410 Statement of Organization Recipient Committee - Initial Not Yet Qualified Statement of Organization ��'P�'am� � • .
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Recipient Committee � D �� `' �5 u U � • - �
Statement T e ❑ Amendment ❑ Termination—See Part 5 For oH;��ai use oniy
YP ' Initial
Notyetqualified�or List I.D.number. List I.D.number: ��� � � �
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2016
Date qu lified as committee Date qual fied as committee Date of Termination +�� ��� �T��4'� u�TY CLER�C
Qf appllca6le) � �
1. Committee Information 2. Treasurer and Other Principal OfFicers
NAME OF COMMITTEE NAME OF TftEASUREft
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`�IV �\��Cr( Vvl/'�S� 1 '`CI..S L� 1 � �
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MAILING ADDRE55OF DIFFERENT) STREET ADDRE55(NO P.O.BOX)
� CITY STATE ZIP CODE AREA CODE/PHONE
� ��o(� C vp���v�a �'I c`��� � Gc�l
COUNTV OF DOMICILE JURISDICTION�VHERE COMMITTEE IS ACTIVE N E OF PRINCIPAL OFFICER�S)
S�'+�- cc� I�'Pe:�2�� �o , L i�- � �c�� L�b1N�lu�r t..-f I��-
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CITY STATE 21PCODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheets. �� ����-
( -( �
3. Verification
I have used all reasonable diligence in
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DAT SIGNATURE OF CONTROLLING OFFICEHOLDEft,CANDIDATE,OR STATE MEASURE PROPONENT
Exetuted on By
DATE SIGNATUftE OF CONTROILING OFFICEHOLDER,CANDIDATE,OR STA7E MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTAOLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROVONENT
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
��D P�c: P�G-�k f AJ S i i`� �'-''�u�'L� C.
• All committees must list the financial institution where the campaign bank account is located.
NAME OF iINANCIALINSTITUTION
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4.Type of Committee Complete the applicable sections. � �
�R����i i.i I la.Y�l.i��i��ii�t��
• 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"nonpartisan:'
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHTOR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAft OF ELECTION PARTY
❑ Nonpartisan
❑ Nonpartisan
■.�r��„��u.a.��„�,.kt.��,�,��f,t,� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S)NAME OR MEASURE(5)FULL TITLE(INCLUDE BALLOT N0.OR IETTER) (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CnECK OrvE
SUPPORT OPPOSE
����sY.;,�� c; r :-ze�'"s s`?Ms��ai� CU�L� ( n )�,1 A'W��-Gk�(L� CD�Nrl�
t�.ri.�l�s M i�1�'�'� �-i J Z— '_' ���'� G �l�v � � !
G � SUPPORT OPPOSE
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FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov