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Statement of Organization <br /> Recipient Committee <br /> INSTRUCTIONS ON REVERSE <br /> Committee to Elect Kevin Bondonno <br /> 4.Type of Committee (Continued) <br /> '� � Not formed to support or oppose specific candidates or measures in a single election. Check only one bax: <br /> ❑ CITY Committee [] COUNTY Committee � STATE Committee <br /> PROVIDE BRIEF DESCRIPTION OF ACTNITY <br /> �� � List additional sponsors on an attachment. <br /> NAME OF SPONSOR <br /> STREET <br /> N0.AND STREET <br /> GROUP OR AFFILIATION OF SPONSOR <br /> STATE ZIP <br /> ENT OF ORGANIZATION <br /> Pege 3 <br /> Not Yet Received <br /> . . . . <br /> ❑ _J__/ Check box and provide the date this committee qualHied as a small contributor committee. If the committee qualifled as a <br /> Date qualified small contributorcommittee on January 1,2001,enter 1/1l01. <br /> 5.Termination Requirements By signing the verification,the treasurer,assistanttreasurerand/or candidate,officeholder,or proponentcertifythat all ofthe following conditions have been met: <br /> • This committee has ceased to receive contributions and make expenditures; <br /> • This committee does not anticipate receiving contributions or making expenditures in the future; <br /> • This committee has eliminated or has no intention or ability to discharge ail debts, loans received,and other obligations; <br /> • This committee has no surplus funds;and <br /> • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> -- There are restrictions on the disposition of surplus campaign funds held by elected o�ce�s who are leaving office and by defeated candidates. Refer to <br /> Government Gode Section 89519. <br /> FPPC Form 410(January/05) <br /> FPPC Toll-Free Helpline:866/ASK•FPPC(886/27&3772) <br />