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Statement of Organization STATEMENTOFORGANIZATION <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />NAME OF COMMITTEE I.D. NUMBER (IF AMENDMENT) <br />/ <br />4. Type of Committee: Complete the applicable seclions. <br />· List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, <br />also list the elective office sought or held, and district number, if any. <br />· List the political party with which each officeholder or candidate is affilialed. An officeholder or candidate not holding or seeking a partisan office must indicate 'non-partisan." <br />· If this committee acls jointly with another controlled committee, list the name and identification number of the other controlled committee. <br />· List the disposition of surplus funds. <br />NAME OF CANDIDATE/OFFICEHOLDEPJSIATE MEASURE PROPONENT: IELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) PARTY <br />I <br />DISPOSITION OF SURPLUS FUNDS: <br />l~r~iti~.l#lj~'~;Z, lltir=Z.l~.liihilti(~l=~ Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE'S OFFICE SOUGHT OR HELD OR MEASURE'S JURISDICTION <br />CANDIDATE'S NAME OR MEASURE'S FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br /> <br /> '~"-~ ~'/ SUPPORT OPPOSE <br /> / / SUPPORT OPPOSE <br /> <br /> Not formed to suppor~ or oppose specific candidates or measures Jn a single election. Check only one box: [] CiTY Committee [] COUNTY Committee [] STATE Committee <br /> PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br /> <br /> ~,*,~,[i~'f,]i~*~'~,]~ih~lJi(~[.:~ Provide additional sponsors on an attachment. <br /> NAME OF SPONSOR: INDUSTRY GROUP OR AFFILIATION OF SPONSOR: <br /> <br /> MAILING ADDRESS: NO. AND STREET CITY STATE ZiP CODE <br /> <br /> FPPC Form 410 (2/98) <br /> For Technical Assistance: 9161322-5660 <br /> <br /> <br />