410 Amendment 2Statement of Organization
Recipient Committee
Statement Type [] Initial
Not yet qualified [] or
Type or print in Ink
~ Amendment
List I.D. number:
I ! I L~
Date qualir,~l as committee Date qualified as commiltee
1. Committee Information
NAME OF COMMITTEE
t
STREET ADDRESS (NO P.O. BOX)
[] Termination - See Part 5
List I.D, number:.
STATEMENT OF ORGANIZATION
BILL JONES ~,.~,
/
D~e/ofTe~;~ CASECR A y y OF CUPErTInO
2, Treasurer and O~er Principal ~cers
NAME OF TREASURER
STREET ADDRESS
CITY S'TATE ZIP CODE AREA CODE/PHONE
CITY STATE ZIP CODE
AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT)
OPTIONAL: FAX / E-MAIL ADDRESS
COUNTY OF DOMICILE
ICOUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
A~ach additional information on approp~fatefy labeted continuation sheets,
STREET ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CiTY STATE ZiP CODE ARF_.A COOF_/PHONE
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
perjury under the laws °f the State °f Catif°mia tflat the f°reg°ing is true and c°rrect' a~ //,~ '
DA~ ~ TAN RER
on
DATE SIGNATURE OF CONTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DATE SIGNATURE OF CONTROUJNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PI:~)PONENT
FPPC Form 410 (Jan/01)
FPPC Tall-Free Helplirm: 866/ASK-FPPC
tatement of Organization
R~cipient Committee
INSTRUCTIONS ON REVERSE
COMMITTI=-E NAME
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGN~i7_ATION
Page2
I.D. NUIv~ER
· 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
distdct number, if any, and the year of the election.
· List the political party 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 PARTY
[] Non-Partisan
[] Non-Partisan
· List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE
IBANK ACCOUNT NUMBER
ADDRESS CiTY STA'I~ ZIP COOE
Primarily formed to support or oppose specific candidates or measures in a single election. 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 APPMCABLE) CHECK ONE
FI)PC Form 4'1o (Jan/01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC