Form 410 Termination Statement of Organization
Recipient Committee
Statement Type ❑Initial
Not yet qualified ❑ or
Date qualified as committee
Type or print in ink
❑ Amendment
List I.D.number:
Date qualified as committee
(If applicable)
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12 3t /'2005
Date of Termination
Date Stamp
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RECEfr18b'__L
n the office of the et
06 0F
7. committee Information 2. Treasurer and Other
NAME OF COMMITTEE
At_ict? -JArcag so N X02 Ct rf Cows e-t t_
STREET ADDRESS(NO P.O.BOX)
164 COCIP COCAWLr
CITY
STATE ZIP CODE AREA CODE/PHONE
E't-1 C i N t T—4 S CA 'e;l 10 7-4—14 3'1
MAILING ADDRESS(IF DIFFERENT)
OPTIONAL: FAX/E-MAIL ADDRESS
wvry i r Ur uUMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
SAN al ECto
Attach additional information on appropriately labeled continuation sheets.
LO GUI C C014 Eit
FEB 4 3 2006
CE MCPHER
STATEMENT OF ORGANIZATION
State
Official Use Only
S"t()S Ffi-lArt, 2A UNtT S;%�
CITY STATE ZIP CODE AREA CODE/PHONE
SA N D+E 9Zrt®-1$15 t#J41,9SI_ 53
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 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 i lCi A E I ,�t� / + f
` DATE BY li �.fJ V�Xit.�.--
\ SIGNATU OF TREASURER OR ASSISTANT TREASURER
Executed on -
DATE BY
-••�•�••+�yvr
Executed on BY 1—i MULLINU UFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
V
DATE
Executed on SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
DATE By
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC(8661275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
rrnA.. . r-.,.
MACE fre2 GtTl Cou"ctt_
OF ORGANIZATION
I.D.NUMBER
12622 +}Et
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 nmri i inc
• List the financial institution where the campaign bank account is located(controlled"candidate election"committees only)
wn - yr rU ANUAL INS 111 UTION
AUUKtSS
AREA CODE/PHONE
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
-•x 11jiligM 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)
CHECK ONE
)RT OPPOSE
OPPOSE
FPPC Form 410 (January/05)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
4161=- IA-to9roi%t Fart Ctry C_ aWC«
4. type OT 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
tOVIDE BRIEF DESCRIPTION OF ACTIVITY
STREET ADDRESS
List additional sponsors on an attachment.
.• - RCG1
CITY
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
ATEMENT OF ORGANIZATION
i V012 I+4
❑ --I-J 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 1/1/01.
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent 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.
FPPC Form 410(January/05)
FPPC Toll-Free Helpline: 866 1ASK-FPPC(866/275-3772)