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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 AREACODE/PHONE <br />1 nn to "4 �vn (_ _rp) I g; nn &St) -26.3- I72S <br />ADOREss Cm <br />S-75' MIJA-I eld ik. 01 I'CQrIweJ 014.4 <br />4. Type of Committee complete the applicable sections. <br />�L.tlmrvneaT. orrmnrm�—� <br />BANK ACCOUNT NUMBER <br />STATE ZIP CODE <br />0A C7 1111)61 T <br />CALIFORNIA <br />•- ' <br />Pace 2 <br />10 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 NUMBER IF APPLICABLE) ELECTION CHECKONE <br />NonpartsanPartisan (lint political party below) <br />CAI(' .Soihc- /1'%, r�/�A � �C L <br />NonpartisanPI San (Int political party below) <br />.4,ijg jj Yi.nm,.4eE,Nni„�� primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(s) NAME OR MFASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) <br />IF A RECALL, STATE "RECALL IN FRONT OF THE OFFICEHOLDER'S NAME. <br />CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br />I SUPPORT I OPPOSE <br />SUPPORT I OPPOSE <br />FPPC Form 410 (October/2017) <br />�ClearPage� Print FPPC Advice: advlce@fppc.ca.gov(866/275-3772) <br />www.fppc.ce.goV <br />