410 Statement of Organization Recipient Committee – Initial Not Yet Qualified – Stamped by SOS Stater:�Qnt of Organization � l� � / �' ) /l � �/�/ y� DateStamp �
Recipient-Committee `"f� `"�� ��,� ��� ,'� ``� . • - � . � �
Statement Type Initial 1 �, ❑ Amendment — '-� �d �
� `� ❑ Termination—See Part 5 offiu us on
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� List I.D.number: List I.D.number: 7
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Date qualified as committee Date qualified as committee Date of Termmation �; - �
(If applicable) � -
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Attach additional information on appropriately labeied continuation sheets.
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i have used ail reasonable diligence in preparing this statement and to the 6est of
MEASURE PROPONENT
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DATE � SIGNATURE OF CONTROLIING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on gY
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR S7ATE MEASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772}
www.fppc.ca.gov
State;►ient of Organization , � _ ,
Recipient Committee � . � �
INSTRUCTIONS ON REVERSE
Page 2
CO ITTEE NAME I.D.NUMBER
9
�c�:�v�/� %������. 1����eL-,��L�� ��. G������ 2-�1�
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• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINA CIALINSTITU�N AREACODE/PHQNE BANKACCOUNTNUMBER
l/ (/�/�S �eGY�`
� STATE � ZIPCODE
� !/ /��✓ -���'' � �� `�- �
4.Type of Committee Complete the applicable sections. '
_
i�•i����.�Il�•ti����i uil�s�_a
• 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"nonpartisan."
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
NAME Of CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE D�STRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
/�� � ` ,� ,�Nonpartisan
✓ C�� -v���. .� ,��v�l� /'��-,�i-���ii�� ���� �'�-���/ �/C
� � ,�,� ❑ Nonpartisan
■������•���►��������a�r���������7+��� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT N0.OR LETT[R) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
❑ ❑
SUPPO0.T O�Q$�
� � ❑�_�
FPPC Form 410(1an/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
�---..._�"�'�^
State�ent of Organization , � _
Re�ipient Committee � _ � �
�NSTRUCTIONS ON REVERSE
, Page 3
COMMIT7E�ME . .� � , I.D.NUM�ER
;�c�ti� �fc j��������., �z���-�-i�L� C��� ��-�-���;� 2.r`
4.Type of Committee lcon�ued) �-'
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY •
����•��,.i���a.t�.�„i,,,�iKa:� List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRE55 NO.AND STREET CITY STATE ZIP CODE
❑ � �
Date qualified
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the 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 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.
-- Leftover funds of ballot measure committees may be used for political,legislative or governmental purposes under Government Code Sections 89511-89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
.. www.fppc.ca.gov