410 Statement of Organization Recipient Committee – Termination (April 2023)Statement of Organization
Recipient Committee
Statement Type, El Initial
❑ Amendment
Q Not yet qualified
or
O Date qualification threshold met Date qualification threshold met
I.D. Number
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NAME OF COMMITTEE
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STATE ZIP CODE AREA
ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE
STATE ZIP CODE
CODE/PHONE
AREA CODE/PHONE
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I have used all reasonable diligence in preparing this
on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
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