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__ �_.._..+..� ___ <br /> M <br /> � Statement of Organization . � _ . <br /> Recipient Committee � _ � � <br /> INSTRUCTIONS ON REVERSE <br /> Page 3 <br /> COMMITTEE NAME <br /> I.D.NUMBER <br /> Rosanne Foust for City Council 2015 <br /> 4.Type of Committee "tco�ti��ea� <br /> � � ' �� - � Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> ❑ CITY Committee ❑ COU NTY Committee❑ STATE Committee <br /> PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br /> �• • •� • List additional sponsors on an attachment. <br /> NAME OF SPONSOR INDUSTRY GROUP OR AFfILIATION OF SPONSOR <br /> STREETADDRE55 NO.ANDSTREET CITY STATE 21PCODE <br /> r � i ❑ <br /> � � <br /> Date qualified � <br /> . , , . . � .__, . . .: ., ., _ �,� . �. . �..�,. , . . ,., r .. . ._.. <br /> 5.Term�nafion Requirements ey s�g���g me�e��fi�aro�,ttie freasure�,assistant treasure�and/oriandidate;officehold'er,or proponent certify that all of the following conditions have been me4: <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 Form 4i0(Dec/2012} <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />