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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />64M"41�M So"M—. C, Oo... 12013 <br />1357417 <br />All committees must list the financial institution where the campaign bank account is located. <br />NAME OF FINANCIAL INSTITUTION <br />United American Bank <br />ADDRESS <br />AREA CODE/PHONE <br />(650)579-1500 144001121 <br />STATE ZIP CODE <br />101 So. Ellsworth Ave, Ste. 110 San Mateo CA 94401 <br />4. Type of Committee Complete the applicable sections. <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 />NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT <br />ELECTIVE OFFICE SOUGHT OR HELD <br />(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION <br />PARTY <br />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 />CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDI <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) <br />CHECK ONE <br />FPPC Form 410 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />SUPPORTOPPOSE <br />SUPPORT <br />OPPOSE <br />FPPC Form 410 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />