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• � � � � <br /> Statement of Organization ' <br /> Recipient Committee � <br /> • - <br /> INSTRUCTIONS ON HEVERSE <br /> Pa8'e 3 <br /> COMMITTEE NAME I.D.NUMBER <br /> Committee to elect Janet Borgens 1374422 <br /> 4.Type of Cvmrnit�e tc.or+�r►�ed� <br /> • • Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> ❑ CITY Committee ❑ COUNTY tommittee❑ STATE Committee <br /> PROV�DE BRIEf DESCRIPTION OF ACTIVRY <br /> . . . . <br /> � List additional sponsors on an attachment. <br /> NAME OF SPONSOR INOUSTRY GROUP OR AFFILIATION OF SPONSOR <br /> STREET AUDRE55 NO.AND STREET CITY STATE 2IP CODE <br /> ��� <br /> Date qualified <br /> ������w��� r��s�i ��i�n.��� <br /> 5.TE1'f11���1l�ilt�ittS Bv s�gr+&�the veri�cation.the treesqrer,assistant treasrner andfw cand&iate,officehckler,c►r proponent c�rtHy t#rat�!of tFee ioilowiesg condiiiorts have 4reert 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 Government <br /> Code Section 89519. <br /> -- Leftover funds of ballot measure committees may be used for political,legislative or governmentat purposes under Government Code Sections 89511-89518,and are <br /> subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br /> FPPC Form 410(Dec/2012) <br /> FPPC Advice:advice�fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />