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410 Statement of Organization Recipient Committee - Amendment 12-7-18 Sta#eaner�t aa��r�a�aizati�n • - • �Z��i�ie�t�orr��n6t#� ° � . stSt�tent'fype �!r's�a.5 A�sa�€aslarsertf � �e��sa�sa�aan—�e�P�rE �i C;, ;` - ,;� '�r o�a�u5e or,�y � Not yet qual'�ied � �Date qua�'�acatioe�U`�teshotd met Dats gua�Efica#fon threshoid naei �a�ofi�rst,inatic� U��3��'���� ��! i t� �fl� -_..��/—� —/ � —�� l.D,�ture��aer 1. ��rr���#�ee I�#orr��tia� �. 3'�ea�tar�r aa�d Clt�ff�i��p�l 'cers {if applicobte} ����'�� I3AM£Of CQMM4TTEE MRME DF FRERSi9§tEtt . �t�p�rti�o Politi�al Refiorrns r�� taa�g�her�Ka� 57AEEI AUDRESS[NO P.O.BQXj . COtiNM OF D6Mit}LE tlhZlSDlCFtON WHERE COMMt7TEE IS ALTIVE NAM£aF PltEAIGPAI OFEFCER(Sj �1�81C���3�'Si XU 3. Zle" sa�a� i have used ati reasonab(e d@liges�ce�n pr�pa�sng�his s�atement and ta t�e best af rny icnowtetige�he�n�orrna�ion contained herein is true and cosr�plete. 1 cer�ifij urr�er penalty af per�ury€�nder�he laws o�the State of Catifcarn'sa OR5TA7cMEA5UREPRQPONENF FJCECUL2tl OIl ,� DATE SIGNATL3AE QF CQNTRQLL4N6 OfFiLESi4LDER,tAY61DA;E,OR SCRTE MFASURE PR04QNEM Execute�on gy DA:E SIGMl+TURE OF CQNTRQlt3A�G OfFiCEHCLUER,fANDlf1ATE,QR SYATE MEASURE PROPESdENF �P�Foss��&16!��aeagust/2P3�.8} EPPC BEdvice:advice[�EPpc.sa.go��866/2?5-3?73� vwvs�v.f�sps.ca.gov �ta���nt�f�g���z�t6�� • r " • � 1e��i�i���Go�a���#� � � - iNSTRSJ�ICNIS DN REVERSE Fa�e 2 C4MRATTTEE NAWi'c I.D.WUMBER e�per��€a�€��'o�tica��efo;ms P�C i�� �F�-7 • �!F cca�saa�uttees mces�6'ss�tize€'iaDaneiat iasii�asBeoaE sna�iere:tse ca�xupadgea ba�k accertanY is 8oeated_ 7iAME Qf FINRNCl0.LINSflTtST70H ARE4CQDE(PHQNE 8AFlXACCOU.YTNUMBER t.J'DRESS QTY StASE ZI?COfJE 4.'f����O��it$�e fomplete the app#ica�sle ser-tians. . o �ast the nar�e of each controPiing o#ficehalder,randicEate,oa s�ase aneasure�srflno€�en�. Ef ca�cfidaie o�a�'icehaEder ec�n€rof6ed,also iis��ite elective o�'ice sough�or 9�eld,and di�rict number,€f any,ar�d the year of�he e€ec€ion. s i�st the qioli�ica�party vvith wFaieh�ac;?cs�acei�oldes or�r.�i�#ate is affiiiatea or check"nos��sar�isan:' Stating"E�c�par�y preferen�"is azc�pYabie. • �#this committee acts join�ty with areother co�trotiec4 comrn6€ine,list t3ae nas�ae a?