410 Amended
vratem~t of Organization
ReCiptint Committee
Type or print In Ink
13,
Date Stamp
OCT 2 9 Z007
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Date qualified as committee
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Date qualified as committee
(lI1Ippbble)
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Date of Termination
OCT! 2 2007
EBRA BOW&.N
S cretary of State
STATEMENT OF ORGANIZAOON
Statement TYpe 0 Initial
Not yet qualified 0 or
g Amendment
~ 1.0. number:
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o Tenninatlon - See Part tin
List 1.0. number:
EIVED AND FILE
office of the Secretary of S
of the State of California
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STREET ADDRESS (NO P.O. X)
lo+'!5:.<''HE ~&.v/). #A. ~JA~~;ii//
CITY . :TE Z1PC e.,. . Jl1.... j
2. Treasurer and Other Principal Officers
NAME OF TREASURER
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I:;fJ'io 1eJt..-&.vI1.*~ ,euc,.~ND,iU~~ Cf!kH~~"
REGISTRAR OF VOT ,.
COUNTY OF SANTA C
1. Committee Information
NAME OF COMMITTEE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODElPHONE
COUNTY VlttERE COMMI'TT6E IS ACTlVE IF DIFFERENT
THAN COUNTY OF DOMICILE
NAMEAND PosmON OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
s
MAILING ADDRESS
Attach additiona' info1mation on appropriately labeled continuation sheets.
CITY
STATE
ZIP. CODE
AREA CODElPHONE
3. Verification
I 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
peljury under the laws of the State of California that the foregoing Is true and correct.
Executed on I D- f 6-0 ::r By
DATF,J
/0-11]-10'7
DATE
By
CANDIDATE. OR STATE MEASURE PROPONENT
Executed, on
Executed on
DATE
By
SIGNAllJRE OF CONTROLLING OFFICEHOlDER. CANDIDATE. OR STATE MEASURE PROPONENT
Executed on
DATE
By
SIGNAllJRE OF CONTROlLING OFFICEHOlDER. CANDIDATE. OR STATE MEASUR PROPONENT
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FPPC Fonn 410 (JanuaI)'106)
FPPC .TolI-Free Helpline: 8661ASK-FPU75-3n2) .
StatePlent of Organization
. Redpient Committee
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INSTRUCTIONS ON REVERSE
COMMITTEE NAME
4. Type of Committee Complete the applicable sections.
Cant/oiled Comnllttee
· List the name of each -mg oftIcehoIder. candidate. or state measure proponenl W candidate or otliceholder~. also list the _ o1Iica sought (J( held. and
district number, If any, and the year of the election.
· Ust the political party with which each officeholder or candidate is affiUated or check "non-partisan."
· If this committee acts jolnUy with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIve OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF ELECTION
PARTY
NOn-Partisan
BA-p.R.
CS1' ~L
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o Non.partisan
· Ust the financial institution where the campaign bank account is located (controlled "candidate eiection" committees only)
NAME OF FINANCIAL INSTITUTION
B~
ADDRESS
R'f~JJ 0
AREA CODElPHONE
~~) ~I') - of-J1-,f'
CITY
BANK ACCOUNT NUMBER
06r/3 - 6),-33 /:,
:2-0 r 6) t;-re-tl5-1Jr c4!.~
BLVD,
STATE
ZIP CODE
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CM.f''!d! (-z }oj' 0 .
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Pnmanly Formed Committee
CAND/DATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
SUPPORT 0l'PQ$E
,
SUPPORT OPPosE
CAND/DATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
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FPPC Fonn 410 (JanuarylOS)
FPPC ToII-F.... Helpline: 8661ASK-FPPC (8661275-3772)
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.' Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
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INSTRUCTIONS ON REVERSE
COMMITTEE NAME
~~o.s
4. Type of Committee (Continued)
G,~nCI J/ Pllf pose COITl/11Jttce
Not formed to support or Qppose speclflc candidates or measures in a single election. Check only on box:
o CITY Committee ~ COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACT1VI1Y
SPU:':;'U;('U CUIi;fll,cll'<.:
List additional aponsoraon an attachment.
NAME OF SPONSOR
INDUSTRY GROUP ORAFFIUATION OF SPONSOR
STREET ADDRESS
NO. AND STREET
CITY
STATE
ZIP CODE
Small Con:',{)L;lOr COIli/lJIttL'C
o
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Date qualified
Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as I
small contributor committee on January 1, 2001, enter 1/1101.
5. Termination Requirements By signing the verlfic:iatlon, the treasurer, assistant treasurer and/or candidate, otfioeholder, or proponent certify that aU of the following conditions have been met:
· 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
Govemment Code Section 89519.
FPPC Fonn 410 (JanuaryIOS)
FPPC TolI-F.... ~elplln.: 8661ASK-FPPC (8881276-3772)
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