410 Statement of Organizational Committee - TerminationStatement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment
Not yet qualified ❑ or List I.D. number:
M
Date qualified as committee Date qualified as committee
(If applicable)
Termination —See Part 5
List I.D. number:
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Date of Termination
L-ornmittee intormation 2
NAME OF COMMITTEE
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STREET ADDRESS (NO P.O. BOX) — —
MAILING ADDRESS (IF DIFFERENT)
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JUL 1 32015
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Treasurer and Other Principal Officers
NAME OF TREASURER
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I REE I ADDRESS (NO P.O. BOX)
AREA CODE /PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
II yr 1--c I JURISDICTION WHERE COMMITTEE 15 ACTIVE CITY STATE ZIP CODE AREA CODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
NArvR yr PRINLIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
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
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE
By
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