�d iden�ifiea�ion n�mber o¢tr�e other caniradled cearasni�tee. £LECTiVE OFFICE SOUGHT OR HEt.fl YEAR O� PARTY NAME OF CkNDIDATE/OFF[CEHOlDE�`STATE MEASURE FRaPQNESV7' (1lVCLUDE DESTRlCT NUiY76zR IF APPLtCABtE} ELECCtON tHECK ON� Nonparas� ParGun (Yist potitical party below) � � Nonp2rtisast Partisas� (tist poiitical party�eEoN+) � � . a�rirrasi#y formed to support ar o�pose specF�ac�and"aclates or measures i�a sing{e e6ection_ isst be�o�sr: CANDE64Ff(S)NAME OR MEASUR£(S)FUCLFiTLE{INCLUOe SALtOF NO.:lft CEFTER} SANBiDATE{S)QFFiCE SOUGHT OR HELD OR MEAS(3RE{5)1URISDICTlCSI�! iFR AE:ALL,S7ASE"kECA#.L tN EH6NT OF THE QFFS�EH6L�ER'S NA.ME. (INCLUDE D65TRiCT NO.,�iPl QR L'OUN3Y,AS APPtlCABLf} ,^.3tEGtc OrtE Sti?PORT OPPIISE � � StJPPORT � f#�C Fossn 42€3(Aetgeas#/2t418� �4�P�Advitee aaluace�ps.ea.gow{856�275-3�2� auv�s�r.�3sc.ca.gc�er i i Statem�t of��g��ag��i�� � n� _ • � � f��ca�sient�rr�anitf�e • - tNSTltUCTtONSaN RENERSc' Page 3 COMMiTTfENAME i.D.iVUM6£R - CiU�i�IP3Q�O�I�ICd���{HPfl2S�A�i !�-(�..L�-� �<��e���OdYii3'11��E €£ont'tnued} � - �� �-', •• �lot�arsned to s¢�pport or op�se specific candic3ates csr meassares i�a s9ngle e!ettion. Chesk flniy one brnc: ���e�.o��,;t�� Cl��u�rr e���tte� fl ss���c�� PROVEDE 8RlEF DESCR{PFION OF ALFIVISY �rornote politica6 reforrr�anc#go�rscr€nent#ranspar�c�cy at Cuper�ino. = e LisE add'rt��na3 spor�sors on an at�ach:nerrt. NAlk"c Of S.°6NSOR lN6t}Sf RY GROtJA OR AFYI4ATS011t OF SPQNSQR SFfiEEiADflRESS ND.AlVD SfREcF CIiY SFAIE ZIP CBFSE FREA CC.'DE/PkONE m �� Date qwiified �e��5i'YtiE3�i�1'����iBE!@!'�ILf1$S Sy sig��irtg the verifira�zos�,the treasurer assis�c�:.treasur�r aarf/ar candida$e,officehotder,cx proponenf neriiy#hat af[of the fa{owing contiftions haue beest met: • This cammitfiee has ceasec!to r�ceive tor,tribuu�tiioa►s an�rr�ake ex�aend'stures; • Tf�is committee does not antic's�.aa�e receiv'sng contri�b�stions oc mak€�-�g expenditures in the€ut�re; • TE:�s comm;ttee i�as eiamirsated or has no infention or abi!€ty to discharge ali deEats,ioans re�eived,and oiher obligatians; • Th;s eoenrni�tee i�as no surp�e�s f�sads;ane3 m Thes eoms�n'sttee has fiSed alt casnpaign staterrsenis requ:red b�the PoiiticaE 3iEforrn Ar�d8scios6�g ati repos;.able�rat�s2c�aans_ — There are res�rs`rtiosas on#�Se c#ispc�s4�on of s:s�#us�ampasgn fs��ds heid by�fecEe�a�f-�cers who are teaer�s�g of�ce and by de#eateci cancfidates. Refer to 6overnsnecat Coae Seet�an 89529. — �efcover€unds of taattot measasre comani�tees may be�!sec!#'eas�I'aticat,legislative o�gove�amer��t purposes un���Govemrraerat Coc3e Sertions 8953.2-89518,and are suia�ect�.o EEecuoras C�de SectPot�1868E3 araG FPPC Reg�a�at�on 25521.5. FeeP�Fortza�14{AugaastJ2018) ���e�a�:ad,�����G�o�r�s���-3�� sn�+•`•p�ae.ea.gov