410 Initial tatement of Organization
Recipient Committee
Statement Type J~ Initial
Notyetqualified [] or
Type or print tn ink
[] Amendment
List I.D. number:
,J I I
Date qualified as committee Date quail§ed as committee
(it ~p¢icable)
1. Committee Information
NAME OF COMMITTEE
[] Termination - See Part 5
List I,D. number:
STREET ADDRESS (NO RD. BOX)
STATE ZIP CODE AREA CODFJPHONE
Date Stamp
STATEMENT OF ORGANIZATION
MAILING AODRESS JIF DIFFERENT)
OPTIONAL*. FAX I E-MAIL AOORESS
·
Date of Termination
2. Treasurer and Other Principal Officers
JUL 2 4 2001
iRTINO CITY CLERK
NAME OF TREASURER
~REE~ ADDRESS
STATE ZIP CODE AREA ODD.HONE
~E OF ~SIST~T TR~SURER. IF ~Y
STREET ADDRESS
CI~ STA~E ZiP CODE AREA CODDPHONE
N~E ~g POSI~ OF OTHE~ P~INClP~ ffFICERJS}, IF APPLI~LE
~ILING ADDRESS
Cl~ STATE ZIP CODE AREA Co0~HONE
COUNTY OF DOM$CILE
JCOUNTY WHERE COMMWfEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach add#ional information on approprialety labeled conlinuation sheets.
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
the laws of the State of California that the foregoing is true and correct.~j~._~ ~
perjury under ~-- ~" ,~) ~-~ / ~ E~SUREROR~,SSISTANT~REASURER
Executed on ' ~ ~ ~ ~' ' ~ ' ' FFICEH~OER C~D OATE OR STA~ M~SURE PROPONENT
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE pROPONENT
FPPC Form 410 (Jar~101)
FPPC Toll-Free Helpline: 8661ASK-FPPC
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
STATEMENT OF ORGANIZATION
Page2
I.D. NUMBER
4. Type of Committee Complele the applicable sections.
· 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 parly 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PAR'PI'
NAME OF FINANCIAL INSTITUTION
BANK ACCOUNT NUMBER
ADDRESS CiTY STATE
ZIP CODE
~lttP. l#l~*l#.J:~,~'~.lt~l~JI~=~'-m Primarily formed lo support or oppose specific candidates o~ measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE IINCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISOICTION
(INCLUDE DISTRICT NO. CITY OR COUNTY, ASAPPLICAB~
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpllne: 866IASK-FPPC