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Statement of Organization <br />Recipient Committee <br />INSTRUCr10NS ON REVERSE <br />COMMITTEE NAME <br />4. Type of Committee (continued) <br />�n,.,...,�m��aa,N.,�+uaa,.ul.aaa••� 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 ❑ Political Party/Central Committee <br />PROVIDE BRIEF DESCRIPTION Or ACTIVITY <br />�n•,N,,.,.�...�+•„,••,IF•aa� List additional sponsors on an attachment. <br />NAME OF SPONSOR <br />STREET ADDRESS <br />NO AND STREET <br />aa�]u�Nlabnn.inuwdna mbsa <br />❑ �� <br />Drte puallfld <br />ORN <br />IINDUSTRY GROUP OR AFFILIATION OF SPONSOR <br />CALIFORNIA <br />•- <br />Page 3 <br />10 NUMBER <br />STATE IIP CODE AREACODE/PHONE <br />S. Termination 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 ceased 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 no surplus funds; and <br />• This committee has filed 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 Government <br />Code Section 89519. <br />-- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are <br />subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br />Clear Page Print I FPPC Form 410 (February/2018) <br />9 7 FPPC Advice: advice@fppc.w.gov (866/175-3772) <br />www,fppc.ca.gov <br />