Form 410 Termination 1/9/15 Statement of Organization Date Stamp CALIFORNIA
CITY 0F E CiIi !
Recipient Committee CITY ('!-F'. FORM Statement Type ❑Initial ❑ Amendment 'R Termination-see Part 5 For Official Use Only
List I.D.number- List I.D.number,
Not yet qualified El or 0 33� [Ll J Jr 7 ` ( 2=
i 3�
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
. ,,., .a° LR:,�"'<�;,.:,.• yo-„`t" i. - ;+:'” - - -
1. Coiimmittee In o`rmation. ,. N .> v`°, Pr ffi
#.. ': ..H; ._ r _. � a. � . - " _ 2- Tre sure'r..Arid"Ott 'ncipal;,0 cers
NAME OF COMMITTEE
E NAME OF TREASURER
(-�
e\`a ( �tme'_' 1 `Rye �C) y JkOtt R
\ -' S'ca ble-ro
STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE 1�
er\c�.n, 1n s G4 160-4%-11-7 C-'A c i G4 -760-y36• _
MAILING ADDRESS(IF DIFFERENT) NAME OF ASSISTANT TREASURER,IF ANY
Mi/A
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
Sipe, Ia S, CGrvvora
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CITY STATE ZIP CODE AREA CODE/PHONE C3TO
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 S1_A 1 �j _��Y �•
— DAT 10 By EE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on 1924 . !�! .f. &!3- BY i
A TT SIGNATURE 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 CALIFORNIA 410
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME LD NUMBER
d%p_,� L( Mayor- '),Oly 1-3-70 35Pa
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
&0 �` �63)-'6 9'13��383
ADDRESS
FCITY SSTTATTE ZIP CODE
'.�..- .w a:`"'^- `sti .'S': °;its`• - :9.,. ;5:oa,i�� ..rt'�"•..- -
4,T:' e`=af Committeecom"lete,tfi'e= hcab'1esections.: s, . ;'
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 OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
►Nonpartisan
Shea�t .51- Curhe.raTr\ MG,y„y, ,,
Sq" 1)+4?3A Coj^-Ny 1 T)ijr. 3 ❑ Nonpartisan
Formed 1 Prim
arily Primarily formed to support or oppose specific candidates or measures in a single election. List below-
CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO OR LETTER)
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
/� SUPPORT OPPOSE
•�ZI^O+� l �a�ydr rt �hC1v� 5 ® ❑
SQ22QRT o
r 'Diqb o Co j••+y Dis}• 3
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 410
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME 1.0 NUMBER
General Purpose Committee Not formed to support o,oppose specific candidates o,measures inasingle election. Check only one box:
[] CITY Committee [] COUNTY Committe [] 5TATECommitte
PROVIDE BRIEF DESCRIPTION o"ACTIVITY
List additional sponsors nnanattachment.
NAME OF SPONSOR USTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET o" STATE ZIP CODE
Fl��
Date qualified
^
This committee has ceased to receive contributions and make expenditures;
°
This committee does not anticipate receiving contributions or making expenditures in the future,
°
This committee has eliminated or has no intention or ability to discharge all debts, loans received,and other obligations,
°
This committee has nu surplus funds,and
°
This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
—
There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. RefertoGnvernment
Code Section 89519
—
Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511 89518' and are
subject to Elections Code Section 1868O and FPP[Regulation 185Z1.5.
;ppc Form«zo(medouzq
rppc Advice:auv/xe@fnpc.ca.00v(usa/azs'arra)
wwwfppx.ca.gov