410 Organization Recipient Committee
Statement of Organization
Recipient Committee
'TYpe or print In Ink
Statement Type )&flnltial
Not yet qualified ts' or
o Amendment
List 1.0. number:
#
#
---1---1_
Date qualified as committee
~ /
Date qualified as committee
(If Ippllcable)
---1---1_
Date of Termination
1. Committee Information
NAME OF COMMITTEE
MtArJ< Sq",ftJYD 141'" Clf.y Ct>~~C"{
STREET ADDRESS (NO P.O. BOX)
"2.-/ , r ( (,. r rut )'
CITY
C tA.Jlc.~ l-f"'- D
MAILING ADDRESS (IF DIFFERENT)
L.. 11 .
STATE
ZIP CODE
AREA CODE/PHONE
C4
CfS-D 1'( C. i(otJ 'lr'-r)~.
OPTIONAL: FAX I E-MAIL ADDRESS
C4. e,./fh(;)""~,,/c. t! ~-/I.c.Q-'
COUNTY 'MiERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
COUNTY OF DOMICILE
Sltlf f-~ C/4~~
Attach additional information on appropriately labeled continuation Sheets,
2. Treasurer and Other Principal Officers
NAME OF TREASURER
<'
S1REETl~~ \"<)[1(1 ~
'2.-\ ~.,q Ll ~
CITY
CU.Ax~.l-11 r\. ()
NAME OF A~SISTANT TREASURER, IF ANY
1\11 " ,... k S 4H 1-1 ~ ~
STREET ADDRESS
'Z..(<if/ . t.ihAy /-.JtI c
CITY STATE 'ZIP CODE AREA CODElPHONE
CtAjI<<,.ffJ,.,D CA t:trOI'1 "(Jtl'i"'-~)t111
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), I F APPLICABLE
La~ Ht Ck-D/~
STATE ZIP CODE A EA CODElPHONE
L ~ ot 'S ~ l4-- ~ ~'66-23&
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
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
pe~ury under the laws of the State of Califomia that the foregoing is true and correct.
Executed on i - 8' - 200":J- By ~~ ~
DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on ~ - i'"- 2.()O~ By ~~ ~
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DATE
Executed on
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
DATE
FPPC Form 410 (January/06)
FPPC Toll-Free Helpline: 8661ASK-FPPC (866/276-3772)
INSTRUCTIONS ON REVERSE
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Statement of Organization
Recipient Committee
COMMITTEE NAME
Mt.\~
s" '" h11"" I:>
4. Type of Committee Complete the applicable sections.
Controlled Committee
. 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 "non-partisan."
. If this committee acts jointly 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
~a,.k Sa~ f''''D C{+y C t>~H c.! / ZOO?- Jil Non-Partisan
o Non-Partisan
. List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
Wa.s4;h
ADDRESS
'2.. OS' '1- 3 ~ f ev(Ji'f j c,.. ~ <t< 8/,,411
AREA CODElPHONE
BANK ACCOUNT NUMBER
,,+u.. I
t(() f)2.S".r... 6 :J:S ()
CITY
3/>>6'1 /'(9'1
STATE
ZIP CODE
c C4 vc,.AAo
.
C,4
t:t .r 0 J '-t
Primarily Formed Committee
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE)
CHECK ONE
I '"_. r-
SUPPORT OPPOSE
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3n2)