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Statement of Organization CALIFORNIA 410 <br /> Recipient Committee FORM <br /> INSTRUCTIONS ON REVERSE <br /> Page 3 <br /> COMMITTEE NAME I .NUMBER <br /> CORRIN RANKIN FOR CITY COUNCIL 2013 1355805 <br /> 4.Type of pmmittee t nar uedl <br /> General Purpose Committee 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 DESCRIPTION OF ACTIVITY <br /> Sponsored Committee List additional sponsors on an attachment. <br /> NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR <br /> STREET ADDRESS NO.AND STREET CITY STATE TIP CODE <br /> Small Contributor Committee ❑ <br /> Date qualified <br /> 5.Termination Requirements ay signing the verifkatiat„tde treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify 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 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 410(Dec/2012) <br /> FPPC Advice:advice @fppc.ca.gov 1866/275-3772) <br /> www.fppc.ca.gov <br />