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HomeMy WebLinkAbout2016-07-01 Form 410 - KellyStatement of Organization Recipient Committee Statement Type 0 Initial ❑ Amendment Not yet qualified 0 of Ust I.D. number: Date qualified as committee Date qualified as committee (It aPPlk2wel 1. Committee Information NAME OF COMMITTEE Kathleen Kelly for Palm Desert City Council 2016 ❑ Termination - See Part 5 List I.D. number. Elate of Termination STREET ADDRESS IND P.O. ROXI CITY STATE ZIP CODE AREA CODE/PHONE Palm Desert CA 92260 ( MAILING ADDRESS (IF DIFFERENT) :•-i"Tiil� FAX / E-MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE Riverside City of Palm Desert RECMEb T Y CLERK'S OFFICE "ALM DESERT. CA JUL 19 PM 4*- 07 2. Treasurer and Other Principal Officers NAME OF TREASURER Peter Rittenhouse STREET ADDRESS IND P.O. RO%I For othdal Use Dni CITY STATE ZIP CODE AREACDOUPHONE Palm Springs CA 92264 (760)464-6595 NAME OF ASSISTANT TREASURER, IF ANY Mary Helen Kelly STREET ADDRESS (NO P.O. eox) CITY STATE ZIPCODE AREACODE/PHONE Palm Desert CA 92260 ( NAME OF PRINCIPAL OFFICERISI Kathleen Kelly STREET ADDRESS (NO P.O. BOX) CITY STATE NPCODE AREACDDE/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 perjury under the laws of the State of California that the foregoing, ) Executed on Executed on Executed on Executed on 07/01 /2016 BY DATE 07/01 /2016 By DATE By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov 1866/775-3772) www.fppc.ca.gov Statement of Organization i Recipient Committee + INSTRUCTIONS ON REVERSE P _ NAME I.D. NUMBER kalMen Kelly for Palm Desert City Council 2016 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION FirsTank ADDRESS AREA CODE/PHONE CITY 0)836-3510 BANK STATE IIPCODE 730011 Highway 111 Palm Desert CA 92260 4. Typ a 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." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Kathleen Kelly Palm Desert City Council 2016 ® Nonpartisan ❑ Nonpartisan Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDAMS) NAME OR MEASUREIS) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, ASAPPLICABLE) CHEac ONE SUPPORT OPPOSE SUPPORT El OPPOSE LJ_ FPPC Form 410 (Jan/2016) FP PC Advice: advice@fppc.ca.gov I866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE ` gURN Kelly for Palm Desert City Council 2016 4. Type of Committee (Continued) 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 I.D. NUMBER Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO, AND STREET CITY STATE ZIPCOVE Me gwliied S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent 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 maybe 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 (Jan/2016) FPPC Advice: advice&ppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee lJ (p l Statement Type ® Initial v / ❑ Amendment ❑ Termination — See Part 5 Not yet qualified ©or List I.D. number: List I.D. number - III Date ified as committee Date qualified�mittee III applicable) 1. Committee_,Informabon NAME Of COMMITTEE Kathleen Kelly for Palm Desert City Council 2016 Date of Termination STREET ADDRESS IND P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE Palm Desert CA 92260 ( MAILING ADDRESS (IF DIFFERENT) same FAX / E•MAIL ADORfSS COUNTY OF DOMICILE JURISDICTION WHERh LU1AMT! IEE 9 AL.11- Riverside City of Palm Desert Attach additional information on appropriately labeled continuation sheets. Date Stamp R CEIVED AND FILED In 1 le office of the Secretary of State of the State of California 'JUL 0.5 2016 2. Treasurer and Othe NAME OF TREASURER Peter Rittenhouse STREET ADDRESS INO P.O_ BOXI For Official Use Only 'rr CITY yrpyTE vpco f AnEA[OIDWHONE Palm Springs CA 92264 (760)464-6595 NAME OF ASSISTANT TREASURER, IF ANY Mary Helen Kelly STREET ADDRESS (NO PO. BOXI 1JTT $we aro)OE AREACODE/PHONE Palm Desert CA 92260 760 902-1442 NAME Of PRINCIPAL nFFICER(S) Kathleen Kell STREET ADDRESS (NO RO BOX) CITY STATE ZIP CODE AREA CODE/PHONE Palm Desert CA 92260 .., :( I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained penalty of perjury under the laws of the State of California that the foregoing is true and orrect. Executed on 07/01 /2016 sy PROPONENT is true and coMA- certify ul3ftr rn � c;:) IZT i3 ;:rJ TTI r/1 N 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 (Jan/2016) FPPC Advice: advice@fppc-ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE WP-g-2 Iralf716ef1 Kelly for Palm Desert City Council 2016 IID_NUMBER • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION FirstEank ADDRESS AREA CODEIPHONE CITY )836-3510 BANK ACCOUNT NUMBER STATE ZIP CODE 73000 Highway 111 Palm Desert CA 92260 4. Typ of'COi -mittEe Comte` plea 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." • if this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CAN MEASURE PROPONENT Kathleen Kel ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION Palm Desert Citv Councii 2016 Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEM NAME OR MEASURE(s) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY Nonpartisan Nonpartisan CHECK ONE FPPC Form 410 Van/2O16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Kelly for Palm Desert City Council 2016 4. Type of Committee ' Wontinuedi • • • 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 Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CM [.9f; r 1:1 1 1 Oate quallfled Page 3 LD. NUMBER 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov