410 Statement of Organization Recipient Committee_Termination _FruenDR
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Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
Who Files
Recipient Committees: Persons (including an officeholder
or candidate), organizations, groups, or other entities
that raise contributions from others totaling $2,000 or
more in a calendar year to spend on California elections.
They must register with the Secretary of State and report
all receipts and expenditures. “Contributions” include
monetary payments, loans and non-monetary goods
and services received or made for a political purpose.
Candidates: The personal funds of a candidate or
officeholder used to seek or hold elective office
are contributions and count toward qualifying as a
recipient committee. However, personal funds used
to pay a candidate filing fee or a fee for the statement
of qualifications to appear in the ballot pamphlet
do not count toward the $2,000 threshold.
Multipurpose Organizations: A nonprofit
organization, federal or out-of-state PAC, or other
multipurpose organization that makes contributions
or expenditures in California elections may also
be required to register as a recipient committee
with the Secretary of State. See the Fact Sheet on
Multipurpose Organizations Reporting Political Spending
and the Supplemental Form 410 Instructions.
When to File
File this form within 10 days of receiving $2,000 in
contributions. Include a $50 payment made payable to
the Secretary of State. Thereafter, the $50 fee is due
annually no later than January 15. In addition to the $50
fee, a penalty of $150 may be assessed if payment is late.
For early submissions, mark the “not yet qualified”
box. The $50 fee is requested at this time but
is not legally required until the committee
qualification threshold has been met.
Where to File
All Committees: Form 410 with original ink signature(s)
Secretary of State
Political Reform Division
1500 11th Street, Rm 495
Sacramento, CA 95814
Form 410 with digital signature(s)
Secretary of State
Via email at: digitalfiling@sos.ca.gov
As a PDF attachment
Must contain a verified digital signature
on the Signature Line.
Please access the Secretary of State’s
website for detailed instructions
on how to submit the Form 410
with a digital signature.
County & City
Committees: Also file a copy with the
local filing officer who will receive
the original campaign statements.
Read instructions carefully as a Form 410 will be rejected if
all applicable sections are not completed.
Committee ID Number
The committee’s ID number will be posted at
cal-access.sos.ca.gov. To receive an official, stamped
copy of your approved Form 410, send a request,
the original form, two copies of the form, and a self-
addressed, stamped envelope, to the Secretary of State.
Amendments
When information contained in the committee’s
Statement of Organization changes, file an amendment
within 10 days of the change with the Secretary of
State and local filing officer (if applicable). During
the period 16 days before an election, file an
amendment within 24 hours as described below.
24-Hour Reporting
In addition to the 10-day rule to file an original.
Form 410:
•A recipient committee that qualifies during the 16 days
prior to an election in which it must file pre-election
statements must file a Form 410 within 24 hours of
qualification with the filing officer who will receive
the committee’s original disclosure statements.
•A recipient committee that qualifies during the
90 days prior to an election or on the date of the
election in which the committee makes independent
expenditures of $1,000 or more to support or
oppose a candidate in that election must file the
Form 410 within 24 hours of qualification with
the filing officer who will receive the committee’s
original disclosure statements and with the
filing officer(s) for the candidate(s) supported
or opposed by the independent expenditure.
•If, during the 16 days prior to an election when a
committee is required to file pre-election statements,
a change occurs in the name of the committee, the
treasurer or other principal officers, or the controlling
candidate, an amendment must be filed with the
filing officer receiving the committee’s original
campaign statements within 24 hours of the change.
These filings must be made by fax, email with a verified
digital signature, guaranteed overnight delivery,
personal delivery or online (if online filing is available).
This form was prepared by the Fair Political Practices
Commission (FPPC). For detailed information on
campaign reporting requirements, see the FPPC Campaign
Disclosure Manual for your type of committee.
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENTDATE
For Official Use Only
1. Committee Information I.D. Number
(if applicable)
3. Verification
DATE
DATE
DATE
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
Executed on
Executed on
Executed on
Date Stamp
By
By
By
By
Statement Type Initial
Not yet qualified
or
Date qualification threshold met
//
Termination – See Part 5
Date of termination
//
Amendment
Date qualification threshold met
//
2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
FULL MAILING ADDRESS (IF DIFFERENT)
NAME OF TREASURER
NAME OF ASSISTANT TREASURER, IF ANY
Attach additional information on appropriately labeled continuation sheets.
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
CITY STATE ZIP CODE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
AREA CODE/PHONEEMAIL ADDRESS OF TREASURER (REQUIRED)
CITY STATE ZIP CODESTREET ADDRESS (NO P.O. BOX)
AREA CODE/PHONEEMAIL ADDRESS OF ASSISTANT TREASURER (REQUIRED)
CITY STATE ZIP CODESTREET ADDRESS (NO P.O. BOX)
AREA CODE/PHONEEMAIL ADDRESS OF PRINCIPAL OFFICER(S) (REQUIRED)
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Instructions for
Statement of Organization CALIFORNIA
FORM 410
Statement Type:
Initial
Mark the “Initial” box and enter the date the
committee qualification threshold was met.
