RAY RUSSOM, CAREN - FORM 410 - TERMINATION ::tment of Organization Date Stamp CALIFORNIA
:.1letyiR►int Committee RECEIVED FORM• 410
Statement Type 0 Initial 0 Amendment g Termination—See Part 5 For Official Use Only
0 Not yet qualified JUN 2 3.2022
' or
0 Date qualification threshold met Date qualification threshold met Date of termination CITY CLERK'S OFFICE
,, �`� _�_� (p ( I C TY OF ARROYO GRANDE
1. Committee Information I.D. Number i 40 le 39I 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE - NAME OF TREASURER
CCce-en Rat' Ru.sson-, Ca.. SSOrr
or' 2020
STREET ADDRESS(NO P.O.BOX)
STREET ADDRESS(NO P.O.BOX) - CITY STATE ZIP CODE AREA CODE/PHONE
C °(3L'
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Airrok60 a), Ci'*-) -
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JIBilkfICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
L Lekc t s cbiseo �a
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I ave use• al reasonable diligence in preparing this sta ement 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 Stat alifo la is th,. ,he foregoing is true and correct.
Executed on / lvCs By
D. E d SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on - - By
I ATE
SIGNATURE OF CONTROLLING OFFICEHOLDER,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:advicecafppc.ca.4ov(866/275-3772)
www.fppc.ca.(;ov
tafement of Organization CALIFORNIA
"Recipient Committee 41 O
FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME -
I.D.NUMBER
air 12aAl
1?u o r J1/4A. or' 202-o I 40 t
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
F D r - r w c4- A. 6racxL cI 6!3 t{-W
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"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)
Nonpartisan Partisan (fist political party below)
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 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:advicePfppc.ca.eov(866/275-3772)
wwwfppc.ca.eov
.'Recipient
of Organization CALIFORNIA
Recipient Committee FORM 41 0
INSTRUCTIONS ON REVERSE
Page 3
COMMITTE AME O
I.D.NUMBER
r2-1A-S.5 T/l ' �Y/- 1.02-C 140(039
. Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee
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 STATE ZIP CODE AREA CODE/PHONE
mall Contributor Committee 0
Date qualified
5. Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or ponent certify that all of the following conditions have been met:
• 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(a fppc.ca.gov(866/275-3772)
www fppc.ca.eov