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Statemerit of Organization STATEMENT OF ORGANIZATION <br /> Recipient Committee ' •' ' � � <br /> . - <br /> INSTRUCTIONS ON REVERSE <br /> Page 3 <br /> COMMITTEE NAME I.D.NUMBER <br /> Committee to Elect Janet Borgens Redwood City Council 2015 <br /> 4.Type of Committee (Continued) <br /> �• � Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> Q CITY Committee ❑ COUNTY Committee ❑ STATE Committee <br /> PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br /> Redwood City City Council Election 2015 <br /> .. . '• .'�-- List additional sponsors on an attachment. <br /> NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR <br /> STREET ADDRESS NO.AND STREET CITY . STATE ZIP CODE <br /> ' ' ' � _J_J Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a - <br /> Date qualified small contributorcommittee on January 1,2001,enter 1/1/01. <br /> rJ'.Termi nation Req u irements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certity that all of the following conditions have been met: <br /> • This committee has ceased to receive contributions and make expenditures; <br /> • This committee does not anticipate receiving contributions or making expenditures in the future; <br /> • This committee has eliminated or has no intention or ability to discharge all debts, loans received,and other obligations; <br /> • This committee has no surplus funds;and <br /> • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to <br /> Government Code Section 89519. <br /> FPPC Form 410(January/05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br />