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Form 410 Termination Statement 2013
Statement of Organization Recipient Committee Statement Type E)Initia I Not yet nualfif4d 1:1 or o 7 1_2L6 i a,7 Date oualffied as Committee 1. Committee Information NAW OF 00WAITTEE Type or pri tit in Ink 1:1 Amendment I_Ist I D number /-I-- Date qualified as!Ort}i)Mee ,I apix K A"Ie STATEMENT OF ORGANIZATION � Termination— See Part 5 Lest I D number it 1130 _�5 7 J 107 1 0'Y/ Dole ut Termination CITY aTATE zip ()ODE hf AREA CC)DE,'PH0 C':-V CN C" NWUNG ADDPI SS OF DIFFERENT OPTIONAL: FAX ENMLADDRESS COUNTY OF D,'IIICILE COUNTY'WHERI:COMIMTTEE IS At T'vE IF OIITTERENT 1 THAN COUNTY OF DOtAICILF A ffaich addMonal Information on app crnately labe*0 conbrN.Ww sheets Stamp 2. Treasurer and Other Principal Officers NAME OF TREASURER dL- CITY STATE ZIP (X)0F AREA CODEPHO(W NAME OF AS�, STANT TREASURER IF ANY AVA)RESS CITY STATE ZIP CODE AREA C",VH;_'NE NAME ANDPOSITION OFOrt4ER PR(INCIP"FICER(S�IFAPPUCABLE 006 43:;oAca- if by T4ie C19 9wo i ©- 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 com plete. I cenity under penalty of perjury under the laws of the State of California that the foregoing is true and correct, E� D ATE SV5WL4RE,-;`F-KA`.;VRER r ASSISTANT T REASt.REP Ewuled or SO S-1,ATUR� ,'F^CNTRC-ulw'0FFJ-_T}:'I.rCA CAND*4f Executed on SIGWTURE OF rONTRaUW,OFFI:EHOLDER C'kW4C4W_ 'R I TATE VEASOPE F*0P"'NEINT F xec uted on E� DATE sj,.W"JRF FT C1'W"'XUFJ:-CM P�iLOEFZ CiMM"L 0P.'77E MEASURL PR77�'w FFIPC Form 410(Jani0l) FPPC Tott-Froo Wk►1ro•ffJWA,.qw.FPPr