410 Termination July tatement of Organization
Recipient Committee
Statement Type ^ Initial
Not yet qualified ^ or
Type or print in ink
^ Amendment
List I.D. number:
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1 to to i
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Termination -See Pa ~ ~ ; ~ ~ E
List I.D. number: , J U L I ~ 200 ~-
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2,~ ~~ CU E1~T1~"O CITY CLEF
DateDate of Termination
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Date qualified as committee Date qualified as committee
(If applicable)
1. Committee Information
NAME OF COMMITTEE
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OPTIONAL: FAX / E-MAIL ADDRESS
2. Treasurer and Other Principal Officers
K
OF ORGANIZATION
For Offidal Use Only
NAME pt= TREAcSURfR L
.n > ~ _
COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Attach additional information on appropriately labeled continuation sheets.
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
3. Verification
I have used all reasonable diligence.in preparing this statement and to the best of my knowledge t i rmation ntained her 'n i rue and compl te. I certify under penalty of
perjury under the I of the S ate of CaliforniaQthat the foregoing is true and correct.
Executed on ~ ~'"~ ZQOS gy
DATE ~ ~ SIGNA F T F,/1 U ER O S TANT TREAS ER
Executed on __~ .r-- ~ gy \\
DATE S ATURE ROLLING OFFICEHOLDER, CANDIDA E, OR STATE MEASURE PROPONENT
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/05)
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