HomeMy WebLinkAbout2022-08-23 Form 410 - HarnikStatement of Organization tCEiVOL ND r!L,_.- %,ALIFORNIA,
Recipient Committee the office of the Sec
Statement Type x 10
of the State of Cal
Initial ❑ Amendment ❑ Termination — See Part 5 For Official Use Only
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1. Committee Information I.D. Number 1az2o67 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER
Re-ele-t Jan Harnik Palm Desert City Counr:il 2E.22 Jan Harnik
STREET ADDRESS (NO PO BOX)
STREET AMRESStNT+PO.EIOXF CITY
STATE TIP CODE AREA CODEIPHONE
Indian Wells CA 92210 (
(I TY STATE ZIP{ODE AREA-..-DE/PHONE NAME Of ASSISTANT TREASURER, IF ANY
Indian Wells CA 92210 :
FULL MAILING ADDRESS (IF DIFFERENT)
West Sacramento, CA 95799
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIO NALI
COUNTY OF DOMICILE IURISDICTtON WHERE COMMITTEE IS ACTIVE
Riverside City of Palm Desert
Attach additional informat)on on appropriately labeled continuation sheets.
Bryan Burch
STREET ADDRESS IND RO- BOX)
C TY STATE ZIP CODE AREA COUE/PHONE
West Sacrament: CA 95691
NAME OF PR Ni IPAL OFFICER(S)
STREET ADDRESS [NO P-; BOX)
CITY STATE ZIPC#DE AREA CODE/PW>NE
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 fore o' ' ru nd correct.
Executed on 8/25/2022 By
DATE
Executed on 8/25/2022 By
DATE
Executed on
DATE
Executed on
OR STATE MEASURE PROPONENT
By
SIGNATURE Or CONI ROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
DATE SIGNATURE OF CONTROLLING OFFICE HOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 414 (August/2018)
FPPC Advice: advice@fppc.ca.gov (8661275-3772)
www.fppc.ca.gov
netfile.com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
2 of 3
COMMITTEE NAME I.D, NUMBER
Re -Elect Jan Harnik Palm Desert City Council 2022 1322067
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
California Bank and Trust
ADDRESS
AREACODE/PHONE
(
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
Los Angeles CA 90071
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 D15TRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
City Council Menber City of Palm Desert
Nonpartisan
Partisan
(list political party below)
Jan Harnik
2022
X
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(5) FULL TITLE (INCLUDE BALLOT NO. OR LETTERI
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME
CANDIDATE($) OFFICE SOUGHT OR HELD OR MEASUREIS) ,L RWICT.ON
(INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE"
CIIECK ONE
T I OPPOSE
nPP 2.LF
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3 of 3
1.1) NUMBER
Re -Elect Jan Harnik Palm Desert City ct:uncil 2C.2::
4. Type of Committee (Continued)
General Purpose Committee i
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 DESCA. PTION OF ACTIVITY
SponsoredList additional sponsors on an attachment.
NAME pF iP4 N34R
'N:,. t I v . ROUP OR AFFILIATION O4 SPONSOR
STREET AODRESS N:: AN, ?T'?E' !T- STATE ZIPCODE AREACODE/PHONE
Contributor• ❑ 1
Date qualified
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 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 (August/2018)
FPPC Advice- advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov