Poway Democratic Club 410 Initial 01/29/2024Statement of Organization
Recipient Committee
Statement Type ® Initial ❑ Amendment
Q Not yet qualified
or
® Date qualification threshold met Date qualification threshold met
03 21 / 2022 /
LD. Number 1445238
(if applicable)
NAME OF COMMITTEE
Poway Democratic Club
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Poway CA 92064 858-218-6528
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
treasurer@powaydemocraticclub.org
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
San Diego City of Poway
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
RECEIVED AND FIL
❑ Termination — See Part 5 I the office of the Secretary of St to MF.,iao
of the State of califomia
JAN 16 2024 AN 2 9'2024
Date of termination
CITY OF POWAY
NAME OF TREASURER
Delta Esparza
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
Poway
GA 92064,
EMAIL ADDRESS OF TREASURER (REQUIRED)
AREA CODE/PHONE
treasurer@powaydemocraticclub.org
651.353.5120
NAME OF ASSISTANT TREASURER, IF ANY
Jana Johnson
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
Poway
CA 92064
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
AREA CODE/PHONE
vicepresident@powaydemocraticclub.org
858.699.2805
NAME OF PRINCIPAL OFFICER(S)
Amit Asaravala
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
Poway
CA 92064
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
AREA CODE/PHONE
president@powaydemocraticclub.org 858-218-6528
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 Califo nia that the foregoing is true and correct.
Executed on ) Z l LU By
DATE SIGN TURE OF TREASURER OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on gy
" DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2023)
FPPC Advice: (866/275-3772)
Statement of Organization
CALIFORNIA1
Recipient Committee
• -
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
Poway Democratic Chub
1445238
• 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
AREA CODE/PHONE
BANK ACCOUNT NUMBER
U.S. Bank
(858) 391-7040
ADDRESS OF FINANCIAL INSTITUTION
CITY STATE ZIP CODE
13395 Poway Rd ,
Poway 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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION 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) 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 {866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
Poway Democratic Club 11445238
se'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 the Poway to network, obtain more information on issues, and to take political action.
List additional sponsors on an attachment.
NAME OF SPONSOR
STREETADDRESS . NO. AND STREET
Small•Contributor Committee
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Date qualified
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
STATE ZIP CODE AREA CODE/PHONE
• 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: ;: :__.,(866/275-3772)