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it <br />Statement of Organization STATEMENT OF ORGANIZATION <br />Recipient Committee ~' ~ ~ ~ <br />.- <br />INSTRUCTIONS ON REVERSE <br />Page 2 <br />COMMITTEE NAME i I.D. NUMBER <br />Re-elect Jim Hartnett i 940672 <br />4. Type of Committee Complete the applicable sections. <br />• 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 <br />district number, if any, and the year of the election. <br />• List the political party witlj which each officeholder or candidate is affiliated or check "non-partisan." <br />• If this committee acts jolfltly with another controlled committee, list the name and identification number of the other controlled committee. <br />NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br />(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br />~ ®Non-Partisan <br />Jim Hartnett ~ Redwood City -City Council <br />Non-Partisan <br />• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) <br />NAME OF FINANCIAL INSTITU ION AREA CODE/PHONE BANK ACCOUNT NUMBER <br />Bay Area Bank ~ 650/365-1800 28545911 <br />ADDRESS j CITY STATE ZIP CODE <br />I <br />900 Veterans Blvd. j Redwood City, CA 94063 CA 94063 <br />• ~ . Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(S) NAME OR M ASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br />SUPPORT I OPPOSE <br />FPPC Form 410 (January/05) <br />FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) <br />