If the committee has not met the qualification threshold,
mark the “Initial” and “Not Yet Qualified” boxes.
Qualification Threshold
The “date qualification threshold met” is the date
the committee received contributions totaling
$2,000 or more during a calendar year.
Amendment
If any of the information reported on an initial
statement of organization changes:
•Mark the amendment box;
•Include the committee’s ID number and name;
•Provide the changed information; and
•Complete the verification.
Candidates: Under certain circumstances, a candidate
for local office may amend the Form 410 to indicate
that the candidate is seeking re-election to the same
office. A candidate for state office must open a separate
committee for each term of office and may not amend
the Form 410 to redesignate an election committee.
Termination
List the committee’s name, identification
number and indicate the date of termination,
including completing the verification.
1. Committee Information:
Provide the full name of the committee. A
committee may use only one name.
The committee’s street address, email address, and
telephone number must be reported. A post office box
is not acceptable. The committee’s mailing address
must also be reported if it is different from the street
address. A post office box is acceptable for the mailing
address. A committee’s “domicile” is its address as
listed on the Form 410. Los Angeles is the county of
domicile for committees located outside California.
Identify the jurisdiction where the committee is active.
For example, a city committee lists the name of the city.
Committee Name Requirements
The following committee name rules apply to the Form
410, the committee’s campaign statements and to any
other references to the committee required by law. See
the instructions for Part 4 for committee definitions.
Candidate Controlled Committees: Any committee that
is controlled by a state or local candidate or officeholder
must include the last name of the candidate in the name
of the committee. In addition, the following rules apply:
•An election committee controlled by one or
more state or local candidates must also include
the office the candidate(s) is seeking and the
year of the election (e.g., Friends of Smith for
Assembly 20XX, Jones for Council 20XX).
•An officeholder committee set up by a state
officeholder must also include the office held, the
year the officeholder was elected to the current
term of office, and the words “Officeholder
Account,” as part of the committee name (e.g.,
Anderson Assembly 20XX Officeholder Account).
•A legal defense fund set up by a state or local
candidate or officeholder must also include the
words “Legal Defense Fund” as part of the committee
name (e.g., Senator Smith Legal Defense Fund).
•A ballot measure committee controlled by one
or more state candidates must also state that it is
a ballot measure committee (e.g., Senator Lee’s
Ballot Measure Committee) prior to the designation
of the ballot measure number. See additional
requirements for primarily formed committees.
Sponsored Committees: A sponsored committee (including
most political action committees) must include the full name
of its sponsor in the name of the committee. If the committee
has more than one sponsor and the sponsors are members
of an industry or other identifiable group, include a term
identifying that industry or group.
Primarily Formed Committees
Ballot Measures: The name of each
committee primarily formed to support or
oppose a ballot measure must include:
•A statement identifying the ballot measure(s) number
or letter and whether it supports or opposes the
measure(s) (e.g., Committee For Proposition/Measure
__ or Committee Against Proposition/Measure __).
Recalls: Each committee established for a recall
election must include the name of the officeholder
subject to the recall. If the committee is not
controlled by the officeholder, the committee must
state its support or opposition (e.g., Committee
Opposing the Recall of Council Member Doe).
Supporting or Opposing a Candidate: The name of
each committee primarily formed to support or oppose
a state or local candidate(s) being voted on in a single
election, other than a recall election, must include
the last name of each candidate, the office sought,
the year of the election and must state whether the
committee supports or opposes the candidate(s)
(e.g., Committee to Support Doe for Senate 20XX).
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
•List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled,
also list the elective office sought or held, and district number, if any, and the year of the election.
•List the political party with which each officeholder or candidate is affiliated or check “nonpartisan.” Stating “No party preference” is acceptable.
•If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
4. Type of Committee Complete the applicable sections.
COMMITTEE NAME I.D. NUMBER
Page 2INSTRUCTIONS ON REVERSE
Controlled Committee
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
IF A RECALL, STATE “RECALL” IN FRONT OF THE OFFICEHOLDER’S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
SUPPORT
PARTY
SUPPORT
OPPOSE
OPPOSE
CHECK ONE
CHECK ONE
YEAR OF
ELECTION
NAME OF FINANCIAL INSTITUTION AND PERSON(S) AUTHORIZED TO OBTAIN BANK RECORDS
ADDRESS OF FINANCIAL INSTITUTION STATE ZIP CODECITY
•All committees must list the financial institution where the campaign bank account is located and the person(s) authorized to obtain bank records.
