Form 410 Statement of Organization 8/20/14 CW
Statement of Organisation Cl I CITY CLERK ,ift Recipient Comme FORM
Statement Type Initial ❑ Amendment ❑ Termination—See Part 5 2011 AUG 26 AM 10: 22 For Official Use Only
Not yet qualified or
List I.D.number' List(.D number'
❑
Date qualified as committee Date qualified as committee Date of Termination
(If apph"W)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF THE ER
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STREET ADDRESS(NO PO BOX) -�- J STREET
MAII ING ADDRESS(IF DIFFERf N 1) NAME OF ASSISTANT TREASURER,IF ANY /
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FAX/EMAIL ADDRESS STREFTADDRESS(NOPO BOX)
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COUNTY OF DOMICILE I URISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREACODL/PHONE
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Attach additional information on appropriately labeled continuation sheets. %A"L �-
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CITY STATE ZIP CODE AREA CODE/PHONE
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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 correct.
Executed on I &0 1 St(5 VL By
CIAT SIGNATURE OF TRLASURER OR ASSISTANI TREASURER
Executed on By E,
DATE NATURE OF ILIN� FFICEHOLDER,CANDIDATE,OR STALE MEASURE PROPONENT
Executed on By L E
DATE ,�����AN�DIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CON TROLLING 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 CALIFORNIA '
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMIT I IE NAME c (� ID NUMBER
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•
All committees must list the financial institution where the campaign bank account is located
NAME Of FINANCIAt INSTHU I ION ARLACODE/PHONE BANK ACCOUNT NUMBER k.
yt � -w-�k (VEE`�- 5TC-6 �� ,ADDRESS CITY `Z STATE ZIP CODE, v� q
4.Type of Committee Complete the applicable section . ..
Controlled Committee
• 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 OrnCE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
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a� Nonpartisan
II�.YO� t�
❑ Nonpartisan
Formed Primarily 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) CHLCK ONE
SUPPORT OPPOSE
t I
Sr PpORT OPPOSE
FPPC Form 410(Dec/2012)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov