HomeMy WebLinkAboutBobby Khullar for Dublin City Council 410 Statement of Organization Date Stamp CALIFORNIA A 1 O
Recipient Committee FORM '�F
Statement Type ®Initial 0 Amendment ❑ Termination—See Part 5 For Official Use Only
r Not yet qualified
or 4 2018
Q Date qualified as committee ---/—/ ---✓---/ APR
Date qualified as committee Date of termination
/---/ erry of DUBLIN
I.D.Number IT IAANACiR'SO�
1. Committee Information Of applicable)
2. Treasurer and tier Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Bobby Khullar for Dublin City Council-2018 Maryanne Tracy-Baker
S FILET ADDRESS(NO P.O.BOX)
1420 Vistagrand Dr
STREET ADDRESS INC PO.BOX) CITY - STATE ZIP CODE AREA CODE/PHONE
5522 Eaglebrook Ter San Leandro Ca 94567 510-329-8286
CITY STATE ZIP CODE ARIA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Dublin Ca 94568 510-584-6760 D 'FPAL-1 1-• AAA L 1...4 .0'
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P..(1.BOXI
55 Zz EAAL.E 30-ei:V s Sic. -6gH-6l23
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP COOT AREA CODE/PHONE
Ati3t.•e1/44 / el 1-156 g
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Alameda Alameda
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE 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 � '— , By / ' / c...^ / c u -
2 (IA '• __JL \.SIGNATURE OF F URER OR ASSISTANNTTT A URER //�
Executed on J/"�C /'ZC9! b By —--� c/ �C� �� / r `'
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(February/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
Bobby Khullar for Dublin City Council -2018
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
4.Type of Committee Complete the applicable sections.
Controlled Committee
• 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
Nonpartisan Partisan (list political party below)
Vivek"Bobby" Khullar City Council 2018
Nonpartisan Partisan (list political party below)
Primarily Formed Committee 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
IF A RECALL,STATE"RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(February/2018)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
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 El Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STALE ZIP CODE AREA CODE/PHONE
Small Contributor Committee El / /
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(February/2018)
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FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov