HomeMy WebLinkAboutGoel Form 410 08-21-2015 Initial_RedactedStatement of Organization
Recipient Committee
Statement Type ® Initial
Not yet qualified ® or
Date qualified as committee
NAME OF COMMITTEE
❑ Amendment ❑ Termination — See Part 5
List I.D. number: List I.D. number:
a #
Date qualified as committee Date of Termination
(Ir applicable)
Council 2016
FAX/ E-MAIL ADDRESS
Alameda
Alameda
ACTIVE
NAME OF TREASURER
Maryanne Ti
STREET ADDRESS (NO P.O.
Date Stamp CALIFORNIA
FORM
RECEIVED For Official Use Oni
AUG 21
CITY OF DUBLIN
CITY MANAGER'S OFFIC
er -'Fk nc'i I Officers
Baker
STATE ZIP CODE AREACODE/
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein;ii is true and complete. I certify under
penalty of perjury under the laws of the State of California that the fore
Executed on 08/20/2015 By
DATE
Executed on 08/20/2015 By
DATE SIGNATURE EPROPONENT
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 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
Arun Goel for Dublin City Council 2016
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
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k.. t"ata'•s�rF'a: :..,:.':��4�'., :v'y- _ .., .:�._ .., .., 'aA :'T .ii < "�':' �"c -'Y - .1. - n iz . ?., :•) :its "�7snc;.. .i
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• 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
Arun Goel
City Council
2016
® Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE($) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO,, CITY OR COUNTY, AS APPLICABLE) rNFrK ONF
FPPC Form 410 (Dec /2012)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
0
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
Arun Goel for Dublin City Council 2016
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
List additional sponsors on an attachment.
NAMEOFSPONSOR
STREET ADDRESS NO. AND STREET
Small Contributor Committee
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
Page 3
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.`,LIMInat1011ft�glJlrenlent5 < y_si�ningthevenfptlon,:the.tre sUreri ssistanG#reasUPe andfgr ;capdidateofflcehOideF,:orpropo ent_Certip� that Ilof3hefolio (r� cohd(�lans.havebeen:met:`::'=
a L
• 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 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov