410 Statement of Organization Recipient Committee - Inital Qualified Stamped by SOS � 'I/�l�
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Stat�ment of Organization � I �a� o�tnestatQot^�����'��tamp . � _ , �
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Recipient Committee � � � �� .� � �� • '
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Statement Type �Initial ( ❑ Amendment ❑ Termination—See Part S For o�;c�ai use oniy
Not yet qualified ❑ or V\ List I.D.number: List I.D.number: ���Ei1iE •
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Date qualified as Committee Date qualified as committee Date of Termination
(If applicable)
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1: Committee lnformafion' ,��� ��' ' �, . 2..,Treasurer and,Other P;rincipal Officers �' ° � -.��};�'
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NAME OF COMMITTEE\� ( NAME OF TREASURER
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STREET ADDRE55(NO P.O.BOX�
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STREET ADDRE55(NO P.O.BO%)
NAME OF ASSISTANT TREASURER,IF ANV
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MAILING ADDRESS(F DIF�E1tENT) - � STREET ADDRESS(NO P.O.BOX)
FAX/E-MAILADDRE55 - CITY STATE ZIPCODE AREACODE/PHONE
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COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFfICER(5)
Sc�vi�'r� C��Vc1 I �v.�evT��v►r,
STREET ADDRESS(NO P.O.BOXI
CITV STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
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I have used all reasonable diligence in preparing
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� [lATE SIGNATU E OF CONTROLLING OFFICEHOLOER,CANDIDATE,OH STATE MEASURE PROPONENT
Executed on By •
OATE SIGNATURE OF CONTROLIING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROVdNENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(1an/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Stat.�;�ent of Organization ' • " ' ,
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Recipient Committee � '
INSTRUCTIONS ON REVERSE �
Page 2
COMMITTEE NAME I.D.NUMBER
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• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION AREAGODE/PHONE
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4.Type of Committee Complete the applicable sections. , '" ' ' � ' . .. .
�N•�uu.�I lx.kR•i u�ui���t:�
• 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."
• 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
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE AROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) . YEAR OF ELECTION PARTY
���G 1 �e��f ��1 � �Nonpartisan
���'�(e� sG��Y-F �v�(�e�r�(^1�� C��l
❑ Nonpartisan
. • • Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) �ANDIDATE(S)OFfICE SOUGHT OR HELD OR MEASUREIS)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS AGPLICABLE) CHECK ONE
SUPPORT OPPOSE
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SIPPORT OPPOSE
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FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772}
www.fppc.ca.gov