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GEORGE, LAN - FORM 410 - INITIAL Statement of Organization • Date Stamp CALIFORNIA Recipient Committee RECEIVE D FORM 410 Statement Type ®Initial 0 Amendment 0 Termination—See Part 5 For Official Use Only 0 Not yet qualified JUL 5 Z02U or 0 Date qualification threshold met Date qualification threshold met Date of termination CI CITY CLERK'S OFFICE TY OF ARROYO GRANDE 1. Committee Information I.D.Number 2. Treasurer and Other Principal Officers (1 a•plicable NAME OF COMMITTEE NAME OF TREASURER —Elect Lan George City Council 2020 Taryn Conaway - 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 COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) San Luis Obispo City of Arroyo Grande Lan George STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. Arroyo Grande CA 93420 3. Verification . I have used all reasonable diligence in preparing this statement and to the best of my knowledge t e information contained herein is true and complete. I certify under penalty of perjury nder the laws of the State of California that the foregoing is true and correct. Executed on I . By Aim --�,/�����'�� ' OR ASSISTANT TREASURER Executed on , 2� 'K l By �� / , TATE SIGN• IRE 0 CONTRO,.FFICEHOLDER,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:advicefa7fpr c.ca.gov(866/275-3772) www.fppc.ca.aov Statement of Organization CALIFORNIA A Recipient Committee FORM `t 1 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D.NUMBER Elect Lan George City Council 2020 • 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 805-473-6875 ADDRESS CITY STATE ZIP CODE 1026 East Grande Avenue Arroyo Grande CA 93420 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 Lan George City Council 2020 Nonpartisan Partisan (list political party below) • Nonpartisan Partisan (list 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:advice@fppc.ca.gou(866/275-3772) wuvlwAnaLC.ca.gov Statement of Organization CALIFORNIA 410 Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME LD.NUMBER Elect Lan George City Council 2020 4.'Type of Committee (Continued). GeneralPurpose 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 - 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 Small Contributor Committee ❑ _�__/ Date qualified 5."Tert inat1011,Requirements By-signingthe,verification,the treasurer;as-sistanttreasurer,and/or+candidate,officeholder,;or•ponent certify:that ail of the.following conditionshave fieen stet • 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@fpac,ca.Fiov(866/275-3772) www-fppc.ca.Rov