410 Initial tatement of Organization
Recipient Committee
Statement Type ~lnltlal
Not yet qualified ~( or
'lype or print In Ink
[] Amendment
Ust I.D. numbec.
I I I I
Date qualified as committee Date qualified as committee
Date Stamp
List I.D. number:
# AUG - ZOO1
I I
Date of Terminalion
STATEMENT OF ORGANIZATION
Official Use Only
1. Committee Information
NAME OF COMMITrEE
~(b'zcns ~r Orrfn
STREET ADDRESS (NO P,O. BOX)
CITY
STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
2. Treasurer and Other Principal Officers
NAME OF TREASURER
c,TY Cu~pcr4~'~o
NAME OF ASSISTANT TREASURER, IF ANY
STATE ZIP CODE AREA CODE/PHONE
CA 95014
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 AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS
orrf~_mahonc¥ ~ bp. corn
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
%adva Clara Co ]T~.COU..OFDOM,C,.E
Attach additional information on appropriately labeled continua#on 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
perjury under the laws of the State of Califomia that the foregoing is true and correc~ , . __ __
/E .:/.////. s,~-,REOF,,~uRE. OR~..,.~T
~x~u,edo. Au§us+ (~,, 'ZOOt By £/¢,.,/ /~.,..,...,_
DAlE SIGNATURE OF ~LING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE PROPONENT
/
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
DATE SIGNATURE OF CONTROLLING OFFICEHOI.DER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/01)
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMI'I-rEE NAME
STATEMENT OF ORGANIZATION
Page 2
I.D. NUMBER
4. Type of Committee complete 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 yea.r of lhe 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
Orr(n I ahon.e¥ Ooi / Co cfl ember ~.o~-Pailisan
[] Non-Partisan
NAME OF FINANCIAL INSTITUTION AREACODE/PHONE
(~u~)er~'nO l~(:~onal D~nk ~-TrusS 4~-qq(o- 1/44
BANK ACCOUNT NUMBER
O01/
ADDRESS CITY
¢0250 eSevcn Creek B/vd C er 'no
STATE ZIP CODE
CA 9 501
· m,. · . - · ·.. - - 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 LEi II:R) CANDIDATE(S) 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/01)
FPPC Toll-Free Helpllne: 8661ASK-FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
C(-hz. en6
4. Type of Committee
(Continued)
i~:'~r'~"a""z'~"~'m'm"li~'J Nqt formed to support or oppose specific candidates or measures n a s ngle election. Check only one box:
~--I CITY Committee [] COUNTY Committee [] STATE Committee
STATEMENT OF ORGANIZATION
Page 3
I.D. NUMBER
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
~i~ '='~m~-'~,lt=z, d'~,'" m --'-z'-~ Ust additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
IINOUSTRY GROUP OR AFFILIATION OF SPONSOR
CITY STATE ZIP CODE
l¢~"~"~#i~'~'"'~'(']"a~'~'"m'[~:i"'m [] I I Check box and provide lhe date this committee qualified as a small contributor committee. If the committee qualified as a small
Date qualified contributor committee on January 1,2001, enter 111101.
5. Termination Requirements ~ysigningtheveri~cati~thetreasurer~assistanttreasurerand/~rcandidate~ceh~der~rpr~p~nentcertifythata~fthef~wingconditi~nshavebeenmet:
· 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.
-- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Janl01)
FPPC Toll-Free Helpllne: 866/ASK-FPPC