Pepin for City Council 2022 410 Amendment 08/30/2021Statement of Organization
Recipient Committee
Statement TypeClerk's'�
Y
tt
1 ::: r amittee
Uate5:aro
Reveivec
AUG 3 0 2021
City of Poway
Other Principal Officers
CALIFORNIA A �y 1
FORMOrly �+ V
For Official Use Only
El
Q Not yet qualified
Or
O Date qualification threshold met
RI Amendment
Date qualification threshold met
08 20 2021
0 Termination
—See Part 5
Date of termination
1n orma
2022
Tit':. I._. N umber
1439479
2. Treasurer and
NAME of TREASURER
William Baber
N,MC of CDF-IF-• iTTFFW
Pepe: for City Council
SS NO O BOX
STREET ADDRESS (ND P.O. BOX)
CITY
La Mesa
STATE ZIP CODE
CA 91942
H NE
CITY STATE IIP CODE AREA CODE/PHONE
Poway CA 92064
NAME OF ASSISTANT TREASURER, IF ANY
FULL MAILING ADDRESS {IF DIFFERENT]
Mesa, CA 91942
STREET ADDRESS MO RD. SOX}
E-MAIL AODRES5 {R E4.UIRED}/FAX {OPTioNAL}
CITY
STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE
San Diego
JURISDICTION W HERE COMMITTEE 15 ACTIVE
City of Poway
NAME OF PRINCIPAL OFFICENS)
Attach additranai information on appropriately labeled continuation sheets.
3. Nerific°tion
STREET ADDRESS (NO P.O DOR)
CITY
STATE ZIPCODE
AREA CODE/PHONE
I have used all reasonable diligence in preparing this statement and to the best at my knowleclge the lnrormanon contalnea nerelrl is true ana cvrnpleLe.
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on August 20, 2021 By
VAT E
Executed an August 20, 2021 BY
DATE
Executed on
Executed on
DATE
By
BY
DATE
SIGNATURE OF TREASUR
SIGNATURE OF CONTROLLING OFF ICI NOL DER, 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/201a)
FPPC Advice: v; ::� �,va. �_(866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
Page 2
COMMITTEE NAME
Pepin for City Council 2022
I.D. NUMBER
1439479
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
Union Bank
AREA CODE/PHONE
619-667-3000
BANK ACCOUNT NUMBER
ADDRESS
CITY
STATE ZIP CODE
3123 Lemon Grove Avenue Lemon Grove CA 91945
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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
Brian Pepin
Poway City Council District 1
2021
Nonpartisan
1
Partisan
(list polltkal 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 MEASURES) 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
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: :i ; r,.; c.. (866/2753772)