Poway Democratic Club 410 Amendment 03/28/2024Statement of Organization
Recipient Committee
Statement Type ❑ Initial ® Amendment
Q Not yet qualified
or
Date qualification threshold met Date qualification threshold met
03 / 21 / 2022 I / /
I.D. Number 1445238
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)
Poway CA 92074
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
treasurer@powaydemocraticclub.org
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
San Diego I City of Poway
Attach additional information on appropriately labeled continuation sheets.
❑ Termination — See Part 5
Date of termination
NAME OF TREASURER
Nicholas Carruthers
Date Stamp
RECEIVED
MAR 2 8 2024
CITY OF POWAY
STREET ADDRESS (NO P.O. BOX)
EMAIL ADDRESS OF TREASURER (REQUIRED)
treasurer@powaydemocraticclub.org
NAME OF ASSISTANT TREASURER, IF ANY
Jana Johnson
STREET ADDRESS (NO P.O. BOX)
EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
treasurer@powaydemocraticclub.org
NAME OF PRINCIPAL OFFICER(S)
Amit Asaravala
CITY
Poway
CITY
Poway
STREET ADDRESS (NO P.O. BOX) CITY
Poway
EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
president@powaydemocraticclub.org
For Official Use Only
STATE ZIP CODE
CA 92064
AREA CODE/PHONE
858-366-5037
STATE ZIP CODE
CA 92064
AREA CODE/PHONE
858.699.2805
STATE ZIP CODE
CA 92064
AREA CODE/PHONE
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 California that the forego.JIng idstrue and correct.
Executed on By
D E OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
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: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.goV
Statement of Organization CALIFORNIA
Recipient Committee FORT,?
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Poway Democratic Club 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
U.S. Bank
ADDRESS OF FINANCIAL INSTITUTION
13395 Poway Rd
AREA CODE/PHONE BANK ACCOUNT NUMBER
(858)391-7040
CITY STATE ZIP CODE
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 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) FULLTITLE (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@fppc.ca.aov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Poway Democratic Club
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
Page 3
I.D. NUMBER
1445238
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
STREET ADDRESS NO. AND STREET
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE/PHONE
Date qualified 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.gov (866/275-3772)
www.fppc.ca.gov