Statement of Organizationr 5
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I . Committee Information
NAME FCOMMITTEE (%C./-1,w y
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STATEMENT OF ORGANIZATION
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3. Verification
I have used all reasonable diligence In preparing INS statement and to the beel of my knowledge Information contained herein is title and complele. I cartify under penalty of
perjury under the laws of the State of Celliomla that the foregoing Is true and correct.
Emuledon 2, ~ o o& Byc ~ 1UnE OF 7AEIt9l1REq OR A6818TIINT>niEABURER
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FPPC Fern 41p (a/9E)
For Technlonl Asstatenoa: lh e03mseo
2. Treasurer and Other Principal Officers
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
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4. Type of Committee (Continued)
Not formed to support oroppmespeclflccandldatesorme eyrealnaehhgleefection. Check only onebox:
❑ CITY Committee ❑ COUNTY Committee [34TATE Commtttee
ENT OF
Page 9
ROVIDE BRIEF DESCRIPTION OF ACTIVITY
LIsl additional sponsors on an attachment.
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• ❑ (For purposes of special elealionoontdbtdonlimits)
5-Termination Requirements By signing everikstion.thekenurer,assistant treasurer anftrcerdldaEe,offtoeholder,orpmponwdoe*thalapotthafotiowfngcondltlonshave bunnlet:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributlons or making expenditures in the future;
• This committee has eliminated ar has no intentlon or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has pied 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
the Informatlon_Marrual on Camoalan Disclosure Provlalona of the Political Ralorm Art_ fnr 1;'Ien10A nra..e.a f,.-A a,.._„ 61__I_ 1,_ J - _
(Manual A). Cvam
Additional filing obligations will be Incurred it, after terminating, the committee receives or spends any funds, or recelves the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
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FPPC Form 00 (91ri9)
For TechnfcN Aselatanoer 9l4fdp2-9e80