HomeMy WebLinkAboutForm 410_03/27/19 33
/ 7 4._ 9
L. / Date Stamp
Statement of Organization CALIFORNIA
Recipient Committee RECEIVED AND FELE FORM 410
Statement Type ® Initial 0 Amendment 0 Termination–See Par{r6the office of the Secretary of S1a
For Official Use Only
of the State of California
• Not yet qualified
°r MAR 272019
Q Date qualification threshold met Date qualification threshold met Date of termination p
/-/ /-/ -/ I /� 46
wi. Committee Information I.D. Number 2. Treasurer and Other Principal Officers
Of applicable)
N MF Mr�r; I. • NAME OF TREASURER _. <-.
Committee to Elect Shelley Kaplan to City Council District One 2019 Shelley Kaplan
STREET ADDRESS(NO PO.BOX)
67785 Foothill Rd
STREET ADDRESS(NO PO.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
67785 Foothill Rd Cathedral City CA 92234 6178421243
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Cathedral City CA 92234 6178421243
FULL MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
shelley_kaplan @aol.com '
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Riverside Cathedral City
STREET ADDRESS(NO P.O.BOX)
CITY STATE 71P CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
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I have used ull reasonable diligence in preparing this statement and to the best of
g p p g ••, "iowledge the information contained herein is true and complete. I certify gndea•
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penalty of perjury under the laws of the State of California that the foregoin: . —, c�/� • �..a
Executed on 3/23/2019 By LO
I
DATE XP". •'� ER T.ASSISTANT TREASU'
3/23/2019 By �/v/ i
Executed on /� _;,:
DATE -
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE �r MEA/ 'ROPE •T' T E5
Executed on By ...
/
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STAT MEASU"'ROPONENT , Cs)
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
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