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Preserve Poway 410 Initial 8/10/20Statement of Organization Recipient Committee Statement Type L/ (j7- „._ L Date Stamp -yy,=l in the office cline S-crct ry of or'the State of CeIIfor( is #� ,� „ a7 p^ i7 ! nz— �t s F,u,t, n L L, CALIFORNIA 41 0 FORM 3-iaTe.4. For Official Use Only 'f: j 0 PH LI: 29 i/ _: o . -t iJ 4 Initial Not yet qualified or Q Date qualification threshold met / • Amendment ■ Termination — See Part 5 Date of termination / / Date qualification threshold met / / 1. Committee Information -t �©uoa.,A. I.D. Number if applicable) 2. Treasurer and NAME OF TREASURER S ' .1 Other Principal O icers S) V ' • NAME OF COMMITTEE e STREET ADDRESS (NO P.O. BOX) / ADDRESS (NO P.O. BOX) l ?-- STATE ZIP CODE AREA CODE/PHONE c CU/4- M 4' u261/ S'S i2, 6 744. 0 71-6 STATE ZIP CODE AREA CODE/PHONE di (R)„. NAME OF ASSISTANT TREASURER, IF ANY ILING ADDRESS (IF DIF ENT) STREET ADDRESS (NO P.O. BOX) E-MAIL ADDRESS (REQUII]R��ED)/ FAX (OPTIONAL) j1�� CITY STATE ZIP CODE AREA CODE/PHONE COUNTY' OF3DOMICILE l1 3 JURISDICTION WHERE �COMMITTEE I ? 3i0\l) IS ACT VE NAM FQF PRINCIPAL OFFICER(S) yCi-v. j.'4CUiL-4-"D'I. a I Attach additional information on appropriately labeled continuation sheets. 3. Verification STREET ADDRESS (NO P.O. BOX) 13STc(t( CODE AREA CODE/PHONE Qum e— 1- z 610 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 under the laws of the State of California that the foregoing is true and c rrect. Q � Executed on 7/ (/2--‘)ByIP1/ �CliTi�/r . on �/ 1( Z_.c. By D E Executed on By DATE Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fpoc.ca.zov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE CALIFORNIA 410 FORM Page 2 COMMITTE I.D. NUMBER • 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 4. Type of Committee Complete the applicable sections. Controlled Committee CITY STATE ZIP CODE • 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. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY CHECK ONE 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) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE Cie' (I1 /� ✓ �� --6 tQ 1J /��-cbo C 0_ Y Cif SUPPORT OP OSE . -` SUPPORT OPPOSE FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE CALIFORNIA 410 FORM Page 3 CO MMITTF€ALCM 4. Type of Committee General Purpose Committee • (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee 0 STATE Committee I.D. NUMBER 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. 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: advicePfppc.ca.gov (866/275-3772) www.fppc.ca.gov