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Statement of Organization STATEMENTO~= ORGANIZATION <br />Recipient Committee <br /> <br /> INSTRUCTIONS ON REVERSE <br /> Pa~e 2 <br /> NAME OF COMMITTEE <br /> <br />4. <br /> Type of Committee: Complete the applicable sections. <br /> <br /> · List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, <br /> also list the elective office sought or held, and district number, if any. <br /> · List the political party with which each officeholder or candidate is affiliated. An officeholder or candidate not holding or seeking a partisan office must indicate 'non-partisan.' <br /> · II this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. <br /> · List the disposition of surplus funds. <br /> <br /> NAME O~ CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT: IELECTIVE OFRCE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPUCABLE) PARTY <br /> DISPOSITION OF SURPLUS FUNDS: <br /> <br /> Not Iormed to support or oppose specific candidates or measures in a single election. Check only one box: [] CITY Committee [] COUNTY Committee [] STATE Committee <br /> <br /> Prey~de addit~)nal SpOnsor~ on an a#achrrlent <br /> <br /> NAME O~ ~ONSOR[ INDUSTRY GROUP OR ^FFILIA'I1ON OF SPONSOR: <br /> <br /> MAILING ADDRESS: NO. AND STREET CITY STATE ZiP CODE <br /> <br /> FPPC Form 410 (2/98) <br /> <br /> <br />