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Home My WebLink About2024-02-12 Form 410 - SmithK 33 Statement of Organization 1466777 Date Stamp Recipient Committee L Statement Type ® Initial ❑ Amendment ❑ Termination — See Part 5 DIGITALLY RECEIVED AND FILED ` For official Use only ® Not y qualified ualified in the office of the Californial Secretary of State j,. , i'. • L I �. i : f'j j or FEB 05 2024 O Date qualification threshold met Date qualification threshold met Date of termination - - LImo; l. - - - - - I.D. Number - - - -- - NAME OF COMMITTEE NAME OF TREASURER Denise Lewis Anyse Smith for Palm Desert City Council 2024 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Sacramento CA 95841 EMAIL ADDRESS OF TREASURER (REQUIRED) AREA CODE/PHONE STREET ADDRESS (NO P.O. BOX) ( NAME OF ASSISTANT TREASURER, IF ANY CITY STATE ZIP CODE AREA CODE/PHONE Mari5sa Russell Sacramento CA 95841 ( STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE FULL MAILING ADDRESS (IF DIFFERENT) Sacramento CA 95841 EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) ( NAME OF PRINCIPALOFFICER(S) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Sacramento City of Palm Desert STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 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 is true and correct. Executed on 01/29/2024 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 netfile.com Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Anyse Smith for Palm Desert City Council 2024 Page 2 of 3 I.D. NUMBER • 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 First Foundation Bank ADDRESS OF FINANCIAL INSTITUTION 18101 Von Karman Ave., Suite 750 AREA CODE/PHONE I BANK ACCOUNT NUMBER (916)283-8043 CITY STATE ZIP CODE Irvine CA 92612 • 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 Anyse R. Smith City Council Member City of Palm Desert District 3 20 .24 Nonpartisan X 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) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE FPPC Form 410 (October/2023) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.eov Statement of Organization CALIFORW Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 of 3 COMMITTEE NAME I.D. NUMBER Anyse Smith for Palm Desert City Council 2024 C , 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 J STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE ❑ ermination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that aloof 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.fpac.ca.gov Created: 2024-01-29 By: Marissa Russell (marissa@rcbs.us) Status: Signed Transaction ID: CBJCHBCAABAANtW18oTBggXaU_FzucatGO3ECObOr70m "CA410 Anyse Smith for Palm Desert City Council 2024" History Document created by Marissa Russell (marissa@rcbs.us) 2024-01-29 - 9:05:15 PM GMT �D. Document emailed to Anyse Smith (anyse.smith@gmail.com) for signature 2024-01-29 - 9:05:19 PM GMT Document emailed to Denise Lewis (denise@rcbs.us) for signature 2024-01-29 - 9:05:19 PM GMT Email viewed by Anyse Smith (anyse.smith@gmail.com) 2024-01-29 - 9:16:11 PM GMT C% Document e-signed by Anyse Smith (anyse.smith@gmail.com) Signature Date: 2024-01-29 - 9:16:43 PM GMT - Time Source: server Email viewed by Denise Lewis (denise@rcbs.us) 2024-01-29 - 9:27:49 PM GMT Document e-signed by Denise Lewis (denise@rcbs.us) Signature Date: 2024-01-29 - 9:28:01 PM GMT - Time Source: server Agreement completed. - Q-W-r)I one nner Statement of Organization Recipient Committee Statement Type ® Initial ❑ Amendment ® Not yet qualified or O Date qualification threshold met Date qualification threshold met --// WD. Number I. (if applicable) NAME OF COMMITTEE Anyse Smith for Palm Desert City Council 2024 El Termination —See STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Sacramento CA 95841 ( FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Sacramento City of Palm Desert Date of termination r Date Stamp" L i_ •- 1 r 4 FEB 142 PM I : 35 For Official Use Only NAME OF TREASURER i Denise Lewis STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Sacramento CA 95841 EMAIL ADDRESS OF TREASURER (REQUIRED) i AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Marissa Russell STREET ADDRESS (NO P.O. BOX) ! CITY STATE ZIP CODE Sacramento CA 95841 EMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED) AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) i STREET ADDRESS (NO P.O. BOX) CITY I STATE ZIP CODE EMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED) AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 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 is true and correct. Executed on 01/29/2024 By DATE SIGNATURE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on Y O1/29/2024 B 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 ey, � DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October/2023) FPPC Advice: advice mfppc.ca.sov (866/275-3772) www.fppc.ca.gov neifle.com