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Statement of Organization <br />Recipient Committee STATEMENT OF ORGANIX. ATION <br /> <br />INSTRUCTIONS ON REVERSE <br /> <br />4. Type of Committee Complstetheapplicablssectlons. <br /> <br /> · List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also Iisi 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 /> NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br /> [] Non-Partisan <br /> · List the tlnancial Institution where the campaign bank account is located (controlled ,candidate election, committees only) <br /> <br /> FPPC Form 410 (Jan/01) <br /> FPPC Toll-Free Hetpllne: 866/ASK.FPPC <br /> <br /> <br />