AREA CODE/PHONE BANK ACCOUNT NUMBER
Nonpartisan Partisan (list political party below)
(list political party below) Nonpartisan Partisan
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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Instructions for
Statement of Organization CALIFORNIA
FORM 410
2. Treasurer and Other Principal Officers:
A committee may have only one treasurer and one
assistant treasurer. A candidate may be their own treasurer
or assistant treasurer. A committee may not accept a
contribution or make an expenditure without a treasurer.
A committee that is not controlled by a candidate or
officeholder must disclose the name, street address,
and telephone number of the committee’s principal
officer(s). The principal officer(s) of a committee are
the individual(s) primarily responsible for approving the
political activity of the committee, including authorizing
the content of communications, authorizing contributions
and other expenditures, and determining strategy. If
more than three individuals qualify as principal officers
of the committee, identify no fewer than three.
If no individual other than the committee treasurer
qualifies as a principal officer, identify that
individual as both the treasurer and the principal
officer. An attachment may be necessary.
Provide the email address of the committee
treasurer, assistant treasurer, and any other principal
officer(s). A committee with three or fewer principal
officers must identify all principal officers. If the
committee has more than three principal officers,
it must identify at least three principal officers.
3. Verification/Original Signature(s):
The Form 410 filed with the Secretary of State by paper
must contain an original ink signature(s). The Form 410 filed
with the Secretary of State by email must contain a verified
digital signature(s). The committee treasurer or assistant
treasurer must sign the Form 410. Also, each controlling
officeholder, candidate or state ballot measure proponent
must sign the Form 410. If more than three control the
committee, one of them may sign on behalf of all controlling
individuals. If a candidate will serve as their own treasurer,
they must sign as the candidate and again as the treasurer.
Bank Account Information
•Qualified committees must list the name and address
of the financial institution where the campaign bank
account is located and the bank account number.
•Qualified committees must also list the names of
persons, other than the treasurer, who are authorized
to obtain the bank records of the committee from
the financial institution where the committee bank
account is maintained. If there are more than two
persons other than the treasurer authorized to
obtain the bank records, the committee need only
list two persons. Disclose the names in the “Name
of Financial Institution and Person(s) Authorized
to Obtain Bank Records” field. If additional space
is needed, an attachment must be used.
•Non-qualified committees are not required to list
a bank account or the names of those person(s)
authorized to obtain the committee bank records.
4. Type of Committee:
Controlled Committee: A “controlled committee” is
one which is controlled directly or indirectly by an
officeholder, candidate, or state measure proponent,
or which acts jointly with an officeholder, candidate,
state measure proponent, or another controlled
committee in connection with making expenditures.
A committee is controlled if the officeholder,
candidate, or proponent, his/her agent, or any other
committee he/she controls, has a significant influence
on the actions or decisions of the committee.
“Proponents” of state measures are persons who
request the Attorney General to prepare a title and
summary of a state initiative, referendum, or measure.
Candidate Election Committee: Identify the candidate’s
last name, office, election year and party, if applicable.
Ballot Measure Committee Controlled by State
Candidate: Identify each measure on which the
committee has spent or anticipates spending $50,000
or more in the current two-year period, beginning
with January 1 of an odd-numbered year. If the
ballot designation has not been assigned, describe
the purpose of the anticipated measure(s). Amend
the Form 410 when a ballot designation is assigned.
Provide this information in the primarily formed or
general purpose section or on an attachment.
Legal Defense Committee: On an attachment,
describe the specific legal dispute(s) for which the
legal defense fund was established. The Form 410
must be amended within 10 days when legal disputes
are either resolved or new disputes are initiated.
Primarily Formed Committee: A committee is
“primarily formed” when it makes or initially plans
to make more than 70% of its contributions and
expenditures to support or oppose a specific candidate
or measure, or a group of measures or specific local
candidates all being voted upon in the same election
on the same date. (FPPC Regulation 18247.5)
New committees: A new committee formed within six
months of a statewide regular election or within 30 days of
a state special election is presumed to be primarily formed
if the committee makes at least $25,000 in independent
expenditures to support or oppose a state candidate
or measure. Monthly review is required for other new
committees that spend at least $1,000 a month and were
formed within six months of an election in connection with
which the committee makes contributions or expenditures.
Quarterly review at the end of March, June, September
and December is required for other committees.
A committee controlled by a candidate for their own
candidacy is not a primarily formed committee.
State ballot measures - qualification ID number: Certain
committees must list in Section 4, Primarily Formed
Committee, the Attorney General’s Office assigned
identification number to a proposed state ballot measure:
• A committee submitting the title and summary;
• A committee primarily formed for the measure; or
• A committee that spends $100,000 or more
on petition circulation for the measure.
