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:Statement of Organization WHERE 10 FILE: r STATEMENT OF ORGANIZATION <br /> · Data Stam <br />I Recipient Committee Pile original &nd one copy of this form with: J.: ..... ~t?~p_ <br />4 ,Government C~e S~mns 84101~4103)' Political Raform Division ~: ~ i <br /> <br /> ' .. ,~ : , *; (~p~.l .merchant .... Sacramento ~950124467 ~ [ <br /> <br /> ;1~" P , :':";' ' ~ ~¢a ~;~71 lnd~nterl'D'~um~r: Thecityorcountyofficer, ifany, whoreceiv"th~-I '-; <br /> ..... ~,~ ~ ' ~. commi~ee'soriginalcampaigndisclmure ~ ~ ',, :' - ~ <br /> <br /> D.te Oual fl~.s -. ; ~/ NAME O¢ T"EASURER <br /> <br /> CiTY ' ';; STATE ZIP ~E AREA CODU PHONE NUMBER <br /> <br /> COUNTYOF ~M[ILE..~, ~ ~ ~ - COUN~E~COMMI~EE~IVEIFDIFFERENT <br /> TH~COUN~ ~M~ LE <br /> ;" ~ :'~' *' ' ' ~ ~< I ~ - , :.u ~ ' CITY STATE ZtPCODE AREACODE~AYTIMEPHONE <br /> ~LING ~DRESS (IF DIFFEREN~ ~. AND STREET OR P.O. BOX ,~ ' <br /> <br /> · , ~STATE ZIPCODE i,.,~EACODUPHONENUMBER <br /> <br />i II Disposition of Surplus Fu ,n. ds YOU must Spaclfy what disposition w t be made of leftover campaign funds, if any, alt termination. <br /> <br />fV Verification ,~.;,,., ,~ .:~'~;~t? F ":"¢:": "' '"' .',' ~ ' <br /> I have us~J all reasonable diligence In preparing this statement and [b the. best of my knowledge the informj~t~on contajne~l herein iA/r-~e and comp eta I <br /> c. rtl fy under pan.lty of par jury und.r the I.ws of th. St.t. of Carlforni. that th. foregolngis true.nd corr~t.~ <br /> <br /> ~ : :ti? ~l~l~q4~l~'*~,! )., : CITY~qCIS'IATS SIGNATLII~OflRSASU~SR <br /> Executed on. At By <br /> D~TI~ ...... cri'¥ ANO SLATS S~,G#ATU41~ Q4~ CONTaO4. LING Of IICSHOfLI)EII~ CANDIOATC, O~ STATE M?ASU~ PROPONENI <br /> Executed on. At By <br /> DATI[ CITY AtdO STATS ~NATURE Of CO#TROLLING OFf KS HO~DSR, CANDIOAT[. O~ SLATS MEASUR~ <br /> <br /> Executed on. At By <br /> Still of Cillfofnll Flit Pollllcll P~icllces Commission <br /> <br /> <br />