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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COMMITTEE NAME <br />• All committees must list the financial institution where the campaign bank account is located. <br />NAME OF FINANCIAL INSTITUTION AREACODOPHONE BANK ACCOUNT NUMBER <br />nn �caTPt) ���..� I�ninn I &So 363-1725 i�(,7 �� <br />ADDRESS99 pp CRY STATE ZIPCOOE <br />Sts /,IIUiAI,2f ew Rrvd P cep ilf 0Q <br />4. Type Of Committee Complete the applicable sections. <br />ll <br />CALIFORNIA <br />FORm 410 <br />Pate 2 <br />II D.NUMBER <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 with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable. <br />• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. <br />ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY <br />NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUM8ER IF APPLICABLE) ELECTION CHECKONE <br />Nonpartisan Pun"n(list political party below) <br />_S17hci 177.�A /I�1n}-Pl /y i 74',�'v�.,�. � ,Zn �� _. /Y1 Qr rC�f <br />Nonpartisan Pa San lis po INcal party below) <br />s.v.�.�.u.ad.•n..0+.,,,.:,,F..=� Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATES) NAME OR MEASUREIS)FULL TITLE(INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />IF A RECALL, STATE "RECALr IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br />SUPPORT OPPOSE <br />SUPPORT OPPOSE <br />FPPC Form 410 (October/2017) <br />Clear Page I Print I FPPC Advice: advicekDfppc.ca.gov (8661275-3772) <br />g 1 www.fppC.ca.gov <br />