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Statement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ a
Dale qualified as committee
1. Committee Information
NAME OF COMMITTEE
Polly Low for Rosemead Council 2011
STREET ADDRESS (NO P.O. BOX)
Type or print in Ink
PY
® Amendment ❑ Termination S,gel Part5
List I.D. number lisU.C1. nu�ntier ( LUU
201! FEL,
# 1273880
Date qualified as committee Date of Termination
(If applicable)
19 2011 1 in
OF ORGANIZATION
JAN 2 4 2011
s OWEN
2. Treasurer and Other Principal Officers Secretary vt JL"Ly
NAME OF TREASURER
Ving Low
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
Rosemead CA 91770
CITY STATE ZIP CODE AREA CODOPHONE
NAME OF ASSISTANT TREASURER, IF ANY
Rosemead CA 91770
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT)
CITY - STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAXIE- MAILADDRESS
NAME OF PRINCIPAL OFFICERS)
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
STREET ADDRESS (NO P.O. BOX)
Los Angeles
CITY STATE ZIP CODE AREA CODEIPHONE
Attach additional intormation on appropriately labeled continuation sheets.
3. Verification
1 have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contai d herein is tr a and complete. I certify under penalty of
perjury under the laws of the Sto of California that the foregoing is true and correct.
Executed on - i S,�T % By
' 'DATE
%
SIGNATURE OFICONTROLLING OFFICEHOLDER, 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 (June/09)
FPPC Toll -Free Helpline: 866/ASK -FPPC (866/275-3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNIA FORM 410
INSTRUCTIONS ON REVERSE
Pane 2
4. Type of Committee Complete the applicable sections.
• 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 "non - partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Polly Low
Rosemead City Council Member
2011
❑ Non-Partisan
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
nrmc Ur nrvnrvuHLirvain UnvN AREA CODE/PHONE BANK ACCOUNT NUMBER --
East West Bank 626 576 7447
ADDRESS CITY STATE ZIP CODE
403 West Valley Blvd Alhambra CA 91803
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 MEASURES) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
$ecretarY Ot Z):adc
_
_ STATEMENT OF ORGANIZATION
Recipient Committee
Type or print in ink
tr Sat�sj�mp
..
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODEIPHONE
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contai d herein is trgle and complete. I certify under penalty of
perjury under the laws of the St to of California that the foregoing is true and correct.
Executed on i / i 3 �� � By
� DATE
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STA E MEASURE PROPONENT
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee Complete the applicable sections.
STATEMENT OF
Page 2
• 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 "non - partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Poll Low
Y
Rosemead City Council Member
2011
❑ Non - Partisan
Democrat
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
East West Bank 1 626 576 7447 1
ADDRESS CITY STATE ZIP CODE
403 West Valley Blvd Alhambra CA 91803
Primarily farmed 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($) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Type or print in Ink
Recipient Committee
p
Statement Type ❑ Initial ® Amendment
List I.D. number
Not yet qualified ❑ w
# 1273880
Date qualified as committee Date qualified as committee
(if applicable)
,. •rfl F `r R
r _;,:, r
fr, : r I in tl
J
❑ Terfm�in tion -See Pala 5
Mist't.D.lnumber �' N
.. , rr.at ; ;;:,.,. ..
I Cr 11, fJ N,
Date of Termination
n..yjC1
��'—•-'Oate Stamp° '
S
eof he Stat- of California
JAN 2 4 2011
DEBRA iSOWEN
Secretary of State
TATEMENTOFORGANIZATION
CALIFORNIA
FORM 410
For Official Use Only
1. committee Information
2. Treasurer and Other Principal Officers
NAME OF COMMITTEE
NAME OF TREASURER
Polly Low for Rosemead Council 2011
Ving Low
STREET ADDRESS (NO P.O. BOX)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
Rosemead CA 91770
CITY STATE ZIP CODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
Rosemead CA 91770
STREET ADDRESS (NO P.O. BOX)
MAILINGADDRESS (IF DIFFERENT)
CITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX I E- MAILADDRESS
NAME OF PRINCIPAL OFFICER(S)
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
STREET ADDRESS (NO P.O. BOX)
Los Angeles
CITY STATE ZIP CODE AREA CODEIPHONE
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 contai d herein is trgle and complete. I certify under penalty of
perjury under the laws of the So of California that the foregoing is true and correct. /
f X771
Executed on 6y
/./
' i DATE
SIGNATURE OFCONTRODUNG OFFICEHOLDER, 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 (June /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee Complete the applicable sections.
