410 Statement of Organization Recipient Committee - Initial Not Yet Qualified Statement of Organization °ateStamP • _
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Recipient Committee `j • -
Statement Type �j Initial ❑ Amendment ❑ Termination—See Part 5 D `� � �� " `" � For official use only
Not yet qualified ❑ or List I.D.number: List I.D.number:
# # At1G 1 2 2016 �
i i i i i i _ .
Date qualified as committee Date qualified as committee Date of Termination �eq���r�-�P y��,-1 ,r e-�-q� jc�����
Qf applicable) d,:� �,,.I� ,�v J 'v i . v t
1. Committee Information 2. Treasurer and Other Principal Officers
NAMEOFCOMMITTEE " l ^ ^4� r NAME OF TREASURER �
S'C�'V�'.h SG�C�r�--�6�-�v.�Hr�i"4�1��Cflw'1�` � d.�% �'i �i a•�,(�`Yl� Z�'lG:,o
STREETADDRE55(NOP.O.BOX) 1 `
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AREACODE/PHONE NAMEOFASSISTANTTREASURER,IFANY
9 Q 1)4')� L��n I � �v���r�l'�G' , Cf7 I,�d'��
MAILING ADDRESS(F DIFFE'1tENT) � � STREET ADDftE55(NO P.O.BOX� .
FAx/E-MAILADDRESS � CITY STATE ZIPCODE AREACODE/PHONE
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COUNTY Of DOMICILE lURISDICTION WHEftE COMMITTEE IS ACTIVE NAME OF PRINCIPALOFFICER(5)
�S�vi�r� C-`��`r�� Cc��e�T���n�
STREET ADDRE55(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verificafion
I have used all reasonable diligence in
��
� �ATE SIGNATUKE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on ey
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDI��TE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLIING OFFICEIiOLDER,CANDIDATE,OR STATE MLASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization ' • ' ' � '
Recipient Committee • "
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUM6ER
.�te��r. �'�l�G�� �a�- �9.�er�',h o C,�'�:�1 �r�c�.�c�� ��1 b ,
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION
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4.Type of Committee Complete the applicable sections
11•1 itu��I l:i•ki•l ui uil�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 cohtrolled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT�NUMBER IF APPLICABLE) . YEAR OF ELECTION PARTY
�c ���N ��YIC.�`�T C_..11� �� f ��e ���� �OU�C'� ���ln`l�-1f �(�1 � �`Nonpartisan .
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❑ Nonpartisan
■s.7,u•„i�.�•,,,,,�•r�•,���,�,rt,i,� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
❑ �
SUPPORT OPPOSE
� ❑ ❑
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov