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� <br /> Statement of Organization ► • - � i <br /> Recipient Committee � - � <br /> INSTRUCTIONS ON REVERSE - <br /> Page 2 <br /> COMMITTEE NAME I.D.NUMBER <br /> Committee to elect Janet Borgens 1374422 <br /> • Ail committees must list the financial institution where the campaign bank account is located. <br /> NAME OF FINANC�AL INSTITUTION AREA CODE/PHONE BANK ACCOVNT NUMBER . <br /> ADDRESS CITY STATE ZIPCODE <br /> 4 `Ty�E�ofw�� ����yColnpl���fti���5pil�=�b���e�ti��is , ' i ; <br /> .��fi� ��,..2~,��a �. � �,�. . .�.. . _ <br /> . . •. . <br /> I <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." <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 � � <br /> NAME OF CANDIDATE/OFfICEHOLpER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br /> ❑ Nonpartisan <br /> ❑ Nonpartisan <br /> � � •� � Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br /> CANDIDATE(5)NAME OR MEASURE(5)FULL TITLE(INCLUDE BALLOT N0.OR LETTER) CANDIDATE(S)OFfICE SOUGHT OR HELD OR MEASURE(S)lURISDICTION <br /> (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE <br /> SUPPORT OPPOSE <br /> ❑ ❑ <br /> SUPPORT O� <br /> 1 1 <br /> L.J <br /> FPPC Form 410(Dec/2012) <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> V www.fppc.ca.gov <br />