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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />Elect Gee for Council 2020 <br />4. Type of Committee (Continued) <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 DESCRIPTION OF ACTIVITY <br />List additional sponsors on an attachment <br />NAME: OF SPUNSOR <br />GROUP OR AFFILIATION OF SPONSOR <br />I.D. NUMBER <br />1315847 <br />a I mrr I Auumraa NU ANu b I KEE I CITY STATE ZIP CODE <br />❑ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a <br />Date qualified small contributor committee on January 1, 2001, enter 1/1/01. <br />5. Termination Requirements By signing the verification, the 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 <br />Government Code 'Section 89519. <br />FPPC Form 410 (January105) <br />FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275.3772) <br />