410 Statement of Organization Recipient Committee 06-30-2010 Statement of Organization
Type or print in ink Date Stamp
Recipient Committee
Statement Type [ i r �� l� ff.�I CT ti9rtly
❑ initial ❑Amendment Terminatiran —See Part 5 i t (l,, {!
List I.D. number_ List I.D. number: ✓ -W--
Not yet qualified or ❑
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Date qualified as committee Date qualified as committee Date of Termination
(if applicable} -r
9. Committee Information 2. Treasur an Other Principal
NAME OF COMMIT t (' �^ NAME OF TREASURER
7l�wt(i ! t Trrt" C t �a�Kr r t {� r. lfPj A) tt.Qe O
STREETADD SS (NO YO. B�
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STREET ADDRESS (NO P.O. BOX) CITY 1 STATE ZIP CODE AREA CODEIPHONE
C4 `1 I4
CITY STATE ZIP CODE AREACODElPHONE NAME CIF ASSISTANT TREASURER, IF ANY
l STREETADL�SS (NO P. . BOX)
MAILIN ADDRESS DRESS (IF DIFFERENT)
CITY STATE ZIP CODE AN EA UUUE1I`HUNE
OPTIONAL: FAX I E- MAILADDRESS Cr
NAME F PRINCIPAL OFFICER(S)
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COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT - - (mot J /10
THAN COUNTY OF DOMICILE
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets. A42 e t, V—C CA 'Noi , f , _
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the
PROPONENT
Executed on B
PATE y SIGNATURE OF CONTROLLING OFFICEHOLDER.. CANDIDATE. OR STATE MEASURE PROPONENT
By
GATE SIGNATURE OF CONTROLLING OFFKvEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPG Form 410 (June/09)
FPPC Toil -Free Helpline: 866tASK -FPPG (8661275 -3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFOR
F
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D. NUMBER
4. Type of Committee Complete the applicable sections.
UZZMEMM
• 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
D K t ei ( � Non - Partisan
I (,k- �1 u K cif 0 0 `7
❑ Non - Partisan
1 I I
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION [
STATE ZIP CODE
- �,� ,� :� sol i
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) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (June /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)
Statement of Organization STATEMENT OF ORGANIZATION
Recipient Committee CALIFORNIA
INSTRUCTIONS ON REVERSE FORM
Page 3
COMMITTEE NAME I.D. NUMBER
D,l y 6d u e,A C.o 0 D q t`31 S 6 g 3
4. Type of Committee (Continued)
.. Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
.. . - . . ' List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRESS NO. AND STREET CITY STATE ZIP CODE
El
Date qualified
5. Termination Requirements By signing the verification, the treasurer. assistant treasurer and /or 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 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 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. Refer to
Government Code Section 89519.
-- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (June/09)
FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)