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S#atement o# Organization . s - . � � <br /> Recipient Commit#se • - � <br /> INSTRUCTIONS ON REVERSE <br /> Page 3 <br /> COMMI?TEE NAME <br /> I.�.NUMBER <br /> Rosanne Foust for City Council 2015 1377423 <br /> 4.T`ype c�f CoEnmittee (ca����ea� <br /> Not formed to support or oppose specific candidates or measures in a singie election. Check orly one box: <br /> ❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee <br /> PROVIDE BRIEF OESCRIPTION CF ACTIVITV <br /> List additional sponsors on an attachment. <br /> NAME OF SPONSOR INDUSTRY GROUP OR AFRLIATION OF SPONSOR <br /> iTREET ADDRE55 NO.AND STREET � CITY STATE ZIP CODE <br /> ❑ �� <br /> Oat_qualified <br /> �.��t�TlttlB�ttTk1�@E[€[Lt'E[Tt�€1�5 8y sigctir�g t€te verifrca4ion,the treasurer,,assistartt treasurer andEar candidate,officehatdef,or pceparrent ce€tify thaf a[[of the fni[owing c�sndKicsns hava heen 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, legisiative 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 410(Dec/2012) <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772} <br /> www.fppc.ca.gov <br />