410 Statement of Organization Recipient CommitteeI 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 certify under
SIGN ATURE OF CONTROLLING 9FFICEHOLDER, CANDIDATE, OR STATE MEASIIRE PROPONENT
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Executed on
SIGNATIIRE OF CONTROILING OFFICEHOL[)ER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
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Statementof0rganization JAN802023 DateS'mp ffi p ' j sOeuaa;rtizxrt+/'yrxrzi++eiei "" - '
S'akemen' TYPe 0 Initial g Amendment Termination - See Part 5 'o"'9
0 Date qu"alification threshold metl Date qualification threshold met Date of termination C U P ERTINO CITY g !# jERT)NO CITY CIIERK
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NAMEOFCOMMITTEE NAMEOF.TREASuRER
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COIINTYOFDOMICILE WHERE ACTIVE NAME OF PRINCIPAL OFFICER151
ZIP CODE AREA CODE/PIIONE
STREET ADDRESS iNO P.O BOX}
Attach additional information on appropriately labeled continuation sheets.
CITY STATE AREA CODE/PHONE