Pepin for City Council 2022 410 Amendment 6/29/2022Statement of Organization
Recipient Committee
Date slaw
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Statement Type El initial
❑ Termination —See Parts
Not yetqualfiedJUN
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2 9 2U22
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of temlination
5 2021
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<, CITY OF POWAY
I.D. Number 1439479
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NAME OF NMMrtLLE
NAME OF TRp3VRER
Pepin for City Council2022
Briana Beleslue
OREFSIXOP.O. YOYJ
STREET ADDRESS (NO ED Ron
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STROT
VFODOE AREACHADPINSHE
Imperial Beach
CA
91932 —
CITY 9ME i1POGDE LPNCOOnVXOXF
"ME OF ADISTANTEREASURER, IF ANY
Poway CA 92064
FULL MAILING ADDRESS (IF DIFFEAE"
rREETADDRESSINORDEGO
Poway, CA 92064
1 Wake ADDRESS IFEREEREEIRUNIFAX IOPAEONAILI
ON
STATE
aPL00E AREAEODEIPXOXE
[OUXIYOFOOMICIIE
TURIMINCITIDN WHERE CA MTTiRISA[9V!
NAME OFPRINGPALOFFlCERI51
San Diego Comfy
City of Poway- District 1
STREET ADORW (NO PD. 9000
Attach additional information on appropriately labeled continuation sheets.
em STATE
21POODE AREACCOUPImNE
DARRYDREED
I have used all reasonable diligence in preparing this statement and to
penalty of perjury under the laws of the
DreEuted on 9/9/22 a,
DATE
6Nemled on g t 9 ji2- t-- al
DATE
Ie best of my Knowledge the Information contained herein Is true and complete. 1 cerRlly W bU
executed on ay
ONF -- SIONATUR€OF CONTROLLING OFFCAIOWERACANDIDATF ORSTATT MEASDRE PROPONENT
laecuted an By
DATE SIGNATURE OF COM&OLLING OFfKEXOLDER, CANDIDATE, OR STATE MEASURE PROMINENT
FINK Form 410(August/2018)
FPPC Advice: advice(Ofooca.mv(866/DS3772)
www.faoc ca.eov
aTatemenl of vrgamzation
Recipient Committee
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INSTRUCTIONS ON REVERSE
Page 3
coMMRRE THEME
for dty Coun2022
Pepin Council
1439479
• All committees must list the financial institution where the campaign bank account is located.
NAME OF iINTN:iTLIXSTITViIOX RET[OOE/i1R1NE
T415.744.6700
86NCAttOYMNVM-•ER
Bank of San Francisco
i
ADDRESS C n
snn nvwDE
575 Market Street, Ste 900 San Francisco
CA 94105
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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 parry with which each officeholder or Candidate is affiliated or check "nonpartisan." Stating "No parry preference" is acceptable
If this Committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OFCpNOIOATF/OFFICEHOLOER/STATF MEASURE pROVOXfHr ldfmn[ nrcrnrtuvu a
xunoe¢....nELECTIVE OFFICES OUGHT OR HEIR YEAROi MRTY
Brian Pepin
Poway City Council - Disltictl
2022
NOn;sanT"nLPamgn
maul Ecal PaMNelow)
Honpvtisan
Panv",
Nis mocapM MENE)
Primarily formed to support or oppose specific Candidates or measures in a single election. fist below:
GNDIDATEM NAME OR MEASURnS) FULL TITLE INCLUDE BALLOT NO. OR LETTER) CANDIMTE(S)OFFICE SOUGHT OR HELD OR MEASUREM JURISDICTION
IF A RECALL,STATE'RECALL"Ili FRONT OF THE OFrICEHOLDE RS NAME. nununc,..m".. ".. ........
�1
FINK Form 410 (August/2038)
FVPCAd m:advicelBfoocrz.eav(866/27S�3n2)
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Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
OMMITTEE NAME 1,0. NUMBER
Pepin for City Council 2022 11439479
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
List additional sponsors on an attachment.
NAME OF SPONSOR
GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Date qualified
► • r.
• 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)
FIRIPC Advice: advicePfppc.ca.gov (866/275-3772)
www.fPOC.Ca_Zav