ® Amendment ❑ Termination—See Part he office oflthe Secretary of Sian
Q Not yet qualified
of the Stag of California
MAR
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Q Date qualification threshold met Date qualification threshold met Date of termination , ,p BAR 2020
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I.D. Number .- r _ 4 _ ` 1
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1406391
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NAME OF COMMITTEE _ ,_ I. NAME OF TREASURER" I
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Caren Ray Russom for Mayor 2020 Caren Ray Russom i _
STREET ADDRESS(NO P.O.BOX) L / '
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STREET ADDRESS(NO P.O.BOX) CITY , STATE ZIP CODE AREA CODE/PHONE
I , Arroyo Grande CA 93420
CITY - STATE ZIP CODE i AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Arroyo Grande CA 93420 '
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
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E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE -
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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)
- CITY ) STATE ZIP CODE' AREA CODE/PHONE
Attach additional information on appropriately labeled Continuation sheets.
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I have used all reasonable diligence in preparin:this
CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT',
Executed on By l
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE j SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
I FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
i ( www.fppc.ca.gov
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Statement of Organization ' '
Recipient Committee CALIFORNIA ��
INSTRUCTIONS ON REVERSE
Page 2 -
COMMITTEE NAME
I.D.NUMBER
Caren Ray Russom for Mayor 2020 i. 1406391
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• 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 93420
4.Type.of Committee Complete the applicable sections:
Controlled Committee..
• List the name of each controlling officeholder,candidate,lor 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 cab1 didate 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 APPLICABLE) ELECTION
CHECK ONE
Nonpartisan Partisan (list political party below)
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Nonpartisan Partisan (list political party below)
Primarily.FormedCoinmittee.Wit}'- 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) CHECK ONE
- SUPPORT OPPOSE
SUPPORTPP E
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FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov