HomeMy WebLinkAboutBobby Khullar for Dublin City Council 410_2018.04.10 •
Statement of Organization Date Stamp CALIFORNIA
Recipient Committee FORM 41 0
Statement Type ®Initial
❑ Amendment 0 Termination—See Part 5 For Official Use Only
Not yet qualified
or
0 Date qualified as committee / / / /
Date qualified as committee Date of termination
I.D. Number
Conimittee:`,Information. 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER •
Bobby Khullar for Dublin City Council • Maryanne Tracy-Baker
STREET ADDRESS(NO P.O.BOX) •
1420 Vistagrand Dr
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
5522 Eaglebrook Ter San Leandro Ca 94567 510"-329-8286•
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Dbulin Ca 94568 510-584-6760 Deepali Khullar
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
5522 Eaglebrook Ter
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
bobbykhullar @gmail.com Dublin
Ca 94568 510-684-6123
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.
D
Executed on L(—I -I g By
DATE SIGNATURE OF TREASURER ASSISTAN E SUR R
Executed on % " / 1 By
�
DATE IGNATURE OF CONTROLLING OFFICEHOLDER,CA DIDATE,OR STAT MEASURE PROPONEN1
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
Recipient Committee FORM 41 0
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I .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
Type of{Committ e )Cornpl0, the applicable sections 4
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 �/ E
Nonpartisan Partisan (list political party below)
El
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
Recipient Committee FORM 41 0
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME
I.D.NUMBER
•
4 Type of Committee,. . (Cormnu'ed)
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
Sponsored Committee List additional sponsors on an attachment.
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 treasuretand/or candidate;.officeholder,orproponent,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.
Clear Page Print I • FPPC Form 410(February/2018)
-- - -- �- FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov