HomeMy WebLinkAbout2018-08-08 Form 410 - HarnikStatement of Organization
Recipient Committee
Statement Type ❑ Initial ® Amendment ❑ Termination -- See Part 5
Q Not yet qualified
or
0 Date qualified as committee
Date qualified as committee Dale of termination
R E'WV� D
IT Y CLERK'S OFFIC
PALM DESERT CA
8 AUG . 8 PM 2: 17
For Official Use Only
i, committee Information
I.D. Number 1322067
(ff applicable)
2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
NAME OF TREASURER
Re-elect Jan Hamik Palm Desert City Council 2018
Dr. William Kroonen
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NOP.O.BOX)
CITY
STATE ZIP CODE
AREACODE/PHONE
73901 Shadow Lake Drive
Palm Desert
CA 92260
760-568-3039
CITY
STATE ZIP Cabe AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Palm Desert
CA 92260
Elizabeth Lopez
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQUIRED)/FAX (OPTIONAL)
CITY
STATE ZIP CODE
AREA CODE/PHONE
jhamik@dc.rr.com
Indio
CA 92203
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Riverside
alm Desert
Jan C. Harnik
STREET ADDRESS INO P.O. BOX)
CITY STATE VPCOOE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets. Palm Desert CA 92260
3. Verification
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 per ury under the laws of the State-oLG41fornia thaLLhe foregoing is true and correct.
Executed on 0lBY LML�;? DATE SIGHIITUR F TREASURER OR ASSISTANT TREASURER
Executed Olt
By /
TE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE
Executed On
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANOIDATE, OR
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Farm 430 (February/2016)
FPK Advice: advlce@fppcca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I D. NUMBER
Re-elect Jan Harnik Palm Desert City Council 2018 1 1322067
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
FirstBank 760-341-7000 462-120-6499
ADDRESS CITY STATE YIP CODE
73-000 Highway 111 Palm Desert CA 92260
4. Type of Committee Complete the applicable sections.
• 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 rHErK ONE
Nonpartisan
Partisan
(list political party below)
Jan C. Harnik
Councilmember / City of Palm Desert
201821
❑
Nonpartisan
Partisan
(list political party below)
El
El
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 MEASUREIS) IURISDICTION
IF a RFrel l cTATF "RFrAI I • IN FRONT nF THE nFFIrFHO1.nFR'S NAME. (INCLUDE DISTRICT NO.. CITY DR COUNTY, AS APPLICABLE)
CHECK ONE
SUPPORT
El
OPPOSE
EJ
SUPPORT
OPPOSE
FPPC Form 410 (February/2018)
FPPC Advice: advice@Dfppc.ca.gov (866/275-3772)
www.fppc.ca.gov