Form 410 Statement of Organization
Recipient Committee
Statement Type Alnitial
Not yet qualified Er or
Date qualified as committee
Type or print in ink
❑ Amendment
List I.D.number,
—_1_ I
Date qualified as committee
(If applicable)
❑ Termination–See Part 5
List LD number
I I
Date of Termination
Date Stamp
IT Y OF ENCINYIIT A S
CITE'
17 AUG -9 PI`S 4: 52
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE Ci (JOJ E F TREASURER
/� �e 0 4W � 1
" R 8 `r�S 1 �.11%ti"r � �_ n4 s 2-O ' STREETADDRESS(NO PC.
CITY
MAILINGADDRESS(IF DIFFERENT)
ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS
6J%,_6*A.2P 111k60, ca t
ILE ICOUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
0"1 "
IF
STATEMENT OF ORGANIZATION
OF
FM
Use
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
STREETADDRESS(NO PO.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 knowie a the infor ation c ned ein 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 A J GUST to, ��r�,. By
ll SIGNATURE OF TREASURER ASS SURER
Executed on /f&& Calf S re 1 /� i 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 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 0 .A
STATEMENT OF ORGANIZATION
Pagel 2
��� /� _ LD PJUMBER
f�.//�'"��C,l�•%1 i%�5 c 1 T c0 V 1J�,�. 0 1.3L
4.Type of Committee Complete the applicable sections.
• •'1 •
• 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 CAN DIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAPTV
• List the financial Institution where the campaign bank account is located (controlled"candidate election"committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
CoMstRIcA -7`n- 9 yz-230 )
ADDRESS CITY STATE ZIP CODE
loo $t e&- CAr M1A& RE PL. a A g,20aa
we 11115,11 • . . 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
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline. 86(i/ASK-FPPC (866/275-3772)