410 Initial
I
Type or print in ink
,13
Statement of Organization
Recipient Committee
JUN 2 7
2005
1 I)
JUN
o Termination - See Part 5
LisII.D, number:
o Amendment
List 1.0. number:
or
Initial
yet qualified,..ef"
o
Not
Statement Type
2005
BRµCE McPHERS
Secretary of Stat,
PERT/NO CITY CLERK
#
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Date of Termination
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Date qualified as committee
(If applicable)
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Date qualified as committee
2. Treasurer and Other Principal Officers
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Committee Information
NAME OF COMMln~E
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1
F.71<:
AREA CODE/PHONE
V 7 ;;253
lIP CODE
~50
STATE
CJt
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lIP CODE
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AREA CODE/PHONE
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šTÄTË ZIP CODE
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ON OF OTHER PRINCIPAL OFFICER{S), IF APPLICABLE
STREET
CITY
AREA CODE/PHONE
7 2 5 ð'937
YoS-
tj5D/
CJS'OI
h~v
STATE
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MAILING ADDRESS (IF DIFFERENT)
I'D,4vx /322
OPTIONAL: FAX! E·MAIL ADDRESS
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
COUNTY OF DOMIC!LE
s.- + v.._ (fA
MAILING ADDRESS
AREA CODE/PHONE
ZIP CODE
STATE
CITY
certify under penalty of
<'I~ ~~'~~)
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
is true and complete.
till
RER OR ASSISTANT TREASURER
Attach additional information on appropriately labeled continuation sheets.
Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge
perjury under the laws of the State of California that the foregoing is true and correct:
\ 5'
DATE
By
Executed on
3
By
DATE
Executed on
CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/OS)
866/ASK·FPPC (866/275·3772)
FPPC Toll-Free Helpline:
SIGNATURE OF CONTROLLING OFFICEHOLDER,
By
By
DATE
DATE
Executed on
Executed on
Statement of Organization
Recipient Committee
.0. NUMBER
INSTRUCTIONS ON REVERSE
J
COMMITTEE NAME
GÇ~>
{
"-
4. Type of Committee Complete the applicable sections.
candidate or officeholder controlled, also list the elective office sought or held, and
If
or state measure proponent
List the name of each controlling officeholder, candidate,
district number, if any, and the year of the election.
List
·
is affiliated or check "non-partisan
the political party with which each officeholder or candidate
f this committee acts jointly with another controlled committee,
·
·
list the name and identification number of the other controlled committee
YEAR OF ELECTION PARTY
ZO oS: f$Non-partisan
o Non-Partisan
(
ElECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
0.),1 CoJ",,&.
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NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
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committees only)
BANK ACCOUNT NUMBER
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STATE ZIP CODe
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"
List the financial institution where the campaign bank account is located (controlled "candidate election
~ CODE/PHONE
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CITY
IlId Ih ù
NAME OF FINANCIAL INSTITUTION
e-v-h v-oNa.. 11.0 "'4.-
tv
ADDRESS
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Cú
5
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below:
Primarily formed to support or oppose specific candidates or measures in a single election, Us
CANDIDATE(S) NAME OR MEASURE(S) FULL TIT'
--, '-','........."............
I I "-'"I--
SUPPORT oppose
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK·FPPC (866/275-3772)
STATEMENT OF ORGANIZATION
Statement of Organization
Recipient Committee
.0. NUMBER
't.!
of
INSTRUCTIONS ON REVERSE
COMMITTEEN~
V"'ß^..o\.J. .!.
Check only one box:
(Continued)
Not formed to support or oppose specific candidates or measures in a single election.
ß CITY Committee 0 COUNTY Committee 0 STATE Committee
4. Type of Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment
NDUSTRY GROUP ORAFFIUAT¡ON OF SPONSOR
NAME OF SPONSOR
the committee qualified as a
ZIP CODe
committee.
STATE
Check box and provide the date this committee qualified as a small contributo,
small contributor committee on January 1,2001, enter 1/1101.
CITY
NO. AND STREET
0---1---1_
Date qualified
STREET ADDRESS
or proponent certify that aU of the following conditions have been met:
By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder,
5. Termination Requirements
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 al
Refer to
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
reportable transactions.
who are leaving office and by defeated candidates.
required by the Political Reform Act disclosing al
There are restrictions on the disposition of surplus campaign funds held by elected officers
Government Code Section 89519.
campaign statements