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Statement of Organization <br /> Recipient Committee <br /> <br /> INSTRUCTION8 ON REVERBE <br /> COMI~ITTEE N~ ~ Page <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 pertY'wl{h which each officeholder or candidate le 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 =ommittee, <br /> <br />~ NAME OF CANDIDR*E/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br />· i (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br /> <br /> ' List the flnanctal Institution where the campaign bank account i. located (controlled .candidate election, committees only) <br /> <br /> NAME OF FINANCIAL INETITUTION ~ONE <br /> ADDRES8 <br /> CITY ~TATE ZIP CODE <br /> <br /> CAN DIDATE(B) NAME OR MEASURE(8) FULL TITLE (INCLUDE BALLOT NO. OR LI=I TER) CANDID,,KrE(8) OFFICE SOUGHT OR HELD OR MEASURE(S} JURISDICTION <br /> (INCLUDE DISTRICT NO., CiTY OR <br /> <br /> FPPC Form 410 (Jan/01) <br /> FPPC Toll-Free Helpllne: MSlASK-FPPC <br /> <br /> <br />