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Form 410 Initial
Statement of Organization Recipient Committe Statement Type � nffial Not yet qualified or NAME OF COMMITTEE CDn9/i9/ rr---2 ,-'i2 DOS 27---55,- Ifie�Date qualified ❑ Amendment List I.D.number- Date qualified mittee (IP applicable) ❑ Termination—See Part 5 1nWt t.ti;RunhQr- i Date Of Termination 713� J/ ei 6o zl/A77o1✓ of,!!E2UC11VI nqS o r Ktt r AUDRESS(NO P.O.BOX) ---7- a3 o s��v (9tis,;r�� os6 X683 ya90 MAILING ADDRESS(IF DIFFERENT) FAX/E-MAIL ADDRESS I ea rq-99 W-11 to o Y s, c14 9a oa �/ 11 DCttJr U11A -e r, If-pM JURISDICTION W HERE COMMITTEE IS ACTIV E �G/i✓/T7�S, G,4 Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing t penalty of perjury under the laws of the State of( Executed on � 3 B DAT y Executed on -A d LZG� /, 02 D/3 By OAT Executed on Date Stamp %A i T d • i on e Gf cI It , t)f Me`,,t O al s Only mAR 0 4 ry e�gts .`y00 9�`��g= fv= �7Sec On, NAME OF TREASURER �� STREET ADDRESS INO PO BOX) x� -a9 F1�� cev W,L�s way CITY STATE ZIP CODE AREA CODE/PHONE �Nc/N/TES �i� NAME OF ASSISTANT TREASURER,IF ANY STREET ADDRESS(NO P,O.BOX) CITY STATE ZIP CODE AREA CODEJPHONE NAME OF PRINCIPAL OFFICER(S) STREET ADORE55(NO P.O.BOX) -- 3o 4-N 1K)/n't/gS CITY W is statement and to the best of my knowledge the llifor/ that thejpregoing is true and correct. .v sIG9�ruREOF F CONTROLLING OFF STATE ZIP CODE SIDE 9oR OS-(r nformation contained herein is true and(completE STATE DATE By - - -.__... SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT Executed on By y SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,ORSTATE MEASURE PROPONENT AREA CODE/PHONE 60) 683-�a9© I certify under FPPC Form 410(Dec/2012) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D.NUMBER c • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION ADDRESS CITY BANK ACCOUNT NUMBER STATE ZIP CODE "'I I, j Th t I• CA]n le e t e,a. I�capl'e ecfions;. • 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"nonpartisan." • 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 Formed Primcrily Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S)NAME OR MEASURES)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATES)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHFCk ONF ! 0r✓M/ =0 e 77fe' Plz93:E2l VA io o F vo,v S SUPPORT ❑ OPPOSE / POi Su� �E FPPC Form 410[Dec/2012) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov