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��� <br /> State�ment of Organization \�1 � `�� STATEMENT OF OR;ANIZATION <br /> Reci ient Committee Type or print in ink \ �\ � �ate stamP � � . � <br /> ��� � <br /> Statement T e � �������� ������ �� i � <br /> Yp itial ❑ Amendment ❑ Termination—See Part 5 Fn t6 ?�ff�s'€���ti�� � "3 '���y t= �t� `- o � ' s , <br /> C�i��1C r;f q ,, ` ' �,.;�. s,":��>. ',���,� �` � ��P,, <br /> ot yet qualified�or List I.D.number. List I.D. number: � <br /> # # �UG °� � I�11'� SEP y 6 2013 � <br /> �� �—� �� ����� ��'�r��..,.� c�=j�•�r __,��� � t. �.��_,�r <br /> Date qualified as committee Date qualified as committee Date of Termination ���������q �'� ��'� � ���.,{,�� �P�� <br /> (If applicable) <br /> 1. Committee Information 2. Treasurer and Other Principal Officers <br /> NAME OF COMMITTEE NAME OF TREASURER <br /> �; ` �(,�` � <br /> �„_.�t`l��,��I�i"'� ����`�=j�, <br /> � �A,� � ��/� /� <br /> <br /> <br /> � :� � • <br /> STREETADDRESS(NO P.O.BOX) CITY STA ZIP CODE AREA CODE/PHONE <br /> �`�,� � �` �-�-�N ��O�`� � �1���2.._. � <br /> CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER,IF ANY <br /> 2������ � ����`-' `''���"°'�� ��l STREETADDRESS(NO P.O BOX) <br /> MAILING ADDRESS(IF DIFFERENT) <br /> e..�-�-_"' <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS <br /> �..) �"�� � .��� NAME OF PRINCIPAL OFFICER( ) � <br /> COUNTY OF DOMICILE COUNTY WHERE COMMIITEE IS ACTIVE IF DIFFERENT �G�v✓��� �-'�'Z�li1/� <br /> C...SL^`" � THAN COUNTY OF DOMICILE STRE�� S��O.B� �� <br /> � 1�1/��. <br /> CITY STATE ZIP CO.DE AREA CODFJPHONE <br /> Attach additional information on appropriatety labeled continuation sheets. ��� 1 /'��_r J - /��� ��� /ti� � <br /> , <br /> 3. Verification � <br /> I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of <br /> perjury under the law of t e State of California that the foregoing is true and correct. <br /> Executed on �,^{� Cl 1 gy � • ��U-n <br /> -�,`t' <br /> c�I���T�� SIGN EOFTREASURERORASSISTANTTREASURER <br /> Executed on � � gy <br /> DATE SIGNATURE OF CO ROLLING O EH LDER,CANDIOATE,OR STATE MEASURE PROPONENT <br /> Executed on gy <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> Executed on gy <br /> DATE . SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> FPPC Form 410 (Aprill2011) <br /> � FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />