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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 I AREA CODE/PHONE <br />ADDRESS CITY <br />4. Type of Committee complete the applicable sections. <br />•4unod1a.4W nunh.u� <br />BANK ACCOUNT NUMBER <br />STATE ZIP CODE <br />CALIFORNIA <br />FORM 410 <br />7Pege 2 <br />I.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 NUMBER IF APPLICABLE) ELECTION CHECK ONE <br />Nonpartisan Partisan (list political party below) <br />Ernie Schmidt City Council 2018 0 <br />Nonpartisan Partisan (list political party below) <br />•�•I•• • •H,-+• ••• �•��• •• •• y— Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (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 MEASURE(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br />SUPPORT <br />OPPOSE <br />E] <br />r7 <br />SUPPORT <br />OPPOSE <br />M <br />FPPC Form 410 (February/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/2753772) <br />www.fppc.ca.gov <br />