410 Statement of Organization Recipient Committee – TerminationStatement of Organization
Recipient Committee
CALIFORNIA
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Statement Type C1 Initial ❑ Amendment Termination —See Part 5
For o1fwUal u%e only
Q Not yet qualified
or
Q date or threshold mcj tale qualification threshold met
Date of tornimatiion
• - I.D. Number
2. Treasurer and Other Principal
Officers
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NAIYEC OF COMiNIr1EE
NAME Ot TREASURER
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AREA COWPRONE
COUNTY OF DOMICILE IIrRISDiCTION WIIFRF COMMIT TfC IS ar IVr
NAME OF PRINCI PAL OFF ICER(S)
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additiorial information on appropriately labeled Continuation sheets.
CITY
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