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.Statement Of 01'QanlZatlOn STATEMENT OF ORGANIZATION <br />Recipient Committee ~ - ~ , ~ <br />INSTRUCTIONS ON REVERSE <br />Page 3 <br />COMMITTEE NAME I.D. NUMBER <br />Re-elect Jim Hartnett 940672 <br />4. Type of Committee (Continued) <br />Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br />^ CITY Committee ^ COUNTY Committee ^ STATE Committee <br />PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br />• ~ . List additional sponsors on an attachment. <br />NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR <br />STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE <br />~ ~ ~ <br />^ ~~ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a <br />Date qualified small contributor committee on January 1, 2001, enter 1/1/01. <br />5.TeCminatiOn Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate,officeholder, or proponent certify that all of the following conditions have been met <br />• This committee has 'eased to receive contributions and make expenditures; <br />• This committee does not anticipate receiving contributions or making expenditures in the future; <br />• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; <br />• This committee has io surplus funds; and <br />• This committee has f led all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br />-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to <br />Government Code Section 89519. <br />FPPC Form 410 (January/OS) <br />FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />