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St1t@Ill@Ilt Of OI'ga111Zat1011 STATEMENT OF ORGANIZATION <br /> Recipient Committee � . - . � � <br /> . - <br /> INSTRUCTIONS ON REVERSE <br /> Page 2 <br /> COMMITTEE NAME ���� ^ , �� ^ 1 ���G} � �� <br /> I.D.NUMBER <br /> n!���A�� � <br /> 4.Type of Committee Complete the applicable sections. <br /> . . •. . <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"non-partisan." <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/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICAB�E) YEAR OF ELECTION PARTY <br /> � 1 � �Non-Partisan <br /> � �,�,t�.s i.�.�. � e� C��;��; I ��.�:�,C� ��� <br /> r ❑ Non-Partisan <br /> • List the financial institution where the campaign bank account is located (controlled"candidate election"committees only) <br /> NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANKACCOUNT NUMBER <br /> �-� t��v ��;-����� � 6��� �3�-� �-17Z.`� �0��2�3gb <br /> ADDRESS CITY STATE ZIP CODE <br /> ��� C���;�z��.�v� � . �,d�.�}��CS �- ���b3 <br /> � <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) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION <br /> (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK oNE <br /> � SUPPORT OPPOSE <br /> SUPPORT OPPOSE <br /> FPPC Form 410 (April/2011) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />