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Statement of Orqanlzat,on '. STATEMENT OF ORGANIZATION <br /> Recipient Commlttee~.~x :,;:;,. , ,. - <br /> <br />:rypeorprlnti~lhk - '~; '~'~t'~" '~" "~ *' ' <br /> <br /> ID. NUMBER (IF AMENDMENT) <br /> <br /> V Type of Co~r,~itiee. Completing ~iS Statement: COMPLETE THE APPLI~BLE SECT~N(S). MORE THAN ONE ~TEGORY ~Y BE APPLI~BLE TO YOUR COMMITTEE. <br /> <br /> · I1 th~ co.reiCH ~ ~t;~d by ~e ~me off kabir(s) ut ca~ete(s), list the name of each controlling officeholder or canal d~te Aim list the ele~ive off~e sou ht or he d, and d str <br /> · numar, if any, fmeachl~Ivldual. =~ ' ' t '~ ' * ' g * <br /> · If this c°mmlffe~ ~ ~°nt~ b~ 6~e or more offkeho~t(s) m ~atl(s) fo~ parian offal, list the ~litical ~y with which each officeho~er o; cad.ate is ~ffiliated. An officeho~er or <br /> candidate n~ h~i~ ut ~king e ~i~n oflke m~ ~ 'n~i~n.' <br /> ~ na~eofeach~ate~ea~ure~,f..,,'~?.~, . I ~ ..... <br /> If thtl c~mi~ee a~ ~ntly with a~r c~t;~ c~m~, I~t ~ name and identlflcatm numar of the ~hl; controlled commi~ee. <br /> <br /> ~E OF~NDIDATE~FFEEHOLb~MTA~ ME~URE P~ENT~OMMI~EE ~ PAR~ ~ ELE~IVE OFFICE SO~HT OR HELD (I~LUDE DISTRI~ NUMgER I; APPLI~BLE) <br /> I <br /> l N~HlyF~;mmlff~. t~lf~rlmmi~f~m~tosup~s~clflccand~m~smme~sur~ Istthecandidatesmmeas; ' ' <br /> , ,.~ · . . ~ ~ ~, <br /> . , * ~ ..... IL , ~ , _~ . <br /> ~DIDATE*S N~ O" M~URE'S ~ULL'tITLE ~I~L"~ BALLOT ~. <br /> ,- ,,..,---- ' ..t... / .',',' '1 ' " ' <br /> / <br /> ............. ' '" ' '1 ' ' .... ' I <br /> <br /> ff~f~m~tosu~~fku~t~wmenurm chKkOiE~x~. .- ,-~ .v., ~,,,, *,:. ~.,~,. , ndcate fthshi D~C~m~fl~ ~COUi~C~m~ee~ ~ STATEC~m~ee <br /> PROVDEBREF~RIP~OFA~V~ ~.~'t ~ ~," % r, '.- <br /> <br /> A~RESS~F.SK~[,K:ANDSTREET ~:.O~, STATE ZIPCODE I ' <br /> I <br /> <br /> ~ ~t (omp~te this ~.) ,. · <br /> ~ ~e~k ~ H t~a ~oad ~le8 {omm~ee. Entel t~ ~te on ~ ~fore which the (ommlUee quallf~d il a ~oad based ¢ommlttee: <br /> ~ Check ~x If this cmmlflee ~ ~pr qua~s is a ~d ~ commlflle. (M~tfl, Day, Yeir) <br /> <br /> <br />