Form 410 Amendment 2014 Statement of Organization
Recipient Committee
Statement Type ❑Initial Amendment ❑ Termination—See Part 5
Not yet qualified❑ or List I.D.number: List I.D.number:
Date qualified as committee Date qualified as committee Date of Termination
(if applicable) .
1_ Committee; nformat�on �s � '
NAME OF CO MITTE;
0( COUA
STREET ADDRESS(NO P.O.BOX)
A
FAX/E-M IL ADDRESS
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
Sir f01",�i— 1 rocs`^-;�2
AREA CO
Attach additional information on appropriately labeled continuation sheets.
NAME
Date Stamp
1
�i
j�
201S ,t)r° 25 Ali'; . S
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For Official Use Only
STREET
ZIP CODE AREA CODE/PHONE
6, "n- -1,202
NAME OF ASSISTANT TREASURER,IF A
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
(A�!`�
NAME
STREET ADDRESS(NO P.O.BOX)
CITY - STATE ZIPCODE AREA CODE/PHONE
I have used all reasonable diligence in preparing this statement and to the Vstof my knowled ge the n ormation contained herein is true and complete. I certify under
penalty of perjury un er the l7/0 f q,,,' tate of Cali n(a th fore of e n correct.
Executed on 0 d�-5
D AT SI TURE OF TREASURER OR ASSISTANT TREASURER
Executed on By
ATE SIGN URE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
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(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFOROU, ,
Recipient Committee FORM 1r
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME /��(/f I 01V I.D.NUMBER
G�ra(oa 'l („Vn 13 G 7s o 2
• All committees mr list W ncial ins titu '`•n where the campaign bank account is located.
ie IL" y/� vl l
NAME OF FINANCIAL INSTITUTIONp- , AREA CpD�E/PHONE BANK ACCOUNT NUMBER
miwt)q F46
ADDRESS��� N, r ��� �) �ITG(21�•'(� `� ( /�/�L�STATE ZIP CODE
4s,
• 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
G"
/�'
Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
-Primarily Formed Committee CANDIDATE MEASURE(S)JURISDICTION
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) S)OFFICE SOUGHT OR HELD OR MEASUR
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
SUPPORT
❑
OPPOSE
❑
SUPPORT
OPPOSE
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov