HomeMy WebLinkAbout250728 Form 410 Bhence 2024Statement of OrganizationRecipientCommitteeREC'EIVE41 CA
FIORMNIA
410
Statement Type 0 Initial 0 Amendment Termination—See Part 5 For Official Use Only
Q Not yet qualified
JUL 2 8 r(?_„or
Q Date qualification threshold met Date qualification threshold met Date of termination
12 09 2024
CIN CLERKS OFFICE
1. Committee Information I.D. Number 2. Treasurer and Other Principal Officersifapplicable)p
NAME OF COMMITTEE NAME OF TREASURER
Blaze B hence for Cypress City Council 2024 Blaze Bhence
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE
Cypress CA 90630
EMAIL ADDRESS OF TREASURER(REQUIRED) AREA CODE/PHONE
STREET ADDRESS(NO P.O.BOX)
NAME OF ASSISTANT TREASURER,IF ANY
CITY STATE ZIP CODE AREA CODE/PHONE Cheryl Bhence
Cypress CA 90630
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE
FULL MAILING ADDRESS(IF DIFFERENT)
Cypress CA 90630
EMAIL ADDRESS OF ASSISTANT TREASURER(REQUIRED) AREA CODE/PHONE
E-MAIL ADDRESS OF COMMITTEE(REQUIRED)/FAX(OPTIONAL)
NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Blaze Bhence
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE
Cypress CA 90630
EMAIL ADDRESS OF PRINCIPAL OFFICER(S)(REQUIRED) AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
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
TREASURER OR ASSISTANT TREASURER
Executed on ( f:E Z. .
ByESIGNATUREOFCONTROLLINGOFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(October/2023)
FPPC Advice:advice@fppc.ca.sov(866/275-3772)
www.fDDc.ca.eov
Statement of Organization CALIFORNIA 41 0RecipientCommitteeFORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Blaze Bhence for Cypress City Council 2024
All committees must list the financial institution where the campaign bank account is located and the person(s)authorized to obtain bank records.
NAME OF FINANCIAL INSTITUTION AND PERSON(S)AUTHORIZED TO OBTAIN BANK RECORDS AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS OF FINANCIAL INSTITUTION CITY STATE ZIP CODE
Raleigh NC 27611-7131
4.Type of Committee Complete the applicable sections.
ontrolled Committee
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 OF PARTYNAMEOFCANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan Partisan (list political party below)Blaze Bhence City Council Member:City of Cypress 2024
Nonpartisan Partisan (list political party below)
rimarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
IF A RECALL,STATE"RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410(October/2023)
FPPC Advice:advice anfppc.ca.eov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA
Recipient Committee FORM 410
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME
I.D.NUMBER
4.Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
CITY Committee 0 COUNTY Committee STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
N/A
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
N/A
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee
Date qualified
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or ponent 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(October/2023)
FPPC Advice:advice(a fooc.ca.gov(866/275-3772)
www.fooc.ca.gov