Poway Democratic Club 410 Initial 01/27/2022Statement of Organization
Recipient Committee
Statement Type
1. Committee
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JAN 2 7 202Z
CI OF P OFFICE
CLERKS
Other Principal Officers
CALIFORNIA A 1 0
FORM �f
For Official Use Only
r4 Initial
threshold met
0 Amendment
❑ate qualification threshold met
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• Termination
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--See Part 5
Date of termination CITY
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ei Not yet qualified
❑r
❑ Date qualification
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Information 1.D. Number
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2. Treasurer and
NAME OF COMMITTEE
Poway Democratic Club
NAME OF TREASURER
Carla Hernandez
STREET ADDRESS (NO P.O. BOXi
STREET ADDRESS (HOP.O.BOXI
CITY STATE 21PCODE AAFA CODE/PI ION E
Poway CA 92064
CITY STATE ZIP CODE AREA CODE/HONE
Poway CA 92064
NAME O F ASSIS TAN TREASURER, IF ANY
F ULLMAILLN3 ADDRESS OF DIFFERENT)
away, CA 92074
STREET ADDRESS IND P.O. BOX)
E-MAIL ADDRESS(REQUIRED) / FAX (OPTIONAL)
CITY STATE ZIP CODS AREA CODE/PHONE
COUNTY OF DOMICILE
San Diego
JURISDICTION WHERE COMMITTEE 15 ACTIVF
City of Poway
NAME OF PRINCIPAL OFFICERCS)
Amit Asaravala
Attach additional information on appropriately labeled continuation sheets.
STRETvT ADDRESS iNO P.O. BOX)
CRY STATE ZIP CODE AREA COOElPHO NE
Poway CA 858-218-6528
3. Verification
I have used all reasonable diligence an preparing this statement and to the best of my knowledge the intormation contained herein is true an o complete.
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed an '" *C2 7' „
Executed on
Executed on
Executed on
BY
OAF E SI URE OF TREASURER OR ASSISTANT TREASURER
OA1F
OAT£
DATE
ev
BY
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFCEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OFCONTROLiI NG OFFICEHOLDER, CANDIDATE, -OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@ fppc.ca.eov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
CALIFORNIA 410
FORM
Page 2
COMMITTEE NAME
Poway Democratic Club
I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
US Bank
4
ADDRESS
13395 Poway Rd.
AREA CODE/PHONE
858-391-7040
CITY
Poway
STATE ZIP CODE
CA
92064
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
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
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fpoc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Poway Democratic Club
I.D. NUMBER
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:
® CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
The Poway Democratic Club provides opportunities for Democrats in Poway to network with like-minded people, obtain more info on issues, and take political action.
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: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov