HomeMy WebLinkAboutForm 460_08/14/19 COVER PAGE
Recipient Committee 1LIFORNIA 460i� t.
Campaign Statement REtFORM
Cover Page
AUG 14 2019 Page of 6
Statement covers period Date of election if applica e:
July14, 2019 (Month,Day,Year) [çlT'v' LE P K DEPT, icial Use Only
from
SEE INSTRUCTIONS ON REVERSE through August 10,2019 August 27, 2019
1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement:
10 Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 12 Preelection Statement ❑ Quarterly Statement
O State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report
O 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)
O Sponsored ❑ Primarily Formed Candidate/
O Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part 7)
3. Committee Information I.D.NUMBER Treasurer(s)
1417408
COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER
Committee to Elect Shelley Kaplan to City Council District One 2019 Shelley Kaplan
MAILING ADDRESS
67785 Foothill Rd
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
67785 Foothill Rd Cathedral City CA 92234 617-842-1243
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Cathedral City CA 92234 617-842-1243
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 i .rmation contained herein and in the attached schedules 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 August 14. 2019 By
Date -ignalur of Trea er orAssis Tree r
zok___________---
Executed on August 14, 2019 By -*/[/
Date Signature of Controlling Officeholder,Candidate,State Me ropone or R onsible Officer of Sponsor
Executed on By
Date Signature of Controlling Office older,Candidate,S ate 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
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