Fppc Form 410 - Statement Of Organization - Recipient Committee Page 6
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7Statement of Organization
410
CALIFORNIA
Recipient Committee
FORM
InSTRuCTIOnS On ReveRSe
Page 3
COMMITTee nAMe
I.D. nuMBeR
4. Type of Committee
(Continued)
General Purpose Committee
not formed to support or oppose specific candidates or measures in a single election. Check only one box:
CITY Committee
COuNTY Committee
STATe Committee
Political Party/Central Committee
PROvIDe BRIeF DeSCRIPTIOn OF ACTIvITy
list additional sponsors on an attachment.
Sponsored Committee
nAMe OF SPOnSOR
InDuSTRy gROuP OR AFFIlIATIOn OF SPOnSOR
STReeT ADDReSS
nO. AnD STReeT
CITy
STATe
zIP CODe
AReA CODe/PHOne
Small Contributor Committee
/
/
Date qualified
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 (October/2017)
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FPPC Advice: advice@fppc.ca.gov (866/275-3772)
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