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Statement of Organization STATEMENT OF ORGANIZATION <br />Recipient Committee <br /> <br />INSTRUCTIONS ON REVERSE <br /> <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 /> distdct 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 andther controlled committee, list the name and identification number of the other contrctled committee. <br /> ELECTIVE OFF[CE SOUGHT OR HELD <br /> NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ......... ELECTION , ,~.. iPARTY <br /> [] Non-Partisan <br /> <br /> · List the financial institution whero the campaign bank account is located (controlled .candidate election, committees only) <br /> <br />*DDREE' aTA <br /> <br /> ll~.r~llre~,~o~l~.a...~qlltlq.~ Pdma~ly fo~ ~ suppo~ ~ op~ spec~c ~ndldates ~ measures in a single ele~on. List ~low: <br /> <br /> C~DIDATE(S) ~M E OR MEASURE(S) FULL TI~E (INCLUDE B~OT NO. OR LE~ER) CANDiDATE(S) OFFICE SOUGHT OR HELD OR M~SURE(S} JURISDiCTI~ <br /> (INCLUDE DIS~[CT NO., CI~ OR COUNt. AS APPU~LE) CHEC~ ONE <br /> <br /> SUPPORT OPPOS~ <br /> <br /> FPPC Form 410 (Janl01) <br /> FPPC Toll-Free Helpllne: l166/ASK.FPPC <br /> <br /> <br />