410 Statement of Organization Recipient Committee_Amendment Stamped by SOSRECEIVED AND FILED
in the office of the Secretary of State
of the State of California
Statement of Organization , G 15 2074
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Recipient Committee
Statement Type ❑ Initial Amendment
Q Not yet qualified
or
Date qualification threshold met Date qualification threshold met
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I.D. Number �[��/j% [�/
NAME OF COMMITTEE
1541CIZ CHA '�� r oR c zT,/ C 6 "'/J C-r L >-o
❑ Termination —See
CITY STATE ZIP CODE AREA CODE/PHONE
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FULL MAI ING ADDRESS (IF DIFFERENT)
.
E-MAIL ADDRESS OF COMMITTEE (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE
5,4-cl (A (-/"A I Cz-ry or C—P6�e-iAA(O
Attach additional information on appropriately labeled continuation sheets.
Date of termination + C
NAME OF TREASURER
4 l l . / 1117 1
For Official Use Only
ERTINO CITY EdK I �ew.u�cl,�1�IL
STREET
EMAIL ADDRESS OF TREASURER (REQUIRED)
NAME OF ASSISTANT TREASURER, IF ANY
FEET ADDRESS (NO P.O. BOX) CITY
EMAILADDRESS OF ASSISTANT TREASURER (REQUIRED)
NAME OF PRINCIPAL OFFICER(S)
/1'2�,f7 f- ,, ckfl 6f7
STREET ADDRESS (NO P.O. BOX) CITY
EMAIL ADDRESS OF PRINCIPAL OFFICERS) (REQUIRED) ' r
STATE ZIP CODE
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AREA CODE/PHONE
.STATE ZIP CODE
AREA CODE/PHONE
STATE ZIP CODE
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AREA CODE/PHONE
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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
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (October/2023)
FPPC Advice: {advice ®rt faq;._c gov (866/275-3772)
Statement of Organization CALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
kJ 61
COMMITTEE NAME I.D. NUMBER
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE �� �� Gu P�� � 3 C %'d�" 9� , z
• 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." Stating "No party preference" is acceptable
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION 1.,«11—
n� CIfAAI� h i2 c:r, C-1i
crry
yr�
Nonpartisan
V;
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below) —
Primarily
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advicePfppc.ca.eov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D. NUMBER
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee
BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Smoll Contributor Committee
❑ /
Date qualified
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
— There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519.
— Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511-
89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.eov (866/275-3772)
www.fppc.ca.gov