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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />COMMITTEE NAM E <br />4. Type of Committee (Continued) <br />R.•I�a 1, ,•..T��i...� 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 OF ACTIVITY <br />_a• . List additional sponsors on an attachment. <br />NA ME OF SPONSOR <br />STREET ADDRESS <br />NO. AND STREET <br />CITY <br />IINDUSTRY GROUP OR AFFILIATION OF SPONSOR <br />STATE ZIP CODE <br />CALIFORNIA <br />FORM 410 3 <br />I.D. NUMBER <br />AREACODE/PHONE <br />aa��lunll\EI•�unlLrtolil•nuiuina:.j ❑ <br />Dae• R�alir�ee <br />5. Termination Requirements Byslgningthe Verification, the treasuter, assistant treasurer and/or candidate,officeholder,orproponeotcerUfythataIIofthefollowingcondiponshavebeenmeD <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 />FPPC Form 410 (October/2017) <br />Clear Page: Print FPPCAdvice: advice@fppc.ca.gov(866/275-3772) <br />-..._._.—____.a www.fppc.ca.gov <br />