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HomeMy WebLinkAboutHaubert Form 410 08-12-2016 Amend_RedactedStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or El Amendment List I,D, number: # 1363526 03/27/2014 Date qualified as committee Date qualified as committee (If applicable) NAME OF COMMITTEE DAVID HAUBERT FOR MAYOR 2016 ❑ Termination — See Part 5 List I.D. number: —✓ —✓ Date of Termination COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE ALAMEDA ALAMEDA Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing this stat( penalty of perjury under the laws of the State of Californi Executed on By DATE Executed on By DATE Executed on By DATE Executed on By DATE NAME OF TREASURER DAVID BAUER For Official Use Only NAME OF ASSISIAN1 7 MEASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE ation contained herein is true and complete. I certify under TE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Dec/2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME DAVID HAUBERT FOR MAYOR 2016 • All committees must list the financial institution where the campaign bank account is located. 2 of 3 I.D. NUMBER 1363526 4 Type of Committee Gomple a the applJcable sectTOnb N r; • 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 DAVID HAUBERT DUBLIN Mayor 2016 [D Nonpartisan sum ❑ Nonpartisan 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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT El OPPOSE El sum OPPOSE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov