Laserfiche WebLink
Statement of Organization 5'TATEMENTOF ORGANIZ.A.T~ON <br /><~ Recipient Committee Type m- print m ink U~e Stamp <br />IJJ <br /> <br />< Statement Type [] Inltfal [] Amendrn~nt Termination - See Part 5 For 0~al L~e o~ry <br />O_ <br /> Not yet qualifiedL~r'm or List I.D. number:. List I.D. number: <br /> <br />~' Date que~ed ~s c~mmittee Date qualirmd as ~>rnmitlae Dal~ of Tarminal~rt <br />~ 1, Committee Irrformation 2. Treasurer and Other Principal Officers <br /> NAMEOFCO~MITTEE NAME OF ~E. ASL~RER <br /> <br /> ~; STREET ADDRESS (NO P,O, t~3X) CITY <br /> ZiP CQCE AREA COOF_~$= i. K3~ E NAME OF AS $tSTANT TR F_ASUAER, IF ANY " <br /> MAILING ADDRESS (IF DIFFERENT) <br /> <br /> O~NAi.,. FAX I E44AIL ADD~.ESS <br /> <br /> Nd~E AN~ POSITION OF OTHER PRINCIPAL <br /> <br /> CO~WTY OF DOMICILE t COUNTY I~-IERE COMMITTEE iS ACTIVE iF DrFFERENT <br /> <br /> CITY STATE ZIP CODE AREA C-QDF_fPHONE <br /> Attach additt~na$ t~kxrrna~=n on apl:u'ol~ateiy ~ed a3nti~ratk3n sheets, <br /> <br /> 3. VerifioaUon <br /> I have used ail reasonable cliligence in prepadr~j this statement and to the best of my k~owledge. J~omnatic~ corltained hem is true and complete. I cedify under penalty <br /> <br /> '-'3 DA'PE ' - , C L{. I NG (~'F t;;E_H O~ E I;~,~aN DI [N~,TE, O R S'F*,TE M E,.~.~J R E <br />LD <br />~ Exeod~ed c~ B~/ <br /> <br /> "1- DATE $~3NATL~E OF CONTROLLING C..,~F~EH~LDER, C~NDiDATE, OR STATE MEASURE PRCPO~E:~T <br /> <br /> FPPC Fora 410 {Jan/~) <br />I-- FPPC Toll-Free Helpline: 886tASK-FPPC <br />Z <br />I.LJ <br /> <br /> <br />