410 Statement of Organization Recipient Committee – Termination Stamped by SOS
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COllllti'llTTEE NA&iE
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1.D. NUMBER
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a All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITIITION
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ADDRi:SS a CITY STATE ZlPCODEo
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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 clieck "nonpartisan." Stating "No party preference" is acceptable
If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEHOIDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOLIGHT OR HELD
ilNClllDE DISI-RICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
YU p o <,5' h Tm cu4ertrnv c,ity coa( '' 2o22
Nonpartisan
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Partisan (lift pollhcal party below)
" [Yl €wd)J2?Nonpartisan ParHsan (list polihcal par§ below)
gggffffllgi'l primarily formed to support or oppose specific candidates Or MEASURES in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULLTITI:E (INCLUDE BALLOT NO. OR LETTER)
F A RECALL. STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(51 0FFICE SOUGHT OR HELD OR M eqsusc(s) JURISDICTION
ilNCLllDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)CHECK )NL
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advtce: advice(a)fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
NSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME l.[) NUMBER
PROl4DE BRIEF DESCRIPTION OF ACTIVITY
@faM#l#f4'ia!rilidh<441 ist additional sponsors on an attachment.
STREET ADDRESS NO. AND STREET CITY S1:ATE ZIP CODE AREA CODE/PHONE
n * * t * a a u n q - I ]//
Date qualified
This committee has ceased to receive contributions and make expenditures;/ / / )- D /2. o)2
This committee does not anticipate receiving contributions or making expenditures in the future;
There are restrictions on the disposition of surplus cai'npaign 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 i'nay be used for pblitical, legislative or governmental purposes under Government Code Sectioi"is 89511-
89518, and are subject to Electioris Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (August/2018}
FPPC Advice: pdvice(afppc.ca.gov (866/275-3772)
www.fppc.ca.gov