410 Statement of Organizational Committee - Termination Stamped by SOSStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
❑ Amendment
List I.D. number:
#
Date qualified as committee
(If applicable)
Termination — See Part 5
List I.D. number:
# ✓�/
/ -.1 /Jl
Date of Termination
Date Stalnp
FILED
in the o o ecre
o f Cal
1h a office of the Secretary (
of the State -of Calffomi
JUI. 2 0.2015
L
AUG 3 2015
1, Committee Informatfan .. 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE .._ .. .... ..._ _...... __.. _... ._........
NAME OF TREASURER _
STREET ADDRESS (NO P.O. BOX) STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE CITY STATE ZIP CODE AREA CODE /PHONE
C4 0/y
MAILING ADDRESS (IF DIFFERENT) NAME OF ASSISTANT TREASURER, IF ANY
FAX / E -MAIL ADDRESS STREET ADDRESS (NO P.O. BOX)
COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS AC FIVE CITY STATE ZIP CODE AREACODE /PHONE
NAME OF PRINCIPAL OFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
3. Verification
have used all reasonable diligence in preparing this statement and to the best of my knowledge the'information contained hereinis true a
nd complete. I certify under
penalty of perjury under the laws of the State of California that the foregoing is true correct.
Executed on 7 f / By
DA E
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDArE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov