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.Stptement of Organization STATEMENT OF ORGANIZATION <br />· ' Recipient Committee Typeorprlntlnlnk '-~"""~,~.'SlamP <br /> <br /> Statement Type [] Initial [] Amendment ,,,~ermination - See Part 5 Rx ORicial use Only <br /> Not yet qualified [] or List I.D. number: List I.D. number: D~'C I 0 2003 <br /> <br /> Date qualifi~ as ~mittee Date qualified as ~miltee Date of Te~na~n <br /> ~f ~) <br /> <br /> 1. Committee Information 2. Treasurer and Other Principal Officers <br /> ~E ~ C~MI~EE NAME OF TR~SURER <br /> <br /> STREET ADDRESS <br /> STREET ADDRESS (NO ~. BOX) Cl~ STATE ZIP CODE AREA CODE/PHONE <br /> CI~ STATE ZIP CODE AREA CODE/PHONE NAME OF ~SISTANT TREASURER, IF ANY <br /> ~ILING ADDRESS (IF DIFFERENT) STREET ADDRESS <br /> <br /> STATE ZIP CODE AREA CODE/PHONE <br /> O~10~: F~ I E-~IL ADDRESS <br /> <br /> NAME AND POSITION OF OTHER PRINCI~L OFFICER(S), IF APPLICABLE <br /> C~N~ OF ~MICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT <br /> THAN COUNTY OF DOMICILE <br /> MAILING ADDRESS <br /> <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Attach add~tional information on appropriately labeled continuation sheets. <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 cedify under penally of <br /> perjury under the laws of the State of California tha, t the foregoing is true and corre,~ <br /> Executed on /~"' <br /> Executed ~ -- <br /> DATE ~' SIGNORE OF CONTR~U~ OFFICEH~DER. C~DIO~E, ~ STATE ME~URE PR~ENT <br /> Execut~ ~ <br /> DATE ~IG~URE OF ~NTR~LING OFFICEH~DER, ~DIDRE, ~ STATE M~SURE PR~ENT <br /> Ex~t~ ~ <br /> DATE SIGN~URE ~ CONTR~I~ ~FICE~OE& ~IO~E. ~ STATE ~E PR~NT <br /> <br /> FPPC Form 4t0 (Janl03) <br /> FPPC TnlI. Fr~ H~lnlln~: RI~RIA,~K-FPP~ <br /> <br /> <br />