410 Organization Recipient Committee
Statement of Organization
Recipient Committee
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AUG h~ 2007 I
CU ERTINO CITY CLE
Type or print In Ink
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o Termination - See Part 1 nUl!
List I.D. number: U I
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Statement Type }8lnitial
Not yet qualified 0 or
o Amendment
List 1.0. number:
~~ :J-O() 7
Date qualified as committee
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Date qualified as committee
(If applicable)
----1----1_
Date of Termination
1/450
CITY
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2. Treasurer and Other Principal Officers
NAME OF TREASURER, _ {
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STREET ADDRESS
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CITY
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STATE ZIP CODE AREA CODE/PHON~ I
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1. Committee Information
NAME OF COMMITTEE
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STREET ADDRESS (NO P.O. BOX)
STATE
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ZIP CODE AREA Co'DE/PHONE NAME OF ASSISTANT TREASURER. IF ANY
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MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4of) 996- 9/00
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
5A~'"IA C LA Rkr-
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowlndge the information contained herein is true and complete. I certify under penalty of
pe~ury under the laws of the State of California that the foregoing is true and correct. !5?t -". .
Executed on ~ ~ ! 0.- ;)"[)O'7 By " ~ ~\
OATE URER
Executed on cP - / () - ~o 7
DATE .
DATE
By
By
Executed on
Executed on
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
DATE
FPPC Form 410 (January/OS)
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