STATEMENT OF
Page 2
• 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 "non- partisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE /OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Polly Low
Rosemead City Council Member
2011
❑ Non - Partisan
Democrat
BANK ACCOUNT NUMBER
East West Bank
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
nnmM Ur rIINANUTALIN]111UJIUN
AREA CODEIPHONE
BANK ACCOUNT NUMBER
East West Bank
626 576 7447
ADDRESS
CITY
STATE ZIP CODE
403 West Valley Blvd
Alhambra
CA 91803
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO.. CITY OR COUNTY, AS APPLICABLE) CHECK ONE
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772)
Statement of Organization —__ STATEMENT OF ORGANIZATION
Type or print in ink -� - OetAStii
Recipient Committee j .—P P& - , ;�4.
Statement Type ❑ Initial
Notyetqualified ❑ or
Date qualified as committee
1. Committee Information
® Amendment
List I.D. number.
# 1273880
Date qualified as committee
(if applicable)
❑ Termination —
List I.D. number.
NAME OF COMMITTEE
Polly Low for Rosemead Council 2011
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE; PHONE
Rosemead CA 91770
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E- MAILADDRESS
Date of Termination
Part 5
19 2011
tC
,y
Treasurer ana utner rnnclpal unlcers
NAME OF TREASURER
Ving Low
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Rosemead
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CA 91770
CITY STATE ZIP CODE AREA CODEIPHONE
NAME OF PRINCIPAL OFFICER(S)
THAN COUNTY OF DOMICILE STREET ADDRESS (NO P.O. BOX)
Los Angeles
CITY STATE ZIP CODE AREA CODEIPHONE
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 contai d herein is tryle and complete. I certify under penalty of
periury under the laws of the St to of California that the foregoing is true and correct. Vr % �`
Executed on 1/13 t By
TREASURER
Executed on / >,i i gy�� /
DATE SIGNATURE OF ONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (June/09)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
4. Type of Committee Complete the applicable sections.
• 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 "non - partisan."
• 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
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Poll LOW
Y
Rosemead City Council Member
2011
❑ Non - Partisan
Democrat
❑ Non - Partisan
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NNmc ur r1Nnrvc1AuNbIIIUUVN
East West Bank
626 576 7447
403 West Valley Blvd Alhambra CA 91803
Pnmadly formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE
FPPC Form 410 (June/09)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee Type or print In ink Dates amp e ,
Statement Type ❑ Initial
Not yet quall0ed ❑ or
I I
Date qualified as committee
1. Committee Information
NAME OF COMMITTEE
Polly Low For Rosemead
STREET ADDRESS (NO P.O. BOX)
lid' Amendment ❑ Termination— See Part 5 F,� E C E@ V E L
List I.D. number:` List I.D. number: CITY OF ROSEMEAD I
# 1273660 FEB 2 4 2005
11 25 1 2005
Date quallfted as committee Date of Termineflon ' CITY CLERK'S OFFIC
Of applkable)
CITY STATE ZIP CODE AREA CODE/PHONE
Rosemead CA 91770
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX /E -MAIL ADDRESS
COUNTY OF DOMICILE
Los Angeles
Attach additional information on appropdetely labeled continuation sheets.
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Ving Low
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
Rosemead CA 91770
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIP CODE ' AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the
perjury under the I!wsP the State of California that the foregoing is true and correct.
Executed on (� By.
., p TE
Executed on � Y!� d J/ LR -QOM By
DATE........
h re: true and complete. I certify under penalty of
Executed on By
DATE SIGNATURE OF CONTROLLING OFFlCEHOLOFR, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/05)
FPPC Toll -Free Helpline: 888 1ASH -FPPC (866/276.3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee Complete the applicable sections.
Controlled 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.
•
Listthe political party with which each officeholder orcandidate Is affiliated orcheck'non-parfisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/ OFFICEHOLDER /STATE MEASURE PROPONENT ELECTISTRIC NUMBER OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Polly Low
Ciy Council Member, City of Rosemead
2005
® Non - Partisan
❑ Non - Partisan
• List the financial institution where the campaign bank account is located( controlled "candidate election "committeesonly)
rvnMC Ur rmnrvcwLirv0111U11UN AREA CODERHONE RANK ACCOUNT NUMBER
Bank of America 310 414 2024
ADDRESS CITY STATE ZIP CODE
835 N. Sepulveda Blvd El Segundo CA 90245
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
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
FPPC Form 410 (January/06)
FPPC Toll -Free Helpline: 8681ASK -FPPC (8681276 -3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4. Type of Committee (Continued)
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 ACTIVITY
NAME OF SPONSOR
STREET ADDRESS
List additional sponsors on an attachment.
CITY
OFSPONSOR
STATE ZIP
❑ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a
Date qualified small contributor committee on January 1, 2001, enter 111101.
5.Termination Requiremerlte By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all ofthe following conditlons 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.
FPPC Form 410 (January/OS)
FPPC Toll -Free Helpline: 888 /ASK -FPPC (888/2763772)