Laserfiche WebLink
~tatement of Organization STATEMENT OF ORGANIZATION <br />Recipient Committee <br /> <br />INSTRUCTIONS ON REVERSE <br /> Page 3 <br />COMMITTEE NAME I.D. NUMBER <br /> <br />4. Type of Committee {Cootinued) <br /> <br />lg].~=~.~lA,~t~,~,~.~r=a,,x,~=~-.m Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> [] Cll3~'Committee ~] COUN'~Committee [] STATECommittee <br /> <br />PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br /> <br />l~/,lm~.'~,J~'-z,~'~,~,~(¢=~--m List additional sponsors on an attachment. <br /> <br />NAME OF SPONSOR tlNDUSTRY GROUP OR AFFILIATION OF SPONSOR <br /> I <br />STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE <br /> <br />l.'f~"/ll~';~'/~/,'mt~7-~,~mm,1=~-.~ [] I /.__ Check box and provide the (]ale this committee qualified as a small contribulor committee. If the committee qualified as a Date qualified small conlributor committee on January 1, 2001, enter 1/1/01. <br /> <br />5, Termination Requirements Bysigningtheveri§cafi~n~thetreasurer~assis~ant~reasurerand~~rcandidate~~~ceh~~der~~rpr~p~nen~cer~ifytha~a~~~fthef~~~~wingc~ndifi~nshavebeenmet: <br /> · This committee has ceased to receive contributions and make expenditures; <br /> <br /> · This committee does not anticipate receiving contributions or making expenditures in the future; <br /> <br /> · This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; <br /> <br /> · This committee has no surplus funds; and <br /> <br /> · This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> <br /> -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to <br /> Government Code Section 89519. <br /> <br /> FPPC Form 4t0 (Janl03) <br /> FPPC Toll-Free Helpllne: 8661ASK-FPPC <br /> <br /> <br />