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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Statement of Organization
Recipient Committee CALIFORNIA
FORM 410
COMMITTEE NAME I.D. NUMBER
Page 3INSTRUCTIONS ON REVERSE
5. Termination Requirements
•This committee has ceased to receive contributions and make expenditures;
•This committee does not anticipate receiving contributions or making expenditures in the future;
•This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
•This committee has no surplus funds; and
•This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
— 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 Code Section 89519.
— Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR
Sponsored Committee
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
4. Type of Committee (Continued)
By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all of the following conditions have been met:
CITY Committee COUNTY Committee STATE Committee
//
Date qualified
Small Contributor Committee
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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Instructions for
Statement of Organization CALIFORNIA
FORM 410
Recall Committees: A committee supporting or opposing
a recall must list “Recall [Officeholder’s Name],” the
office held by the recall target officeholder, and mark
the appropriate box to indicate whether the committee
supports or opposes the recall of the officeholder.
General Purpose Committee
A committee is a “general purpose committee”
if its principal activity is supporting or opposing
a variety of candidates or measures voted on in
different elections. (FPPC Regulation 18227.5)
•A state committee makes contributions or expenditures
to support or oppose candidates or measures voted on
in state elections, or in more than one county; it does
not make over 70% of its contributions or expenditures
in a single local jurisdiction. State contributions include
contributions to other state general purpose committees.
All political party committees that meet the requirements
as a political party pursuant to Elections Code Section
5100 (Government Code Section 85205) (including
county central committees) are state committees.
•A county committee makes more than 70% of
its contributions or expenditures to support or
oppose candidates or measures voted on in a single
county, or in more than one jurisdiction within
one county. This includes contributions to other
general purpose committees in the same county.
•A city committee makes more than 70% of its
contributions or expenditures to support or
oppose candidates or measures voted on in
a single city, or in one consolidated city and
county. This includes contributions to other city
general purpose committees in the same city.
A city or county committee may make up to four
contributions in a calendar year to candidates for elective
state office whose districts are within the same jurisdiction
and is not required to change its status to a state committee.
Brief Description of Organization’s Political Activities:
A multipurpose organization, other than a federal or
out-of-state PAC, must describe its mission or most
significant activities and describe its political activities.
This description shall include all activities undertaken
for the purpose of directly or indirectly supporting
or opposing state or local candidates; or qualifying,
supporting, or opposing, a state or local ballot measure.
A committee that has made contributions or expenditures
of $5,000 or more during a quarter must review its activity
at the end of March, June, September and December
to determine if the committee is filing reports in the
appropriate jurisdiction. During the first six months, a new
committee must check its jurisdictional status each month
the committee makes expenditures of $1,000 or more. If
a change of filing locations occurs, reports must be filed in
both the new and old jurisdiction through the calendar year.
After marking the appropriate state, county or city box,
provide a brief description of the committee’s political
activities such as whether it supports candidates or
measures that share a common political affiliation.
Sponsored Committee
A “sponsored committee” is a general purpose or primarily
formed committee, other than an officeholder or candidate
controlled committee, that has one or more sponsors.
An organization, business, or other entity is a
sponsor if one or more of the following apply:
•The committee receives 80% or more of its
contributions from the entity or organization or its
members, officers, employees, or shareholders.
•The entity or organization collects contributions
for the committee by use of payroll deductions or
dues from its members, officers or employees.
•The entity or organization, alone or in combination with
other entities or organizations, provides all or nearly
all of the administrative services for the committee.
•The entity or organization, alone or in combination
with other entities or organizations, sets the
policies for contribution solicitations or payment
of expenditures from committee funds.
See the instructions for Part 1 for a sponsored
committee’s name requirements.
Small Contributor Committee
A “small contributor committee” is one that has been in
existence for more than six months; receives contributions
from 100 or more persons; makes contributions to
five or more candidates; and has not received more
than $200 from one person in a calendar year.
5. Termination Requirements:
Recipient committees may only terminate when:
•They have ceased to receive contributions
and make expenditures; and
•They do not anticipate receiving contributions,
repayments of outstanding loans made to others,
or any other receipts in the future, and they do not
anticipate making expenditures in the future; and
•They have eliminated or have no intention
or ability to discharge all their debts, loans
received, and other obligations; and
•They have no funds; and
•They have filed all required campaign
statements disclosing all reportable transactions,
including disposition of funds.
State Candidates: There are mandatory termination
deadlines applicable to your committees.
How to Terminate
After the termination requirements above are met:
For State Committees: Complete page one of the
Form 410 and mark the termination box. Send
the Form and last Form 450 or 460 (mark the
termination box) to the Secretary of State.
For Local Committees: Complete page one of the
Form 410, mark the termination box and send
the Form to the Secretary of State. Send a copy of
the Form 410 and last Form 450 or 460 (mark the
termination box) to your city or county filing officer.
FPPC Form 410 (October/2023)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov