410 Amendment
Statement of Organization ~pe or print In Ink o Te""lnallon - S88 Perf ~
Recipient Committee
Slatement 1Ype o Initial fill Amendment
Not yet qu.11tIed 0 or LIaII.D. numbe" list I.D. numba" j .
# 1279538 # !
---1---1_ -.!.....t-.!LJ~ ---1----1 I (·iJ· EfiTi'·I() CiTY Cl F' '\
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Date qualltled II convnll\ae Date quaHftod II convnII\ae Date ofTonnlnatlon
(11_)
1. Committee Information 2. Treasurer and Other Principal Officers
-
NAME OF COMMITTEE NAME OF TREASURER
Citizens for Orrin Mahoney
STREET AOORESS
STREET ADDRESS (NO P.O. BOX) -
CITY STATE ZIP CODE AREA COOEIPHONE
CITY STATE ZIP CODE AREA COOEIPHONE NAME OF ASSISTANT TREASURER, IF _
MAIUNG AOORESS (IF DIFFERENT) STREET AOORESS
P. O. Box 1523, Cupertino. CA 95015 CITY STATE ZIP CODE AREA CODEII'HONE
OP11OIIAL: FAX I E-MAIL ADDRESS
orrin_for _councll@comcast.net NAME AND POSITION OF OTHER PRINCIPAL OFFlCER(S), IF APPLlCASLE
CQU\ITY OF DOMICILE COUNTY V\otiERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE MAILING ADDRESS
CITY STATE ZIF CODE AREA CODEIPHONE
_ _81 infonnatlon on appropriately IabeIod contlnu.tion sllaeta.
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 end complete. I certify under penally of
peljury under the laws of the State of California that the foregoing is true and oorrect. ~ I ~E:~
E>œcuted on 9/28/05 By
D4TE ;¡
E>œcuted on 9/28/05 By ~
&'iË iii NG OFFICEHOLDER, CANDI~'Æ. OR STATE MEASURE PROPONENT
E>œcuted on &'iË By iii
SIGNATURE R, CA~TE. OR STATE IlEASURE PROPONENT
E>œcuted on &'iË By
'Ai R, CAJÐDATE, OR STATe MEASURE PROPONENT
FPPC Form 410 (J....rylO6)
FPPC Tol~F_ HelplIne: _ABK-FPPC (1M/276-3TT2)