HomeMy WebLinkAboutForm 460-2019 Recipient Committee COVER PAGE
Campaign Statement Date Stamp CALIFORNIA 460
"'Cover Page FORM
Statement covers period Date of election if applicable: Page 1 of 6
from 01/01/2019 (Month,Day,Year) For Official Use Only
SEE INSTRUCTIONS ON REVERSE through 06/30/2019
'
1. Type of Recipient Committee: All Committees-Complete Parts 1,2,3,and 4. 2. Type of Statement:
INT Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement
0 State Candidate Election Committee Committee E Semi-annual Statement 0 Special Odd-Year Report
0 Recall 0 Controlled ❑ Termination Statement
(Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination)
(Also Complete Part 6)
❑ General Purpose Committee ❑ Amendment(Explain below)
0 Sponsored ❑ Primarily Formed Candidate/
0 Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part 7)
3. Committee Information I.D.NUMBER Treasurer(s)
1368029
COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER
Mark Carnevale for Cathedral City Council 2018 James Tolliver
MAILING ADDRESS
68470 E Palm Canyon Dr Ste B
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
69-302 Serenity Rd Cathedral City CA 92234 760-328-4185
CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Cathedral City CA 92234 760-413-8339
MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached sch:. --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. c--........
07/23/2019 Jim Tolliver
Executed on By , / `
Dale i Cr :r ,.igkeSfVdltl Ti4�l,urer or As--tent Treasurer
Executed on 07/23/2019 By c/Ii
Date Signatu--. Controlling•'iceholder,Candidate,State Measure Proponent or Responsible Officer of Sponsor
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent
Executed on By
Date Signature of Controlling Officeholder,Candidate,State Measure Proponent
FPPC Form 460(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
N
0073
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