410 Statement of Organization Recipient Committee – Amendment Statement of Organization D � � �e�m� � �� �,
Recipient Committee � � � � � �
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$tatement Type ��nitial �Amendment ❑ Termination—See Part 5 (� q j For OHicial Use Only
List I.D.number: List I.D.number: A U U � 7 2Q 16
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Date qualified as committee Date qualified as committee Date of Termination
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NAMEOfCOMMITTEE NAME OF TREASUHER
gH arw c�l �of' Pari-�n gha�v�rr�.e(
C�Yj/��) 1, 10 ���� CVUIIv�� �O�`�' STREETADDRESS�NOP.O.BO%)
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STREETADDRESS�NOP.O.BOR) ❑TY STATE ZIPCODE AREACODE/PHONE
�' C��`(}Q,I�I-IYLD C/� �)SD IS ►
CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANTTREASURER,IF ANV
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FA%/E-MAIL ADDRESS �
CITY STAT[ 21PCODE AAEACODE/PHONE
COUNTYOF DOMICI�E JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAIOfFICER(S)
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CITY � STATE ZIPCODE AFEACODE/PHONE
Attach additional informatron on appropriately labeled continuation sheets.
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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 06/��/�� By �
DATE �—
OFFICEHOLDER,CAN�IDATE,OR STATE MEASURE PROPONENT
Executed on gy
DATE SIGNATURE OF CONTROILING OFFICEHOLDER,CANDIDATE,OR STATE MEASUftE PROPONENT
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization . � - .
Recipient Committee � - � �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
�h a rwa � C i t� Cuu►� c i( 2 0 l 1.0 ,'� I 3 g�'-t ss'3
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAlINSTITUT10N AREACODE/PHONE BANKACCOUNTNUMBER
W�Ids�f,qo �GY1k � I � °
ADDRESS CITY
STATE ZIPCODE
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■N u rn i.�I la.k�.�u i u�i��a:�
• List the name of each controlling of(iceholder,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 aNiliated or check"nonpartisan"
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASUftE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAftTY
Parrh g1n aw�ccQA C ��r�l�V ` �� C�/V Y I C� � '�� I � '—' '""npartisan
❑ Nonpartisan
■..i���:�.��.a��.�,�:,.r.�.�,.�„�fn:+:� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)NAME OR MEASURE(S)FULL TITLE(MCLUDE BALLOT N0.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HEID OR MEASURE(S)JURISDICTION
(INCLUOE DISTftICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
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SUPPOAT OPPOSE
❑ ❑
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov