BARNEICH, KRISTEN - FORM 410 - AMENDMENT Statement of Organization DateSa CA
�tECEILIFORNIA 410
Recipient Committee FORM
Statement Type 0 Initial ® Amendment ❑ Termination-See Part 5For Official Use Only
0 Not yet qualified JUN 2 9 2020
or opt CLERK'S OFFICE
0 Date qualification threshold met Date qualification threshold met Date of termination Crry OF ARROYO GRAND
__/_/ _� 24 , 2020 �
— _/
1. Committee Information I.D. Number 1426688 2. Treasurer and Other Principal Officers
(i applicable
NAME OF COMMITTEE NAME OF TREASURER
Committee to reelect Kristen Barneich Arroyo Grande City Council 2020 Brittany Bersbach
STREET ADDRESS(NO P.O.BOX)
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)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
Barneich2020@gmail.com
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
•
San Luis Obispo Arroyo Grande Kristen Barneich
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
Arroyo Grande CA 93240
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury underlthe laws of the State of California that
(the foregoing is true and correct.
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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.eov(866/275-3772)
b www.fppc.ca.tov
•
Statement of Organization CALIFORNIA 410
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Commitee to reelect Kristen Barneich Arroyo Grande City Council 2020 1426688
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Mechanics Bank 805)473-7710
ADDRESS CITY STATE ZIP CODE
1026 E Grand Arroyo Grande CA 93420
4' Type of'Committee7 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
Kristen Barneich City Council 2020 Nonpartisan Partisan (list political party below)
I
Nonpartisan Partisan (list political party below)
'Pr�r�arlly Fo`rrrig`d Committee.t '<< 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:advice aPfupc.ca.gov(866/275-3772)
www.fppc.ca.aov
•
Statement of Organization CALIFORNIA A 1 O
Recipient Committee FORM '�F
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Committee to reelect Kristen Barneich Arroyo Grande City Council 2020 1426688
4.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 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
t-Sponsored•Committee' .i 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
tiSitall.Contribator,Cornrriiftee;.,; ❑ / /
Date qualified
fiy'IS.>Te mfn�h i R Irertlen s B 3i `In`'the verifitation,.the`freasarer;assistant treastfrerandjor candidate,;officehofde'r,oP ponent`certify;tha,'t'all oftfig„ollowing,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(cilfppc.ca.gov(866/275-3772)
www.fppc.ca.gov