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Statement of Organization �,` �,�c ��.DateS[amp , � _ . I
Recipient Committee e - �
Statement Type �Initial Amendment ❑ Termination—See Part 5�������� �,'g���,1 ����� ForOfficial Use Only
Q Not yet qualified in th orfice of the Secretary af Stat�
or of the State of California
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Date qualified as committee Date of termination � N
(If amending to provide this date) ���--7
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�-^NAME OF COMMITTEE ��4�� .�,������i�� �4� /�n�l.1!J j� NAME OF TREASURER
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�.STREET ADDRESS(NO P.O.BOX) .�CITY STATE ZIP CODE AREA CODE/PHONE
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o CITY STATE ZIPCODE AREACODE/PHONE oNAMEOFA5515TANTTREASURER,IFANY '
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` MAILING ADDRE55(IF DIFFERENT) �-STREETADDRE55(NO P.O.BOX) ,
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o E-MAILADDRESS�REQUIRED�/FAX(OPTIONAI) P^CITY STATE ZIPCODE AREACODE/PHONE
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w COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE �'NAME OF PR�CIPAL OFFICER(5)
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�STREET ADDRESS(NO P.O.BO%�
- .aCITY STATE ZIPCODE AREACODE/PHONE
Attach additionol information on appropriately labeled continuation sheets.
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I 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 �-�;�
penalty of perjury under t e laws of the State Cal' rnia that the foregoing is tr d correct. _= ' _` .
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Executed on �/ �O /?3 B `� (� �r-�� , c�,.� �. _'
OAT SIGNATUREOFTRE URERORASSISTANTTREASURER •"""
Executed on � �� ey ..w�— ;. _ rv'+�:.
� D E SIGN UR OF CONTROLLING OFFICEHOLDEN,CANDIDATE,OR STATE MEASURE PROPONENT _ _ •�^' �
Executed on By �`,
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT. . . . . ,, ,
Executed on By '
DATE SIGNATURE OF CONTROLIING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
. FPPC Form 410(May/2017)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www:fppc.ca.gov
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Statement of Organization ' • " '
Recipient Committee ___ � '
• -
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME � I.D.NUMBER`
r���.yr��cr� C��A�� �a� ����,�u�.� ���� co�c,►��,�� �c� _ l��,a`�8 �
• All committees rnust list the financial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION . AREACODEJPHONE - . BANKACCOUNTNUMBER
(��Li,,� ��.C9-f� ��1-�.I� �i51-3�� -- ��� ��� ���' ��'�� .
ADDRESS � CITY STATE ZIPCODE
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e.a`. '=sr:c .a ..;s.� ? �a` ,.t_�"�"� , '�"�'^P" " i �";.. �:e. � �qsE.,; � �
r• � � �,a.s .�a�r,�—z � �<_�a< '�;'. �.�.�. �., � °:s. "r�e, a, R�.� �.$�, t, �
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Y'�� �'M,����� � 4r� ��s:���u�,�S�a..a:o�" �.� 4� ,.e...,.., b�..� Y�..., E � .«F L .,W�i::..�`- �..�£:i. ..sm��.�.va.-..,:�a��C.�:.`t . .�...,..,�..,a
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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 check"nonpartisan." ' � '
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
��� ELECTIVE OFFICESOUGHT OR HELD �
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) YEAR DFELECTION PARTY
���,��r�►� ��� ��� ��-r( �occ���� , 'A�,���-� �a�� onpartisan
� ❑ Nonpartisan -
•. • Primarily formed to support or oppose specific candidates or measures in a single election. List below:
�:
CANDIDATEIS)NAME OR MEASURE(5)FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(SJ OFFICE SOUGHTOR HELD OR MEASURE�S)IURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNTY,ASAPPLICABLE� criECK oNe
� . SUPPORT OPPOSE
. . � ... . .. - � ' � ,. ❑ ❑
. � � SUPPORT OPPOSE
� � . . . ., ._ ., ... .: - . :.. � . � � �:-.. -�� �
— � - ❑ .
� FPPC Form 410,(May/2017)
� FPPC Advice:adwce@fppc.ca.gov(866/275-3772)
� . �:www':fppc.ca:'gov