410 stamped from state
Statement of Organization
Recipient Committee
45
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Date qualified as committee
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Date qualified as committee
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Date of Termination
1. Committee Information
2. Treasurer and Other Principal Officers
STATEMENT OF ORGANIZATION
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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 cenlfy under penalty of
perjury under the laws of the State of California that the foregoing is true and correct
Executed on / - ]() ~ 07
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S G'\JA-'~RE OF co~ I ROLL NG OFFICEt-<OLDER CA,ND OATt: OR STAT:: iV1E:AS.JRE ='R8PO\k.NT
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
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CALIFORNIA 41 0
FORM
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4. Type of Committee Complete the applicable sections
Controlled Committee
· 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 "non-partisan"
· If this committee acts Jointly with another controlled committee list the name and identification number of the other controlled committee
'lAME 0= CA \jC JA-E/O"F CErCLC=~IS-A-E v ::ASJR:: "~CPC\JE~-
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PAR-Y
G/i{j?f<.,7 elff Co V1/VC II.. 2- ~~ 7 ~ Non.Partisan
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D Non.Partisan
· List the financial Institution where the campaign bank account IS located (controlled "candidate election" committees only)
\lAVE OF FI~AI\C AL ~STITL O~
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Primarily formed to support or oppose specific candidates or measures in a single election List below
CA~C JATE;S) \lA\!E CR MEASJ"E;S; =JL_ TlTL:: (I~C_l):: BA_LO- \lC CR _ETTER)
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SUPPORT OPPOSE
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/215-3772)
Statement of Organization
Recipient Committee
STATEMENT OF ORGANIZATION
\JsnJCTIC\lS C~ REV::RSE
CALIFORNIA 41 0
FORM
COVM TT=E 'lAVE
4. Type of Committee (Continued)
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General Purpose Committee
Not formed to support or oppose specific candidates or measures In a single election Check only one box:
Eia CITY Committee D COUNTY Committee D STATE Committee
"ROVIJE 3R EF CESCRIP- O~ OF ACT V-Y
Sponsored Committee
List additional sponsors on an attachment.
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Small Contributor Committee
o ----1----.1_ Check box and provide the date thiS committee qualified as a small contrioutor committee If the committee qualified as a
Date qualified small contributor committee on January 1,2001, enter 1/1/01
5. Term ination Requ irements By signing the verification. the treasurer, assistant treasurer andior candidate, officeholder or proponent certify that all of Ihe following conditions have been met
. This committee has ceased to receive contributions and make expenditures
. This committee does not anticipate receiving contributions or making expenditures 11 the future;
. T'lis committee has el minated or has no intention or ability to discharge all debts, loans received and other obligations,
Ths committee has no surplus funds, and
. This committee has filed a'l campaign statements reqUired by the Po!'tlcal Refor,T Act disclosing all reportable transactions
There are restnctions or the disposition of surplus campaign funds held by elecIed officers who are leaVing office and by defeated cand dates, Refer to
Government Code Section 89519
FPPC Form 410 (January/OS)
FPPC Toll-Free Hel pline: 866/ASK-FPPC (866/275-3772)