Form 410 -1Z)48t0wrant of Organization
Recipient Committee
Statement Type
Initial
Not yet qualified ❑ or
Date qualified as committee
Committee Information
NAME OF COMMITTEE
? Type or print in ink /
r RE(
❑ Amendment to tha
List I.D. number: ❑ Termination-See Part 5
List I.D.number:
Date qualified as committee
;If applicable) Date of Termination
R ' '�' j-0,c_c
STREET ADDRESS (NO P.O.BOX) CI"
11Y - p
CITY �
MAILING ADDRESS(IF DIFFERENT)
OPTIONAL- FAX/ MAIL ADDRESS
COUNTY OF DOMICILE
IA I E ZIP CODE
AREA CODE/PHO
THAN COUNTY OF DOMICILE ITTE IS ACTIVE IF DIFFERENT
Attach additional information on appropriately labeled continuation
STATEMENT OF ORGANIZATION
Of the Secrete __'
StSte of Cat-6f"
A06 12 264 ,l use ur
t^ �
KEVIN 4HELLEY, Secrliwy of
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Lo LA (o H i_N
STREET ADDRESS
I—S;,0 S t' I A -7 I Is
CITY S'A M � Lc�U CA g211Ufct ! CS�-�5� �
STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER,IF ANY
s5�? R IL\c_ .�Lc �- ��C"- t-1
STREET ADDRESS
IV-
CITY
r— 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
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the informatio n contained h -
penalty of
perjury under the laws of the State Of California that the foregoing is true and correct.
erein is true and complete. I certify under
Executed on
DATE By
Executed on
DATE
Executed on
Executed on
BY
SIGNWURE OF CONTROLLING OFFICEHOLDER,CA,NDID/VE,OR STATE MEASURE PROENT_
DATE PON
SIGNFVURE OF CONTROLLING OFFICEHOLDER,CfINOID/VE,OR STATE MEASURE PROPONENT
DATE By
SIGNFSU E 0 ONT LLIN FFICEH LDE A
TAT EAU NN
Cm A0�i a FPPC Toll-Free He� �p ,A ---
"ataterl-rent of Organization
Recipient Committee `.? TJpe or print in ink RE^
vvv !!! in ft tt
Statement Type ( Initial Amendment t
Y` '� ❑ ❑ Termination—See Part 5
Not yet qualified or List I.D. number: List I.D.number:
_J--/ KVIN
Date qualified as committee Date qualified as committee Date of Termination
,If applicable)
1. Committee Information
C OF GUMMITTEE
STREET ADDRESS(NO P.O.Box)
r �('-4 Cep - UV--�
CITY j STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS(IF DIFFERENT)
Ur 1lUNAL: FAX/EMAIL ADDRESS
i-
CCU C- L* r2— Jc:.e �4&-n
(.c' \3 C v\e-}.
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
of the Secre'.ar1,-A
State of Cal,,
ALLY 122 .
Secreary of
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
For'OfficiAt Use Only
7
NAME OF TREASURER
,r, LDUtSc CaHt N
STREET ADDRESS
,� S"►05 '=2rAtiS jZa mss-► 'AM Dr`: rU CA 9211 D �q�j�51-ioS� 3
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER,IF ANY
sy RLLBc_e—
STREET ADDRESS
1.111 r 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 rnrrar:t
Executed on ( \ =�(tii��oATE i ZC)(A By
Executed on
Executed on
Executed on
DATE
OY
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT_
By
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
By
SI NMURE OF CONTROLLING OFFICEHOLDER, DATE,OR STATE MEASURE F N
FPPC Form 410(Jan/03)
FPPC Toll-Free Helnline:8661ASk-FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
I.D.NL
ORGANIZATION
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 ofthe other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PRCPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
,t Non-Partisan
• List the financial institution where the campaign bank account is located(controlled"candidate election"committees only)
IW\Mt Ur HNANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
C) CCDC
ADDRESS CITY STATE ZIP CODE
• 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)
F] Non-Partisan
CHECK ONE
OPPOSE
FPPC Form 410(Jan/03)
FPPC Toll-Free Helpline:866/ASK-FPPC