410 Friends Termination
Statement of Organization
Recipient Committee
Type orprintin ink
STJlfEMENT OF ORGANiZATION
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Date of Termination
Statement Type
0 Amendment
List 1.0. number:
~ Tenmination - See Part
Jl.);;t 1.0. number:
0 Initial
Not yet qualified 0 or
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-----1-----1-
Date qualified as committee
-----1-----1-
Date qualified as committee
(If.ppUœblo)
1. Committee Information
NAME OF COMMITTEE
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STREET ADDRESS (9 ~ c~~ ~
CITY
STATE
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OPTIONAL, FAX I E-MAiL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DiFFERENT
THAN COUNTY OF DOMICILE
Mach additional information on appropriately tabeled continuation sheets.
2. Treasurer and Other Principal Officers
NAME OF TREASURER :f,
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STREET ADDRESS
lCß(C) ~\)Q~~ ~. ~d~ (A'1Q)\<t-
CITY STATE liP CODE' REACDDE/Pt-/ONE
NAME OF ASSISTANT TREASURER. IF ANY
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIF>\L OFFICER(S). iF APPLICABLE
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
I certify under penalty of
3, Verification
I have used all reasonable diligence in preparing this statement and to
OR STATE MEASURE PROPONENT
OATE
Executed on
Bf
SIGNArURE OF CONTROLLING OFFICEHOLOER. CANDIOArE. OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/O3)
FPPC TolI-F,.. H.loHn.' 866/ASK-FPPC
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
CALIFORNIA 41 0
FORM
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COMMITTEE NAME
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Ac-(è~
I.D.NUMBER
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4. Type of Committee Complete the applicable sections.
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 orcheck "non-partisan."
. If this commillee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
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ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRiCT NUMBER IF APPLICABLE)
YEAR OF ELECTION
PAR TY
NAME OF CANDIDAfE/OFFICEHOLDERISTATE MEASURE PROPONENT
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CCA-...Y\G -..l
Non-Partisan
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0 Non-Partisan
. Listthe financial institution where the campaign bank account is located (controlled "candidate election" committees only)
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CITY STATE ZIP CODE
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BANK ACCOUNT NUMBER
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ADDRESS
I 0260
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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
~",~"~'OO;J(:'"" m"'~WŒ~~"o",m'", I ,"'"CO","'"'" ~""OO'OO~M,""O_' ~
FPPC Form 410 (Jan/OJ)
FPPC Toll-Free Helpline: 8661ASK-FPPC
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
CALIFORNIA 41 0
FORM
p. a, g, e. 3
INSTRUCTIONS ON REVERSE
h~
A~
I.DNUMBER
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General Purpose Committee
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATECommittee
PROVIDE BRIEF DESCRIPTI~JrAVITY
x
Sponsored Committee
List additional sponsors on an attachment.
NAME OF SPONSOR
~
A
INDUSTRV GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS
NO. ~ND STREET
CrTY
STATE
ZIP CODE
A
0 -----1-----1~ Check box and provide the date this committee qualified as a small contributpr committee. If the committee qualified as a
Date qualified small contributor committee on January 1. 2001, enter 1/1/01.
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer andlor candidate, officeholder, or proponent certify that all of the following conditions have been met:
, This committee has ceased to receive contributions and make expenditures;
. This commillee does not anticipate receiving contributions or making expenditures in the future;
, This commillee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
, This commillee has no 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.
Government Code Section 89519.
Refer to
FPPC Form 410 (Jan/O3)
FPPC Toll-Free Helpline, 866/ASK-FPPC