HomeMy WebLinkAbout2018-08-28 Form 410 - Harnik3�;
Statement of Organization
Recipient Committee
Statement Type ❑ Initial ® Amendment ❑ Termination -- See Part 5
Q Not yet qualified
or
O Date qualification threshold met Date qualification threshold met Date of termination
1. Committee Information I I.D. Number
(if applicable) 1322067
NAME OF COMMITTEE
Re-elect Jan Hard Palm Desert City Council 2018
STREET ADDRESS INDP0 BO%I
45025 Manitou Drive
C17Y STATE ZIP CODE AREA CODE/PHONE
Indian Wells CA 92210 760-285-7531
FULL MAILING ADDRESS (IF DIFFERENT)
Palm Desert, CA 92261
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
Jan@janharnik.org
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Riverside Palm Desert
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
.ECEIVED AND -lL
the office of the Secretary
of the 5tnte of Calitnmin
AUG 3 0 2010
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STREET ADDRESS (NO P.O. BOX)
For Official Use Only
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CITY STATE ZIPCDDE AREA CDOE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP COOS AREACODE/PHONE
NAME OF PRINCIPAL OFFICERISI
STREET ADDRESS INO P.O. BOxI
CITY STATE ZIP CODE AREA CODE/PHONE
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 perjury under the laws of the State of California ore true and correct.
Executed on August 28, 2018 By
DATE * TREASURER
Executed on August 28, 2018 By
DATE.._. .__ _.... ......._..-� _-.._.___ _..._._._
Executed on By I.
GATE SIGNATURE OF CON7ROLL iN i OFF iCEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
ay
SIGNAtURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
Statement Type ❑ initial ® Amendment ❑ Termination - See Part 5
Q Not yet qualified
or
Q Data qualification threshold met Date qualification threshold met Date of termination
CITY CLERIC'S 0
PALM DESERT.
2019 AUG 28 PM
1. Committee Information I.D. Number 1322067 I 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE
Re-elect Jan Hamik Palm desert City Council 2018
STREET ADDRESS (NO PO BOX)
45025 Manitou Drive
CITY STATE ZIP CODE AREACOOE/PHONE
Indian Wells CA 92210 760-286-7531
FULL MAILING ADDRESS IIF DIFFERENT)
Palm Desert, CA 92261
EMAIL ADDRESS [REQUIRED) / FA%(OPTIONAL)
Jan@janhamik.org
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Riverside Palm Desert
Attach additional information on appropriately labeled continuation sheets.
TREASURER
STREET ADDRESS (NO P.O. Box)
For Official Use Only
CITY
STATE 41PCODE AREACODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (No P.O. sox)
CITY
STATE ZIPCODE AREACODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREACODE/PHONE
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 perjury under the laws of the State of California or true and correct.
Executed on August 28, 2018 By
PATE PINIATIURE OF TREASURERM ASSISTANT TREASURER
Executed an August 28, 2018 B
PATE y `-
Executed on By ;
DATE '' SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
01TF
9y
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 {August/2018]
FPPC Advice: advlce@Dfppcca.gov (866/27S-3772)
www fppc.ca.gov