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'Statement of Organization STATEMENT OF ORGANIZATION <br />Recipient Committee <br /> <br /> INSTRUCTIONS ON REVERSE <br /> Page 2 <br /> <br />COMMITTEE NAME t.D.NUMBER <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 joinfiy with another controlled committee, list the name and identification nurnber of the other controlled committee. <br /> ELECTIVE OFFICE SOUGHT OR HELD <br /> NAME OF CANDID/q'EIOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION pARTY <br /> [] Non-Partisan <br /> [] Non-Parlisan <br /> <br /> · List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) <br /> <br /> NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER <br /> <br /> ADDRESS CITY STATE ZIP CODE <br /> <br /> l~.//~.~d~F/.,~..,d...--x,B,.x.z,,;..~[(:i-J Primarily form,ed to support or oppose specific candidates or measures n 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 /> <br /> SUPPORT OPPOSE <br /> SUPPORT OPPOSE <br /> <br /> FPPC Form 410 (Janl03) <br /> FPPC Toll-Free Helpline: 8661ASK-FPPC <br /> <br /> <br />