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Home My WebLink AboutBobby Khullar for Dublin City Council 410_2018.05.23 05-23-1 8P03:44 RCVD Statement of Organization RECEIVED CALIFORNIA 41 0 Recipient Committee FORM Statement Type ❑Initial 0 Amendment ❑ Termination-See Part 5 For Official Use Only 0 Not yet qualified MAY 2 3 2018 or 5 21 2018 0 Date qualified as committee —/—/ —I—I—I CITY OF DUBLIN Date qualified as committee Date of termination CITY MANAGER'S OFFICE -/--/- 1 Committee information '+1•D. Number r-'1-1.. Treasurer andaOther Principal Officers`r I (if oPPlicable) NAME OF COMMITTEE NAME OF TREASURER Bobby Khullar for Dublin City Council-2018 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 Dublin 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_:-.i 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 ws ooff)the State of California that the foregoing is true and correct. Executed on bi 2'3J By 44 . _• ■ Z,QIV DATE / SIGN• UR OF TR R• OR A SI TANT TREASURER Executed on 5^2.Z—I$ By 1Jb1 , --. DATE SIGNATURE OF CONTROLLING•FFICEHOLD -, •'• •ATE,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 410 Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME 1.0.NUMBER Bobby Khullar for Dublin City Council-2018 1404867 . . . 4..Tripe o Committee (Continued) _• Generol 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 ❑---I-f Date qualified 5:Termination R equirements •By signing the verification,the.treasurer,assistant treasurer and%r candidate,pificeholdei,,or proponent certIkthat altofthe following contlinons 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) Clear Page Print 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 1404867 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Bank of America 415-216-0781 325093627874 ADDRESS CITY STATE ZIP CODE 1525 Market Street San Francisco Ca 94103 4:Type of Committee Complete the applicablesections: 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 MEASURES)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 ED FPPC Form 410(February/2018) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov