Poway Council Member Appointments 410 Initial 01/04/2024Statement of Organization
Recipient Committee
Statement Type ® Initial ❑ Amendment
Not yet qualified
or
O Date qualification threshold met Date qualification threshold met
I.D. Number PENDING
NAME OF COMMITTEE
POWAY COUNCIL MEMBER APPOINTMENTS
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
SAN MARCOS CA 92069 619-806-0698
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
TNSGRW@GMAIL.COM
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
SAN DIEGO I POWAY
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
❑ Termination — See Part 5
Date of termination I I 3A N 0 ¢ 2024
/ / 1 1 1 _, CITY OF POWAY
NAME OF TREASURER
J STEVAN KEMP
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
SAN MARCOS
CA 92069
EMAILADDRESS OF TREASURER (REQUIRED)
AREA CODE/PHONE
JSK@PTF-INC.COM
619-548-4084
NAME OF ASSISTANT TREASURER, IF ANY
SARA KEMP
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
SAN MARCOS
CA 92069
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
AREA CODE/PHONE
STSPOLITICAL@GMAIL.COM
760-212-7413
NAME OF PRINCIPAL OFFICER(S)
NATHAN BLAIN
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
POWAY
CA 92064
EMAIL ADDRESS OF PRINCIPAL OFFICER(SI (REQUIRED)
AREA CODE/PHONE
TNSGRW@GMAIL.COM 858-382-4822
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 correct.
12/29/2023 Sara Kemp Digitally signed by Sara Kemp
B
Executed on y p Date: 2023.12.2917:09:39-08'00'
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
12/29/2023 Nathan Blain Digitally signed by Nathan Blain
Executed on By Date: 2023.12.29 17:10:42 -08'00'
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on I By
DATE
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2023)
FPPC Advice: advice@fPPc.ca.Bov (866/275-3772)
www.fppc.ca.goy
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
POWAY COUNCIL MEMBER APPOINTMENTS PENDING
• All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS
ADDRESS OF FINANCIAL INSTITUTION CITY
AREA CODE/PHONE I BANK ACCOUNT NUMBER
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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)
Nonpartisan Partisan (list political party below)
• 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (October/2023)
FPPC Advice: advice@fnnc.ca.l=_ov (866/275-3772)
www.fpgc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
POWAY COUNCIL MEMBER APPOINTMENTS
Page 3
I.D. NUMBER
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
Supports requiring Poway city council to hold district -only special election for council member vacancies (or city-wide special election for Mayor vacancy) instead of appointmed
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
Date qualified
S. 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 (October/2023)
FPPC Advice: advice@fPPc.ca.eov (866/275-3772)
www.faac.ca.sov