410 Statement of Organization Recipient Committee - Initial not yet qualified (State Committee) i
Sta?c@ment of Organization Date Stamp
Recipient Committee RECEIVED >
Statement Type [u]jnitial ® Amendment ® Terminateon—See Part 5 in the Office ai the Secretary S t ®.E
®°r List I.D.number: List I.D.number: r$the State of Cadlfcrrsi
Not yet qualified or
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# # MAR 2 2 2011 I ",riAR 3 1 21017 l z„
Date qualified as committee Date qualified as committee Date of Termination Hand lhjel° a r"� t
(If applicable) E R� I N O CITY C E K
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NAME OF COMMITTEE NAME OF TREASURER
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vaJ STREET ADDRESS(NO P.O.BOX))
NAME OF ASSISTANT TREASURER,IF ANY
MAILING ADDRESS(IF DIFFERENT) STREETADDRESS(NO RO.BOX) -
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFIICER(S)
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STREET ADDR SS(NO P.O.BOX) %�'
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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 perjury under the laws of the State of Ca' rnia that t�eg�gicLg.is true and correct.
Executed on 2 �P By '
DATE ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice.advice@fppc.ca.gov(8661275-3772)
www.fppc.ca.gov
a
Statement of Organization A • -
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D.NUMBER
11�Mer)'Oern joel C? d C 8!✓e0)t��`' r "li T spo'� �l'1//t�'i! ''l e�0°► L i!3913'7 1 C L_-
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE BANK ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
s r u
rfsmc
3 F uF
4 1 v Y
..Jir�4, '�..�,y�,uAe.rn.drrw�.d,wd4]2-'`W;�..,.lwlwxv'u'..taxl�'ffi:.�kF4.�x.,.L.aiB"d�l,,,Yi�,!',kaA �m�r��ivax�tns�..�`,.� WmdL tl,:1,uWw�:ll�iw�C,m.'�.+�sw..rv.n,�,+�"PI1„J✓�a ml+,'�R4..�.b4..�',�,i^vncwi wl�RG`�Y41a?.r uUmx.'IMs�uw„Bd.'v�Wr�tiu.;NuH„«a..Sr midM: ,76�md mP.Lr,sSaF�.'tu„^4,.'�^.nrx.`�'4H,an^nCwlw,a.v.�d�x�,0.�uv!ur�,.qu,�4 icY�k.xwi;°
• 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 PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
❑ Nonpartisan
❑ Nonpartisan
Primarily Formed Committee:. Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CAN DIDATE(S)NAME OR MEASURES)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATES)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
Statement of Organization . I. 0 .
Recipient Committee - 1
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME _ ,,..�;? I.D.NUMBER
n ���'• ��( �l�l���c*? >�G��G!Y1� �t��j`��i t ca� ���i�.� ��:':�'71�'?i' �'�
�mw7,afS in4a°i,�xmi.ar.,5a1.�',atEaa..h7it�a�,wb�.wsar�'at�k.;..a,S;k.GansucG�s,:�SY�,+��.,aetrkd'.udwrL u.;,.a,�.�'.�''>Lany_ ?;Uai«v,.«arx�'.w.lieE,;,rs.,.:.c.,,,Lstr�.�,U�i.Ntv,�Gvt•�"m.,xrv..l%t[v r''a.e� u:xy1e�3,fi"�71 A,�,n�ad�.urt�eke,�w�:v�rt'�a����a'rLNarT�v�rr`J:uva"d�".2s�i„�C'>�'�i:o�i„vwwau3.e.em.5.�rwn/.�u�v.W.:^:"..;}Ir~0
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
CITY Committee COUNTY Committee TATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
j ILO
i t 177 JV ��t����� ���i�Jf�(i7�y✓� E%t,,;vy-el- re•f c'� "0 �' ��e�16;��� Y'�
•• List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
SM a • • • CO ❑
Date qualified
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.., � i h. � fi h esu .ra slstant reasurera�id.a ca Id t a ceho er., r t. ,.4...
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts,loans received,and other obligations;
• This committee has no surplus funds;and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
— There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees maybe used for political,legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov