Poway Democratic Club 410 Initial - I.D. 03/22/2022-22
Statement of Organization
Recipient Committee
Statement Type
1. Committee
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CALIFORNIA 410
FORM
atperMisteeffte
2 .f
MAR 2 `022
city of POWer
of the State of OsitfOTflIa
FEB 2 3 2022
threshold met
threshold met
■ Termination — See part Sri
Date of termination
_I-,
the office of the Socretcry of Slate
of the State of ratifn nia
JAN 3 1 2QZZ
Other Principal Officers
I'j Initial
• Amendment
el Not yet qualified
Dr
Q Date qualification
�!__,
Date qualification
_/__y
Information I.D. Number
,fop. 'cable
Club
2. Treasurer and
NAME OF TREASURER
Carla Hernandez
NAME OF COMMITTEE
Poway Democratic
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (No P.O. BOX)
Mr — OW
CITY STATE ZIP CODE AREA CODE/PHONE
Poway CA 92064
CITY STATE 2IP CODE
Poway CA 92064
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
FULL MAILING ADDRESS (IF DIFFERENT)
P.O. Box 28, Poway, CA 92074
STREET ADDRESS (NO PO. BOX)
EMAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE
San Diego
JURISDICTION WHERE COMMITTEE IS ACTIVE
City of Poway
NAME OF PRINCIPAL OFFICER(S)
Amit Asaravala
Attach additional information on appropriately labeled continuation sheets.
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE . AREA CODE/PHONE
Poway CA
3. Verification
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I have used all reasonable diligence in preparing thr
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on / " Q_ - apaa,By
DATE
Executed on By
DATE
Executed on By
DATE
Executed on By
DATE
SI RE OF TREASURER OR ASSISTANT TREASURER
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(afonc.ca.eov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
NSTRUCTIONS 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
AREA CODE/PHONE
858-391-7040
BANK ACCOUNT NUMBER
ADDRESS
13395 Poway Rd.
4. Type of Committee Complete the applicable sections.
Controlled Committee
CITY
Poway
STATE ZIP CODE
CA 92064
• 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 FIELD
(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)
c ncnrcurn naP'
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 420 (August/2018)
FPPC Advice: advice@fppc.ca.eov (866/275-3772)
www.fapc.ca.eov
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:
CrTy 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 AFF MAT ION OF SPONSOR
STREET ADDRESS
NO, AND STREET
CITY
STATE ZIP CODE
AREA COD EJP HONE
Small Contributor Committee
Oat. 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: adviceiBfopc.ca.euv (866/275-3772)
www.fppc.ca-goV