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� <br /> Statement o� Organization ' <br /> . • _ o . <br /> Recipient Committee , <br /> INSTRUCTIONS ON REVERSE <br /> • - <br /> COMMITTEE NAME <br /> Page 3 <br /> I.D.NUMBER <br /> osanne Foust for City Council 2015 <br /> 4: Type of Committee �connn�ea� <br /> Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> ❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee <br /> PROVIDE BRIEF OESCRIPTION OF ACTIVITY � <br /> � � �� List additional sponsors on an attachment. <br /> NAME Of 5°ONSOR <br /> INDUSTRY GFOUPOR AFFILIATION OF SPONSOR <br /> STREET ADDRESS NO.AND STREET CITY <br /> S7ATE ZIPCODE <br /> � 4'' <br /> ❑ / / <br /> D;te qualined <br /> 5. T2i'fYlltlBt'IOCI ReC�UICQft'l2p�5 By signing the verificahon,the treasurer,assistant treasurer and/or candidate,officeholde�,or proponent certifythat ali of the following conditionshave beenmet <br /> _ _._ _ <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 governmental purposes under Government Code Sections 89511-89518, and are <br /> subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br /> FPPC rorm 4i�(Decj20i2j <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />