Pavletic for Alameda City Council 410Sta~~~J11ent of Organization
Recipient Committee
Statement Type O Initial
Not yet qualified D or
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
.r/d( I/(.,, 'El/ c
STREET ADDRESS (NO P.O. BOX)
Type or print In Ink
D Amendment
List l.D. number:
# _______ _
Date qualified as committee
(If applicable)
If Termination -See Part 5
List l.D. number:
# J 2J-/ c; °I (o 9 City
I z.-, 3 ( , 2-coz __
Date of Termination
2. Treasurer and Other Principal Officers
NAME OF TREASURER
;v·eJ?,; .ss:A i~.4·J'tt1::s
STREET ADDRESS
-/
CITY STATE ZIP CODE AREA CODE/PHONE
-; -! ALAMEDA c .. 4 9¥50 i -:> .,,. ? .c.:.~' '"'/} 1/l 1 .• ~·":" ~-, (."' ~} / / I
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX/E-MAILADDRESS
COUNTY OF DOMICILE
STATE ZIP CODE AREA CODE/PHONE
q (/)·~1 ~:f}.5"~~~16.2385
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE
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.
perjury under the laws of the State of California that the foregoing is true and corref!'\ ,
AREA CODE/PHONE
AREA CODE/PHONE
I certify under penalty of
Executedon ( Jc.rx.-G0J "aa:::>o By ' ~
Executed on~=·~~-•--------~---,.-----------------='--'---------"'--------------------------DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
Executed on ---------------DATE
By~--~~~--~-~----~----~--~~~----~~-~-SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By _________________ __,,.,,,,.,.,..,,,..___,~--=-------,,...,..,....,..,.---,,.,,..,,.,.,.,,.---------
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/01}
FPPC Toll-Free Helpllne: 866/ASK-FPPC
s•~tement of Organization
Recipient Committee
STATEMENT OF ORGANIZATIOI
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
4. Type of Committee Complete the applicable sections.
Controlled Committee
. CALIFORNIA 41 O
FORM
Page2
J.D.NUMBER
!:2L/5109
• 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 "non-partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION
-.-P.A L/ //67( C----crrf c c1L1tYc1 L-:::zoaz_ . I?', IV\ (. ..
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
Primarily Formed Committee Primarily fonned 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
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
PARTY
Jifif Non-Partisan
D Non-Partisan
CHECK ONE I '"'ro"'
SUPPORT
FPPC Fonn 410 (Jan/01)
FPPC Toll-Free Helpline: 866fASK-FPPC
Stat,ement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITIEE NAME
l~l/ f/t-E:77 c
4. Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE 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
Small Contributor Committee 0---'----'---Date qualified
Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small
contributor committee on January 1, 2001, enter 1/1/01.
5. Te rm in a ti 0 n Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate' officeholder, or proponent 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.
--Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Fonn 410 (Jan/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC