410 Amendment 3Statement of Organization
Recipient Committee
Statement Type [] Initial
Not yet qualifled [] or
Type or print in Ink
[~ Amendment
List I.D. number:
~1 I ~1 /.~
(~f eppa~,b~)
1. Committee Information
NAME OF COMMITTEE
STREETADDRESS (NO P,O. BOX)
[] Termination - See Part 5
List I.D. numbe~.
STATEMENT OF ORGANIZATION
JUN 0 6 Z00Z I JUL n $ 2002 ~
BILL JONES ~,~,
Datel;3fTermi'"'"~t~ CA SECRETARY OFS-r~ Y OF
CUPERTIr o
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
CITY
STATE ZIP CODE
AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS
CITY STATE ZIP CODE AREA CODF_JPHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(SI, IF APPI. ICABLE
MAILING ADDRESS
CITY STATE ;ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE
ICOUNTY WHERE COMMI'i'TEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
At~ach additional informaBon on appropriately labeled continuaEon sheet&
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herdn is true and complete. I certify under penalty of
perjury under the taws of the State of California that the foregoing is true and correct. ~ ~/,~._/,j
By ~'~J ~l~rlG, l~. ~L~[~I~)N~ROLUN f.~ P ICEHOLOER. C~4~U~uATE, OR STATE MEASURE PROPONENT
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DA~E SIGNATL~,E OF CONTROl. LING OF FIC:EliOLDE'R, CANDIDATE, OR STATE MEA. S~RE 1=I~3PONENT
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helplin~: 8~/ASK-FPPC
tatement of Organization
R~cipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
COMMITTEE NAME- I.D. NUMBER
'~ulc iL, i,~7/~
4. Type of Comm~ee ComNete me apN~ble s~ions.
* Lira the name of each ~ntrolli~ ~~r, ~ida~, or state me.ute pro~nent. If ~ndi~ or offi~holder ~ntmll~, al~ I~ ~e el~De ~ ~ht or heM,
disM~ nu~r, ~ any, ~d ~e year of ~ el~.
. L~t the ~li~l pa~ wRh ~Mh each o~lder or ~nd~ate is affiliated or che~ "nompa~isan."
. If ~is ~mM~ ac~ ~intly ~ another ~mll~ ~mm~, list the name and ident~tbn numar ~ ~e other ~t~l~ ~mm~.
ELECTIVE OFFICE S~G~ OR H~D
~E OF CANDIDAT~O~ICEH~DE~STATE M~RE PROPONENT (IN~UDE DISTRICT NUMBER tF AP~I~LE) Y~ ~ ~ECTION PAR~
[] Non-Partisan
[] Non-Partisan
· List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION .J AREA CODE/PHONE
ADDRESS CITY
JBANK ACCOUNT NUMBER
STATE
ZIP COOE
· , **-, , .- Pfimarilyformedtosupportoropposespedficcandidatesormeasuresinasingleelec~ion. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPt. ICABLE) CHECK ONE
FPPC Form 4~0
FPPC Toll,Free Helpllne: 866/ASK.FPPC