061522 Form 410A Miller 2022.icatiaramrrB m Organization
D I I
Recipient Committee
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E
e
Statement Type Ej Inlffal ® Amendment
❑ Termination
- Se¢PartS
FnE ommlu[e only
Q Not yetqualreed
JUN 15 2022
or
0 Date qualification threshold met Dale qualification threshold met
Dale of termination
CITY CLERKS OFFICE
06 08 2022
LD. Number
• ¢
m6k
NAME OF COMMITTEE
NAME OF LXF<SIIXEO
Tel Miller for Cypress City Council 2022
Rijani Maiatico
STREET ADDRESS IND GA. Box)
STREET ADDRESS (NO ROC BOR
CITY
STATEZIP
CODE
ARISCODEAPHOUNE
Aliso Viejo
CA
CA
928656
CITI sTglF ZIP CCOF AREA fODF/pNONF
NAME O[ASSISTANT TREASURER, 14 ANY
Cypress CA 90630
Jennifer Miller
FULL MAILING ESS 10 DIrtEXENII
STREET ADDRESS (NO v.O. GOR)
ADDRESSE MAIL IXepum101/[qx lOPnoxay
Cltt
STATE
ZIpfODE
REACODE/PHONE
Cypress
CA
90630
UBOWOACONNrYOSDOMICILE MORNI1SACTI-
NAME OFPRINCIPALOF[ICERIS)
Orange
City of Cypress
Terry Miller
STREET ADDRESS (NO RO. BOX)
Attach additionalinybrmatfon on appropriately labeled continuation sheets.
CITY
STATE
VPCODE
/PHONE
Cypress
CA
90630
3. Verification
Iaveuse a rezxonnhe iinonre in nrnnarine♦:. ..�.e.,...,....A..,. _ .._._ _.. I,__..._ __.�_:_____�_ .. _
penalty of perjury under the laves of th
Executed on I �I
DATE
Executed on test W-24
Ipere. ice unser
Executed on DATE aY
SIGNMRE OF CONLROINNG OFFICEHOLDER, CANDIDATE. OR S MEASURE PROPONENT
Executed on 9Y
DATE SIGNATURE OF CONEROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 610 IAugust/2018)
FPPC Advice: adviceitfgoc w gov (866/275-3772)
wwwf
Statement of Organization e -
Recipient Committee -
INSTRUCTIONS ON REVERSE
INUMBER
COMMIITEEHAME ED
Terry Miller for Cypress City Council 2022l
All committees must list the financial institution where the Campaign bank account is located.
ADDRESS CITY ETAIF ZIP COOS
Brea CA 82821
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.
ELECTIVE OFFICE SOUGHT OR HELD YEAR Or PARTY
NAME OF CANDIDATE/OFnCEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IT APPLICABLE) ELECTION
YWIYKi�iYY1WYi'� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANOIUATEISI NAME OR MEASL Is)FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)IUR6DICTION
IF A REGALE STATE'RECALL' IN FRONT OF THE OFFICEHOLDER'S NAME.
(INCLUDE
DISTRICT NO, CITY OR COUNTY. AS APPLICABLE)
CHECKONE
Terry Miller
Cypress City Council
2022
Nonerisan
Patllssn
019 FaliReal Fogy WOW)
�
NPnparein
FaraMn
REE MRIDW; y ow
YWIYKi�iYY1WYi'� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANOIUATEISI NAME OR MEASL Is)FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)IUR6DICTION
IF A REGALE STATE'RECALL' IN FRONT OF THE OFFICEHOLDER'S NAME.
(INCLUDE
DISTRICT NO, CITY OR COUNTY. AS APPLICABLE)
CHECKONE
YPPOnT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (Augmt/2018)
FPPC Advice: 4dvice@fppc.ca.gov (866/2753772)
www fooc Ca eov
Statement of Organization
Recipient Committee
INSTRUCIIONS ON REVERSE
Faille 3
Terry Miller for Cypress City Council 2022 11447291
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTMW
List additional sponsors on an attachment.
Small Contributor Committee
5. Termination Requirements Bysigning the verificaden, the treasurer, assistant treasurer and/or candidate,officeholder, or period certify that all of the following conditions have been met:
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.
FPPC Form 410 (August/2018(
FPPC Advice: agvicerdfooc caeov (866/275-3772(
www foot ca eov