410 Re-Elect Termination
State~ent of Organization
Recipient Committee
Type orprintln ink
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Date ofTermination
Statement Type
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Not yet qualified D or
D Amendment
LIst 1.0. number:
Æerminalion - See Part
List 1.0. number:
2. Treasurer and Other P' .
NAME OF TREASURER nnclpalOfficers
STREET ADDRESS PtUl.~~ ~
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STREET ADDRESS
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Date qualified as committee
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Date qualified as committee
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1. Committee Information
NAMEOFCO~ d)<Î. ~~ ~ ~
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STREET ADDRESS (NO 1'0. BOX)
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OPTIONAL, FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE
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COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
CITY
STATE
liP CODE
AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIF>lL 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 the
1/9;'/~E4-
Executed on
By
DATE
TREASURER
Executed on
By
DATE
Executed on
By
DATE
SIGNArURE OF CO'TROLLING OFFICEHOLDER, CANDIDArE. OR STATE MEASURE PRDPONENT
FPPC Form 410 (Jan/O3)
FPPC Toll-Free Helollne, 866/ASK.FPPC
STATEMENT OF ORGANIZATION
INSTRUCTIONS ON REVERSE
CALIFORNIA 41 0
FORM
P'a.g,',2
Statement of Organization
Recipient Committee
COMMITTEE NAME
R~e\e.ð: ~r. ~~~
Cv~
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 or check "non-partisan,"
. If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee,
NAME OF CANDIDAfE/OFFICEHOLDERISTATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF ELECTION
PAR TY
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(ç.~
(9C¡
'Non-Partisan
D Non-Partisan
. Listthe financial instifution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
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ADDRESì (J ), 6 ()
A&~~P;ON~17 - 6 Cf ref rANK
CITY STATE liP CODE
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Primarily Formed Committee
Primarily formed to support or oppose specific candidates or measures in a single election, List below:
;x
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
,~o'"~,_oo "~:(; ,,~"'"oo, _00 OO"'~ I oo,,"",m=m"""OO""""'~""~'" ~
FPPC Form 410 (Jan/O3)
FPPC Toll-Free Helpline: 866IASK-FPPC
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
CALIFORNIA 41 0
FORM
p' a. g... 3
INSTRUCTIONS ON REVERSE
4. Type of Committee
(Continued)
~~
COMMITTEE NAME
R~ ~(, lA\cl~
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 DESC~Z~CTlVITY
Sponsored Committee
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRV GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS
NÓ. AND STREET
CITY
STATE
liP CODE
Small Contributor Committee
0 ~-----1~ Check box and provide the date t\1is 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 ofthe following conditions have been met:
. 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 abiiity to discharge all debts, loans received, and other obligations;
. This committee has no surplus funds; and
, This committee has filed aU campaign statements required by the Political Reform Act disciosing 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. Refer to
Government Code Section 89519.
FPPC Form 410 (Jan/03)
FPPC Toll-Free Helpline, 866/ASK-FPPC